The Uyghur Dilemma

Something is horribly wrong in Xinjiang.

Here’s a brief summary:

Since 2017, the Chinese government has detained about a million people from the mostly Muslim Uyghur minority group in “re-education” camps. Countless others are subject to constant surveillance just for the ‘crime’ of being Uyghur (and by extension, Muslim).

As someone who loves reading about history, I have always wondered how people can just stand by while terrible things are happening around them. How did the Holocaust happen? Did people not care about the terrible oppression of the Jewish people back then, or were they just pretending to look the other way, in effect, silently condoning the massacre?

Something similar is happening here with the Uyghurs. What’s worse is that no one apart from the Chinese government seriously denies that this is taking place! Instead, the Chinese government is basically saying to the rest of the world:

Look, we know YOU know about the terrible things happening in Xinjiang. The question is: what are you willing to give up to stop this from happening?

China has, for better or worse, become the workshop of the world. Unfortunately here, with great power comes even greater potential to abuse that power. That is what is happening in Xinjiang right now.

I would like to share this article that I’ve just read on The Atlantic, titled ‘One by One, My Friends Were Sent to the Camps‘ which was written by Tahir Hamut Izgil. It makes for difficult reading, and I honestly struggled to finish it all at once because of how terrible the situation was (and still is) that he is describing. Nevertheless, this is a hugely important issue that everyone should know about.

Here are some quotes from the article:

If you took an Uber in Washington, D.C., a couple of years ago, there was a chance your driver was one of the greatest living Uyghur poets. Tahir Hamut Izgil arrived with his family in the United States in 2017, fleeing the Chinese government’s merciless persecution of his people. Tahir’s escape not only spared him near-certain internment in the camps that have swallowed more than 1 million Uyghurs; it also allowed him to share with the world his experience of the calamity engulfing his homeland.

And later on in the article:

Ostensibly, the purpose of these maneuvers was to maintain a state of readiness against violent terrorists; if anyone failed to cooperate or took part only passively, their name would be forwarded to the neighborhood police. In reality, it seemed that the aim of these activities was to keep us in a constant state of fear.

Regarding the confiscation of religious items:

The government in Kashgar had required all Uyghurs there to hand over any religious items they held. Frightened by the ongoing roundups, most had surrendered to the state any belongings relating to their faith: religious books, prayer rugs, prayer beads, articles of clothing. Some were unwilling to part with their Qurans, but with neighbors and even relatives betraying one another, those who kept them were quickly found out, detained, and harshly punished.

I understand that times are difficult for many peopleCOVID, economic recession, political upheavalbut I hope we will not lose sight of the suffering inflicted upon the Uyghurs.

Socially-Distanced Spider Webs

I took these pictures in early June as I was cycling to the hospital. Along the cycle path I noticed a series of dense spider webs but what struck me was how neatly spaced-out they were (see second picture). I’d love to know why, and more importantly, how they can estimate the distance between neighbouring webs.

Any araneologist lurking around in here might care to explain perhaps?

Lessons in communicating uncertainty & complexity

Over the last year or so, I have really enjoyed reading whatever article Ed Yong has written for The Atlantic. It’s not just the degree of care that he puts into writing his articles, it’s also the fact the he is very good at explaining complex problems in simple terms.

His latest article is entitled The 3 Simple Rules That Underscore the Danger of Delta. It boils down the interaction between vaccines and the virus into 3 simple rules as follows:

  1. The vaccines are still beating the variants
  2. The variants are pummelling unvaccinated people
  3. The longer Principle No. 2 continues, the less likely No. 1 will hold

More than these simple rules, however, is the way these ideas are put forth. I particularly like how he balances complexity vs clarity. Another writer who does this extremely well is Zeynep Tufekci. As someone in a similar position (but with a far smaller audience), I’m trying my best to learn how to communicate uncertainty & complexity from writers like Yong & Tufekci.

I hope The Atlantic will forgive me in quoting one paragraph from the article in its entirety. It describes our problems dealing with low-probability events that have far-reaching consequences.

The discussion about vaccine-beating variants echoes the early debates about whether SARS-CoV-2 would go pandemic. “We don’t think too well as a society about low-probability events that have far-reaching consequences,” Majumder told me. “We need to prepare for a future where we are doing vaccine rollout again, and we need to figure out how to do that better.” In the meantime, even highly vaccinated nations should continue investing in other measures that can control COVID-19 but have been inadequately used—improved ventilation, widespread rapid tests, smarter contact tracing, better masks, places in which sick people can isolate, and policies like paid sick leave. Such measures will also reduce the spread of the virus among unvaccinated communities, creating fewer opportunities for an immune-escape variant to arise. “I find myself the broken record who always emphasizes all the other tools we have,” van Kerkhove said. “It’s not vaccines only. We’re not using what we have at hand.”

It goes without saying, but we really need to do something about this.

Town & Gown 10k

A few weeks ago—in a moment of madness—I signed myself up for the Town & Gown 10k run here in Oxford.

I am not a runner. For the record, my normal definition of a jog/run is ‘ambling along taking pictures of interesting things’.

I also know that I will never run a marathon or even a half marathon, for the following reason: the numbers are wrong! Instead of running 40km for a marathon, and 20km for a half marathon, you have to run (approximately) 42km and 21km, respectively. Now, before you sharpen your pitchforks, I know there are historical reasons for it. They probably even make sense in some weird historical way. All I’m saying is, the numbers are inelegant, mmmkayyy?

Anyway, back to the run itself which took place last Sunday, the 27th of June 2021.

Due to restrictions imposed by the virus-that-shall-not-be-named, the runners were split into different groups, or waves, based on starting times. I was assigned to wave 1a by virtue of my excellent performance in previous runs expected finishing time of 2 hours.

At 8.30am on Sunday, I therefore made my way to the warmup area, past a speed limit sign that read 5mph. Well, no danger of me exceeding that, I thought!

The warmup itself was brief but fun. Apart from the usual stretching routine, the event host (who apparently is a Bollywood dance instructor) also led us on a Bhangra-inspired warmup routine:

After that, it was a short walk to the starting line. The runners were released in pulses of 10 people to avoid overcrowding. And so began my first 10k run…

The run itself was nice, taking us along closed roads past many beautiful buildings in Oxford. I ran the first 5km diligently, but then did my usual stuff of stopping to take pictures along the way. What can I say, old habits die hard.

Prior to this event, the longest run I’ve ever participated in was a 5km one, but I’ve done 7km runs before in my own capacity. So when I saw the sign below, the following words from Samwise Gamgee somehow crossed my mind:

If I take another step, it’ll be the farthest away from home I’ve ever been.

Samwise “Sam” Gamgee

Ignoring my tingling Hobbit senses, I shouldered on and eventually finished the run in 71 minutes, enough to earn me 1,876th place out of 2,045 people who actually finished the race.

(bows down for applause)

Below is a picture of me at the run:

Wait, sorry, that was from the week before. Dang it!

Here’s the correct picture:

Epilogue

Naturally, one might ask if I plan to take part in further runs. The answer is: probably not. Like I said, I’m not a runner, and my feet actually hurt like hell after the run. Having run through the Oxford city centre, I think it helps to have a really nice setting around you to take your mind off the actual pain of running. But it can’t beat the simple pleasure of jogging/walking in the park next to my house, taking pictures of wonderful things that catch my eye (like the snail above).

Thus endeth my first, and likely my last, 10km run.

Thank you for reading.

Balancing rights & responsibilities

My friend Dr Khor Swee Kheng convinced me to turn one of my previous blog posts into a proper newspaper column, so I did. Below is the article entitled ‘Balancing rights & responsibilities‘, first published in The Star on Wednesday, 23 June 2021:

Balancing rights & responsibilities

The rights and responsibilities of medical students appear straightforward and uncontroversial, but this issue recently surfaced after Universiti Malaya stopped a medical student from taking the second year exams because this student was unvaccinated.

Some reports indicate that this student had previously refused a Covid-19 vaccine for unclear reasons. Fortunately, this student is an extreme outlier and does not represent the vast majority of medical students and doctors.

The exact circumstances of this case do not matter for the purposes of our article, as we want to ask a much broader question with ethical and policy implications: Should a university be allowed to bar a medical student from taking an exam if he or she refuses the Covid-19 jab for no valid reason (such as a history of severe allergies)?

Indeed, this question raises a variety of subsequent questions, like “Should patients be allowed to decline a doctor if the doctor is unvaccinated?” or “Should the Malaysian Medical Council deregister a doctor who is clearly anti-vaccination?”

Let’s answer the original (and simpler) question, as a basis for answering the subsequent (and more complex) questions.

We both agree that Faculties of Medicine in any university can, should and must bar a medical student from exams if they refuse the Covid-19 vaccine.

Highly respected fraternity

There are several reasons why we hold medical students (and doctors) to a higher standard compared to other professions.

One, society is sensitive to a doctor’s influence (for both right and wrong reasons), and this influence must be used in positive and responsible ways.

Two, doctors are frequently the leading proponents of science, evidence and rationality, and they must maintain their leadership in the face of anti-science and anti-truth movements around the world.

Three, medicine is a profession with strict ethical codes and professional standards, and doctors must uphold these codes and standards.

Today’s medical students are tomorrow’s doctors, so they too, must also be held to these higher standards.

To be absolutely clear, we believe that it is equally important to inform and educate people into getting vaccinated, rather than coerce them.

Education, knowledge and information are not mutually exclusive from our hard stance on exam bans for medical students who refuse vaccinations.

We are also firm believers in the benefits of vaccination and call on everyone to register for vaccinations as early as possible.

We are not saying that doctors are the most important members of society – indeed, nurses, pharmacists, paramedics, allied health professionals, technicians and hospital cleaners are arguably more important than doctors, even in a small hospital.

However, for reasons both good and bad, doctors are seen in a different light and therefore have greater responsibilities to society.

Attitude matters

Being a good doctor is not just about securing good grades.

A doctor’s attitude (towards knowledge, his profession and with other people) is far more important than merely good grades.

For example, let’s imagine a doctor who doesn’t believe in the importance of hand hygiene and handwashing.

That disbelief could be a deeply held personal conviction, but is contradictory to science, evidence and professional standards.

Handwashing can be substituted with vaccines or safe childbirth practices, as examples where a doctor’s personal beliefs must be consistent with prevailing science, evidence and professional standards.

In other words, the doctor’s right to personal beliefs must be balanced with his responsibility to follow the science, evidence and professional standards.

A second example is the doctor who refuses to attend to a medical emergency because it will disrupt his sleep.

It may seem preposterous, but this doctor argues that his right to rest overcomes his responsibility to save a life.

Society does not accept this, and indeed the doctor can be sued for criminal negligence.

In other words, the doctor’s right to rest must be balanced with his responsibility to save lives.

The bigger question is, where does the right of a medical student (or a doctor) stop and his responsibilities begin?

Aren’t we impinging on that person’s right to become a doctor simply because his or her beliefs aren’t aligned with those of modern medicine?

Well, society “impinges” on an individual’s professional rights all the time, because professional rights are never absolute and the public interest is more important than personal interest.

For example, anyone can say they want to be a lawyer, accountant, car mechanic, taxi driver or hawker, but societies have agreed that governments can enforce licences, laws, regulations and standards to ensure that society is protected from any incompetence or malice.

In the case of medical students, their right and privilege to practise medicine clearly must be balanced with their responsibilities to look after their patients.

Protection for all

During the Covid-19 pandemic, it is reasonable to expect that healthcare professionals looking after the most vulnerable members of society should be vaccinated.

Vaccines protect them and their patients.

Medical students should also be vaccinated as their clinical training involves direct interactions with patients.

Indeed, some have advocated for medical students to be considered frontliners and to receive the first vaccines.

But what if a doctor refuses to be vaccinated?

It is important to start by understanding the reason(s) for his refusal, and to manage all the reasonable reasons.

But after that, compassion and understanding must have limits, especially when public interest is at stake.

If push comes to shove, Malaysia should consider making it mandatory for all healthcare professionals (HCPs) to be vaccinated to continue delivering clinical services (unless there are valid reasons not to be vaccinated).

This will protect the HCPs, provide psychological comfort that their colleagues are all similarly vaccinated, protect their patients, and perhaps acts as a litmus test to identify HCPs that have unusual beliefs.

However, this is controversial and may have unintended consequences.

Therefore, it is a nuclear option to be deployed only as an extreme last resort.

Nonetheless, it should remain a viable policy option.

To return to the original question concerning rights and responsibilities of medical students (and doctors), we can conclude by saying that any nobleness in being a doctor comes from the emphasis on our public responsibilities over our personal rights.

People who choose to become doctors must perhaps make more than the usual personal sacrifices to help their patients heal.

In the case of medical students who refuse vaccinations for non-valid reasons, they might be better off looking for a new profession.