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YANGON: Myanmar’s tourism sector is setting up to decide up following the monsoon season, but journey operators hope the latest attacks in Rakhine point out will not spook guests.
Rakhine, situated in the west, is about an hour’s flight from Yangon. It is frequently in the information for clashes involving the Rakhine Buddhist local community and the Rohingya Muslims, and couple men and women know of its increase as a tourist spot.
It offers a single of the most wonderful, pristine beaches, referred to as Ngapali, in the southern portion of the point out. Next to the famous archaeological city of Bagan, Rakhine is also dwelling to Mrauk-U, that includes hundreds of ancient pagodas and temples.
Supplied the most up-to-date incident of violence in Rakhine practically two weeks ago, journey operators are monitoring developments closely.
“I felt a small bit anxious for the reason that this is a delicate space … (there has been) no affect on our tourist areas such as Mrauk-U or Ngapali and (there are) no far more curfews and it’s quick to entry and safe and sound for journey, so this is our statement – specifically to my clientele,” explained Chairman of the Myanmar Journey Affiliation Thet Lwin Toh.
This time having said that, journey operators have witnessed a distinction.
“Unlike in the previous, there ended up some cancellations as quickly as there is anything like the latest incident which occurred in Myanmar, but until eventually now we have not acquired any cancellations … Rakhine is quite appealing spot and it’s a disgrace to take it out of the brochures of the tour operators and it’s a disgrace to take it out of their programs to occur to Myanmar and I do feel they really should contemplate Rakhine as a opportunity tourist spot for them to take a look at,” explained the running director of All Asia Unique Journey Phyoe Wai Yar Zar.
Previous calendar year, Myanmar welcomed four.7 million guests. This calendar year, five.five million holidaymakers are anticipated.
When bloody communal conflicts broke out in Rakhine point out about 4 yrs ago, overseas embassies in Myanmar issued journey warnings to advise their citizens versus likely to Rakhine. But following the most up-to-date spherical of attacks, couple embassies have issued new journey advisories, merely updating their information and facts about the attacks and advising merely caution.
That is terrific information for journey brokers who are hoping to boost Rakhine point out as a journey spot even far more, as it remains reasonably not known to quite a few overseas guests.
SINGAPORE: A law enforcement report has been lodged in opposition to a female who allegedly ran around a puppy when driving on Sunday early morning (Oct 23).
Particulars of the alleged incident, which occurred alongside Pasir Ris Farmway three, ended up posted on Fb by animal shelter Animal Lovers League.
In accordance to the submit, when two witnesses requested the woman driver to stop and enable with the wounded puppy, she responded with an expletive and said “it’s only a dog”, ahead of driving off.
The submit has because absent viral, with more than 4,000 shares as of 11pm on Sunday.
Speaking to Channel NewsAsia, the shelter’s founder Cathy Robust said the puppy, named Sayang, ran into the bushes subsequent the incident. Volunteers searched for Sayang and took it to the vet.
She additional that the puppy was found with bloodstains around its mouth. It is now in the clinic beneath observation for inside bleeding, she said.
The puppy, named Sayang, was allegedly operate around by a woman driver on Oct 23 (Photograph: Animal Lovers League)
NETIZENS’ Reaction ‘OVERWHELMING’: SHELTER FOUNDER
Ms Robust said that the response from netizens was “overwhelming” and she did not expect the submit to “go viral”.
“We just wanted individuals to notify us who the driver is,” she said. In the Fb submit, the licence plate on the auto is obviously obvious. But she additional that they have not been equipped to discover the driver however.
Some netizens have also raised inquiries about why the puppy experienced not been leashed when out on the road. Ms Robust clarified that volunteers experienced been taking other leashed canine out of the shelter at the time and it is probable that Sayang might have adopted the other canine out. “Sayang is an uncommon puppy and he has jumped around the fence in the previous. But we have because raised the fence and he has not been equipped to go around because,” she said.
“I can have an understanding of why individuals are asking why the puppy was not leashed up,” she additional. “I appreciate that only an animal lover would question that issue mainly because they care.”
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BANGKOK: A big group of Thais collected on Saturday (Oct 22) outside Bangkok’s Grand Palace to sing the royal anthem in honor of King Bhumibol Adulyadej, who died on Oct. 13 immediately after seven decades on the throne.
The government has declared a calendar year of mourning for the 88-calendar year old king, who was found as a father determine for generations of people today, and, though a constitutional monarch, a calming affect in excess of the country’s typically turbulent politics.
People dressed in black traveled by bus, boat and on foot to Sanam Luang, a tree-lined open up place that has been applied for royal cremations outside the river-side Grand Palace, bringing the space to gridlock very well in advance of the singing.
Law enforcement mentioned far more than one hundred fifty,000 were in Sanam Luang and side streets with far more people today envisioned as a result of the working day.
Mourners collected outside the Grand Palace in Bangkok. (REUTERS/Athit Perawongmetha)
The royal anthem, known as Sansoen Phra Barami, is played in advance of the screening of just about every cinema display in Thailand, when the viewers stands to honor the king as images of his everyday living and perform are proven on the display screen.
Saturday’s singing was recorded for use in cinemas, organizers mentioned.
“Because he went to heaven we want all Thais to exhibit their really like and sing this song to display in advance of movie screenings,” Prince Chatri Chalerm Yukol, a motion picture director in demand of the filming of the singing, advised reporters.
Because the king died, people today from across Thailand have flocked to the gilded Grand Palace to spend homage to the only king most of them have at any time known, who is lying in point out there.
Buddhist monks have been chanting prayers beside his coffin in an imposing throne corridor, and they will chant for 100 times as part of the funeral rites.
“I required to be below to spend respects to His Majesty,” mentioned Haysri Watanakulpipat, 47, who mentioned she drove right away from the japanese province of Prachinburi.
Saturday’s singing was recorded for use in cinemas, organizers mentioned. (REUTERS/Jorge Silva)
The military government has not set a date for the royal cremation but it is envisioned in about a calendar year.
The government has mentioned Crown Prince Maha Vajiralongkorn will ascend the thrown quickly but he had requested that his succession be delayed for an unspecified period, so he can grieve with the people today.
The government has moved to quash uncertainty surrounding the succession and to reassure the state that the king’s dying will not derail plans for a return to democratic rule, which include things like a normal election in late 2017.
It has pressured business enterprise and government really should carry on as normal and tourism really should not be impacted.
Law enforcement mentioned they envisioned far more people today at Sanam Luang as a result of the working day.
“There are far more than one hundred fifty,000 people today below previously but it could effortlessly increase to 250,000 by the night,” Thai deputy law enforcement spokesman Major Typical Songpol Wattanachai advised Reuters.
Thailand continues to be in country-broad mourning pursuing the dying of its widely-revered and a lot-beloved King. (REUTERS/Jorge Silva)
The Grand Palace is a former royal residence that is applied only on ceremonial instances.
The royal anthem was the national anthem of what was then Siam till 1932, when young army officers and bureaucrats staged a coup to conclude complete monarchy.
ADEN: Fierce gun battles erupted overnight involving Yemeni rebels and pro-govt forces alongside the border with Saudi Arabia irrespective of a three-working day ceasefire because of to stop late Saturday (Oct 22), armed service officers mentioned.
Warplanes from the Saudi-led coalition battling in assist of President Abedrabbo Mansour Hadi also bombed suspected Huthi rebel missile launchers east of the funds Sanaa late Friday, a armed service official mentioned.
The air raids came following Patriot missiles shot down two rebel missiles on Thursday above Marib, east of the rebel-held funds.
UN special envoy Ismail Ould Cheikh Ahmed mentioned on Friday the ceasefire was “fragile but largely keeping,” urging all get-togethers “to clearly show restraint, stay away from additional escalation, and strictly adhere to the 72-hour ceasefire.”
The truce took effect just in advance of midnight on Wednesday to allow for help deliveries in Yemen, where by the war has killed hundreds and left millions homeless and hungry.
The UN envoy is liaising with the get-togethers in an endeavor to extend the ceasefire in get “to develop a conducive natural environment for a extended-long lasting peace” in Yemen, he mentioned in a statement.
He met late Friday with Yemen’s Vice President Ali Mohsen al-Ahmar in Riyadh, according to Yemeni condition media.
Ahmar mentioned govt forces have been “working out restraint” and stressed that there have been orders to “abide by the truce and respect UN initiatives”.
But he accused the rebels of 449 violations in 24 hrs following the ceasefire took effect.
Rebel-controlled media, meanwhile, accused the coalition of conducting air strikes across the country, such as the provinces of Sanaa, Saada and Jawf in the north, and Shabwa in the south.
A senior rebel, Hassan al-Sharafi, was killed in border clashes on Friday night in Saada province, the fiefdom of the Iran-backed Huthis, armed service officers mentioned.
The rebels seized two hills in the Alb border region from govt forces who had earlier superior from Saudi Arabia, a armed service official mentioned.
A wrecked automobile in the Yemeni port town of Hodeidah on Oct thirteen, 2016. (AFP)
It is the sixth ceasefire endeavor considering the fact that the Saudi-led coalition intervened in March final year to assist Hadi’s govt following Huthis overran a lot of the impoverished country.
Just about 6,900 folks have been killed in the conflict, extra than 50 percent of them civilians, when an further three million are displaced and millions extra need foods help.
Meanwhile, 5 suspected Al-Qaeda militants such as a area main have been killed overnight Friday in a suspected US drone strike in Marib province east of Sanaa, a stability official mentioned.
The 5 alleged jihadists have been in a automobile that was focused in the Wadi Obeida region.
Washington is the only govt to run drones above Yemen, but the United States only sporadically releases statements on its extended-running bombing marketing campaign against the country’s highly effective Al-Qaeda department.
The United States considers Al-Qaeda’s Yemen-based mostly franchise, Al-Qaeda in the Arabian Peninsula, to be its most hazardous.
On Tuesday, 8 Al-Qaeda suspects have been killed in a related drone strike in south Yemen.
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SINGAPORE: Lee Poh Wah considers himself a gadfly, aiming to agitate society and the government, to disrupt the status quo in making positive change. As CEO of the Lien Foundation, Lee has been spearheading the foundation’s model of “radical philanthropy” for more than a decade. It has spearheaded a variety of initiatives in several sectors including early childhood education, end-of-life care and eldercare.
He went “On the Record” with Bharati Jagdish about what’s standing in the way of better outcomes for children and the elderly, how philanthropic organisations can work better for Singapore, and how his battle with cancer shaped his attitudes towards life and work.
Lee Poh Wah: I visited a GP because I had abdominal pain. It had been 8 months of pain and I had various consultations with doctors before that but they had brushed it off. So I visited this other GP and I said I wanted to do a colonoscopy tomorrow at the hospital and that was arranged. And when they broke the news that I had stage 3C colon cancer, my response after 10 minutes of asking questions was “take it out tomorrow.”
I also underwent 6 months of chemotherapy. I moved from denial to acceptance in a short span of time. I think perhaps that’s my nature. If there’s a problem, let’s move forward with it in terms of what can be done.
Now, my life policy is that I live as if I won’t be around one year from now. Do work that gives you meaning. Do work that you feel is important. Do work that gives you energy. Through that episode I developed a greater empathy for people who go through suffering and I developed an interest in palliative care that I use in my work.
Bharati: You have also been running campaigns to get people to open up about death and dying. So what plans have you made for death and dying in your own life?
Lee: When it comes to my parents, I always have this honest conversation with them, even if they may be a bit reticent. I do know what they want and what they do not want. So I give them assurances that I will take care of everything.
Bharati: What about your own death?
Lee: Yes, absolutely. I do share with my wife what I want and what I do not want. It is very clear.
Bharati: What do you want and what don’t you want?
Lee: Mostly, it’s about peace of mind, body and spirit where you want to minimize the unfinished. Whatever needs to be said has been said. Whatever needs to be done has been done.
A SPIRIT OF INSUBORDINATION
Bharati: You worked in the civil service for some time.
Lee: In fact, I spent about 2 years in the civil service to champion social entrepreneurship, to enhance vibrancy in the non-profit sector. I joined the foundation as their first staff almost 12 years ago because it was a clean slate to try philanthropy.
Bharati: Why did you leave the civil service?
Lee: I have a strong spirit of insubordination. I’m not very obedient or civil; unlikely to survive in the civil service. It’s just my nature. It was just that it was difficult for me to fit in.
Bharati: In a previous interview, you said that if you want to solve the deepest problems in human life, you have to be, in a sense, abnormal. Stop accepting the status quo. Stop going with the flow. Who or what influenced you to be this way?
Lee: It’s my nature and I suppose this system of values was shaped over time. Especially the experience at the foundation through which I’ve seen my fair share of death, disease and discontinuities in life which inform the way that I am. I don’t drop out when things get tough. That’s what you need to solve problems. You also need to be creative to think of new solutions and not be afraid to be different.
Bharati: You’ve said before that when you first started, you couldn’t even spell the word philanthropy. So what influenced you to do this with your life?
Lee: In a way, I grew up in a very insular world. My parents are not very educated. We were not wealthy, but I never felt poor. Before joining the ministry, I never volunteered. I wasn’t interested in the non-profit world. It was during business school way back in the 90s when I read about the work of Muhammad Yunus and the work of Grameen Bank. That made me think, wouldn’t it be wonderful if we could do something like that in Singapore? And that opportunity to work on social entrepreneurship prevailed. One thing led to another.
I think the foundation’s work in early childhood development, eldercare, end-of-life care, water sanitation – these are all complex and awesome challenges to grapple with. And in a way, at a personal level, I find it an immense privilege and extremely rewarding to practise philanthropy. These are causes that are bigger than ourselves, that are bigger than even the foundation. All worth dying for.
TOUGH TO DO INSPIRING PHILANTHROPY IN SINGAPORE
Bharati: You mentioned oddballs. This goes back to how you feel that in order to solve the greatest problems you need to go against the flow. What challenges do you face finding such people?
Lee: It is a challenge, but I make the effort to hunt for free-spirited leaders and talent for our causes. By encouraging and giving them courage, we seek to awaken and unleash their inner ‘Bruce Lee’ to fight for justice. I think that the fundamental difference between working in the civil service and working at the foundation is that at the foundation, we have more latitude because we don’t have a political or business agenda.
Whereas in the service, the advantage is that you have a bigger team you can count on. You have more resources, access to information and policy levers at your disposal. But the reality is that it is tough to do inspiring philanthropy in Singapore because you have a big government and a small civil society.
There are two great myths about philanthropy. One is that we are at the cutting edge of social change led by far-sighted folks; but most of the time we are pretty ignorant and impotent because of the lack of resources and access to information. So we must offer some other compelling propositions. Another myth would be that money can solve more problems and more money means more impact. We don’t see that in philanthropy or in the government.
Bharati: It’s about how use that money, isn’t it?
Lee: Yeah. I would say money is a necessary ingredient but insufficient. At the end of the day, it is about how we can design better solutions so we have to induct the right intellect, talent, energy to solve all these intractable problems.
Lee Poh Wah standing in front of a digital artwork by Indonesian artist, Keo Budi Harijanto, titled Power.
Bharati: Aside from the fact that we have a big government and small civil society, why is inspiring philanthropy hard to achieve?
Lee: I would say we probably have the most generous philanthropy regime in the world because I think the government recognises that you can’t count on the government to do everything. There is a need for the citizens to come on board to work together. That’s the reason they have very generous tax incentives to encourage the formation of foundations. There is even a tax reduction to all these Institutions of Public Character.
Bharati: So it would appear that the government contributes to growing this sector. What’s the problem then? Why do you say it is tough to do inspiring philanthropy in Singapore even with that support?
Lee: I would say that the current practice of philanthropy hasn’t fulfilled its potential. There is still lots of room for philanthropy to be more purposeful and more exertive in solving social problems. These are the lofty aspirations that all of us aspire to. But I don’t have this romanticised western view of civil society being an autonomous non-participant counterbalance to the state. The reality is that we have a big government, small civil society.
But I do think it’s important that this evolving relationship reflects a greater sense of interdependence, mutual trust and respect. So when you preach partnership, try not to practice paternalism. And I think all governments should sustainably become more transparent, more accountable, more responsive to the needs of our citizens.
Bharati: So paternalism is standing in the way. Shouldn’t civil society see this as par for the course – to continue agitating for change even when it comes to its relationship with the government?
Lee: When we use the term “government”, it is really a collection of ministries with different personalities and values and goals. It is always a delicate dance between big government and a small NGO. Of course at the foundation we have the benefit of being self-sufficient. Sometimes we don’t always have to rely on the government to tackle certain problems. We are acutely aware that this road to reformation is strewn with rocks, not roses.
But I always view ourselves as a kung fu practitioner. So if you want to be better, you must be prepared to be bruised and bloodied by sparring with someone who is bigger and stronger than you are.
WHAT IS POSSIBLE VERSUS ACCEPTING THE STATUS QUO
Bharati: So the problem also lies with people in civil society. You’ve got to try and convert other members of civil society in order to achieve inspiring philanthropy.
Lee: Absolutely. Sometimes social change is slow. We may not succeed fully right at the start but things will move faster if we first acknowledge our fallibility and our deficiency.
I think when the couch is comfortable, we tend to get into our routine, we toe the line, we follow the path of the least resistance. So sometimes we become slaves to the ordinary and that is understandable. And in Singapore, there is always a risk of falling into the trap of satisfactory underperformance – accept the status quo rather than seeking what might be possible because the government takes the lead on most things.
Bharati: You’re trying to change that.
Lee: Yes, our tagline is “Radical Philanthropy”. That was a term that I helped to coin more than 10 years ago. I don’t use it internally but so far it has been used extensively by outsiders to describe the foundation. Sometimes I feel that language can shape and define reality, so “radical” can connote unconventional and effecting fundamental change by attacking root causes. But over time, I have come to view radical philanthropy as a practical remedy or being radically practical. Compared to the great and the grand, I think we are incrementalists. We are striving to be radical. You chase perfection, but you catch excellence.
To differentiate from other funders, whether it is foundation or government, I think we are quite different on 3 fronts. Firstly, we took responsibility for solving niche problems. So there’s clarity in terms of purpose and priority. On our part we are interested in early childhood development, eldercare, end-of-life care, water sanitation.
Secondly, we do better when it comes to ideation all the way to implementation. So there’s fidelity to performance and lastly, we dare to be different. We aren’t afraid to work with unconventional players, use unorthodox tools to move our mission. We take sufficient risks and failure is an acceptable cost of innovation. For example, who would have worked with a funeral director like Ang Ziqian when it comes to our work? I feel that funeral directors are professionals who are like palliative care professionals. They should be co-opted in our end-of-life issues.
Bharati: But clearly you still feel that big government is standing in the way of such efforts.
Lee: I certainly think so. Again, to be balanced, there are some initiatives whereby we are glad that the government came in and scaled the initiatives that have proven successful.
Bharati: I understand this happened in the preschool education sector.
Lee: Yes, we call it the “Mission: I’m Possible” programme through which we help children with mild special needs in 25 pre-schools. We started the program in 2009 and it has shown results. There was an evaluation piece by NIE. The government came in 2012, and right now they have scaled to close to 400 pre-schools. These are the PCF schools, and other anchor operators that have put in place services to help children with special needs to fit in.
ENGAGING THE GOVERNMENT
Bharati: What’s your strategy when it comes to convincing government, and making it less paternalistic.
Lee: I don’t have an overarching strategy. I always believe that strategies that worked in the past often get in the way of progress. So sometimes we have to be orthogonal in our approach. So what we need to do is keep learning, keep questioning, keep challenging. So you must have faith in your abilities, you must believe in yourself, and constantly reinvent ourselves.
In fact, our journey has not been easy either. We started this programme in 2012 and the first year was very trying because of high turnover from the pre-school teachers. It was a tough environment to work in. The classroom environment was a big group of stressed-out children with stressed-out parents and stressed-out pre-school teachers. But with conviction, we were able to work everything out. Right now we have seen much improvement in terms of pre-school attendance from 30 per cent to 70 per cent. They are more school-ready and there is more parental involvement. Parent-teacher meetings had zero attendance when we started. Right now, there is regular attendance. We started with two centres and this year we have scaled to nine centres integrated with two primary schools and next year, we are heading towards having about 15 centres. The government has just started that journey, and they have co-opted the anchor operators to figure out how to come up with different solutions. So I would say, we are still in the experimental stage.
If the government is able to get their act together, then there is no role for us. So again, we must do things that they maybe cannot do but need attention anyway.
Bharati: So do you see your role as just filling the gap, or do you see your role as having to convince government of your ideas so that government can eventually implement them on a larger scale?
Lee: I would say it is a mixture. I like this quote from Martin Luther King Jr., “Philanthropy is commendable, but we must not overlook the circumstances of injustice which makes philanthropy necessary.” Foundations are independent funders of public goods. There’s a role for it to support and develop alternative solutions and to temper government orthodoxy. So we can exert influence by empowering others or through research and advocacy to solve root causes. We have a view and we have to be that view.
Bharati: What do you think got the government onboard when it came to the pre-school initiative? What do you think convinced them of that?
Lee: Because the programme showed positive child outcomes, the civil servant came to me and asked about it. We said we put in S$2.5 million, we have put in top leadership down there to work with the ground, to design the whole solution. It’s time for you to take over.
Bharati: So it’s clear that it has to be evidence-based.
Lee: That is the key word, so that is why we have an evaluation policy whereby we input evaluation components and whether it works. At the same time, we want to be honest about whether the programme has achieved its objectives.
FIGHTING APATHY, COMPLACENCY AND MEDIOCRITY
Bharati: There’s got to be action and perceptible change on the ground. To what extent do you think there’s also an issue of people generally being out of touch – for instance, many in our society aren’t even aware that poverty is a problem in Singapore.
Lee: That’s why you need gadflies to make people uncomfortable, to make people see reality. Creating awareness and understanding of the issue is obviously important. There may be some folks out there who will step forward. The role of the agency or the foundation is how to enable them. We must give them the courage, the space and the resources to do great work.
I’d like to go back to what our PM said during the National Day Rally. He exalted Singaporeans to have the divine discontent to never settle and to always aim high. In some ways, he is actually encouraging all of us to be rebels, to fight for a better vision of Singapore. To be a gadfly for the state, Singaporeans – government and citizens included – we must have the moral courage to right the wrongs, the creative courage to design better solutions to build Singapore. So overall, Singapore is a small country with big ideas and ideals. As a whole, we have a good government and we should count our blessings. But the real enemy is apathy, complacency and mediocrity.
Bharati: You seem to think there’s a considerable amount of this in Singapore. You mentioned mediocrity off-air earlier too. To what extent do you think this has to do with the tone the government has set – to take care of everything in its own way?
Lee: It’s human nature as well.
Bharati: So do you feel while the government needs to be more open to ideas from civil society, it also needs to step back, and find a better balance in order to encourage those ideas and disrupt this culture of apathy, complacency and mediocrity?
Lee: I would say that sometimes they will need to know how to work together, not just with civil society but also, among themselves. As I mentioned, I recognise the government is a collection of agencies. Different personalities, values and goals. I give an example to illustrate this.
MOE’s vision is that every school is a good school. The vision for the MOE kindergarten is: A strong start for every child. And the vision for ECDA (Early Childhood Development Agency) is: A good start for every child.
I like the statements and my response to that is: Really? How? Every child? I don’t see that in their plans. There is actually a disconnect between national narratives and the realities on the ground. People have said it – is every school really a good school? It goes beyond academics because everything is inter-linked including the socio-economic backgrounds of the children and the additional help they might need.
So if I look at the system, the primary schools are governed and funded by the Ministry of Education, the student care centres within the primary schools are governed and funded by the Ministry of Social and Family Development (MSF). Pre-schools come under MSF. Social workers come under MSF, but occupational therapists come under the Ministry of Health.
GOVERNMENT AGENCIES NEED TO WORK TOGETHER TO SOLVE PROBLEMS
Bharati: And you think that will be better done if the work was streamlined and consolidated?
Lee: Yes and somebody must take ultimate ownership. The buck must stop with one party because right now, the schools don’t have a therapist because they are all licensed under MOH. They are not working on the ground. There are not enough social workers. There are only like 5 primary schools with social workers. Their allied educators are under-resourced with insufficient skills.
But the consolidation must not just be physical. Psychologically and spiritually, we must be able to work together as a team. I visited the South Australia Department of Education this year. I went away so impressed. The interaction with the policy-makers and the practitioners on the ground, whether it is pre-school or primary school – was commendable. Everybody knows what the vision is and their narrative when it comes to children is always from birth all the way up. Unlike in Singapore, they focus on 0-3, 4-6, primary school and they don’t look at the transition.
In fact, our programme was precipitated because I visited a brand new pre-school way back in 2012; 50 per cent of the kids came from a total monthly income of less than S$3,000; 15 per cent from single-parent households. Imagine the stress of raising children. The pre-school was free for these kids but there was chronic absenteeism. They only came a few times a month or late in the afternoon.
So what appears to be a case of acting out, anger, disinterest, forgetfulness, actually is an indicator of chronic stress, neglect and anxiety. These children come from complicated backgrounds – divorce, incarcerated parents with unstable incomes and mental health issues, violence.
We should be concerned because children who experience persistent poverty are at higher risk of poor health, lower educational attainment and are more likely to live in poverty as adults. So I see poverty as a childhood disease that leaves a lasting signature. For every entrepreneur that poverty has produced, it has poisoned and impoverished many young souls.
So the question we need to ask is: do we want to have a permanent underclass in Singapore? Do we want apartheid where the haves, have it all, where mobility and meritocracy is no longer a reality.
So we need to do something, there is no simple solution to the whole thing which is why we started this whole circle of care programme – a multidisciplinary approach whereby a preschool teacher, the social worker, the therapist and community partners will address the complex needs of the child and the family together.
Bharati: The government has various initiatives to address such difficulties in families, but you’ve said there needs to be a more streamlined approach to holistic solutions. What do you think is holding this up?
Lee: Insufficient leadership or courage. Perhaps you don’t want to hurt people’s feelings. Maybe the thinking is: better not encroach into the space of your colleagues in the other ministry.
BETTER NURSING HOMES FOR SINGAPORE’S ELDERLY
Bharati: The foundation has also done several studies on the problems with nursing homes in Singapore, the existing ones run by other operators and those currently being built by the government. You’ve offered alternatives that are more cost-effective yet much more pleasant – just single or two-bedders, not dormitory style wards. But when you tried to work with the government on one such nursing home, I believe it’s called Jade Circle, it didn’t work out.
Lee: Yes, it was conceptual mode. We did not ask anything from them. It was just the permission to build additional beds and to be able to take subsidised patients who right now may be living in a normal ward. We wanted to give them high-quality care even if they’re not able to totally afford it on their own.
The project itself was a democracy of deeds. We had a very mission-orientated nursing home with strong leadership – Peace Haven – which was contributing the land; the construction costs were underwritten by 2 foundations and we had a pro bono designer to help. The architects and consultants were all charging goodwill prices. We believe in the vision that whether you are rich or poor, you deserve high-quality care, service and living environment.
In fact, we had the support of the Ministry of Health when we went public about Jade Circle early last year but somehow someone changed their mind one year later.
They wanted us to combine the 2 twin-bedders to become a 4-bedder and if we wanted to go with the original configuration of single and twin, they said you can only take in private patients. So indirectly you are saying Jade Circle can only serve the rich who can pay.
Bharati: I know you wanted to show them that it might be possible to do this for all Singaporeans and not just the rich Singaporeans, but the Ministry has to think of this on a larger scale. MOH did say it will be difficult to provide ongoing subsidies to patients staying in wards that are designed to proxy private or A-class ward configurations. It will be hard to scale. It will be financially unsustainable if applied to the rest of the aged care sector.
Lee: I think the starting point is always to ask whether we are meeting the needs of the elderly and the family. If we are not meeting the needs of the elderly and their families, it is pointless to talk about sustainability.
I have visited many nursing homes in Singapore and overseas – places like Japan, Australia, Finland. I can’t help but feel we are stuck in a time warp 20 years ago where the rest of the world has moved on. When I see some of these nursing homes here and what are the prices they are charging, I ask myself how come we are not getting value for money in Singapore?
A typical nursing home costs about S$2,300 or S$2,800 and you’re staying inside an 8-bedder dorm. And you look at the quality of the programmes, the food, the lifestyle and what you can get in Japan for almost the same or slightly more. It worries me. Too many of our Singapore nursing homes are cold factories housing warm bodies. They are awakened, cleaned and fed on a regimental schedule. So sometimes I find it heartbreaking when I see a long hall of wards filled with residents isolated by their own suffering.
The first nursing home that is operated by the government is at Pearl’s Hill and they broke all boundaries by having 32 residents in a ward. It is a platoon of patients that outclasses all the acute hospitals. Generally, people who live in these conditions are zombified and confined to their wheelchairs, not interested in the world around them or to reciprocate a smile when it is offered.
So there is an institutionalized absence of life and joy, a state of homelessness and helplessness in nursing homes. I won’t be surprised if there is a high prevalence of clinical depression. I can understand why because these elderly have lost almost everything – their home, their freedom, their privacy, their personal possessions, so I always ask myself, is this the fate that is awaiting our elderly and us?
In Singapore, 90 per cent of nursing home beds are in 6- or 8-bedder dorms. The other 5 per cent to 10 per cent of them are single or twins. They are more for infection control purposes. So if you go in as a couple, you have to be separated because there is men’s ward and a women’s ward.
In Japan, they stopped building 6-bedder wards 40 years ago. In fact, single rooms have been a norm for almost a decade. You can see that also in terms of their policies, their programmes, and their professional practice, they are way ahead of us.
There are also some false assumptions here that the elderly in the single rooms will be isolated and withdrawn. But the Japanese have done research on this and they found that the elderly in single rooms are not isolated or withdrawn. In fact because they have greater emotional stability, they sleep better, they eat well and they are more involved in their daily activities. The folks in the larger wards are more stressed and worried, because it’s like an open zoo.
Bharati: We were talking about whether the government should subsidise these, the single and double-bedders. Does the government subsidise these on a large scale in Japan?
Lee: Indeed, the government does chip in to long-term care insurance and at the same time they also give resources to VWO’s to startup services. In Japan, the dynamic is such that the majority of the nursing homes are operated by the private sector and of course there is a small section that are Voluntary Welfare Organisation-driven. The transformation just happened in the year 2000. I think it is partly because of the introduction of the long-term care insurance. Because of that, many in the private sector came in to offer innovative services.
Bharati: So you feel more of this can be done in Singapore.
Lee: Indeed, what we see in Singapore is tantamount to a market failure.
Bharati: There are some real problems like space issues, construction costs and manpower shortages. But your study claims that all these can be resolved. For instance, the lack of competent staff – they’re paid little and you’ve suggested that more could go into pay rather than towards levies for the foreign staff. That would attract more competent staff.
Also, if the homes were built differently, some of the more independent boarders could look after themselves and this would mean you wouldn’t need so many staff. On the issue of space constraints, you’ve said if the homes were better designed, you could have 1 or 2-bedders without requiring much more space, etc. And your study shows that while it may cost more, it can all be had for S$8 to S$13 more per patient per day even taking into account construction costs in Singapore. That would mean S$19 million more per year if we apply it to the Ministry of Health’s plans for 5,000 more nursing-home beds by 2020. This additional cost would be just 0.2 per cent of MOH’s budget of S$11 billion for the financial year of 2016. Why do you think the government is not buying into this?
Lee: Yes, things like construction costs etc often come up. But let’s look at that example: the cost of building a nursing home. If you were to amortize it over 30 years, the total life-cycle of a nursing home, construction costs only constitute about 10 per cent to 15 per cent of the total cost. It is costly to do remedial work because once these nursing homes are up, they will be there for 30 years and it is probably going to be very costly to convert them into single or twin-bedders or maybe even impossible. So it is more cost effective if we get the product right upfront.
When it comes to manpower, if there are toilets within their own rooms, they will be able to clean themselves. Things like that will reduce your need for manpower. It’s a simple premise. The best way to save on manpower and to enhance productivity is to encourage the elderly to do things themselves. By doing things by themselves, they have a sense of autonomy and there’s a sense of achievement.
Also, my take is that cheap labour is expensive because right now we don’t have the right people who are able to deliver quality outcomes, and we are not making efforts for them to stay on. So Singapore becomes like a stepping stone for all these care staff before they move on to places like Canada and Australia. If the staff you need are paid better and they see a future in the job, you can keep the good ones.
But I get worried when they say MOH is on track to have 17,000 beds by 2020.
Bharati: The focus is on numbers and you’ve said that’s part of the problem – the focus on meeting KPIs.
Lee: My question is: really, are we on the correct track? Will this nursing home model serve the needs and aspirations of all Singaporeans?
Bharati: What do you think is preventing the government from seeing this?
Lee: Money is never the issue because they have already committed hundreds of millions of dollars to build nursing homes. So money is never the issue.
I will address this issue in this way: I’ve always liked Khoo Teck Puat Hospital’s care philosophy: to give a level of care that is good enough for your own mother. By asking: “If this patient was your mother, what would you do?” it changes people’s perspective.
So people who build nursing homes in Singapore should ask themselves if they would want their own parents to live in them. If the answer is “no”, why do we continue on this track?
Bharati: So what do you think the problem is?
Lee: To be fair, these are all moral people with good intentions. I would attribute it to two reasons. Firstly, the fixation with meeting KPIs to build 5,000 additional nursing home beds by 2020. And busy-ness creates a false sense of progress. I think it is also human nature that when you are lost, you tend to run faster. So in such a situation, what we actually need to do is pause, ponder and plan what we should be doing together. Another reason could be self-silencing because of the fear of hurting others, the fear of isolation, the fear of retaliation or “better don’t complain” otherwise my mom may not be well treated inside the nursing home. “Better don’t complain” so as not to antagonise management or the government.
Bharati: So this is why residents of nursing homes and their families are not giving feedback, you’re saying?
Bharati: But if what you said is true, that people in government who are building all these nursing homes and trying to meet their KPIs are aware, they shouldn’t need feedback to act.
Lee: Sometimes I think the oppressed forget their values and they adopt the values of the dominant. Maybe it is the value system. Maybe this over-fixation on GDP. However, you must look at the construct of GDP. It doesn’t include informal care for the children, for the elderly. It doesn’t include all the intangibles.
Our report on nursing homes is called “Safe but Soulless”. I find it interesting because the title has been used by foreigners to describe Singapore. Singapore is safe, clean, efficient, controlled, somewhat unnatural and there is a psychological fear in society. Unfortunately, the nursing home sector is a microcosm of this stereotype which must change.
Bharati: At the end of the day, if you want things to change, you’ve acknowledged that you need some buy-in from the government. How do you plan on doing this while being critical of it? How do you plan on doing this without alienating government?
Lee: Indeed, it is difficult to juggle between this aspiration to build a collaborative relationship and to be a gadfly of the state. So obviously, I made some deliberate efforts to look at the issues and my conscience is clear. Even in the case of Jade Circle, I had a lot of people coming to me saying, “Eh, Poh Wah, you better yield. Don’t go on this track yourself.” I am human. Of course I have doubts and uncertainties but I still act on it despite these doubts and uncertainties. In the case of Jade Circle, I felt that we didn’t want our integrity to be compromised. It’s as simple as that. So if we had yielded to that, it may have been a Pyrrhic victory.
We shouldn’t pigeonhole the people in government or nursing home leaders. I’m sure there are some in senior management who are enlightened. They are progressive. So we just need to persuade them. So we are putting out new information, new insights as a mirror for us to look at the sector honestly. Our objective is to provoke rethinking, to provoke public soul-searching, and get everybody involved. But if at the end of the day, Singaporeans feel that 6- and 8-bedder dorms are the way to go then I’ll say “good luck”. At least, we would have done our part.
It is impossible to make everybody happy. And it’s not my role to do so. But I eat well and I sleep well because my conscience is clear.
I believe that nobody has a monopoly on solutions. But if the projects are successful we would want it to be adopted and scaled by other parties, whether it is the government or the private sector. There’s a saying: A country without imagination is like an observatory without a telescope. So I think it goes back to the point that the real enemy, the real disease is apathy, complacency and mediocrity and we each have to do our part to address this.