News
Such a medical tragedy, but so are the comments.
Negligence is not exclusive to government practice and we don't experiment on patients. And the best don't always move on to the private sector.
But really, it's a real medical tragedy to befallen on a fellow colleague and our reputation.
“The survey showed that in Kuala Lumpur, the provisional estimates of a living wage ranged between RM2,700 and RM6,500 per month.
It said the living wage for a single adult was RM2,700 per month; RM4,500 per month for a couple without children; and RM6,500 per month for a couple with two children.
...
The central bank also said the living wage estimates in Kuala Lumpur were below the median income (in Kuala Lumpur) of RM9,073, emphasising that up to 27% of households were earning below the living wage.
“In terms of household type, a larger share of single-adult households and couples with two children were earning below the estimated living wage in 2016, compared to couples without children.
“The finding for single-adult households is consistent with the fact that graduates with a first degree or diploma earn on average, starting salaries of RM2,207 and RM1,346 per month, respectively.””
A provisional living wage in KL as low as that? Let's not kid ourselves.
“Unsold housing units increased on an annual basis by 22.7% in 2017 (2016: 41%) to 129,052 units as at end-September 2017.
More than 80% of the unsold units were priced at RM250,000 and above.
Many of these units were high-rise residential properties and were mainly in areas located far from major economic centres and with limited public transport facilities.
“The high number of unsold housing units also reflects the persistent mismatch between the selling price of houses being built and what most households can afford,” according to the report.”
That's not sustainable for buyers.
“Bank Negara pointed out that activities in the commercial property segment (comprising shops, office space and shopping complexes) remained soft, amid an oversupply in these segments and challenges faced by businesses in the oil and gas (O&G) sector.
The volume of commercial property transactions declined by 8.2% (2010-2016 average: -4.7%) to 16,025 units during the first nine months of 2017. The value transacted nonetheless increased by 3.8% to RM17.8bil driven by higher transactions of properties priced RM1mil and above.
Slower activities in the commercial property segment were observed in most major states such as Kuala Lumpur, Selangor, Johor and Penang.”
It's not hard to find empty shop-lots and empty malls (I'm typing this in Quill City Mall). And if people lose jobs because of bad business, who's gonna pay for those property purchases?
Ingredients: Water, 9 mg/ml of salt and nothing else
But apparently it's not easy to manufacture; it has to be the right concentration (there are various formulations) and pure (of impurities and germs). Amazingly, the whole US gets its bag of saline from only 3 manufacturers (my observation has been that all of peninsular Malaysia is supplied by Ain Medicare). Apparently Hurricane Maria jeopardized the American supply as manufacturers can't simply ramp it up; interestingly 1 reason for this is the high barrier to entry as the hospital groups' purchasing power ensure that they buy saline at the absolute lowest prices (only the companies with the lowest costs win).
“Oral rehydration therapy has been studied for nearly 60 years. It has been shown to reduce mortality from diarrheal illnesses by 93% and to reduce the case fatality rate of cholera from 30% to 1%. It is less expensive than IV-fluid therapy, and its use results in fewer admissions and shorter lengths of stay. A 2006 meta-analysis showed that oral rehydration was equivalent to the administration of IV fluid for the management of dehydration due to gastroenteritis in children. Data on use in adults have revealed similar efficacy, although in smaller studies. Oral rehydration therapy has been widely adopted in low- and middle-income countries where IV fluids are expensive and resources limited. Conversely, despite this evidence, oral rehydration has not been widely used in adults in high-income countries, probably owing to the widespread availability and ease of use of IV fluids.”
Interestingly, the saline crises has forced American ED's to stop being lazy and do the right thing and encourage oral rehydration. Despite good evidence that it's better than iv fluids (both in terms of efficacy and cost), we still stick to iv fluids for what can only be described as "laziness". There's just nothing easier for the nurses than putting that iv line in, spike that bag of saline, hang it up, and continue with ward work instead of the kind "Western way" of encouraging patients to drink that solution of electrolytes; imagine if it was a typical Asian parent instead of that nurse instead. And if the patient can tell us that the bag of saline has just finished, all the better as now you can simply chart it as 500 ml (or 1 L) in!