Yours Toothfully by Dr Chan Joon Yee

In Tabitha Wang’s Budget Tai Tai column in Today 25th July 2008, she touched on a seemingly unsurprising topic - that rooms in Singapore are expensive. So what’s new? All our foreign visitors know that. That’s why Singapore is only a place for “Transit” and you don’t need a whole week to see Sentosa, the zoo, Chinatown, Little India etc. Apart from the expats, not many tourists would stay around for months and then elope with our girls to further lower our birth rates

However, Madam Wang added a new perspective which may serve as an eye-opener for those of us who are still seriously thinking that Singapore is going to be a medical hub of the region. A couple of Australians contemplating dental treatment in Singapore have emailed me to discuss the cost of treatment which sounded very attractive to them. But the moment they factored in the acommodation costs - for procedures that require multiple stages, the relatively low treatment costs are no longer attractive. The total bill is not very different from that in Australia.

Let’s face it. Within the developed world, medical (and dental) fees in Singapore are considered low. Our hotels are expensive, but naturally, few locals would complain about that. Strangely, we see a lot of effort being put to making sure that doctors don’t overcharge, but very little is done to make sure that medical and other long-staying tourists would have more sensible options than staying in our hotels.

In an unrelated article, Ansley Ng talks about being single, walking into a video rental store … which makes me sympathise with him. I used to be so busy doing a lot of meaningful but unprofitable things when I was single that I’m far more likely to watch TV (make that Transformers or Tom & Jerry) now that I’m married with kids. This guy probably doesn’t know how much he can do with his life before he gets married. I figured that perhaps I could introduce him to some happening club or society, some excellent backpacking destinations and so on.

When Mr Ng mentions “so it would be interesting to see what measures the Government (capital G) unveils next month to help singles-networking processes along …” I had to pronounce him hopeless. Apart from the uncles and aunties, even our young, educated people are not taking charge of their own lives anymore. So sad.

No long after the terrorists struck on 911, George Bush appeared on TV condemning the “cowardly act”. That remark had me scratching my head. I was wondering what he meant by that. Terrorists are cowards? Was George Bush brave enough to blow himself up for what he believed in? I don’t think so. The terrorists were not certainly not cowards. I think they were just insanely courageous. Fortunately, there aren’t too many people like that in this world. Certainly far fewer of them than cowards. George Bush forced the cowardly label on these extremists to calm the frightened American public. See, they’re actually cowards, so you need not be afraid of them. Look at all the tight security measures after 911 and anybody with common sense would see who is frightened of who.

I also remember that my secondary school teacher used to tell us not to be afraid of bullies. She said that bullies are all cowards. She told us they all come from broken homes, have been abused when they were children and have very low self-esteem. A flip through any self-help book will give an indication of where my teacher got her ideas from. There are probably hundreds of titles out there which dispense advice on how to deal with difficult people, how to choose the right partner, how to maintain a relationship, how to be more attractive to the opposite sex, how to boost our self-esteem and become more popular within our social circles. I’ve got a couple of friends who snapped up these titles whenever they appeared on the shelves of the bookstores. One of them is still single and dateless. The others didn’t have very happy marriages. And in spite of these books hitting the bestseller’s lists in the America, American couples are still breaking up in larger numbers than before and friendless people remain without any real friends.

There is too much clutter in the ocean of information out there. People are drowning in guru science and junk philosophies. Promote these ideas American style and you’ll find that a lot of these unsupported claims and unhealthy beliefs can turn into gospel truth for the hordes of insecure people who worship the self-help gurus. Nobody bothers to question their teachings. Do they really help?

Even when I was in secondary school, I had a gut feeling that my teacher could be wrong. That’s because very few of the bullies that I knew then were from broken homes or were ever abused by their parents. They were far more likely to be spoilt brats whose only trouble with self-esteem was having too much of it. But like George Bush, who found it more convenient to label terrorists as cowards than to admit to his own fears, my teacher wanted us to think of bullies as people with problems so we can forget that we the victims are actually the ones with the problem. A spade will not be a spade if we call it a spoon. I wonder if it works for patients with dental phobia to see their dentists as cowards.

With all that information overload hanging over me, I refer to only one source for self-help. The Buddha’s 2000-year-old teachings were spot on. Our problems stem from the fact that humans tend to pay too much attention to the cultivation of “self”. A person who has no friends should seriously consider a little humility and self-effacement. When one cares for and shows compassion for others, genuine friendships can develop. The one who concentrates on his self-esteem and self-love may draw a lot of envious attention but no genuine compasssion. With so much sound advice from the ancient world, why are the gurus still trying to reinvent the wheel? Who enlightens America?

Like most people, I have a handful of very trustworthy old friends. If there’s anything good about the army at all, it has to be the opportunity it gave me to make some “friends for life”. And like most people, I’ve had unpleasant experiences with fair weather friends as well. These are people who shower you with gifts, praises, words of concern when you are doing well, but would quickly sever all ties with you when you are in debt, in trouble or both.

Many people are disgusted by such behaviour. I’m a little more forgiving. That’s because I recognise that everyone has the right to self-preservation. Nobody; not even your best friends, not even your spouse or family is obliged to stay on a sinking boat with you. With this in mind, I’m usually not very harsh towards people who abandon me in times of trouble. It’s their right, actually. There is nothing morally wrong with being a fair weather friend. Everyone is a fair weather friend to somebody. We are mere mortals who can’t spread ourselves too thin.

I take a guarded approach towards sales people who are nice to me. I’m often friendly towards them, but I understand very well that they are just making a living and friendship with the customer is secondary. In any business environment, there is nothing wrong with favours and treats being conditional. Even amongst true friends, how many of us would feel comfortable if our friends keep doing us favours without anything in return? Would we not feel bad about it?

But there is one category of friends who are worse than fair weather friends. I call them the On & Off Friends. These are people who shower you with attention when you are doing well, abandon you when your boat is sinking and then return to you when the storm is over as if nothing happened.

These are people who point out every little mistake you made to get yourself into dire straits (even though it’s temporary and planned). They draw a line to indicate that they have no part in your predicament and declare that they will not go down with you. Again, I would not fault these people if they feel so strongly about the one they condemn as a loser. However, I would be totally disgusted if these folks make a quick switch when your fortunes take a turn for the better. They are completely amnesic about your alleged incompetence, poor judgement and ignorance. They want to be a part of your team again. They want to be onboard your ship, sailing off into the sunset on calm seas.

Forgiving and recovering from the hurt of abandonment can come quite naturally for most of us. What is difficult is to allow a deserter to come back onboard. Life and business are so full of uncertainties. What if the boat hits another storm? Can we trust the former deserter to sail through it with us?

I’ve been watching the discussion with great interest. Our unfortunate Indonesian kidney “donor” and his compatriot have been caught, charged and duly punished. They’ve committed a crime by selling (instead of donating for free) their kidneys. The difference between what is legal or illegal lies in whether money changes hands. But are donations always without strings attached?

When an NSman is asked whether he will give his life for his country, the politically correct answer, especially if given in front of a camera, is yes. But our dear NSman is basking in luxury. His favourite pizza, sushi or burger is just a call away. The roads are safe, the seas are calm and the earth will never open up and swallow up his expensive property. In this land of sheltered walkways, he doesn’t even need to carry an umbrella when it rains. But what if it’s raining enemy artillery shells? What if the taps don’t run? What if there is no electricity to run his laptop or charge his mobile phone? What if he can’t bathe for days and have to dodge real bullets and shells. Would he still be giving the same answer if he could be sipping a glass of chardonnay in that house of his in Australia?

Everybody with any EQ at all knows the right thing to say. And it’s really quite easy to say that we must save the earth, help the unfortunate and be against organ trading. A real test to our commitment towards these principles will only come when we are pushed by desperate circumstances whereby the top priority to save our own lives.

Someone who has received a kidney from her brother tells us that she finds organ trading repugnant. Yeah, but she is one of the lucky ones who didn’t have to fight the war. What about people who have no brothers or relatives to donate kidneys to them? What about people who are dying and still waiting? It’s like condemning starving people fighting for food when they are having a feast themselves. Now, that is repugnant to me.

In implant dentistry, we sometimes use something called an allograft. In English, it means something of human origin used in surgery to build up the patient’s deficient tissues. The identity of the person from which the bottle of freeze dried bone or skin originated will never be made known to either the dentist or the patient receiving it.

If I want to be anal retentive about it, I might want the manufacturer of the allograft to guarantee that the material did not originate from a dead body whose relatives sold for an obscene amount of money. Regardless of what they may say, nobody really knows what goes on at the other end. An allograft made in Germany could well contain Indian body parts. We are all assuming that these are willing donors whose family members did not receive a single rupee for the dead person’s body parts. Every penny that the manufacturer charges us goes to the processing of the material. Sometimes, we deliberately act like we were born yesterday.

Back to the issue of illegal organ trading. We all know that the only reason or excuse for cracking down on it, is to prevent the expoitation of vulnerable humans. Allow me to be nasty. Since when were we so magnanimous? How did these organ sellers get to be so desperate in the first place? Are the rich people and the government of these impoverished societies not at least partly responsible? Why condemn organ trading to “protect” the underprivileged when not enough has been done to provide these folks with equal opportunity to succeed in life?

Are we to assume that laws will work better in protecting the poor from being exploited? What if a donor has been promised a small fortune for his kidney, he goes along with the operation and the recipient reports the matter to the authorities before any money is paid out! No, they won’t take the kidney and return it to the donor. The law will just ensure that the donor doesn’t get any money for his donation and the cunning recipient gets his kidney for “free”. I wonder how many desperate individuals have been cheated this way. How does the law protect these desperate and vulnerable people from being duped?

There was a time when high profile donation drives in Singapore were accompanied with grand prizes for lucky donors. See? Even donations can come with enticements. Sure, not every donor is guaranteed to win, but what if the recipient of the kidney (a relative) buys a car for the donor as a gift? Is that considered organ trading?

One idiot suggested that we restrict organ donation in Singapore to only come from citizens and PRs. Hello, anybody out there wants to donate his kidney for a good cause? Let’ face it. Nobody of sound mind would want to give his kidney away to a complete stranger. He might not even want to give it to his best friend. It’s a huge sacrifice. The pain, this risk and permanent loss of something pricelsss. If someone is willing to do that for a dying you, don’t you think it’s already a gift? That’s because no amount of money will ever compensate him adequately. The least that the recipient can do is to help improve the donor’s quality of life. Why must it be “cashless” to be noble? Maybe I have lower moral standards than the disgusted people, but the starving and destitute people on the streets of any Third World country do not have the means to be noble. Those who are healthy, well-fed, well-educated and have the means to be moral and noble will certainly find it very convenient to condemn organ sales as repugnant from their comfortable armchairs. What have they done to improve the lives of the destitute without them having to sell thir organs? That would be the ideal solution to stem organ trading, wouldn’t it. With everybody financially comfortable, who would want to sell his kidney?

Fortunately for some and unfortunately for others, this is never a perfect world and humans are always selfish. If one really looks deeply into the issue, it’s really only about saving and improving lives. A win-win situation for everybody. People who condemn kidney sales as repugnant are only convincing when they are themselves dying from kidney failure