Dental Care, HOTA, Infection Control and Cloning

10 Feb 2009

By Mr Khaw Boon Wan

Affordable Dental Care

1. Yesterday Mr Chiam See Tong spoke on dental care. He quoted a few examples, from his point of view, very expensive dental care treatment i.e. root canal treatment costing $6500, and crowning costing about $2000 in Singapore. The figures sounded were very high. I had checked. At National Dental Centre, root canal treatment typically ranges from $300 to $800, while crowning ranges from $600 to $800. In any case, Mr Chiam’s proposal is for MOH to subsidise dental care. In fact we do, basic dental services like filling and cleaning etc, is available at polyclinics, and charges typically range from a few dollars to $25, depending on conditions, and for the elderly, it is heavily subsidised. For specialist care, we provide subsidised services at the National Dental Centre, where patients typically get 50% subsidy. 

HOTA for Muslims

2.  Mdm Halimah and Mr Zainudin asked about the Human Organ and Transplant Act (HOTA). Currently there are more than 100 Muslim patients on the waiting list for kidneys. We achieved a major milestone when the Muslim community joined HOTA last August. It is truly life saving and the numbers speak for themselves. In 2007, before HOTA extension, the number of Muslim patients receiving a transplant was 19.  Last year, despite only 5 months of HOTA, the number has already doubled to 38.  I expect a record number this year.

3. Similarly, in terms of the percentage of all patients receiving transplants, the Muslim recipients have increased their proportion from 11% in the past, to 19% last year. 

4. Whilst some Muslims have opted-out of HOTA and we respect their decision, the vast majority of Muslims, like non-Muslim Singaporeans have stayed within in HOTA and they support organ donation.  So far, over five months, 4 Muslim cadaveric donors have saved the lives of 15 organ recipients.

5. Our hospitals are very sensitive to the need of relatives to take the bodies of their loved ones as soon as possible for religious rites. Our organ donation teams work through the night to ensure that the donation process is completed within hours, certainly well within 24 hours. Adequate washing facilities in hospitals and a second sitting for Coroner’s cases are now available to reduce any possible delays. And we have prepared our hospitals staff quite thoroughly to cope with the HOTA extension to Muslims. There are always Malay speakers around and the staff has been briefed by MUIS on the religious cultural sensitivity of the Muslims. In my view, implementation has been quite smooth, and we will further improve over time. 

6. I am particularly grateful to the support rendered by Muslim religious leaders. Upon request, they have readily gone to the hospitals, even in the middle of the night, to support the family through the grieving process and also to clarify any religious doubts regarding organ donation. Their excellent work complements the work of our medical staff and social workers. As noted by SPS, the number of Muslim patients struck with kidney failure continues to rise, so the key is still prevention and not HOTA. This means changing lifestyle for those on the wrong side of healthcare divide.   

Hospital Disinfection Measures

7. Mr Low Thia Khiang asked if there has been an unusual increase in the number of patients who died of pneumonia in TTSH. Data from TTSH indicates that apart from seasonal variations, there has been no unusual trend in the number of such deaths. TTSH recorded about 600 pneumonia deaths every year. Nation wide, pneumonia is our third killer, just like many countries. National data hovered around 2,300 every year, and has been so for many years. The reason for it being a major killer is that it is outcome of conditions with many different causes. Typically patients with stroke, with cancer, with COPD, or are bedridden for a long time can somehow die of pneumonia. Some pneumonia is caused by viral infection like SARS.

8. SARS has taught us to be constantly vigilant.  Hospitals are required to put in place surveillance systems to monitor (a) inpatients with atypical pneumonia, (b) inpatients with unexplained fever > 72 hours and relevant travel history, (c) sudden, unexplained death cases with acute respiratory symptoms.

9. All hospitals are required to adopt strict infection control protocols: staff are required to clean their hands regularly and correctly, infectious patients are isolated with regular environmental disinfection. The hospital infection-control teams carry out regular audits to make sure that SOPs have been followed. I visit hospitals quite regularly, and I find that the procedures are in place. I accept that globally hospital-acquire infections is one of the complications, and can happen even in the best of hospitals. Hospital staff  have to put in the efforts and we need the cooperation of patients and their visitors too. What is important is to constantly remind ourselves and try to bring down the rate to as low as we can. To try and eliminate it to zero, no other hospital has done it and I doubt we can reach that stage.

Human Cloning

10. Mr Christopher de Souza asked about human cloning.  Our stand on human cloning is clear – we ban it and it is illegal.

11. But I agree with Mr de Souza that the science on stem cell research is evolving and our law must try to keep pace.  We do monitor developments globally and we are further advised by an excellent Bioethics Advisory Committee (BAC), comprising some of the top names in the world. They scan global developments, consult the public and scientific community, and periodically make recommendations to the Government.  We then review our law to see if we should amend it to allow us to implement their recommendations.

12. One of the issues currently being reviewed by the BAC is human-animal combinations for research. A public consultation was conducted by the BAC last year I await their recommendations and in due course, if we need to change the laws. We will do so.