A (H1N1) blaming game started?

 A (H1N1) blaming game started?


Comment: These girls were not advised properly not to touch their masks unnecessarily. I the lower wide view picture more students are caught touching the masks. I had seen this similar view at out side. Most of the population even donot care about the cough and sneezing ettique. I was coughed on my face by few patients. They want to pull and rotate the chairs to be near the doctor.

The media appears to have started the blame game. More journalists are angling around the idea that because the A (H1N1) flu is fast spreading in the community and more and more people are reportedly succumbing to the infection, then there must be someone to blame, some agency which is at fault.

Perhaps the Health Ministry has not done enough, despite its earlier promise of containment and now mitigation. How is it that when we are now in the mitigation phase, there are more people dying, comes the indignant cry of disbelief and alarm?
Sadly this is the myopic vision and misunderstanding of most people in this country. The Health Ministry and the Malaysian Medical Association (MMA) have been proactively warning of this possible scenario right from the outset of this pandemic.






But then many detractors (some tourism officials, air carriers, doctors even) have pooh-poohed our contingency plans as being too alarmist, too exaggerated, pointless even. They have been spreading counter messages that some of us have overstated the A (H1N1) flu threat, blowing things out of proportion, in our initial reaction to this ‘benign’ flu!
But I think we need not apologise for what our public health measures had been – these steps had been carefully put together according to well-thought out protocols accepted by health authorities, worldwide. It is precisely because these measures were put in place, that I think we managed to slow the unstoppable entry of this influenza into the country.
Believe it or not, our earlier stringent containment measures – which displeased many agencies, appear to have stemmed the more rapid spread of the H1N1 bug, until we are now closer to the more definitive vaccine, currently under tests.
We’ve also learnt from the mistakes, the resultant serious complications, the better management strategies of other countries with a runaway pandemic, such as Mexico, the United States, United Kingdom and Australia! It is our hope that we can now truly mitigate the final spread of this virus, decrease its lethality.
Perhaps, we may have a much greater chance to use the soon to be ready vaccine to help decrease the severity of this influenza, which has yet to show its potential true colors of devastation, yet to be played out.

Consequences of an outbreak

Even among within some of our own physician communities, there have been suggestions to just let this pandemic loose into the community so that we can rapidly reach some form of spontaneous equilibrium, some herd cross-immunity, sooner.

The problem is no one wants to talk about the expected consequences of any outbreak, no matter how ‘mild’ or how ‘generally benign’ such pandemics appear to be at first glance.

Have we really considered the likely fatalities which must necessarily accompany this outbreak? Who should cope with explaining or even looking after the rising number of deaths and the very critically ill?








Now when the fatalities begin to ring in, we are suddenly sensitised to the rude truth that this flu can kill. More disturbingly, the deaths so far have been unpredictable, the victims were not necessarily the most ill or immune-compromised to begin with, except for some comorbid features – obesity being one of them. And, these are relatively young people, who normally should not succumb to common cold/flu ailments.
To make matters worse, there appears to be more confusion on the ground. Guidelines and press releases are fine, but so far have been difficult to implement on the practical side, not necessarily due to not trying hard enough.
Reports from the mass media have been skewed differently by disparate interests, without giving the entire picture, but only highlighting preferred slants quite dependent upon the journalists covering the news, or even their editorialising staff.
Sadly, we do need all the mainstream and alternate media to play a more accurate and comprehensive role in educating and informing our citizens, not to play the blame game, nor second-guessing our hardpressed Health Ministry’s personnel and facilities, or worse to apportion blame of inadequacy on the private sector, which has of late become the convenient ‘whipping boy’ of the media.
The dedicated A (H1N1) website

by the MOH is not sufficiently updated and spot-on contemporary, being at least one to two weeks behind, except for the daily numbers and DG update. Unfortunately the website is entirely in Bahasa Malaysia, and this may discourage some people from accessing this site.
And again, how many of our citizens bother to check with these information on a compulsive manner, daily, to keep themselves totally abreast of the most current information?
Tricky and frustrating
Realities of the ground however, are proving to be tricky and frustrating. With the high alert mental state among some citizens, there has been growing exasperation for some people (including some foreigners, visitors) when trying to seek treatment and confirmation on what appears to be influenza-like illness (ILI).
Directives from the MOH are not entirely clear, and although on paper these may look good. The interpretation of what constitutes serious symptoms always pose a dilemma and a bone of contention with many a presenting patient, who demand to know for sure, to be tested and be confirmed (or dismissed), and treated appropriately, quickly.

There has been crescendoing demands for the Tamiflu antiviral drugs, which are now under strict control and distribution by the

As of now, 23 major private hospitals have been supplied the Tamiflu antiviral drug to help look after the expected rise in H1N1 infections. Whether this stringent control is practical or simply too bureaucratic remains to be seen.







       Conflicting media calls, purportedly attributed to the DG of Health, do not help the already pandemonic situation.

 At a press conference, a patient demanded to know why she could not bhe had been sent away each time, by an MOH facility in KL, which prompted the DG of Health to reassure her that she should be examined and then tested. This was reported by The Star as “Docs cannot refuse requests for swabs to be taken.”
At my hospital there have angry demands for testing for the virus: an irate expatriate father demanded to have the testing for his child who had been having mild fever for a few days, but with no other features of high risk.


Because the protocol demands that the Emergency department doctor teleconsult with a MOH officer before submitting or sending a throat swab, this was not understood, especially when the MOH officer did not agree with the need for the swab or testing.
Thus, this artificial stumbling block is yet another area of gap for public-doctor misunderstanding. It is therefore, not simply a question of compliance, the ground rules are fluid and are not black or white.
This pre-approval necessity for A (H1N1) virus testing is making it very hard for doctors out there who are facing daily demands from worried ILI patients to be tested. Almost invariably there will be those who feel that their illness is more serious than what some of us doctors would feel otherwise, even after full examination/reassurance–so what do we do then?
In the early phases, can this ailment be so readily distinguishable from other more benign colds and other URTIs? Are we expected to be spot-on diagnosticians who must get this correct every time? Would our patients and the MOH officials understand this difficulty?
Or should we expand our testing facilities much more widely until this can be performed on demand by anyone, anytime? Would this be too expensive and would we really have sufficient test kits to answer to this need? Is this really necessary and shouldn’t our citizens be made more aware of this, so that they do not panic and demand unnecessarily?

Iron out the glitches

In fact, although in our frustration, the media and some of our officials may wish to find someone at fault, it is more likely that there are real logistic problems on the ground, rather than non-compliance on the part of some doctors, clinics, or even hospitals – be they private or public institutions!


       We must strive to iron out some of these glitches, these inconsistencies, and perhaps, where posible, allow every health facility (pubic or private) to carry out such heavy demands for testing, treatment, since almost every interested physician and major medical facility have already been empowered to now treat the more seriously complicated (A) H1N1 patient.

We have to make the handling of this pandemic easier and less bureaucratic. If the WHO projection is to be believed, it will become even more devastating once the spread escalates to unimaginable proportions.

At a recent briefing to the National Influenza Pandemic Task Force meeting (July 27, 2009), Dr Tee Ah Sian, director of communicable diseases of WHO, painted a possible scenario for the Malaysian A (H1N1) pandemic. While I do not wish to be alarmist, it is good to at least recognise the least impact scenario which has been projected.

For our 27.7 million population, if simply 20% are at risk and exposed, then some 5.5 million people will contract the A (H1N1) flu. Based on other serious influenza statistics, if 2% to 9% require hospitalisation then, some 110,000 to 500,000, respectively, would need hospital care.

From these numbers, if we estimate the case fatality rate to be from 0.1% to 0.5%, then some 5,500 to 28,000 of infected patients would die, respectively. In the latest updates of the most seriously ill patients identified and confirmed infections, the global case fatality rate has risen from the 0.4% to 0.66%. So, the hardnosed reality is that it is more than likely that the worse is yet to come. We can only hope that this is the worst case scenario.

Keep our heads cool

In the meantime, let’s keep cool heads, and work together. We must maintain, even heighten our sense of vigilance, so as not to miss out the more serious complications and the more potentially at risk people, so that we can help reduce the death rate.

This pandemic is expected to linger on for at least a year or two, before it burns itself out, by hopefully mutating into a more benign form, indistinguishable from the seasonal flu bugs; or because it is finally controlled to near-eradication by specific vaccines.


       But there is that possibility that it can also mutate by reassortment into a far more lethal form, that much feared second or third wave, which would then demolish all our efforts achieved thus far!

Of course, if this does not pan out, then hooray for us! We’d have survived the wiser, slightly poorer, bruised, but alive and healthy! A “Y2K-like non-event” would be a most welcome projection, if and when this does come to pass!

But, we are not anywhere near out of the woods as yet. So let’s be vigilantly proactive, while remaining socially responsible.

The Health Ministry can only help put in place some instruments to help mitigate and systematically monitor the spread, but it cannot ensure our own personal health safety on this A (H1N1) outbreak.

Only we as individuals and groups, can. We will all have to do our part.





Flu measures: Confusion rather than non-compliance, DR DAVID KL QUEK, Malaysiakini

DR DAVID KL QUEK is president of the Malaysian Medical Association.

The Star:Sir Bobby Robson dies

LONDON: Bobby Robson, who coached England to the 1990 World Cup semifinals and won football trophies in four countries, died Friday. He was 76.

“It is with great sadness that it has been announced today that Sir Bobby Robson has lost his long and courageous battle with cancer,” a family statement said.

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The Star:What next after failure to make junta change its way?

If Burma condemnation is boring for Encik Anifah, (your Culture and FM taught us by giving example by calling like this to the HE Ambassador of Turkey) for us ASEAN leaders are also shamelessly using the lame excuse of BORING Unconstructive DIS engagement to support Myanmar Military just to continue exploit Burma’s resources.


All the other Asean foreign ministers and their dialogue partners kept harping on the same two issues – Myanmar and North Korea – in their three days of discussion and Malaysia’s new Foreign Minister Datuk Anifah Aman found this kind of repeated discussion “boring”.

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Asean’s Burmese diplomacy has failed

The trial of Aung San Suu Kyi has highlighted the inability of Burma’s neighbours to counter the generals’ stranglehold

The bizarre and protracted trial of Aung San Suu Kyi has just heard the final arguments of the prosecution and defence. The verdict – not expected for another month – will not only decide the fate of Burma’s iconic opposition leader, who has been held under house arrest for the best part of 19 years, but will cast a decisive shadow over elections scheduled for 2010.

Read more>>guardian.co.uk

Malaria resisting Southeast Asia’s best drugs

BANGKOK, July 31 — Malaria is becoming resistant to the most powerful drugs available in Southeast Asia, as the World Health Organisation (WHO) races to stop the spread of the strain that could be disastrous for global malaria control.

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China steps up fight against online porn

BEIJING, July 30 — China’s ongoing war against Internet pornography and prostitution is to be ramped up, China’s Xinhua news agency reported quoting the Ministry of Public Security as saying today.

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Man scandalises Saudi Arabia with TV sex confession

JEDDAH, Saudi Arabia, July 30 — A Saudi divorcee with four children has shocked Saudi Arabia, one of the most conservative countries in the world, with details of his sexual exploits on an Arabic television show.

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Suspected A(H1N1) patients open stunned DG’s eyes

Rahmah Ghazali
Jul 30, 09

Health Ministry Director-General Ismail Merican vowed this morning to keep a close eye on his doctors at Kuala Lumpur Hospital when his suspicions were aroused that some lacked adequate understanding of how to treat the A (H1N1) fever.

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Objections against use of Rela to fight crime

The government’s plans to deploy personnel from a notorious volunteer task force to help enforce a crackdown on crime triggered criticism from human rights campaigners today.

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Iran opposition leaders to attend ‘Neda’ memorial

TEHRAN, July 30 — Iranian opposition leaders will attend a memorial ceremony today for protesters killed since the country’s disputed presidential election in June, an opposition website said.

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Don’t Sell Burma Short

By Ko Bo Kyi

Mae Sot, Thailand – The Obama administration’s attempts to find a new approach to dealing with Burma are laudable, even if the world doesn’t know which direction it will take yet. The U.S. must maintain a tough stance whilst it seeks new avenues for engagement. Although regional cooperation as part of a new U.S. “carrot and stick” strategy has potential, thus far the incentive element lacks depth. The renewal of U.S. trade sanctions against Burma by the U.S. Congress is welcome; there must be no change to these measures until the ruling State Peace and Development Council (SPDC) show at least a modicum of respect for basic rights.

Read more >>Far Eastern Economic Review

Killing fields of ABSDF under Dr Naing Aung and Dr Aung Naing

Killing fields of ABSDF under

Dr Naing Aung and Dr Aung Naing


The Forgotten Justice under the shadow of the curse

Dear other bloggers, editors and publishers,

                I hope some of you could remember the following true story occurred during 1990/1995 at the ABSDF, upper Burma student rebel camp, in the Burma’s Kachin State, near the China border. There were some 40 anti-government activists, unjustly tortured and sadly killed by fellow activists. I was one of them and this could be called as the memoirs of a student revolutionary.

Please kindly read to taste some selected pages of my chronicle and if you wish to publish this teaser, please feel free to do so.

I would like to discuss the future publisher who would be interested to publish the full book. I wrote it into a story form rather than as a plain diary to attract the reader’s attention and for easier and pleasurable reading.

As some of you may be experienced authors and may be the experts in Burma politics, I hope any one of you would be interested to edit the whole book and find a publisher for me. We could discuss about the terms and conditions if you are interested.

Thanking You,

Yours Sincerely,

 SMAR Nyi Nyi

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The Irrawaddy:Suu Kyi Insists Her Trial Will Test Rule of Law in Burma

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WASHINGTON —US President Barack Obama on Tuesday signed into law the Burma Sanctions Renewal Act, thus extending sanctions on the country’s military junta.

The bill, unanimously passed by both the US House of Representative and the Senate last week, renews the current sanctions on imports from Burma for an additional three years and maintains the ban on the import of jade and other gems from Burma.

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