Health: A silent killer

Malay Mail: One in three Malaysians aged 30 and above suffers from hypertension while only six out of every 100 have their blood pressure under control, said Malaysian Society of Hypertension president Datuk Dr Azhari Rosman.
“This is more worrisome than the fact that only slightly more than one fifth, or 23 per cent, of Malaysians with high blood pressure are on medication,” says Dr Azhari, a cardiologist at the National Heart Institute.
Dr Azhari adds that the statistics underscore a serious treatment gap involving both patients and doctors.
“The medical community and the public must change their attitudes towards the dangers and the necessity of treating hypertension early and aggressively.”
One reason compliance rates for the treatment of high blood pressure are so low could be that the earlier generation of blood pressure drugs had some side effects, including dizziness, tiredness and some sexual dysfunction, so the treatment was actually causing more symptoms than the disease.
Hypertension-related deaths have been on the rise in Malaysia, partly because many who have high blood pressure do not take their medication.
The number of cases of hypertension in Malaysia almost doubled between 1985 and 1998 – from 58,961 to 103,512. The International Society of Hypertension estimates that about 42 per cent of the world’s population or one in two adults will be hypertensive by 2020.
This has prompted the 2006 National Health and Morbidity Study to probe 70,000 people aged 18 and above in more than 14,000 households to determine the incidence of hypertension, cardiovascular disease and diabetes, says Datuk Dr Zaki Murad Mohd Zaher, chairman of the working group that developed the Malaysian guidelines for the treatment of hypertension on behalf of the Health Ministry and the Academy of Medicine.
Dr Zaki, head of nephrology at Kuala Lumpur Hospital, says that hypertension is a major cause of heart disease, stroke and kidney failure.
“Hypertension is a common problem, but what is worrying is that many people do not know they have high blood pressure. Of those who are aware of their condition, not all are being treated. Even among those who are receiving treatment, only a minority have their blood pressure under control.
“It has been shown in several countries that with good control of blood pressure the incidence of strokes and heart disease can be reduced, saving a considerable sum for the healthcare system.
“A major aspect of the treatment of hypertension is fostering compliance. The choice of medication is also important.
The factors taken into account include absence of major side effects, convenient dosing schedule, cost and any other medical conditions the patient might have. The class of drugs called Angiotensin receptor blockers, or ARB, has few if any side effects and thus may encourage greater compliance.”
Dr Zaki adds that the major challenge is to convince patients to take medication to control their blood pressure, as the condition often presents itself without symptoms.
Fewer than half of the patients with hypertension are successfully on medication, a situation that needs to be looked into. It may mean patients are either non-compliant, not on the right medication or on the right combination of medications. Alternatively it might be that doctors are not aggressive enough in treating their blood pressure.
Says Dr Zaki: “In recent years, it has become apparent that blood pressure should be controlled to a lower level than previously advised to reduce damage to the heart. Meeting these new targets usually requires two or three anti-hypertensive drugs but compliance can be expected to be a problem.”
“High blood pressure is the single most treatable cardiovascular risk factor and Co-Divan is one of the medications I use for ensuring compliance,” he says.
The Co-Divan 160/25mg is a fixed-dose combination of valsartan 160mg (valsartan is an ARB) and 25mg of hydrochlorthiazide (a diuretic). It is a new formulation which has just been launched by Novartis Malaysia, for patients who need additional blood pressure reduction.
The Health Ministry has approved Diovan to improve the survival rate after a heart attack. This approval makes Diovan the only ARB that is indicated for the treatment of post-heart attack, heart failure and hypertension.

Shortage of medical staff

The Star: Malaysia is facing not only a shortage of doctors but also allied health services personnel.
Health Minister Datuk Dr Chua Soi Lek said that there were only 61,472 healthcare professionals, and 129,634 more were needed.
By the year 2020, a total of 255,791 allied health services personnel will be needed. The shortage of such personnel are from 11 categories – staff nurses, physiotherapists, occupational therapists, dental nurses, dental technicians, therapeutic radiographers, diagnostic radiographers, pharmacy assistants, medical assistants, medical laboratory technologists and health inspectors.
“Allied health staff makes up 57% of the workforce in the government healthcare services,” Chua told reporters after launching Masterskill College of Nursing and Health and its RM1mil scholarship award in Cheras yesterday.
Chua said the ministry’s 18 nursing colleges could only train 2,500 nurses a year, but the number was set to increase with the completion of several new training institutions under the Eighth and Ninth Malaysia Plans.
“We have outsourced the training of more than 1,500 nurse students to 10 private colleges since 2001, and currently there are 89 trainee nurses at Masterskill,” he said.
He said the ministry had also received approval from the Cabinet recently to continue the outsourcing.

RM1m used for shelter, blankets, medical aid

The Star PETALING JAYA: RM1mil of the RM3.6mil collected to date for the South Asia Quake Fund has been used for tents, blankets, medical services and other kinds of shelter for earthquake victims in Pakistan, said Mercy Malaysia president Datuk Dr Jemilah Mahmood.
The balance will go towards building semi-permanent shelters, maintaining the health centres as well as the running of mobile clinics and field hospitals in Bagh.
Dr Jemilah said Mercy was also supporting the district hospital in collaboration with the local district office there.
“To date, we have deployed 14 teams comprising 150 volunteers and will continue to deploy them until the end of January when we will reassess the need,” she said yesterday after receiving a cheque of RM1.15mil from The Star’s South Asia Quake Fund to Mercy at Menara Star here.
The Star’s South Asia Quake Fund, set up to help victims of the earthquake that hit the Indian sub-continent on Oct 8, is now closed.
Thanking The Star for being a part of the humanitarian relief project, Dr Jemilah said: “We just do our best. We are indebted to The Star.”
She revealed that Mercy received a special grant of RM3.7mil for three years from Khazanah Malaysia.
With the grant, which is to cover expenses, all the money collected for the fund will go to the beneficiaries.
For next year, Dr Jemilah said Mercy would focus on awareness programmes to educate communities on risk and disaster management.
She said they hoped to empower the local community with such knowledge because first response must come from the community.

Addicts Buying Dangerous Drug ‘Cocktails’ at Clinics

PENANG, Malaysia, Dec 23 (IPS) - From the outside it appears like any other private medical clinic, though a little shabby. But a closer look reveals something unusual.
First, the ‘patients’ are predominantly male adults. Every few minutes one of them walks into the clinic, steps up to the counter and produces a card or booklet. Words are exchanged. The patient then walks into an adjoining room — and less than a minute later, walks out.
What happens inside the room is anyone’s guess. But the managers of two drug rehabilitation drop-in centres told IPS that certain private general practitioners are dispensing legitimate drug substitutes and potentially dangerous — though also legitimate — substances to drug addicts a little too freely.
Drug substitutes such as Subutex (buprenorphine) or, more recently in Malaysia, methadone, are legitimately used by doctors to reduce the craving among drug addicts without producing many of the harmful side-effects of illegal drugs such as heroin.
On their own, these substitutes may be effective in treating addicts — but they can be potentially deadly when mixed with other substances.
Close supervision is required. When drug addicts are prescribed Subutex, for instance, doctors often issue them instructions to help them monitor the dosage and their consumption of the drug.
The booklet carries a printed warning: ”You are reminded that Subutex cannot be injected or taken together with Benzodiazepines (sleeping pills such as Dormicum) or alcohol. It may result in breathing difficulties or death to Subutex users.”
But this is precisely what some drug addicts are doing to get a quick and easily available fix. They mix these drugs and inject the ‘cocktail’ into themselves.
Dormicum (midazolam) belongs to the benzodiazepine family of drugs and is used as a sedative. It can induce amnesia and is often given to patients before traumatic surgery. At very high dosages, it can trigger a heart attack and stop the lungs from working. Taken repeatedly, it can also be addictive.
Benzodiazepine users quickly develop tolerance to the intoxicating effects of the drugs, which narrows the safety margin between an intoxicating and a lethal dose.
The fairly easy availability of the cocktail ingredients at private clinics worries the two drug rehab centre managers, who declined to be identified for fear of repercussions.
Addicts taking Subutex or methadone need to be closely monitored, said one of them. “You cannot give them benzodiazepines (as well). These addicts, when they are provided with benzodiazepines, will inject it into themselves with either methadone or Subutex.”
”There is no such thing as using benzodiazepines in treating drug addiction,” he stressed, adding that he has received threatening phone calls for highlighting the easy availability of these drugs and their abuse.
One recovering addict told IPS that such benzodiazepines can be easily obtained from ”no fewer than 10 clinics in town” in this northern Malaysia port city. He said he used to take four or five tablets of midazolam or 20-30 tablets daily of valium, either alone or mixed with heroin. ”I know about a hundred addicts who are on these types of drugs.”
He is now upset with the doctors who sold him these pills, because addicts on a high from this cocktail become unaware of what they are doing. ”This is worse than heroin — and the doctors (who sell benzodiazepines) know it. They are selling it for profit.”
Last year, authorities raided two clinics in Kuala Lumpur and seized 1,280 midazolam pills. But the problem persists.
The other rehab centre manager told IPS of the tragic case of a HIV-positive middle-aged addict who died last month after injecting himself with a cocktail of Subutex and midazolam, both obtained from a general practitioner’s clinic.
”I urge doctors and pharmacists who give out Subutex to properly monitor the programme of administration of these drugs and not to abuse them,” said the manager, pointing out that Subutex dosage should be gradually reduced over time. “Certain doctors appear to be looking for profits and not the treatment. They are indiscriminately giving out these drugs to addicts.”
At the drop-in centre he manages, he provides addicts with only two mg of Subutex a day and gradually reduces it to 0.5 mg after about 10 days, before stopping it altogether.
He believes some addicts may be taking up to six mg of Subutex daily and injecting themselves with a dangerous mixture of Subutex and midazolam.
”Anyway, now that the government is focusing on treatment using methadone, Subutex should be stopped,” added the manager.
There are guidelines for the use of Subutex, one experienced general practitioner told IPS. ”You are supposed to reduce the amount gradually,” said Dr T Jayabalan, who often advises consumers about their rights. ”Unfortunately, doctors generally don’t follow the schedule.”
Jayabalan said doctors are supposed to help the addicts kick their habits but often the psychological aspect of addiction is not adequately addressed: ”Most of these addicts have instead become addicted to Subutex.”
”It’s also a well known fact that there are clinics dealing with benzodiazepines, such as midazolam,” he added.
Some say methadone is less prone to abuse, but the first rehabilitation centre manager says addicts can just as easily mix methadone with other substances and inject the cocktail.
A surgeon working at a private hospital here was equally concerned. ”The authorities should stop allowing the casual sale of these psychotropic drugs in the private sector so that addicts cannot get a supply of these ‘legitimate’ drugs such as the benzodiazepines, which are now available in some of the clinics in town,” he said in an interview.
IPS contacted the Malaysian Medical Association and Ministry of Health about these concerns but got no response to its inquiries at either place.
Time is not on authorities’ side. One private physician treating drug addicts told IPS he estimates there are some 600,000 drug addicts in the country and this could rise to two million within a decade.
Errant doctors have to be reined in fast. ”The only way out is for the enforcement people to do their duty” and curb the availability of these substances, says another doctor at a private hospital in the capital Kuala Lumpur.

Life sciences fund a good first move, say biotech entrepreneurs

The Star :BIOTECH entrepreneurs say the Malaysian Life Sciences Fund (MLSF) is a good first step to fully develop the country’s biotechnology potential, but fell short of its requirements.
While recognising that the MLSF, which has a fund allocation of RM100mil, is well-intentioned, panellists at a biotechnology forum in Kuala Lumpur yesterday said more funds should be set up. There should be streamlining of approvals and reduction in bureaucracy.
Organised by TH Properties Sdn Bhd, panellists at the forum on “The Impact of Budget 2006 on Biotechnology in Malaysia” were drawn from entrepreneurs in various biotech-related industries, as well as from the Malaysian Technology Development Corp (MTDC) and Ernst & Young.
Datuk Dr Salleh Mohd Nor, the executive director of TropBio Forest Sdn Bhd – a biotechnology firm researching jungle soil microbes – felt that there were problems with the translation of policies into implementation, and that the Government needed to invest wholeheartedly in the sector.
“There are many ideas to harness biotechnology in the country, but the execution is a problem,” he said.
Dr Rajen M, the managing director of Tropical Botanics Sdn Bhd, a herbal-extraction company, felt that private firms sometimes expected too much financing from the Government.
“We need to streamline the approval process and promote the industry as Malaysia can lay claim to having the oldest rainforests in the world, and this is an extremely good selling point,” said Rajen.
KLBiotech Sdn Bhd chief executive officer Dr Abdul Reezal Abdul Latif agreed that there was still much to be done to support the industry.
He said while it was important to capitalise on the herbal industry, development of other advanced medical services such as cell research, should not be neglected.
Sharon Low, the managing director of cell-therapy and medical services firm Stemlife Sdn Bhd, said although both MTDC and the Health Ministry had been very supportive of her firm, advanced medical services should not be neglected and would be needed to provide Malaysians with a high level of medical care.
Ernst & Young executive director (health sciences) Carol Wong said the Government’s 2006 Budget had provided group tax relief aimed at encouraging companies to venture into new industries, such as biotechnology.
There were also clear incentives provided to gear Malaysia towards developing contract research organisations as well as contract manufacturing organisations, she said.
MTDC chief executive officer Azlin Alias said although the MLSF was the main vehicle to promote biotechnology, other accelerator strategies were in the works.

Sexuality Education Not Done In Haste

PUTRAJAYA, Dec 23 (Bernama) — The sexuality education to be implemented early next year was not a hasty move but was mulled over for two years, Education Minister Datuk Seri Hishammuddin Tun Hussein said Friday.
The project, to be implemented in collaboration with the Women, Family and Community Development Ministry, would be carried out with great care in schools and pre-schools, he told reporters after chairing a meeting of the Main Committee on Discipline here.
Allaying the fears of some parties, he said: “I would like to assure them that we have mulled over the guidelines (on sexuality education) for two years. We are extremely careful and sensitive in putting it across,” he said.
Hishammuddin announced last Tuesday that education on sexuality would be implemented at the school and pre-school level early next year to help students protect themselves from sex crimes and to boost their morale.
The module planning had been completed and the National Guidelines On Sexuality Education would be submitted to the Cabinet in the first week of January.
It would involve five age groups — four to six years (preschool), seven to nine (children), 10 to 12 (early adolescence), 13 to 18 (adolescents) and 19 years and above (adults such as university students, parents and senior citizens).
Hishammuddin said the sexuality education would not follow the open western concept but would be discreet.
It would be included in current subjects and not taught as a special subject, he said, adding that only expert teachers would be involved.
On fears that the subject might not be suitable for preschoolers, he said the scope for them would different from that for adolescents.

Malaysia Still Uses Tamiflu To Combat Bird Flu

KUALA LUMPUR, Dec 23 (Bernama) — Malaysia will use other types of drugs if it is proven that the bird flu virus has shown itself to be resistant to the anti-viral Tamiflu currently used to fight the disease.
Health Ministry Secretary-General Datuk Dr Ismail Merican said that until then, Malaysia would still be using the Tamiflu anti-virus drug which was proven effective.
He was asked to comment an AFP report yesterday that bird flu has shown itself to be resistant to Tamiflu in the case of two Vietnamese deaths recently, a development which a doctor described as worrying in the fight against the virus.
Ismail said the claim by the Vietnamese doctor should be studied further.
Currently, Tamiflu is the most effective treatment available to the fight the H5N1 strain that has killed more than 70 people since 2003.
Ismail also advised Haj pilgrims to take the necessary vaccinations before travelling to the holy land.
Although there was no requirement for bird-flu vaccinations from Saudi Arabia authority, normal vaccinations were sufficient to prevent them from contracting diseases, he added.

Poor English Why Few Join Nursing

KUALA LUMPUR, Dec 22 (Bernama) — Poor command of English is among the reasons why less and less people are joining the nursing profession and which has led to more than 57 per cent of nursing job vacancies in government hospitals to go unfulfilled.
Health Minister Datuk Dr Chua Soi Lek said that unlike in the past where nursing was a competitive course because of the chance to work with the government or overseas and earn a high salary, today there seemed to be a lack of interest among the younger generation to join the profession.
“The ability to communicate in English is still very much in demand. We still have some senior nurses working overseas. They are still needed there probably because of their ability to communicate with the patients,” he told reporters after launching Masterskill College of Nursing and Health at Hulu Langat here.
To overcome the shortage of 89,960 nurses in the country, Chua said the Cabinet had recently approved that government nurse trainees be trained by local private nursing schools.
He said currently the ministry’s 18 nursing colleges could only train 2,500 nurses annually instead of the 8,000 needed to achieve the ideal ratio of one nurse to 200 patients by 2020.
Masterskill is among 16 private colleges and five universities that provide training for nurses. Its new campus is located at Taman Kemacahaya, Batu 9, Cheras here.

Call to set up PROSTAR club for Sabah youths

Daily Express:A WORRISOME trend of 19 new cases of HIV and AIDS are detected in the country each day, according to Deputy Chief Minister Datuk Yahya Hussin, citing statistics from the Malaysia AIDS Council.
“When HIV and AIDS were first detected in Malaysia in December 1986, there were only three reported HIV cases and one reported AIDS cases. Cumulative figures up to December 2004 indicate a total of 64,439 reported HIV and AIDS cases.
“What is saddening is that the majority of HIV and AIDS sufferers in the country are those in the 20-39 age range.
Reported HIV infections by age groups between December 1986 and March this year show that those in the 20-29 age group constitute 36.1 while those in the 30-39 age group make up 42.8 per cent of the total cases,” he said when closing the seminar.
Yahya said about 1,500 people die of AIDS each day in Asia.
Yahya who is also Minister of Community Development and Consumer Affairs noted that 75 per cent of the reported number of HIV and AIDS cases in the country are from among drug addicts who share needles for intravenous injections.
“Hence, the Government-sponsored ‘Harm Reduction’ Programme in the form of condom distribution and injection needle exchange, is most timely.
Contaminated needles are given up by drug users in exchange for new ones to prevent the spread of the deadly virus to non-infected persons.”
From his observation, factors like ignorance, lack of preventive measures, inadequate medical facilities, low level of cleanliness and superstitious beliefs invariably contribute to the spreading of HIV and AIDS, and loss of more human lives.
Yahya stressed that reproductive health is the most valuable asset to human beings for development of the future generation.
“We must leave no stone unturned in our efforts to wage war on the killer - HIV and AIDS.”
However, the Deputy Chief Minister lamented that society, particularly young people, have a low level of awareness on sexual and reproductive health.
He said this causes them to be vulnerable to sexually transmitted diseases (STDs) including HIV and AIDS, and also leads to unintended pregnancies.
In this respect, Yahya called for the formation of the PROSTAR Club in Sabah to assist the authorities in addressing the HIV/AIDS problem. PROSTAR stands for Program Sihat Tanpa AIDS untuk Remaja (or Healthy without AIDS for Youth Programme).
He noted that the Federal Government had taken the initiative to set up such club in each district and region as a catalyst for youth groups to fight the HIV/AIDS scourge. Launched in 1996, its concept is “Action by Youth, through Youth and for Youth”.
Also present was the ministry’s Permanent Secretary, Michael Emban.
Earlier, MPWS Chairperson Datin Asnimar Hj Sukardi said the increase in the number of cases involving women and youth in the country by 13 per cent last year prompted the council to organise the seminar through its implementing agency, Sabah Women’s Affairs Department.
Based on statistics from the Ministry of Health, she noted that there has been a steady increase in the number of HIV infections and AIDS cases from 1986 until March this year.
“As at December last year, cumulative number of HIV/AIDS cases was 64,439 and by March this year, the figure had risen to 65,370.” The seminar was held to mark World AIDS Day this year. The theme for the Malaysian version is ‘Women, Youth & AIDS’.
Responding to a request from the participants that a similar seminar be held at departmental level, MPWS Health Committee Chairperson, Dr Maria Suleiman who was the Organising Chairperson said they could write in officially to the Department of Health.
“We would be pleased to send our speakers and even the voluntary anonymous HIV screening team.”

Over 500 in Sabah have HIV

Daily Express: Kota Kinabalu: Sabah recorded 541 cases of reported HIV infection (397 males and 144 females), 162 cases of full-blown AIDS and 63 deaths between 1991 and October this year.
State Health Department’s Principal Assistant Director (HIV & AIDS), Dr Narimah Hanim Ibrahim said Tuesday, the State showed an upward trend from zero HIV infection in 1991, except for 2003 when only 52 cases were reported due to failure of notification, culminating in 105 reported cases last year.
“All the 144 females contracted HIV via the heterosexual mode of transmission. Sabah registered 71 new HIV cases, 35 new AIDS cases and 19 new reported AIDS deaths between January and October this year.
“Last year, only eight AIDS deaths were reported,” she said at a seminar on HIV and AIDS jointly organised by the Sabah Women’s Advisory Council (MPWS) Health Committee and State Health Department.
In her talk on “A Study on HIV & AIDS in Malaysia and Sabah”, Dr Narimah said of the Sabah cumulative figure (541), non-Muslim Bumiputeras topped the list of HIV cases at 243, followed by foreigners (142), Chinese (110), Malays (37), Indians (6) and Sarawakians (3).
“This is in sharp contrast to the national scenario of reported HIV infections by ethnicity where Malays formed the bulk at 47,418, followed by Chinese (9,699) and Indians (5,422).
“Likewise, based on HIV cases by risk categories in Sabah, the main mode of transmission is heterosexual (84 per cent), followed by intravenous drug use (IDU) which is 4.8 percent, vertical (mother-to-child) at 2.8 per cent and homosexuality (2.2 per cent) for the 1991-October 2005 period.
“In comparison, IDU was the main mode of transmission for the rest of the country (75 per cent), followed by heterosexual means (13.8 per cent), homosexuality (1.1 per cent) and vertical transmission (0.7 per cent),” she told some 200 civil servants from State and Federal Government Departments.
In respect of occupations, Dr Narimah said 223 HIV-positive people in Sabah (among the 541 cases) refused to state their occupation, followed by others (169) made up of businessmen, labourers, contractors, farmers and other self-employed persons.
“For the 1991-Oct 2005 period, housewives made up 35 and 23 were unemployed while 22 were factory workers and 21 from the police and army. There were 18 government servants (both male and female), 13 prostitutes, five fishermen, five drivers and three students.”
Going by districts, KK (189) topped the HIV cases between 1991 and 2004, followed by Tawau (66), Lahad Datu (35), Sandakan (41), Keningau (27), Papar (20) and Penampang and Kudat (each 19).
The seminar heard that 10 mothers in Sabah tested HIV-positive between 1998 and 2003 under the Prevention of Mother-to-Child Transmission (PMTCT) programme. It was launched in 1998 at all government antenatal clinics.
Asked on the fate of HIV-positive foreigners, Dr Narimah said the Health Department would inform the Foreign Workers’ Medical Examination and Monitoring Agency (Fomema) about their status and refer them (foreigners) to the Immigration Department for their deportation.
“However, it is difficult to detect HIV in illegal immigrants.”
According to the doctor, voluntary anonymous HIV screening is available at 35 clinics throughout the state including Luyang Clinic. On the HIV/AIDS epidemic in Malaysia, Dr Narimah said cumulative figures (from December 1986 to March 2005) show that there were 65,370 cases of reported HIV infection (including AIDS).
Of the number, 60,773 are males and the rest females. Children aged below 12 years make up a separate figure of 546.
During the same period, there were 9,705 reported AIDS cases and 7,362 reported AIDS deaths.
The prevalence of HIV among antenatal mothers is 0.04 per cent.