pulmonary embolism: when less is more

got this link up from literature of note.

This is where Dr. Newman and Dr. Schriger, outstanding clinicians and analysts of data, present a compelling case regarding the diagnosis and treatment of pulmonary embolism. The paper in pdf. In brief, the authors try to estimate, based on the limited evidence, both the benefits and harm of diagnosis and treatment of pulmonary embolism. In their review, very few patients were found to benefit from treatment of pulmonary embolism - the existing evidence is weakly supportive of anticoagulation. Additionally, they show a great many patients were harmed by excessive testing and treatment of clinically unimportant pulmonary embolisms.

This is, while a complicated opinion piece, a lovely summation in a nutshell of the concept that finding more "disease" does not equal better outcomes. And, depending on the risks of testing and treatment - the barbaric contrast, radiation, and rat poison that diagnosis of PE typically entails - more people would be alive today if we all stopped testing for pulmonary embolism.

Probably time for us to stand back see things fall into place rather than go all out and create further mayhem.


There's a saying that goes - Please give me the strength to change the things that I can change, the serenity to accept the things that I can't change, and the wisdom to differentiate them.

Likewise, hopefully, we can treat those pulmonary embolism that really requires aggressive management, be expectant in pulmonary embolism to prevent harm in treating, and finally the wisdom to choose the safer path.

Probably Well's criteria is the closest to wisdom we can have, but still, it is not the holy grail to go by absolutely. At least, not yet.

diabetes is a word, not a sentence!

after so much of soul-searching, i finally decided that i will continue this blog, but keep my other (much pissed, and more hateful) rantings separately, away from the public views, mainly because of the obvious reason.

here's a something new that probably everyone should update, but not completely take it down their throat as a whole.

diabetes is no longer a non-curable disease.

that's right. diabetes is a word, no more a life sentence.

traditionally, diet has no role in primary treatment of diabetes, unless it is gestational diabetes - the type of diabetes that comes when a lady get pregnant. it was hypothesized that the diabetic climate sets in because of the rising pregnancy-related diabetogenic hormone, mainly the human placental lactogen, which peak and plateau after 20weeks, meaning a negative testing before that will required a further reconfirmation testing around that time. Some people advocate the skipping of early testing and go on to test later on but then, the in-utero insults may have started already. And so, instead of sitting on the fence listening to both sides of medical geniuses, we follow protocol set by the people from the highest hierarchy.

Although all the proper medical thoughts blamed human placental lactogen for the rising sweetness in the blood, I firmly believe without any two-tailed, prospective, randomized trials that it is the irresistible malaysian food and the maternal cravings during pregnancy that could have been more contributory.

anyway, diet control has always been the primary line of treatment for gestational diabetes (GDM), with an obligate referral to the dietitians, and regular capillary blood glucose monitoring and control till delivery.

and recently, the gateway of definitive treatment for type 2 diabetes had opened.
nevertheless, to walk through it isn't an easy thing to do, unless one can be as persistent (or more) as my dearest in losing weight.

weight loss by extreme dieting (talking mere 600calories perday for 8weeks) or after bariatric surgery may reverse type 2 diabetes. though, the risks of it re-reverse has not been duly explained.

there are lots of good choices of food under 600calories, but you gotta divide it to 3 meals and sustain it for 8 weeks. that's not just tough, its inhumanely tough.

therefore to go such extreme dieting, medical supervision is more than mandatory.

one may actually drop dead before all the appalling diabetic complications set in.

11 people had done it, none drop dead, but only 7 got their diabetes reversed.

i couldn't imagine how depressed the other 4 were, being fruitless after going through thick and thin. mainly thin (diet).

no matter how this new piece of revolutionary finding may be, the cornerstone of reducing diabetes is in its prevention.

this maybe just another golden bullet passing through, that creating ripples but not waves.

for the full article here and here.

P.S. this entry is to commemorate the few C-sections done lately for big, really big mothers. One of them being 12okg. hats off to their respective husband, too. respect!

down and out

last breath of this blog...

dear frens, i'm ditching this blog to start another anonymous blog,
for i believe that revolution at its best can't do without some good amount of secrecy.

drop me your email and identity if you wish to follow the trail of the rebirth of this blog.

one baby step forward

a memorable gastritic attack

when work and busy schedule being prioritized, often health has to take the backseat.

with background of flu and sinusitis, i went to work today, knowing clinic load will be heavier today not because of the number of patients, but rather it was purely because of three main reasons. Firstly, the main sonographer nurse was on leave still. Next, the pathological lacking of aptitude and attitude in junior medical officers in handling and learning up management of gynaecological problems. Lastly, the uncontrolled appalling receding participation of many level of staffs (although, not all) in our department to make sure clinic finishes.

Sad, but true. The clinic ended at 220pm, through the lunch hour, without any breaks. Had junior doctors following me, like ducklings following motherduck. Had them lining up outside the door like i was running a circus or something. Had to re-re-reconfirm the review and findings of junior doctors. Nurses bugged me to perform procedures and ultrasound.

As I got in to my car, the sharp pain struck me right on the epigastric area - a vague sense of displeasure that I had felt before.

when work and busy schedule being prioritized, often health has to take the backseat.

although my primo supremo granted me rest, but it was something that came too little too late. It was something that is preventable at all level and the unrelenting effort to face this problem had my respect totally out the window.

the peeping: piracy of privacy

A strange dream that I had, that just felt so real. So blardy real.

Ward round with specialist.

Every patients going for examination were screened up for privacy, yet others continued in their own rest or breastfeeding fully trusting the fellow esteemed manager of the ward to maintain their privacy at the non-visiting hour.

Yet, it was far, almost a galaxy away from the real privacy.

The prying eyes of a man was on the hunt, standing elegantly clothed in the yellow uniform of our hospital non-medical staff.

His dark hand was held up tightly a packet of food and drink, a sorrow excuse for his pathetic lustful intention.

His reasoning of wanting to wait for his sister-in-law to pass her the food was absolutely absurd, as he was standing at the side of the ward, where his sister-in-law was totally AT THE OTHER SIDE of the ward - a different cubicle.

Such a violation was noted and instantly, the Ward Sister and the security guard vented their helplessness in keeping this peep artist out.

It was almost like against this felon, the Ward Sister's and guard's jurisdiction was reduced to sweeping the drain on an overflow monsoon season.

I confronted that animal, which stood there, like a catatonic schizo.

His busy prying eyes was still searching and consuming pleasurable sights while ignoring my simple words for him.

"Encik, jika nak bagi, tolong letak dan tunggu di luar."

It was few minutes until he realized I was talking to his arrogance.

"Never mind. I wait here"

"No, this is a female ward, and we're doing rounds, you need to wait outside."

"Who are you?!?! You must be new here. I know a lot of doctors here. You shut up."

"WHAT?!?!"

As I recollected emotion from being shocked, surprised and totally lost for words, he left the ward.

Instead of being ashamed for their failure to keep this peepster out, the Ward Sister and the security guard rejoiced, telling the string of many,many previous episodes of this piracy of privacy.

Weirdest dream I ever had.

grace and disgrace

If a person, by grace, was given a chance to be a healer, he or she should, by grace, do the rightful thing. Or at least, know what they are doing.

Apathy among my fellow men can not surpass the apathy of my fellow healers.

To had held on one hand the water of power which is unknown and pass it into the body of the weaker innocent other person, by grace, it's a disgrace in its own totality.

If the end result is death, the court's verdict will be no lesser than manslaughter.

Long time ago, in a far far away land, there was this healer who follow blindly the order of her fellow men to dilute a reagent prior to operation. Not knowing what the reagent was for, she had syringed up some anaesthetic fluids, labelling it as the antibiotics. It took a few milliseconds before the sedative wonders came into light, with the patient knocked out cold like most opponents of the great boxer Mohammed Ali, followed by the emergency airway support with the indwelling tube. As much as it seemed like a joke to any healers who heard it first hand, it was an unnecessary risk trip that the patient can do without.

Forward to the present, another healer who couldn't care less, by grace, held in his hand the agent to avoid the anticipated complications in the future progeny of the patient. Though, he was given the privilege to heal, his lack of basic knowledge in its own unique totality assaulted the normal hemostatic balance of a defenseless innocent newborn by a simple sting on the thigh. What was meant for the mother was instead....

A moment of silence.

If a person, by grace, was given a chance to be a healer, he or she should, by grace, do the rightful thing. Or at least, know what they are doing.

Apathy among my fellow men can not surpass the apathy of my fellow healers.

Is there really no stopping the rampaging apathetics?

Let's us say our grace, for now.

teething

pretty happy when my princess started to vocalize mama and papa.

plus she is currently teething

got me thinkin'

Just came back from the first day of the OGSM Congress with the awesome Prof's Kula preCongress workshop in the morning till evening followed by the night time welcoming talk and reception. Had throbbing headache shortly after the workshop, but luckily, recovered after an hour of rapid-eye-movements supine on the couch of CH's sponsored room. Too bad PT's not around.

This is my 2nd OGSM, with my virgin OGSM being 2 years ago. If I remembered it correctly, there was more fanfare previously, but still, it was nice to meet up with my friends and colleagues within the fraternity who came from all over the country.

Just as the congress decided to call it a day, managed to sit down with a friend to my colleague. Found out more about the current climate of working in Ireland - the workload, the quality of life, work, opportunity and all. Basically, the shades of grass aren't that greener, just it's different. Somehow, the fact that being in the system is usually required to beat the system, still hold water.

I have always eyed Down Under (no pun intended). But at this stage, as my children growing up rapidly (Yes! Genevieve finally could say 'papa'), and I am not getting any younger, I really wonder whether I should make a bold life-changing decision, at this point of time.

I wonder whether I am ready to take the plunge for all its worth.

Timely as it seems, I got to read about The Migrant's Eye, an essay by Shaun Tan, made it to the finals in the World Bank 2011 Essay Competition ( http://www.essaycompetition.org/ ).

And I simply love the few lines below:

"It allows us to take more risks and dare greater things. The open door presented by migration therefore simultaneously hinders and helps the process of change in Malaysia."

The essay in full:

THE MIGRANT'S EYE

"Our young people represent the future of our country." This phrase has been echoed by almost every politician in almost every country in modern history. However the changes instigated by the increasing ease of migration are such that not even this time-honoured cliché holds the weight it once did. Young people still represent the future, but it is the future of whichever country they decide to settle in or impact, which may or may not be their country of origin. As with most changes, there are new benefits and drawbacks, and new winners and losers. Among the most pressing questions countries now face are how to prevent their young people from migrating, and how far they should go in providing for the migrants residing within their borders.

Exodus

Smart Indians go to med school,

Smart Chinese go to investment banks,

Smart Malaysians go to Singapore.

— Anonymous

My first brush with migration was in 2002. My father came home one day in a state of great excitement. My father is an excitable guy. He is also an alumnus of a university in New Zealand, and he had just learned that, because of this, our family was entitled to permanent residency (PR) status in New Zealand upon fulfilment of a few (relatively minor) requirements. One of the requirements was that we reside in New Zealand for at least three months over the next two years. We discussed it and decided it might be fun. We packed for summer.

Within a few weeks I was bored. New Zealand was charming enough in its own way, but it didn't have the vibrancy of my home city of Kuala Lumpur, and I couldn't imagine us choosing to live in this land of sheep and five o'clock closing times instead. And yet I understood why my father pushed for PR status so eagerly. He remembered the Indonesian racial riots of 1998, and he kept the pulse of rising extremism in Malaysia. If violence ever broke out in Malaysia my family would have a back door, a way out.

Later on I saw that most of my Malaysian friends who could afford it went abroad for at least part of their education. Some went to boarding schools in Singapore, Australia, and the UK. When it came to university, almost all my Malaysian friends went to Australia, the UK or the US. The reasons they (and their parents) gave for wanting a foreign education were the same: the racial quotas in Malaysian universities, the skewed syllabi, the controls on free expression, the low standard of the Malaysian education system (apart from a few private university colleges), and the relative quality and prestige of foreign schools and universities.

At university this trend continues. Many of my Malaysian friends plan to remain overseas after graduation, or to work in Singapore. "Everything in Malaysia is on such a small scale," one of them said, "it can't compare with the training you get overseas." Some of them hope to return to Malaysia later, but only in the distant future, after earning enough money and establishing themselves in their industries. I know the power of inertia, and every year that goes by makes it less and less likely that they will return.

Asian societies have very tight family bonds. Most of my friends have parents who miss them very much, and who dislike them living far away. However, far from meeting with parental opposition, these plans have full approval: the message my Malaysian friends get from their parents and relatives is: "Don't come home."


No Brain, No Gain

Malaysia faces a brain drain crisis. Recent decades have seen the migration of many ethnic Chinese (comprising 26 per cent of Malaysia's population) [1] and Indians (8 per cent) [2], as well as considerable numbers of Malays, the majority ethnic group (53 per cent) [3]. Shamsuddin Bardan, executive director of the Malaysian Employers Federation, reported that there are 785,000 Malaysians working overseas. [4] Unofficially, the figure is thought to be over a million. [5] According to the World Bank, the number of Malaysian emigrants has increased almost a hundred-fold in the past 50 years, from 9,576 in 1960, to almost 1.5 million in 2005. [6] A parliamentary report revealed that 140,000 Malaysians emigrated in 2007. [7] According to Deputy Foreign Minister Kohilan Pillay, the figure between 2008 and 2009 was 304,000. [8] As of 2007, 106,000 Malaysians had renounced their citizenship. [9]

Many of these Malaysians go to Australia, the UK, and the US. [10] About half of them go to Singapore, [11] which has a GDP per capita almost four times larger than Malaysia's [12]. The portion of the Malaysians who return is minimal (Prime Minister Najib Razak reported the figure to be less than 1 per cent) [13] prompting former Prime Minister Mahathir Mohamad to suggest that other countries should pay Malaysia for having seduced them to stay "since by right, the graduates' training and knowledge should be called intellectual property." [14]. Prominent writer Mariam Mokhtar outlines the reasons given by emigrants: "improved employment and business prospects, higher salaries, better working environments, greater chances of promotion and a relatively superior quality of life." [15]

This has severely retarded Malaysia's development. Malaysia continues to be the poor cousin of the Asian Tigers — Hong Kong, Singapore, South Korea, and Taiwan. Malaysia's growth rate dropped from 9 per cent a year, from 1991 to 1997, to 5.5 per cent a year, from 2000 to 2008. [16] Stewart Forbes, the executive director of the Malaysian International Chamber of Commerce and Industry, explained that many of Malaysia's lost investment opportunities stem from the brain drain — because international companies had trouble finding skilled employees in Malaysia. [17] "People have left, growth prospects have dimmed, and then more people continue to leave," [18] said Danny Quah, an economics professor at the London School of Economics and Political Science, and Council Member on Malaysia's National Economic Advisory Council. "It's a vicious cycle that the economy has had to confront for the last decade or longer." [19] The increasing ease of migration has produced new winners — countries like Singapore, Australia, the UK and the US, who get to cherry-pick from a global talent pool. It has also produced new losers. Malaysia is certainly one of them.

The Malaysian Dilemma

As there are new winners and losers from migration, so too are there new benefits and drawbacks. A classroom discussion threw this debate into stark relief.

It was last year. The date was the September 27, the country was America, and I was in my International Relations class. We were discussing globalisation, and having gone through some of its benefits, we moved on to its drawbacks.

"Well," said one of my classmates, "one drawback is that it increases the brain drain effect and leads to greater inequality between countries. Developing countries lose a lot of the talent that they badly need." This received a general nodding of assent.

I raised my hand. "Actually," I asked, "is greater inequality necessarily a bad thing?"

My class, accustomed by now to my mannerisms, still looked at me strangely.

"I mean, it's true that many developing countries end up losing their talent, but really, some of these countries bloody well deserve to lose them."

This created a small firestorm. From my classmates' reactions you'd have thought I'd asked what was wrong with genocide. There were gasps. Before I could finish, a forest of hands shot up to respond. One of my classmates burst out angrily; "Now you're just being facetious!"

My professor moved to restore order. He was a kindly old man who usually let our discussions run their course. He did however step in whenever our discussions threatened to turn into a pseudo-intellectual brawl.

He turned to me. "I assume you said that to be deliberately provocative," he said gently; a teacher reasoning with a difficult student.

"No," I said, "not at all."

I looked at the rest of my class who now whispered amongst themselves and eyed me warily, apparently taken aback to see their (I hope) usually charming and amiable classmate say such callous things.

But to me my statement seemed as normal as breathing. And said to any reasonably informed Malaysians, it wouldn't even have raised an eyebrow. I realised then that there were perspectives on this issue that are unique to Malaysians, and to those who have experienced similar circumstances.



Push and Pull

I've left a few unanswered questions over the course of this essay. Like why do loving parents tell their children not to come home? And why do many Malaysians think Malaysia deserves to lose its talented young people? Now at last is the time to answer them.

Malaysia has a lot going for it. It has much untapped potential. It is devoid of natural disasters and rich in natural resources. It is a country with warm weather, amazing food and hot women. Its people are generally warm, friendly, and (with certain exceptions like yours truly) humble. Pull-factors like these would require considerable push-factors to trigger mass emigration.

But there's a darker side. A side behind the strained tranquillity and Malaysia Truly Asia adverts. Since its independence in 1957, Malaysia has been run by the Barisan National (BN) party, and its regime is an autocracy that institutionalises racism. Non-Malays, including the ethnic Chinese and Indian minorities, are discriminated against in favour of the majority Malays, whose support BN depends on. Malaysian laws make non-Malays pay higher prices for certain goods and services, allocate them only a small percentage of places in public universities, and impose significant barriers against their advancement in the military, police force, civil service, and in government-owned companies. The BN government persecutes minority religions, and major Malay politicians often refer to Chinese and Indian Malaysians as pendatang (immigrants), of inferior status, while the current Prime Minister Najib Razak is alleged to have threatened to "bathe a keris dagger with Chinese blood".

The BN government is also very protectionist, making it even more difficult for international companies to set up business there, for example, international law firms can only operate in Malaysia by acting in partnership with a local firm. Furthermore, the BN government is both grossly incompetent and highly corrupt. Billions of dollars in public funds are squandered on cronyism [20] and ill-conceived mega-projects [21], instead of being properly used to develop the country. The judiciary is largely comprised of underqualified yes-men, the police force is unreliable, and the public schools and universities are of low standard, such that even Malaysia's top university, University Malaya, has dropped out of the top 200 universities in the world on all major rankings. [22]

This is why loving parents tell their children not to come home. They don't want their children to live as second-class citizens in Malaysia, where their ambitions will be limited by institutional inefficiency, where they will be passed over for promotion in favour of others, not for any lack of skill, but for the colour of their skin. "Money does have a significant role but the most important factor… is opportunity," outlined Wan Saiful Wan Jan, founding chief executive member of the Institute for Democracy and Economic Affairs. "Malaysia is too politicised and opportunities are not evenly available to everyone." [23]

This is why Malaysians flock to Singapore, not because Singapore's government is less despotic (it is even more so), but because the Singaporean government at least prizes efficiency, and recognises merit regardless of race. When a Malaysian renounces his citizenship, he doesn't see it as an unpatriotic betrayal, he sees it as washing his hands off a regime that has marginalised and persecuted him. As one Malaysian, Wan Jon Yew, explained: "I'm not proud of being a Malaysian because I think the government doesn't treat me as a Malaysian." [24] Migration is beneficial because it increases efficiency; it allows young Malaysians to move to take their best offers, to move to where their ability is truly valued. A mind is a terrible thing to waste, and migration helps to reduce this wastage.

Not all Malaysians mass-emigrating are Chinese and Indians. Many Malays are emigrating too. Although they do not face racial persecution, many of their reasons for doing so are the same as those of non-Malays: the corrupt and inefficient system, the lack of security and religious freedom, the quashing of free expression, human rights abuses. Furthermore, Malays face a different form of religious persecution — forced piety by the overzealous Islamic moral police. Non-Muslim Malays and Malay homosexuals are jailed or sent to "re-education centres" [25], and earlier this year 80 Malays were arrested for celebrating Valentine's Day [26]. In light of this, Malaysia deserves to lose the talents of its young people. It doesn't appreciate these talents; it punishes its best citizens — those brave enough to stand up for themselves, or those too principled to fake devotion to a religion they don't believe in — and instead it rewards its worst elements — the religious extremist, the racist, the snivelling sycophant. In a sense, we as Malaysian citizens deserve to lose the benefits those talents would have brought, because through our participation or collective inaction we allow this wretched state of affairs to continue. Migration is beneficial because it allows Malaysians to leave, and to live in a country that accords them the dignity commensurate with their status as a human being.



The Open Door

The ability to migrate presents young Malaysians with an open door to the rest of the world. This is not without its drawbacks. Many of the Malaysian émigrés leave not because they are weak or cowardly, but because they are ambitious, or because they are uncompromising — they refused to take orders from those who are their inferiors, or to remain party to a system that is morally indefensible. One cannot help but imagine how much good such spirit could have done if they had no choice but to remain in Malaysia. Not necessarily by engaging in overtly political activities, but by simple apolitical acts — by living their lives in their own way, free from compromise, and refusing to curb their ambitions. As Vaclav Havel explained in his book "The Power of the Powerless", such simple acts are often the most potent weapons against oppressive regimes. Thus, migration has its drawbacks — it makes it harder for Malaysia to achieve real change because it takes away some of its most spirited people.

However there are also many young Malaysians who choose to return, and who seek to bring real change to the country. People like Nathaniel Tan — a Harvard graduate, who writes books exposing the abuses of the BN regime, even if his efforts meet with harassment and detention. Or Alea Nasihin — a friend of mine, and a student at Nottingham University, who resolves to return to work as a human rights lawyer. [27] Or myself. For us the open door is comforting. It gives us the courage to say or do things we might otherwise be wary of. Because it reminds us that there are limits to what an oppressive government can do. Because we know that even if our efforts harm our careers in Malaysia, even if the BN government hounds us and bars us from getting a job at any major company in Malaysia, there will always be many other places eager for our talents. It allows us to take more risks and dare greater things. The open door presented by migration therefore simultaneously hinders and helps the process of change in Malaysia.

Point of Origin

From a Malaysian perspective, good measures for broadening opportunities for young migrants in their countries of origin are relatively straightforward. The most obvious one is to increase meritocracy, to distinguish merit instead of race, religion, gender, or sexual orientation. When each citizen is judged solely on the basis of his ability, when high standards are promoted, when the most innovative people are rewarded and encouraged, the whole country progresses and develops, creating greater opportunities for all. Nepotism and cronyism should be prohibited in all industries, so that positions and promotions go to the most able candidates. This policy should be pursued in conjunction with scholarships and financial aid for poor youths to attend schools and universities, again awarded on the basis of merit.

The other obvious measure is to liberalise. A liberal society that respects human rights provides the broadest opportunities for free expression and the free practice of religion simply because fewer things are prohibited. Laws should be enacted against the interference with an individual's expression or religious practice, unless he harms or grossly misrepresents another person in doing so. The judiciary should be allowed to become strong and independent, so that everyone has the opportunity for a fair trial.

Meanwhile, opportunities should be given to migrants who consider returning to their country of origin. Those living overseas, but with vital skills in various fields should be invited back and offered senior positions, with PR status or citizenship offered to their families.

A fair, liberal government that rewards merit provides the broadest opportunities for its people. Measures like the Malaysian government's Returning Export and Brain Gain Malaysia programmes fail to attract young people because they make only cosmetic changes, refusing to give effect to the principles of fairness, liberalism, and meritocracy, that are the essence of true improvement of opportunity.

Destination

Good measures for broadening opportunities for young migrants in their countries of destination are relatively straightforward too. They largely consist of refraining from the policies these migrants were fleeing from in the first place. Other than some free basic language-training programmes, no special privileges should be given to these immigrants, and no affirmative action policies should be implemented. Instead, these immigrants should be allowed to compete for (generally) the same opportunities as everyone else, judged on the basis of their merit, rather than race, religion, gender, or sexual orientation. They should be given equal opportunity to exercise their civil rights, like the rights to free speech, association, and religious practice. Their right to marry should be recognised regardless of sexual orientation, and the continued ban on gay marriage is an instance where the US has fallen short of this standard.

However governments should be conscious of where granting formal rights in fact restricts opportunities. In "Beyond Liberal Democracy", Daniel Bell contrasted Western and East Asian approaches to dealing with migrant workers. He described how migrant workers in East Asia are denied citizenship (and thus full legal protection) no matter how long they stay, while those in Western countries are able to obtain it much more easily. The result of this is that East Asian countries are able to officially admit many more temporary contract workers. Comparatively, Western countries can officially admit few migrant workers, although many more work there illegally, without any legal protections at all. "In the West," Bell explained, "the liberal political culture places higher priority on the justice of legal forms… In East Asia, by contrast, the authorities prefer to enact… laws that allow for large numbers of migrant domestic workers to engage temporarily in legally protected work in their territories." [28] Governments therefore should not dogmatically pursue form over substance, but should be pragmatic in their measures to achieve the best results for immigrants.

Ich bin ein Inmigrante

"Once I thought to write a history of the immigrants in America. Then I discovered that immigrants were America."

— Oscar Handlin

America is not without shortcomings in providing for its immigrants. True equality of opportunity can only be achieved with the shattering of glass ceilings, and there are numerous social barriers that still need to be overcome. To this date, the highest office in the country, that of the President of the United States, can only be held by someone born on American soil. And yet America remains the land of opportunity for so many people. The immigrants in America are integrated far better than those in Europe, because Americans are conscious of the fact that they were all immigrants once. And America has benefited greatly from this. It gets physics from Einstein, political theory from Arendt, movies from Ang Lee, eye-candy from Maggie Q, and literature from Junot Diaz. The fact that Irish-Catholic immigrants like the Kennedys could become America's most prominent family, that an Austrian immigrant like Arnold Schwarzenegger could become Governor of California, and that a black man born in Hawaii and raised in Indonesia could become President, is a testament to this tradition.

I am the product of migration. It was through migration that my ancestors from Fujian province in China came to live in Malaysia. It is through migration that I have been able to grow up in Malaysia and study in Britain and America, and it is through migration that I have had the privilege of learning from people from all over the world. My accent is a bastard mix of British, American and Malaysian. My upbringing was a schizophrenic blend of liberalism and Asian Tiger Mom-style parenting. I revel in living in a mixed-up world and having a mixed-up self. [29] I have tried to live consistently with the principles advocated in this essay. Where in my life I have failed I have accepted it and tried to learn from my mistakes. Where I have succeeded, I have taken pride in the knowledge of having done so myself, not needing any legal crutch to prop me up. The only right I have demanded is the right to a fair contest. I think that the right to fair competition is the only thing we can and should expect.

疑人不用, 用人不疑

Sometimes I really don't understand why I do thing that I do.

Exactly how I felt today, except with more hair. scalp hair, that is.

never pull a 'balisan' on anyone

i am glad i was able to make it to this month in one piece.

the end of may was an excruciatingly painful time to be and this will go down in the my personal diary of tolerance that although in the small time frame of milliseconds, I was over the roof, frustrated, annoyed, superduper agitated and (fill in vulgarities here) and the next milliseconds, I dropped my moha to the bare minimum, because I had lose respect.

Somehow I felt like any other Malaysians currently living in this land we called tanahair. But somehow we just couldn't really take the flip flop double standards set by the Balisan. They may be all capable and well-structured mainly due to their experience and whatever powerful accumulative skills that they had in the previous years, but the contradictory propaganda of 1Malaysia together with Tanah Melayu really baffled people. There was too much of flip-flop policies going around. You don't have to look into the secret files to know that. In the early years, everyone was over the roof, frustrated, annoyed, superduper agitated and (fill in vulgarities here), and some still were, but the most of us, we're just plainly lose respect in Balisan.

I would like to coin the word 'Balisan' because of their hyper-flexibility and supremacy in flip-flop policies. Some actually had a blog on the flip-floppiness of things.

Someone pulled a 'Balisan' on me at the eleventh hour.
Not one, but a few can attest to it.

Eventually, the 'Balisan' episodes will drown out the towering respect.

Another angle of seeing is probably it's part of the greater plan for me to cooked up the skill of being patient and embrace flip-flops, because afterall, that's probably what flip-flops are for, right?

Not this kind of flip flop...