MAIN AND DEVELOPMENT - ESTIMATES OF SINGAPORE FOR THE FINANCIAL YEAR - 1ST APRIL 1979 TO 31ST MARCH, 1980
8 a.m. to 8 a.m. That is right - 24 hours. It is also his duty to switch on the steriliser daily at half past seven in the morning. "Please confirm that you agree to the duty hours before accepting the caretaker's quarters." Mr Ashari was given ample time. In fact, he replied very promptly on 5th January, 1972, the very next day. He said: "Thank you for your letter, reference .... of 4th January, 1972, I wish to inform you that I shall be shifting in on 10th January, 1972, and also to confirm that I understand and I agree to the conditions stated therein in your letter." So the Member for Kampong Kembangan must know the full story before he listens to a yarn put to him by a member of his constituency. I think he should be experienced by now that, in the meet-the-people sessions, one has got to be a little more careful in listening to grandmother's stories. Otherwise Members of Parliament would be on a futile chase. The Member mentioned the point that the AUPE approached my Ministry on re-rostering the duty hours of a medical and health servant after the style of nurses. It is true we have got a study team doing this survey. It is trying to find out what it means in terms of costs and in terms of manpower. But while we were doing this survey, as Members are aware, my headquarters in Palmer Road got burnt down. So we are back to square one and we have got to restart the study again. But as soon as the study is completed, we will contact the AUPE. I hope that satisfies the Member for Kampong Kembangan and that the complaint lodged by the AUPE has been seriously looked into and we will give the AUPE a reply in due course. The Member for Kim Seng is a paradox. On the one hand, he advocates doctors who have finished their education at the University and the housemanship in the hospitals should serve the Government. On the other hand, he objects to compulsory bonding. How does one go about making doctors serve the Government without bonding or without making them sign an undertaking to serve the Government? So it is natural indeed that those who are in receipt of bursaries and scholarships should be bonded and, in fact, they are always bonded by the Public Service Commission. I agree with him on the point that "bonding" may not be a very nice word. It takes us back to the film that we saw on television, a series called Roots. "Bond" connotes slavery. Doctors are not slaves in my Ministry. In fact, many of them talk back to me. So we agreed on an undertaking; I gave them very ample time to think it over and finally all private students signed their undertaking. I cannot speak on behalf of the University as I am no longer its Vice-Chancellor. The new rule about controlling admissions into the medical and dental faculties is related to a trend which has been taking place since 1973. May I take the time in reading out to Members certain figures which I had not really prepared to distribute, I am referring now to pre-university students who have finished their 'A' level and who scored 60-64 points. If a student scores 60-64 points, he is a very good student. I was the Vice-Chancellor for seven years and I know it is pretty hard for students to be in that category. In 1972, there was not a single student who wanted to do Medicine. No student with 60-64 points wanted to do Medicine in 1972. In 1973, there were eight. In 1974, there were 12. In 1975, there were 11. In 1976, it shot to 21. In 1977, it was 30. Last year, 1978, it was 41. As against students with these points who opted to study in other faculties such as Arts, Social Sciences, Law, Accountancy, Business Administration, Architecture, Building Management, in 1972, there were 9. In 1973, there were 14. In 1974, there were 24. In 1975, there were 26. In 1976, there were 18. In 1977, there were 18. In 1978, there were 16. There was, therefore, a disproportionate number of top talented students concentrated in the Faculty of Medicine, whereas at least four other faculties were starved of top talent. The Member for Kim Seng and Members of the House will agree with me that it is necessary that we should try and spread talented people in different fields. If a doctor through negligence kills a patient, he kills one patient. If a politician in power makes a mistake, he cripples a whole nation. It is very necessary, therefore, that we should realise this trend that has been taking place over the last six years. We should not starve the administrative service in the Government nor should we starve those who aspire to take over the reins of Government, nor should we starve those who are in the commercial and banking sectors of talent. This is a problem which we face and which the British also face. Let me refer to an article in the Lancet on medical education, dated 4th March, 1978. I have been following this. But I must thank a good friend of mine who reminded me of it. I have read the article but forgot all about it. This is what is happening in England. It says: 'it may well be true that we are at present admitting too much high talent for the good of the country and even for the good of some sort of doctoring. But as long as all places can be filled with candidates who by referees' reports and at interviews are judged to have the personal qualities and stamina to make good doctors and have also done well in examinations, it is scarcely possible to prefer those mediocre examination results.' Just look at the state of Britain today. I do not need to denigrate the state of the economy in the United Kingdom, nor do I have to say anything in detail about the National Health Service, filled with very bright doctors. But when the Minister in charge of the health services in the United Kingdom was hospitalised for a circulatory defect (I suspect cardiac infarct) and he had to deal with strikes by hospital porters, hospital nurses, those who are in charge of auto cleansing linen and operation equipment - the strikers declared that they did not want to serve the Minister. I hope that I will not be placed in the same unfortunate position in Singapore! The Member for Kim Seng will recollect when, in his maiden speech at a budget sitting, he took up cudgels on behalf of his medical colleagues, I said that if a three-star general went off in a boat or in an aeroplane, he would end up in a foreign country probably as a restaurant waiter, at best a taxi driver. But if he were a doctor, he would be welcomed. Members have read very recently of the many boatmen who landed in Singapore or on the coast of Malaysia. The Australians picked them. First, "Who is the doctor?" They pick him. The Vietnamese refugee who is a doctor will not take too long a time to pick up a few words of English. Then they post him to some bush station which no Australian wants to go to. But the Vietnamese will only be too happy to go down there. I have just recited to Members the figures of those who opt to do Medicine since 1972. From zero in 1972, it has risen to 41 in 1978. Whether it is coincidence or whether it is by design, 1973 was the year of the Tet offensive, if my memory is correct. 1975 was the year when the Americans packed out from Vietnam and since that time the figures of those who wanted to do Medicine have shot up dramatically. In fact, the cut-off point for Medicine, I was told, has gone up as high as 48. It was astounding. When I was Vice-Chancellor, we were quite happy to have the cut-off point at 40. I did mention that even for two years I had to lower it to 38 points to allow Singapore students to study Medicine. Even so, it was almost like scraping the bottom of the barrel. 3.00 p.m. It is important that we should understand the objective of this exercise. We are not trying to prevent clever students from wanting to be doctors but we are trying to achieve a better spread of talented students who will in future occupy leadership roles, either in the public sector or in the private sector. We must have them, otherwise Singapore must collapse. Doctors alone cannot keep Singapore afloat. They can cure Singaporeans who are sick but they cannot keep the nation economically viable or make it stable. We will not have a painless budget as we have this year, if Goh Chok Tong was a medical doctor. As regards objections to the quota of females joining the Medical Faculty, I said in Parliament (Hansard, Vol. 35, col. 364, dated 16th March 1976.) three years ago that I wanted to conscript them into national service because of a shortage of doctors. Those who were in the Medical School vigorously objected. They told the newspapers, "My gosh, by the time I graduate I will be 24 years old. I must get married, otherwise I will be an old maid." It is very tough indeed for a woman who has to perform multiple roles: firstly, as wife to the husband; secondly, as mother to her children: and thirdly, to be on night calls at the Hospital or to look after sick people. She will not have time to do even cooking. In fact, I know that as of today, quite a number of lady doctors are not even in private practice and not all of them are working in the Ministry of Health. They would rather act as locum tenentes and they can bring up their children, which I thought was a very clever idea. They have time for their profession as well as for their family. When the husband gets home, he has a happy wife waiting for him. Attrition rate among women doctors is very high, 15%- 20%, as the Member for Kim Seng has reiterated. We have 140 vacancies in the Medical Faculty in Year 1. I think about two years ago I was alarmed when I came to know that it took in about 60 females. If we have an attrition rate of 20%, that means we are not going to have 60 doctors who will be actively working. We will have only 60 doctors minus 20%. That is a considerable loss in investment, and their places could have been easily filled by male doctors. And the other objection - it is not quite an objection really - is that female graduates are very choosy. In America, when a woman graduates as a doctor, her first choice of field of specialisation is obstetrics and gynaecology; second, paediatric; and third anaesthetics. Here in Singapore when I meet women patients they tell me they want to see a female doctor. But most of our obstetricians and gynaecologists are males, not females. I cannot understand why Singapore women do not want to do Obstetrics and Gynaecology. It is an open field for them. They can make a lot of money. The trouble, of course, is that babies pop up in the middle of the night and they have got to rush from home to the hospital to deliver. Some of them tell me that they do not mind so much the obstetrics part of it but they do not like the gynaecological part. It is very difficult indeed to have female doctors on the establishment who do not want to do this and that but who want to work office hours, and watch the clock. I have been getting complaints. Our outpatient dispensaries open at 8.00 a.m. and close at 4.30 p.m. I had a complaint from a patient who went to a dispensary at 4.15 p.m. but he was turned away. He was very annoyed, and quite rightly because there was a big notice down there saying, "Opening hours - 8.00 a.m. to 4.30 p.m." Nearly 85% of the OPD doctors are females. I hope they are doing a good job, otherwise I will get more complaints. But this is only one of the reasons why we are imposing a limit and I had previously suggested that it should be 30%. We are more generous. So we are making it one-third - 33%. The Member for Kim Seng was speaking on behalf of Tan Tock Seng Hospital doctors. I refer to his special field of Orthopaedics. I think the Member for Kim Seng is particularly more interested in orthopaedics than internal medicine. The quarterly statistics bulletin (July - September 1978) showed that in the Orthopaedics Department at Tan Tock Seng Hospital there were 492 discharges and deaths. That is, 492 admissions. For the next quarter, October - December 1978, the figure was 413. So there has been no dramatic increase between the two quarters. But I do agree with him that there has been an increase over 1977 for the simple reason that attendances at the A & E Department at Tan Tock Seng Hospital have risen by 57%. When we began the A & E Department at Tan Tock Seng Hospital in 1977, only during daylight hours, the attendances were 23,900. When we opened it for 24 hours, the attendances increased to 37,600. Ambulances have their directions. They have their zones. Their main objective in caring for patients who have met with an accident is to take them to the nearest hospital. I agree with him that the catchment zone for Tan Tock Seng Hospital is large. In fact, it extends to Katong and Bedok. It surprises me considerably. The zoning system is very artificial. It can be changed. We have been overtaken by urban renewal and population resettlement. Hospitals are long-lived buildings. Once you build a hospital, you cannot move the hospital together with the residents. We have been caught flat-footed. This is the problem that the Ministry of Health has faced; that instead of following what is in the think-tank of the Housing and Development Board or the Ministry of National Development, they thought that the Ministry of National Development officials would go to the Ministry of Health. It should be the other way round. So we have been caught out. But the zoning system affects not only the Ministry of Health but also the post offices. The post office, as I understand it, is now revising postal districts, for the same reasons that I have explained: resettlement of population and the building of more roads. When Kent Ridge Hospital becomes operative in the early 1980s, probably 1982 or 1983, those who are living in Bukit Timah, Bukit Panjang, Woodlands, will find it very convenient indeed to travel down Bukit Timah Road, turn into Clementi Road, which is a dual-carriageway, and land themselves in Ayer Rajah Road, and that is Kent Ridge Hospital. As of this moment, the zoning for the Singapore General Hospital includes Woodlands, Bukit Panjang, Bukit Timah. It is a very strange way of zoning. I cannot understand the thinking behind the zoning system. I was not responsible for that. But that will change. If the staff in Tan Tock Seng Hospital or in any hospital find themselves overworked, it is quite easy to change the zoning system and re-direct the ambulances. But I ought to add, in all fairness, that when the orthopaedic surgeons are overloaded at Tan Tock Seng we do send across a spare surgeon from the Government Unit to Tan Tock Seng to help out. If the Member for Kim Seng would like to volunteer his services, we will be happy to receive him, to help out his peers, in Tan Tock Seng Hospital. The Member for Kim Seng will have to remember that he has also to attend outpatients specialist clinics. I am quite sure he will be quite pleased to do that and set an example to his colleagues in the university. In fact, he is tempting me with the idea that 1, as Minister for Health, should take over all the doctors in the university under my wing so that we will have a fair distribution of talents in all our hospitals. But I think it will create a general row among the academics over university autonomy and academic freedom. So I will postpone that idea to some future date. I am surprised, Sir, that this year I have been let off so easily!