Yours Toothfully by Dr Chan Joon Yee

The plot thickens. It seems that only the swine flu in Mexico is deadly. How it became a much kinder virus after being brought into the US, Canada and Europe is something that will keep researchers from being retrenched for quite a while. People who came into contact with the Mexican toddler who died in Texas were also uninfected. Could this virus be less infectious than we thought? Or as one of our ministers said, the light in the tunnel could be an oncoming train.

Meanwhile, colleagues in the hospitals are complaining about suffocating inside their N95 masks. It reminded them of 2003, which wasn’t a good time at Hougang where I shared premises with a medical colleague. Those in hospitals are only complaining about stuffy masks. Those of us who need to pay the rent are worried about the economic impact. Some pessimists predict a fallout worse than SARS.

So where do we go for hope and encouragement? It seems that the most popular place to go for answers to today’s problems, is the past. And if you walk into the “New Age” section at Kinokuniya Bookstore at Takashimaya (my favourite hangout after lunch or before dinner), you’ll find rows of books on ancient wisdom, bizarre, unorthodox practices and the occult. How is all this considered “New Age”? Another paradox lies in our dislike for things which are obsolete. My 3-year old dental chair is giving me problems already. My “obsolete” chair which didn’t give major problems for 10 years is not being produced anymore. Have things really improved? Maybe that’s how one can sell old ideas as “New Age”.

There was a time when Westerners looked down on ancient China and India as backward. This sense of superiority os very much toned down nowadays, but there is suddenly an interest or even a worship of ancient Asian values. Below is my review of the book on Tibetan medicine by Ralph Forde:

Closely associated with Buddhism, Tibetan medicine attributes ill health to diet, behaviour, season and … (would you believe it?) karma. Every living body has a certain “breath of life” called tsog lung. This breath has 3 main branches and a total of 72,000 minor channels, allowing tsog lung to pervade every part of the body. Within the body, there are 3 life forces namely “lung”, “tripa” and “bekan”. There are 7 bodily fluids recognised. They are saliva, blood, bone, marrow, flesh, fat, reproductive juices.

The body has ayurvedic chakras. There are 5 elements in the environment, namely earth, water, fire, air and space. Crystals are believed to contain all 5 elements and hence possess healing powers. Prayer and meditation also help. So does herbal therapy, moxibustion, cupping and massage. Diagnosis is often made by taking the patient’s pulse or examining his tongue/urine.

Such is the basic paradigm or framework of Tibetan medicine. Anyone with enough knowledge of the exotic East to cease finding it exotic should be able to see that Tibetan medicine is by no means unique. And this is perhaps all the useful info that I managed to filter out from the book.

I’m curious about how Tibetan physicians would diagnose an illness from the patient’s pulse. One can find detailed descriptions and explanations in any TCM book on pulse-taking, but Forde’s book is rather vague on details except that an irregular pulse is caused by demonic possession!

There is likewise, scanty details on which kind of herb combination would treat common ailments. Forde’s recommendations on herbal therapy and diet can be found in almost any book on wellness. In fact, his advice on healthy eating is most unTibetan. I wonder where he borrowed that from.

I’m disappointed that instead of going into details on herbs, yoga and meditation, Forde often digressed into history, politics, miracles and even advertising for Tibetan medical practitioners with dubious track records. As a healthcare practitioner in the 21st century, I can understand that an ancient philosophy in the remote Himalayas would include occult practices, but as Tibetan medicine goes global, writers like Forde needs to be very careful about including chapters on astrology and a whole illustrated section on divination with prayer beads! As open-minded individuals, we need not reject the occult claims outright. Instead, we can regard them as parables. This is probably the best way that an ancient art can coexist with modern science.

If I want to discover the secret of longevity, I would study the diet and habits of the longest-living and healthiest people in the world. In spite of James Hilton’s virtually immortal Shangrilians, we know for a fact that Tibetans are not amongst the longest living and healtheist people in the world. The quality of life of the Tibetans have been tremendously improved with childhood vaccinations, vitamin supplements, sunblock for the ladies, cataract surgery for the elderly. So what does traditional Tibetan medicine (TTM) have to offer? Is there something not already covered by TCM, ayurveda, Buddhist meditation, Indian yoga and Western medicine/nutritional science? Is the “preservation” of TTM and all its original tantras equivalent to a backtrack to Medieval science (TCM now uses xrays and ultrasound)? Why doesn’t somebody write about the wisdom of the alchemists? Perhaps it’s because our modern chemists have grown far wiser than their predecessors.

All of a sudden, we turn to the mysterious past for answers to our problems. It’s not that there is nothing to be learned, but more often than not, the past is full of negative demos - what not to do. Just last month, my friend Major Ling went to China and saw a TTM practitioner. Just by looking at his palms, the divine healer could tell that he has high blood pressure and high cholesterol. I’m impressed if not for Major Ling’s obvious post-stroke gait and a brace he wore on his affected arm. At the end of the consultation, Major Ling parted with a few hundred S$ and came home with a few big bags of Himalayan herbs which looked neither rare nor Himalayan. And it’s twice the price of his warfarin, aspirin and statins.

Whether it’s the recession or a deadly epidemic, mere mortals like us are just sitting ducks. Desperate and impatient for answers, we dive into the murky past for solutions that seem creative because they have been forgotten. Drinking urine, crystal therapy, mud therapy, poo therapy … I wonder if the Tibetan doctor has anything less obnoxious for swine flu.

Even before we’ve stopped talking about the Indian rojak saga, Mexican is next on the menu. And it’s not about food poisoning. 1400 people in Mexico have contracted swine flu at this time of writing. 86 have died.

Fortunately, swine flu is a lot less deadly than SARS. However, it is more infectious than SARS. The SARS patient is only infectious a few days after the onset of fever. By that time, he could have been safely quarantined. The swine flu patient, on the other hand, is infectious the moment he shows signs and symptoms. This makes the virus a lot more difficult to contain. In spite of all our efforts to screen passengers coming into Singapore, patients who are yet to develop symptoms may slip through. Already, there was talk about closing borders. All the ridiculously extreme measures which were suggested in online during the SARS epidemic suddenly came back to life. I’m glad that our health minister is not even considering that yet. That would be equivalent to self-strangulation.

Back in Hougang when I shared premises with a doctor, the effect that SARS had on the practice in 2003 was nothing short of devastating. This time round, I don’t have any coughing and sneezing patients in my waiting area. Hopefully, the effect that an outbreak of swine flu might have would be somewhat blunted. Unlike deadly SARS, the fatality rate of swine flu is estimated to be 6%. The bad news is, the virus is somewhat resistant to Tamiflu (oseltamivir). Another drug, Relenza (zanamivir) is slightly more effective against it. Rumour has it that Relenza may be replacing Tamiflu as the drug of choice for treating life-threatening influenza.

As this is a new strain of swine flu virus, we are still learning new things about it as events unfold. My next blog entry may contradict some of the info in this one. But the biggest question on my mind right now, is when all this is going to blow over. As we’ve seen from SARS, the economic impact can be as deadly as the pathological impact. The current outbreak is something that this economic crisis doesn’t need. Just as everyone thought that the bulls are out on Wall Street again, the pigs rear their ugly heads. Why worry about nuclear proliferation?

I thought I had died and gone to food heaven when my classmate Chin Leong invited me to stay at his home in Penang. Every day I was there, we went on a walk, stop and eat tour of the island. We went to Penang Hill. We went to the snake temple and many other tourist spots and at the end of each day, I would have eaten at least 3 bowls of laksa, a few pieces of grilled cuttlefish, 2 plates of char kway teow and a bowl or 2 of Hokkien mee for supper - all at roadside stalls, all of which couldn’t have gotten a D grading from our world class NEA.

Someone once joked that in Singapore, the standard of a hawker’s food is inversely proportional to the hygiene grading. I prefer to judge food quality by the rudeness of the hawker. But food hygiene is definitely no joking matter nowadays. Two people have died after eating some contaminated Indian rojak. Unlike anti-suicide barriers at MRT stations, the response to food poisoning deaths was swift.

Yes, the heat is on at hawker centres. Food hygiene is a major issue these days. To show how major it is, 80 out of 83 stalls in Geylang Serai had their hawker hygiene grading downgraded to C.

That’s interesting. But why C? Why not D? Why only 80/83 stalls? Why not all 83 stalls? Regardless of whether the stalls are “downgraded” to C or D overnight, people still need to eat and they are certainly smart enough to know that their chances of getting food poisoning at these familiar but “downgraded” stalls would not be any higher than before. The only “effective” thing about this downgrading exercise is that if anyone gets food poisoning at Geyland Serai, he can’t blame the NEA for being mistaken about the standard of stall cleanliness there.

What next? Compulsory continuing education on food hygiene for our hawkers? That’s easy to implement. What’s not so easy is for the hawkers themselves to take time off to attend these courses and keep their prices low. They may need to start looking for locums too. What’s even more difficult, is for the governing body to vouch for a hawker who has completed all his hygiene courses, judiciously implemented state of the art hygiene measures at his stall and still ends up with customers in hospital. It’s not wrong to make the hawkers take ultimate responsibilty for the safety of their own food, but if I were a hawker, I would feel a stab in my back if my stall’s cleanliness is instantly downgraded when something happens nearby.

The most reputable brand of electronics can explode. The most skillful surgeon can make mistakes on or off the operating table. Athletic people collapse and die for no apparent reason. Self-sacrificing monks can lend $50,000 in charity funds to their boyfriends. A stall that has been doing brisk business for decades may have a fatal food poisoning case. We live in an imperfect world. Accidents will happen no matter how careful you are. While it’s only right that we mourn the unfortunate people who died, taking drastic measures to prevent such things from ever happening again will not only be futile, but will make Singapore even more uniquely dull, sterile and unforgiving. I’m not a foolhardy person (and I certainly won’t tolerate a cockroach in my har gow), but I still need to live on and enjoy life. Bring on the good stuff.

For people in Bangkok and Pattaya, the Easter weekend was anything but uneventful. Red shirt protesters stormed into the Royal Cliff Beach Resort and forced the cancellation of the ASEAN Summit. They later moved to Bangkok. Thai PM Abhisit Vejajiva then declared a state of emergency. Arrest warrants were issued for protest leaders, Thaksin called back to fuel the flames and a violent crackdown by the military followed.

Today, the red shirts pulled out of their final stronghold at the government house, protest leaders surrendered themselves and everything seemed to have died down as suddenly as it had started. Of course nobody is complaining. Everybody is relieved, but we all know that this won’t be the end. There is still no resolution in sight. As long as there are no elections, the red shirts will not be happy. As long as anyone even remotely related to the former TRT party gets elected (and chances of that happening are extremely high), the yellow shirts won’t be happy. Election or no election?

Meanwhile, arrest warrants are going out for Thaksin for inciting violence. Some people must hate him for that and I personally hate to see people being sacrificed for some other people’s political agenda. But looking a bit deeper at the red shirts movement, a keen observer will notice that it has gone beyond Thaksin. A number of red shirts have declared that they are not even fighting for Thaksin but a new system. If death and injury occurred simply because people want Abhisit to resign, then I think it’s rather foolish. But if this is a peasant’s revolt to demolish Thailand’s brand of contemporary feudalism, then those who believe in the new system should be prepared to sacrifice a little more.

Elected politicians are always in the limelight. How much can they steal from the country? But what about the “lords” and “knights” influencing the country from behind an opaque curtain? Their names are seldom mentioned. Some names are not even mentionable. It’s this bunch of elite that many generations of short-lived politicians must answer to before they even think about serving the people. For many generations of peasants, getting gifts from the “lords” and “knights” was something to celebrate. To attract more gifts and charitable acts, the peasants must act subservient, always lowering their heads, walking in small steps and speaking softly. Borrowing becomes the first solution to their money problems. Marrying a daughter as mia noi in exchange for money is another alternative.

But times have changed and under Thaksin, radical changes in the mindset of the peasants have occurred. These folks suddenly realised that with the appropriate programmes and funding, they can well be masters of their own fate. They no longer need to rely on the charitable acts of the lords and knights. As long as the state could focus some of its attention to the hinterlands and make them more happening, even poor peasants can become proud owners of profitable farms or factories.

Thaksin is not so much an idol worshipped by the peasants. The red shirts are gathering momentum because of an awakening from centuries of indoctrination. Something is wrong with this rich country and its very humble majority. While it is my wish that the peasants’ dreams will come true one day, the “knights” and “lords” are still too powerful to be toppled with peaceful or even small scale violent demonstrations. Not forgetting the millions of class conscious urban, middle class Thais who despise the peasants and happily embrace traditional beliefs which allow them to share some of the wealth that the elite milked out of the peasants. There is no reason for this group of people to stand with the peasants. In fact, they may even put on yellow shirts and stand against the peasants. Afterall, the tumour is not causing them any pain yet. Why bother to shed blood and excise it?

Having said that, the day may come when even the yellow shirts will see the big picture and turn against the “lords” and “knights”. Why am I ambivalent about it? I hate to think about the casualty numbers and the price that the Thai people have to pay. On the other hand, it’s only with a radical change in this current feudal system that Thai peasants will be able to live as dignified individuals and earn a respectable living without making collect calls to Farang boyfriends to send money.