What's in a name? Plenty, If it's Chinese

source: The Sunday Times, 5 July 2011

Persisting Despite Everything

Editors' Note: A rare peak into the life of the Lee's family. Dispelling many unfounded rumours that MM Lee was angry with the daughter-in-law Ming Yang who had an albino child and the mistery death of Ming Yang. 

Persisting despite everything  No matter the trials, one must roll with the punches and carry on with life Source: The Sunday Times Apr 24, 2011

By Lee Wei Ling  My elder brother Hsien Loong's son Yipeng was born on Oct 7, 1982. The baby had albinism, which means he had no pigment on his skin and eyes, and his vision would be impaired.  Hsien Loong phoned our father to tell him about the baby's condition, and added: 'He will not be able to do national service.' Loong's late wife Ming Yang died of a heart attack three weeks after delivering the baby. I had just returned to Boston then after passing my MRCP (UK) examination, when my father phoned me to tell me that Ming Yang had died. I flew home immediately, and stayed for a month. Then I returned to Boston to continue my training in paediatric neurology. Recently, while clearing some papers, I came across old letters exchanged between my mother and me from that period. They speak of a sad time in our family, of persisting despite everything, of keeping faith with the fundamentals. Below I reproduce a letter from my mother to me, dated Nov 25, 1982, and my reply, dated Dec 7, 1982. My dear Ling, Your letter of 14/11 arrived a few days ago. We (Pa and Ma) were barely stirring, about to wake, when the SOs (security officers) put through your call. We were both glad to hear your voice. You sounded more like your usual self. I was fearful you would be down and depressed and very vulnerable then to 'falling in love'. Papa always assures me that when he 'fell in love' with me, it was a very carefully considered decision. => WTF is this? He wanted someone intelligent so he could talk to her; someone healthy to bear healthy children, and someone tall and big because he wanted tall big children.The fact that I am two and a half years older than he is, was also carefully considered! => LCB should have looked for cow then! He did not discuss me with his parents, though he was very close to his mother. I hope you have inherited Papa's approach to this very important decision, and will not allow yourself to fall in love with the wrong person, and that you will make as happy a choice as your father did. => Who? Loong has brought Yipeng to Mount Elizabeth medical centre. Dr KCY, an ophthalmologist, arranged for a British specialist, Dr MR, to see Yipeng. => Public hospital docs not good enough? Dr MR did not tell us much that Loong did not already know. He examined Yipeng's eyes in a darkened room with an ophthalmoscope and made what Loong cynically described as 'comforting sounds'. He said that the pigment will probably develop when the child is between 12 and 15 years old, but he was just making a general statement, not forecasting anything for Yipeng. We invited Loong to a poolside barbecue, and he said he would (come) and did bring Xiuqi to this second poolside barbecue. The first dinner must have been painful for him because it was less than a month before that he and Ming Yang were at a similar dinner, and at times, I saw his face drawn with pain and his eyes filled with tears. The second dinner, he was a little more composed. He must and will get over it. But it's so painful. Mary Thatcher (the widow of W.S. Thatcher, my father's former tutor at Fitzwilliam College, Cambridge University), to whom Loong had sent the two cards (one to announce Yipeng's birth and the other Ming Yang's death), wrote a letter to him and one to me. She was very perceptive, and wrote that I must be grieving to see my son grieve, and that is true. I don't want to make you sad, Ling, but I must get it off my chest. I went to see Dr LYK and Dr CBL for a thorough check because I still have heartache. They made me do the treadmill test and took some ultrasound pictures of my heart. They said everything was fine and I quite believe them, and know it is just psychological heartache. Look after yourself and write home. Love, Mama Dear Pa, Ma & Family, This past weekend was the first weekend since returning from Singapore when I did not have to carry my beeper, because my colleague is back from vacation. Saturday was an exceptionally warm day. I went for a long walk at Mount Auburn Cemetery. I have walked there many times before, especially last fall and this past spring and summer. The last time I walked there I was depressed over failing the MRCP exam and anxious about trying the exam again. I remember Ming Yang wrote me a comforting letter soon after I arrived back in Boston (after failing the first MRCP exam). This time Ming Yang is gone. I felt very, very sad as I walked in the cemetery. But cemeteries always have a calming effect on me and put life in its correct perspective. When I see graves of whole families with members dying at all ages, from babyhood to their 90s, I remember what we all know but purposely try to forget: how transient and unpredictable life is. Ma, if you could send me at least US$3,000, I want to open a 'First Rate Account'. I am enclosing a letter from the bank. You can see the conditions and let me know whether I am wise. I can start the account any time after 14/12/82. My current account is running low again because I have been buying quite a lot of books. Ma, stop fretting about my falling for an American. I can't give any 100 per cent guarantees, but have always let reason override passion in this particular matter. Besides, I am not even sure I want ever to get married. Love, Ling It is now April 2011. Yipeng is a polite, gentle and determined young man of 29, a graduate of the National University of Singapore. He is still undecided about what career he wants to take on. He assures me that he does not want a routine job but one where he can contribute to society. Hsien Loong got over his grief and married Ho Ching, who has two sons, both now studying at the Massachusetts Institute of Technology. She has been a kind and sensible mother to Ming Yang's two children as well as to her own. She has been a filial daughter-in-law and a kind and very considerate sister- in-law. And I have remained happily single, and now support my father in his old age. Life is an obstacle course. Neither moaning nor surrendering to depression can change things for the better. We have to roll with the punches, grit our teeth and carry on with life. As a character in the Samuel Beckett novel, The Unnamable, puts it: 'You must go on, I can't go on, I'll go on.'

When bundle of joyturn to sorrow

Source: The Sunday Times 13 Feb 2011

Childless couples can seek medical help or turn to adoption, but be aware of the risks 

I have a 32-year-old family friend who has been married for more than six years but had not been able to conceive. So she turned to Assisted Reproduction Technology (ART) treatments at one of Singapore’s public hospitals.  Since September 2008, for couples who have difficulties conceiving, the Government has co-funded 50 per cent of the cost of ART, up to a maximum of $3,000 per course. My friend went for three courses, the maximum the Government will co-fund, stoically putting up with the discomfort. She did not conceive.

That is not surprising as the average success rate of ART is just 30 per cent – and the rate falls as the woman grows older. What is more, if my friend had conceived by ART, there would have been a 20 per cent risk of multiple pregnancies – that is, having more than one baby in the uterus. This risk is also age dependent, being higher in younger women. Multiple pregnancies have an increased risk of pre-maturity, and premature babies are prone to a variety of permanent handicaps.

There are rules in Singapore to reduce the risk of multiple pregnancies: 

• Singaporeans and permanent residents must be under 40 years old to qualify for co-funding. They are allowed to transfer only two embryos each time.
• Patients who are not receiving co-funding are allowed to transfer up to three embryos, regardless of their age.
• If patients are above 35 and have failed twice or more, they are allowed to have four embryos implanted. This improves the chance of delivering a living baby but also increases the risk of multiple pregnancies and thus premature babies.

I was not happy when the Government announced it would co-fund ART because of its high cost, relatively low rate of success and the possibility of having a handicapped child. The rules governing ART in cases that do not require government funding are lax. The number of handicapped children as a result of ART is not public. But I am also aware of the anguish of women who desperately want a child but fail to conceive. It is easy to reduce the risk of multiple pregnancies: Transfer only one fertilised ovum each time, and try again if that fails to produce a living baby.

This is already being practised in Denmark, where 6 per cent of children in primary school were conceived by ART. More courses of ART will obviously cost more. But the cost of handicapped citizens who need lifelong care certainly outweighs the cost of multiple courses of ART.

My friend, having failed three courses of ART, turned to adoption. She found a Chinese baby girl from Malaysia who was checked by a doctor and pronounced normal. Now my friend is a happy mother. When I spoke to her on the phone, and questioned her, she called out to her husband, “Daddy”, for the answer. Within three months of adopting her baby, she became pregnant naturally. Needless to say, she and her husband are delighted and so are my father and I.

In treating infertility, both husband and wife should go for a medical checkup. Some problems are easy to overcome, others may be insurmountable. In the latter case, ART may be tried. If that too fails, adoption is an option. But assessing a baby for future intelligence or even hearing ability is not easy. Early in life, babies can only sleep, wake and cry. As they grow older, they begin to focus their eyes on objects, especially human faces, smile responsively, reach out for objects, hold their heads up steadily by three months of age, sit steadily by eight months, and walk a few steps and say a few words and know their meaning at the age of one year. By 13 months, they should be able to walk without support.

The milestones indicating cognitive function – such as recognizing and smiling at a familiar face, or realizing that the person approaching is unfamiliar and responding by crying – are subtle. All in all, even a careful assessment of a baby cannot tell us how intelligent the child will be at school age. Even hearing impairment may be missed because the baby may hear low frequency sounds but not high frequency sounds, which is what we depend on to distinguish speech sounds. I have seen a significant number of adopted babies who turn out sometime after adoption to be deaf, mentally retarded, suffer from cerebral palsy or have congenital cardiac and other malformations. It is possible that a parent willing to give up a baby for adoption – especially in Singapore – does so because there is something wrong with the parent or the baby or both.

I know of a couple who adopted from a Chinese woman. They underwrote the entire cost of her pregnancy and delivery and received an apparently healthy Chinese baby girl. The baby subsequently was found to have a hole in her heart, but that has not adversely affected her health. A few years later, the couple wanted another baby, and went back to the same woman. Again she became pregnant, the baby grew to term, and the couple happily carried back an apparently normal baby boy. I wondered how this woman was able to produce babies on demand. The couple had no information on who the father was. At the age of six, the boy suddenly developed severe seizures which have been impossible to control. Worse still, over the next few years, his intellectual ability dropped. Now he is a handsome tall teenager, with an IQ less than that of a child in kindergarten, and which continues to drop. His temperament also changed. He has become aggressive, even attacking his parents and sister. He has ruined the lives of his adoptive parents and sister. I advised the parents to institutionalise him as they could afford to, but they were too attached to him to do so. I cannot pinpoint what is the underlying disease that is causing his brain to change so dramatically.

But I have a suspicion it is genetic in origin, probably autosomal recessive, meaning it shows up only if the patient has two of the bad genes. Autosomal recessive diseases are more likely to occur if the parents are related. I wonder whether he is the product of incest. Adoption carries a risk of adopting a handicapped baby. The best chance of a normal baby is to find one whose parents are known to you, and who are willing to give up the baby because they already have too many children. Even so, if the baby is a Chinese boy, think long and hard before adopting him. Chinese are more than willing to give away baby girls, but not baby boys. Couples who have difficulty conceiving have some options, but none is risk-free.

 So dear reader beware if you are trying hard for a baby. The baby may ruin your life.

The writer is director of the National Neuroscience Institute.

Medals don't matter, doing right does

Soruce: The Sunday Times, Aug 1, 2010

Don't be afraid to speak up and take action if you are in a position to do so
By Lee Wei Ling

I was searching for some old books containing many of my favourite Chinese poems.

My books and my room at my parents' house have seen extensive changes since I moved to live with my brother Lee Hsien Loong's family from 2002 to 2005. My room at Hsien Loong's house was too small to move more than a tenth of the books I needed. So the rest, I left in my room in Oxley Road.

In 2003, after my mother suffered a bleed into her brain, my room at my parents' house was extensively renovated so a nurse could rest there. The nurse needed more creature comforts than I did. So a bed was placed in the room and a water heater was installed in the bathroom so she could have a warm shower.

And my books, packed in boxes, were moved into the basement. It took me two days a few weekends ago to find the books I wanted and even then, I couldn't find several.

But by chance, I did find the nine medals that I had been awarded for topping my cohort in medical school as well as individual prizes in subjects where I was first in class. One medal that I recall was made of pure gold was missing. I had handed it to my mother to be locked up as I have a talent for losing things.

I was surprised that I felt no sense of triumph or joy when I found the medals. In my immature youth, I had worked very hard to earn them. Indeed, 35 years ago when I was in medical school, I would study the following year's subjects even while on vacations, reading several textbooks on each subject before the new term began.

Hence, I knew not only the scientific facts that the authorities agreed about, but I was also aware of what was still controversial. When term started and I attended the lectures, I didn't have to take notes except when I wanted to prevent myself from falling asleep.

I remember that while I was still a medical student, I accompanied my parents on a trip to Osaka. A Mr S. Oya, an elderly gentleman who owned Teijin, a manufacturer of synthetic fibre, invited us to his house for dinner. His first wife had died and he had married a woman much younger than he was - a vivacious Japanese lady not at all sedate as one would expect a Japanese wife to be. When my parents introduced me to her, she prophesied 'one day you will be a famous professor'. I did not demur since that indeed was my ambition.

Decades have passed since then, and my priorities in life have changed. Medals and titles now mean little to me. What matters is that I must do right, and I should do so even if I offend people who have power over me.

I have acquired the title of 'Professor', but that gives me no joy. In fact, I prefer to be addressed as 'Dr'. The title 'professor' has been sprinkled around liberally among the medical fraternity here, and there are some professors with whom I certainly do not wish to be grouped.

My younger brother, Lee Hsien Yang, once asked me: 'Why do you step on powerful and sensitive toes?'

I replied: 'But if I don't, who will do so to put things right?'

Hsien Yang is no coward. When in the army, to which he was bonded for eight years for accepting the President's Scholarship as well as the Singapore Armed Forces Scholarship, he earned badges for scuba diving as well as parachuting. He needed to get only one of the two badges, as all senior officers had to to prove to their men that they were not cowards.

Hsien Yang got both. Like me, he likes physical challenges. But as a businessman, he knows that antagonising powerful people does not make good business sense.

But I am not a businesswoman; I am a doctor serving patients in the public sector. Since 2008, I have also been a regular columnist in The Straits Times and The Sunday Times. I am much less important and well known than my two brothers or my sisters-in-law. But writing columns gives me a chance to discuss social trends and to point out government policies that I think are wrong.

That does not mean my bosses cannot take action against me if they so wish. But it is better to do what is morally correct than to be so afraid that one does not dare say 'boo' to our superiors. Pay rise, bonus, promotion or demotion are much less important than doing what is right. Besides, if I do not try to right a wrong that I am aware of, my conscience will bother me.

I don't think my temperament has changed since I was a child, but my purpose in life certainly has - and I hope it has changed for the better. I try not to hesitate to speak up when my superiors or even the Government do something that I think is not in the best interest of Singapore. The criticism is made with the sincere wish to improve our system and to benefit Singaporeans.

I do all this not because I wish to score points or gain glory. I do so because I owe Singapore a debt for the opportunities it has given me. In return, people in my position should always do what they think is the best for Singapore. 

Neuroscience institute puts patient care first

Source: Angrydr.blogspot.com, 1997

I READ the letter by Dr Ranjiv Sivanandan, 'Patient care should drive policy, not vice versa' (ST, March 9). I disagree that in all restructured (i.e., public-sector) hospitals doctors and departments are recognised first and foremost for the number of private patients they bring in.

While it is true that block funding makes it essential that all of us working in public hospitals observe financial prudence, we at the National Neuroscience Institute (NNI) have always put patient care first. Not only do I remind all staff, whether medical or administrative, of that fact, but I also personally set an example.

In addition, our appraisal system, which was designed with the input of our senior doctors, purposely excluded any consideration of number of private patients or earning capacity of a doctor from our appraisal form. While education and research are also included in the appraisal, the quality of care given to all patients is the key factor determining each doctor's appraisal rating and hence bonus and annual increment.

This is an ethos which permeates all departments and all medical and paramedical staff.

If the block budget runs out before the end of the financial year, which has happened before, NNI continues to function as usual, knowing full well that at SingHealth cluster HQ someone will have to find some way to keep us going until the next financial year.

I personally treat my subsidised and full-paying (i.e., private) patients with the same care as do all my doctors. The main advantage of being a full-paying patient is that you can specify the doctor of your choice.

I cannot overemphasise the importance of those in charge of the hospitals determining the ethos of their individual hospital.

At the end of the day, if you are recognised and rewarded by the quality of patient care you provide and not how many private patients you have, you will naturally put patient care as the first priority.

Assoc Prof Lee Wei Ling
Director
National Neuroscience Institute