1. In healthcare, as in life, change is part of the natural order of things. It is necessary for progress. Incremental change, in particular, is desirable, as long as it produces better outcomes without exceeding the coping capacity of existing systems. Nevertheless, a “gently does it” approach rarely brings about transformative change. Disruption, on the other hand, often does produce radical changes. While these are sometimes planned, more often than not they are unanticipated. Rapid adaptation may be required, and far-reaching and unintended consequences are possible.
  2. With this in mind, I’m sure you will not be surprised that the theme of this Congress, “Disruptive Forces – Reimagining Our Future”, was inspired by the greatest global disruptor in recent memory, the COVID-19 pandemic. Since it started a year and a half ago, life has changed significantly for us all. Virtual interactions which were previously the stuff of science fiction, have become the norm. Most of us now spend long hours staring into the ubiquitous screens that have become central to our everyday lives. Professional, social, and even cultural activities are conducted in this way. Preventive health protocols such as sanitization and the use of personal protective equipment or PPE – previously the domain of specialized healthcare workers – are now common currency.
  3. Within the medical profession, the work of surgeons has been particularly disrupted by the pandemic. Hospitals and critical care units have struggled to cope with the burden of COVID-related care. While COVID-designated hospitals have had to delay their surgical services indefinitely, hybrid hospitals have been re-zoned to ensure COVID-free pathways. Hospital management teams have had to be highly creative to develop appropriate solutions.
  4. Despite these precautions, many elective surgeries have still been deferred, due to concerns about disease transmission as well as insufficient resources. Such delays may unfortunately lead to complications in some cases. Surgical training has also been affected as both surgeons and surgical trainees have been redeployed to non-surgical roles. This may undermine the provision of surgical care in the longer-term. There are likely to be other longer-term impacts on the medical field which we have yet to perceive.
  5. The pandemic is not the only disruptive force at play in our lives, however, and nor have its impacts been entirely negative. Information and communications technology, or ICT, continues to evolve in astonishing ways, and is a largely positive disruptive force in our lives. It has helped us enormously in meeting the challenges created by the pandemic. This reflects the ongoing advances in various related technologies, and particularly those that enable huge amounts of data to be transferred instantaneously around the world.
  6. If a pandemic had necessitated a lockdown even ten years ago, we could not have managed things nearly as well as we have been able to. So much more of life would have had to come to a stop. At the same time, had we not been hit by Covid-19, our use of virtual spaces for work, shopping, medical consultations, and a whole host of other interactions, would likely not have happened, or at least not nearly so quickly. Generally, people like things to stay as they are, and so many resist such radical changes.
  7. But there is no going back now. Zoom meetings may not be a preferred form of interaction for many people, but they certainly beat flying half way around the planet to attend a brief meeting or short conference. The savings they have allowed, in expense, time and health, let alone carbon emissions, are immense at both the personal and societal level. While face to face meetings will of course return for some purposes, many will permanently be replaced by the virtual kind.
  8. Another positive but highly disruptive force on the horizon is 5G technology. The speed and volume of data transfer that 5G enables will undoubtedly be game-changing in many realms. In the medical field, 5G will make it possible to perform surgery remotely using robotic lasers. So a surgeon in Kuala Lumpur would be able to operate directly on a patient in Perak, for example. Imagine a surgical service in which surgeons are centralized in one location, allowing easy interaction with their peers and students, but are able to operate on patients in hospitals around the country. Patients will no longer need to be transferred between hospitals, and time dedicated to surgery itself will be maximized.
  9. Medical training will also be transformed, with 5G technology serving to intensify existing trends in this area. Lecturers will no longer have to deliver their material live, but rather will be able to pre-record them. Their lectures will then be made available online for students to refer to at their ease. With proper organization, trainees can be guided through online learning material, and be equipped with the specialist skills and knowledge they need. They will be even able to practice robotic laser surgery in this way. Some of these developments are already happening in the most advanced settings, and they will become commonplace.
  10. This is just one of the many positive and significant impacts we can expect from the roll out of 5G. But, and of course there is always a but, far less positive disruptions to life as we know are also on the horizon. We can see unwelcome political and economic developments here in our region, and all over the world. Authoritarian regimes are strengthening their hold, progress towards democratization is faltering, and poverty and inequality are once again on the rise.
  11. Such developments are rooted in the greed for power and wealth of a small minority, many of whom display a callous disregard for the health of this planet. Since the focus of this event is on health and healthcare, let us remember that the health of the planet is intimately and directly connected with our own health. And unless we collectively transform our interactions with the planet, the health implications for its inhabitants are nothing less than dire.
  12. The COVID-19 pandemic diverted our attention away from the climate crisis, but it has been brought back into sharp focus in the last few months as Greece and Turkey burn, China floods, and Tokyo just hosted the hottest Olympic games on record. The climate crisis is already impacting our food systems, our cities, our seas, and ultimately our health. As more extreme weather events such as typhoons, fires and floods affect communities the world over, there will be more illness and injury, and ever-growing pressures on our health services. And what are our responses? Regrettably, it seems that, so far, these are vastly insufficient.
  13. As well as the catastrophic events that hit the headlines with increasing frequency, the climate crisis also affects our health in more insidious ways. As soils are depleted by droughts and over-use of chemicals, our crop and pasture lands are increasingly unable to produce nutritious food. This is contributing to growing hunger and malnutrition. Water shortages are another pressing issue, with water tables around the world falling to dangerously low levels. This affects health directly and indirectly, as sanitation also suffers when water supplies are inadequate. Heat-and pest-related illnesses are also on the rise, with more frequent outbreaks of mosquito-borne diseases such as dengue and malaria.
  14. Another set of urgent challenges arises from the accelerating loss of biodiversity, due to deforestation, land conversion, and urbanization. Countries in our region are among the most biodiverse in the world, but face a huge threat in this regard. Nature may be fighting back, however. The emergence of zoonotic diseases such as COVID-19 is closely associated with ecosystem degradation, as it greatly increases our proximity to disease-carrying animals.
  15. If we want COVID-19 to be the last such pandemic, we must protect our natural ecosystems, and respect Mother Earth. My plea to you, the Malaysian and Singapore surgical community, is to become strong advocates not only for your patients, but also for our planet in peril. Our traditional approach to medicine and public health to human disease must now be expanded to include the health of the planet more broadly.
  16. Along with the rest of society, the health sector must start to make serious preparations for the dramatic disruptions that we will have to face. We must also radically shift our behaviour, at a personal and societal level, in order to reduce carbon emissions and thus avert or mitigate the climate catastrophe that otherwise awaits us. Put in medical terms, it is clear that prevention is even more important than treatment. We must also put pressure on our politicians to ensure that preventative polices are in place, so that the greed of a few does not destroy the health of the many.
  17. As a species, we humans are clever. We have learned, adapted, innovated, and invented over our fairly brief presence on this planet. We have achieved incredible feats. The examples of the application of 5G technology I mentioned earlier more than adequately demonstrate the extent of our capabilities. We must now develop new ways to adapt, which reimagine the future. We cannot continue to be passive bystanders before the challenges that we now face. We must anticipate, take control, and direct the changes that are upon us. We cannot forestall these disruptive forces, but we can shape how we respond to them, and how we reduce their fury.
  18. The analogy of a plant may be particularly appropriate here. It grows according to its inherent natural design and purpose. But a gardener can twine it, prune it, fertilize it, and care for it, until the plant takes the shape that the gardener has chosen. In the same way, in the face of the disruptive forces we face, we must identify the opportunities we have to take hold of, shape, and reimagine the future.

Ladies and Gentlemen,

  1. This theme of this event is “Disruptive forces – reimagining our future”. We are already in the future. It is here. It is now. Let me close with a question for all of us to reflect and act upon – what will be our response?
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