Materia Medica Malaysiana

June 25, 2004

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Malaysia fears providing pollution figures amid haze will hurt economy

KUALA LUMPUR : Malaysia said air pollution figures would remain a state secret due to fears the economy would be hurt by revealing how much smog from neighbouring Indonesia had blanketed parts of the country.

“The only problem is that it gets distorted by the international media. It then gives a grim picture of Malaysia,” deputy prime minister Najib Razak said Thursday.

“It could be overplayed and then it will have an adverse effect on the economy,” he added.

In 1997, at the height of the haze crisis, Malaysia classified the air pollution index as an official secret.

Malaysia now only refers to air quality as “good, moderate, unhealthy or hazardous” after banning the release of air pollution figures for fear it might drive away tourists.

The tourism sector is Malaysia’s second largest foreign exchange earner after manufacturing.

The pollution index measures the quality of air on a scale of zero to 300. It considers zero to 50 as good, 51 to 100 as moderate, 101 to 200 as unhealthy and 201 to 300 as very unhealthy. Anything above 300 is hazardous.

Asmah Ibrahim, department of environment air division head told AFP that the overall situation in the Klang Valley had improved but in Port Klang, west of here, in the southern Johor state and Malacca — the air quality remained “unhealthy.”

Malaysian environment officials blame forest fires in neighbouring Indonesia’s Sumatra island for the haze which has drifted to Malaysia since last week from across the narrow Malacca Straits. The busy straits divides the two countries.

On Wednesday the opposition Chinese-dominated Democratic Action Party (DAP) urged the government to make public the pollution index throughout the country to fully minimise health hazards posed by the haze.

“It was most short-sighted decision for while Malaysians support tourists promotion to bring in tourist revenue, this cannot be at the expense of the health and welfare of the citizens or those of the tourists themselves,” DAP chairman Lim Kit Siang said in a statement.

Lim said in the era of information technology, it is sheer folly for the government to pretend that it could mislead foreign tourists into believing the air in Malaysia is clean.

Marine police have issued haze alert for seafarers plying the Malacca Straits where hundreds of ships pass through daily.

“Visibility in the Malacca Straits has been reduced to just one kilometre (0.62 miles) from the normal six kilometres due to the haze. I advise ships and barter-traders to put on navigational lights,” Abdul Salam Abdul Halim, marine police chief in the sourthern Johor state told AFP.

Abdul Salam warned ships to remain alert because they usually travel at about 15 to 20 knots and with poor visibility, they do not have sufficient time to avoid a head-on collision and advised fishermen to fish near the coast instead into the open sea.

– AFP

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June 23, 2004

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Filed under: Uncategorized — malaysianmedicine @ 7:15 am

Taking care of rural health

HEALTH in the rural areas has been well developed over the last 47 years, since independence.

The Government has taken numerous steps to ensure that the population in rural and remote areas, including Sabah and Sarawak, are not neglected in terms of health care and facilities.

Initially there were only seven maternal and child health clinics in the late ‘50s but now we have over 4,000 health clinics, of which almost 80 per cent are located in the rural areas.

These clinics provide maternal and child health and dental services which cover a comprehensive range of promotive, preventive, curative and rehabilitative services.

Health Minister Datuk Dr Chua Soi Lek says: “We did not stop there however.” Since the Seventh Malaysia Plan, we have moved towards providing a wider scope of health services, beyond just maternal and child health. Adolescent, women, geriatric health has been introduced. Mental and rehabilitative health has also been expanded. Over the last 10 years more than 30 per cent of the health clinics have started such services and the number is growing by the day.

Family medicine has made its debut. There are 110 such specialists giving not only specialist services but also clinical leadership at the health clinic level.

These clinics, where the family medicine specialists are posted, are equipped with radiology, pathology services and specialist drugs.

Dr Chua says more diagnostic equipment has also been sent to such clinics.

“We will still have a wide spectrum of progress, ranging from very basic clinics, run by a one-person community nurse or medical assistant, that see a minimum of 20 patients a day, to a health clinic that has a comprehensive range of services seeing over 1,000 patients a day.” Hence, depending on the type of services available in a particular clinic and the illness of the patient, he or she will be treated accordingly or referred to the nearest clinic or the hospital.

The re-employment of retired doctors and employing private doctors to work in health clinics are among the steps taken by the ministry to overcome a shortage of doctors in rural areas.

Dr Chua says the ministry has also recruited 643 foreign doctors — 203 specialists and 440 medical officers — to work in rural hospitals, health centres and polyclinics.

“We have re-employed 34 retired doctors to work in rural areas,” he says.

“Concerned with the shortage of doctors in rural areas, efforts are being made to make rural health postings more attractive.” The measures taken include providing quarters and allowing career development with the creation of family medicine speciality. Those posted to Sabah and Sarawak will be given a regional allowance — 12.5 to 17.5 per cent of their basic pay.

The use of friendly information communication technology is also being explored to allow doctors in rural areas establish continuous and reliable connections both in follow-up of cases as well as educational and professional contacts.

As of December last year, there are 864 community polyclinics, 1,927 community, 95 maternal and child health and 168 mobile clinics in rural areas.

The Government had allocated RM460 million under the Seventh Malaysia Plan and RM862 million under the Eighth Malaysia Plan (8MP) for rural health development, that is for 425 projects.

The main thrust of the 8MP is to upgrade existing facilities and the construction of new health facilities in rural areas. However, this objective is somewhat obscured by the zest of building new hospitals. Almost 53 per cent of the revised ceiling approved under the 8MP has to be channelled to fund these new hospitals.

As for the overall shortage of doctors in the country, Dr Chua says as of March 3 this year, there were 13,457 vacancies, of which 10,195 or 76 per cent were filled. These included 2,191 specialist posts, of which 1,525 were filled and 11,266 non-specialist/clinical specialist posts (8,570 filled).

The ministry’s long-term plan to resolve the shortage is to increase the output of medical graduates.

There are now 15 approved local medical universities and colleges but only eight public and five private institutions are expected to produce some 2,000 students starting this year.

In view of the shortage of doctors, the ministry wants doctors in private hospitals to serve a certain number of hours a week in government hospitals.

On health standards, the minister says it is influenced by several factors which include socio-economic status, educational attainment, provision of good basic amenities as housing, water and electricity and not just the provision of health services alone.

The main health problems in rural areas are basically diseases of the respiratory and digestive systems, skin and parasitic infections such as malaria, scabies, and worms.

As for health awareness among the rural population, he adds that there are health programmes provided on antenatal care, child health, school health, family planning, diabetic conrol, and cardiovascular prevention.

“Local findings on the health of rural people are also done through home visits and patient’s responses during their visits to the health clinics.” The ministry’s vision is to develop a nation of healthy individuals, families and communities through a health system that is equitable, affordable, technologically appropriate, environmentally adaptable, consumer friendly and which promotes individual responsibility and community participation for an enhanced quality of life.

The ministry aims to build partnerships for health to facilitate and support Malaysians in attaining their potential in health, motivate them in appreciating health as a valuable asset and taking positive action to improve and sustain their health status to enjoy a better quality of life.

June 22, 2004

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Filed under: Uncategorized — malaysianmedicine @ 1:33 pm

Delays stall toddler’s liver transplant

After an arduous five-month wait, it is still uncertain whether 15-month-old Nur Atiqah Najwa Mohd Sharif will be able to undergo liver transplant surgery on June 26 as hoped.

It seems the much-anticipated surgery may not take place just yet, as Dr Goon Hong Kai, the paediatric consultant in Subang Jaya Medical Centre, who will perform the operation, wants the child’s lungs to be in good condition before the surgery.

“She is stable, but her lungs are infected,” Dr Goon said outside SJMC’s intensive-care unit today.

“We will have to treat it and hopefully the surgery can be on the appointed date.” The toddler was transferred to SJMC from the University Malaya Medical Centre for the surgery this afternoon. “The surgery is still tentative and we will proceed with it only if everything goes well,” Dr Goon said. “Things can still change.” Nur Atiqah’s prospective donor, Ahmad Khairi Al-Hadi, 27, is eager for the surgery to be over and done with.

“I have been waiting for two years to donate since I registered with the Selangor Youth Council. I am ready and if the doctors tell me that we need to operate now, it would not be a problem for me,” he said. “I sincerely want to help this girl,” he said, adding that others had helped his own three-year-olddaughter when she needed RM8,000 for surgery.

Nur Atiqah’s father Mohd Sharif Abdul Hamid remains anxious.

“I am quite happy for what’s happened of late. Many people have taken interest in my daughter’s plight and I wish to take this opportunity to thank them all.” Aware that his daughter may not be operated on the stipulated date because of her complications, which include internal bleeding, Sharif was leaving it to the doctors to decide.

“They know best. This is very risky surgery,” he said, adding that the family had been waiting for surgery since February. “I hope that in future, such cases will not be bogged down in red tape. It is sad to note that liver transplant patients such as my daughter have to wait for a long time before getting the necessary approval from the Health Ministry as her donor is not related to her,” he said. However, Health Minister Datuk Dr Chua Soi Lek, said the matter of Ahmad Khairi being unrelated to Nur Atiqah was unlikely to lead to changes. .Chua, at a Press conference in Universiti Putra Malaysia after a cheque presentation ceremony, said procedures needed to be adhered to, especially if potential organ donors were unrelated to recipients.

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Organ donation: ministry will stick to medical ethics

SERDANG June 21 – The Health Ministry will stick to medical ethics requiring a potential organ donor, who is not a relative to the patient, to get its approval, said its minister, Datuk Dr Chua Soi Lek.

He said this was not bureaucracy but the accepted medical ethic practised everywhere in the world.

“We sympathise with all patients as they have to wait but this is to protect the donors and the patients,” he told reporters after witnessing the handing over of a cheque for RM40,000 from ExxonMobil to Universiti Putra Malaysia (UPM) to reprint 5,000 copies of each of the five book titles on breast cancer.

Dr Chua said there was a need to verify whether a non-relative potential donor was suitable in terms of blood type and genetics as well as the possibility of the organ being rejected by the patient’s body after surgery.

He also refuted claim by Deputy Works Minister Datuk Mohd Zin Mohamad on Sunday that the ministry took weeks to give its approval.

“It’s not so and the claim is misleading. It could upset the doctors serving in hospitals as there is no bureaucracy in this context,” he said.

In the case of 15-month-old Nur Atiqah Najwa Mohd Shariff, who is suffering from a liver ailment, Dr Chua said the ministry gave its approval to Ahmad Khairiri Al-Hadi Md Yusop on June 18 after receiving his application to become the child’s donor on June 10.

He said the process was not simply of issuing an approval letter but of evaluating a non-relative potential donor.

A committee comprising a psychiatrist, a social worker and a medical specialist would have to evaluate a potential donor for his own good as one out of 100 cases, the donor would not make it, he said.

The so-called bureaucracy in the Health Ministry also drew the attention of Prime Minister Datuk Seri Abdullah Ahmad Badawi, who wanted to know why the delay in operating Nur Atiqah, who is in critical condition.

Nur Atiqah was transferred to the Subang Jaya Medical Centre (SJMC) from the intensive care unit of Universiti Malaya Medical Centre (PPUM) at noon on Monday.

She would undergo surgery on June 26.

Earlier in his speech, Dr Chua said there were almost 40,000 cancer patients in the country in 2002.

Of this, he said 4,3378 were breast cancer victims as reported by the National Cancer Registry Report.

June 20, 2004

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Filed under: Uncategorized — malaysianmedicine @ 3:42 pm

Rigidity that kills medical service

HIS first encounter with civil servants was spectacularly shocking.
When he presented his qualifications, they pored over the documents and then dismissed him by saying: “Go back. We can’t pay you, so just go back.” They were probably being realistic; the civil service does not allow for exceptions. You either fit in or stay out of the system altogether.

Still, their indifference was a stinging slap on TJ’s face.

Even the most self-assured person would have been bruised by the rejection but the foolish young man persevered.

Friends thought he was mad. Top-rung clinics abroad were courting him but he remained resolute about working at home.

Amazingly, it is now four years since he joined the government service, a period so fraught with piffling obstacles created by petty officers that you would cry just listening to the stories.

TJ still receives job offers from abroad and he continues to say no — because he hasn’t quite finished his work here.

“I love my job, it’s as simple as that,” he says, with no hint of bitterness or anger in his voice.

But friends say it is unlikely that he will hang on for much longer on the miserable salary he draws.

For now, Malaysia has him and you can be assured that his expertise is rare and his skills, first-class. When he leaves, we will be pushed back to square one.

Which is strange, really, given the loud exhortations politicians have been making over the last decade about bringing Malaysian specialists home to work in government hospitals.

In the UK alone, there are some 100 Malaysian specialists. If the Ministry of Health can get its act together, some of these individuals may seriously consider coming home.

But they may not stay long if structural problems are not resolved, if attitudes don’t change and if rampant politicking is not reduced.

TJ’s story is not uncommon; all those living abroad would probably have heard variations of it.

Indeed, why work in a system which, in TJ’s case, adamantly places seniority above experience? Why succumb to a pay structure where even the most highly-skilled Malaysian contract doctor must begin at the bottom rung? And, why put up with small-minded bureaucrats when you know your expertise is needed elsewhere? Unhappiness, it turns out, is not limited to Malaysian contract doctors. Medical professionals who have served in government hospitals for decades are equally distressed by the treatment they receive.

Last week, a professor of medicine, unable to contain her frustrations, sent an open letter to the Prime Minister, parts of which were carried by the NST.

“My husband and I are fair dinkum Malaysian doctors who returned as medical specialists back in 1982 after our medical training and after working abroad for some 13 years,” she wrote. “He served as a lecturer and later professor in medicine, planned and administered the Hospital UKM whilst I first served in the Ministry of Health as a kidney specialist before joining the department of medicine in UKM. “We have each contributed much of our private time to serve in our respective professional societies and in setting up or strengthening national patients’ associations. We are among pioneers of both the undergraduate and postgraduate medical training programmes in our local universities as well as in paramedical training programmes.” More than all this, said the professor who is about to retire, is the satisfaction she has gained from research and her interaction with trainees, housemen and colleagues. Seeing her patients get better by the day also keeps her going.

But all this, she said, has been soured by the way the Public Service Department treats government doctors, nurses, paramedics and other health professionals.

“To them, we exist as mere statistics within a group much like the unskilled and semi-skilled staff in the civil service who work office hours, 8am to 4.30pm, with all the public holidays and alternate weekends off.” “Although some minor improvements have occurred in recent years, inflation, long working hours, the near-absence of career advancement and further training opportunities, the time-consuming and morale-deflating examinations (all of which are totally unrelated to patient care) have pushed doctors into a corner.

“Is it a wonder there are fewer and fewer of us left? Is it a wonder that waiting lines are getting longer at government clinics and outpatient departments?” The professor said if no one fights for the medical profession, good doctors and nurses will move on to greener pastures.

Which is not to say that money is the motivating factor for all doctors, but they certainly “cannot live on chicken feed and self-gratification” today.

The solutions she offered were: Keep the doctors we have by giving them equitable remuneration and training opportunities rather than enticing a few to return at exorbitant salaries or recruiting expatriate doctors and paying them higher salaries.

Facilitate promotion of government doctors based on professional merits and qualifications as this would help maintain and enhance professional standards to provide the best care possible for patients.

Remove red tape and stumbling blocks e.g. SSM-PTK examinations — these take away critical staff for two weeks at a time.

She ended her letter with a plea to the Prime Minister to “intervene before we lose most of our young medium-rank specialists and medical lecturers to Singapore and the private sector”.

Ninety-five per cent of the rakyat, she pointed out, could not afford extensive private health care. This is why, a good, sound, comprehensive health care system staffed by sufficient, efficient and caring Malaysian doctors, nurses and paramedics is critical for the country, she said.

Since her letter was published, she has received the support of many. Letters in the NST attest to this. Interestingly, there are individuals in the Ministry of Health who recognise the problems.

“The rot set in a long time ago,” said one anonymously.

“We have a bloated bureaucracy but any attempts to remove the deadwood will be met with resistance,” he said. “At the bottom, we have clerks and junior officers suffering from power denial psychosis (where a little power gets to the head) and, at the top, we have senior people who cannot see eye to eye.” As a consequence, he said, the people who matter most — the medical professionals — are trapped in between. Of course, not all medical personnel behave like hapless sheep; those who see the benefit of playing politics will jump into the fray.

But those who cannot stomach the nonsense and neglect, leave.

This is said to be another reason why certain units in teaching hospitals are almost depleted of critical staff. In one hospital, the cardiology unit is as good as dead.

If nothing is done to resolve this, we may soon be sending our medical students to be trained in Russia or Myanmar, even.

As it is, the minister is now thinking of getting doctors from Myanmar (who speak English and are better trained, he says) because doctors from other countries have not worked out as well as expected.

The main complaint has been language. As pointed out by a doctor from Sungai Petani in a letter to the NST last Friday, foreign doctors are not able to communicate with patients. The doctor said in most instances, Malaysian doctors who are themselves overworked, are being asked to train the foreign ones.

A specialist who travels the country to introduce new methods and equipment to doctors said he was stunned that some foreign doctors were not even able to conduct basic procedures.

He was asked by one Bangladeshi doctor whether he could recommend a book on some of the basic surgical methods.

More worrying is that many have poor medical knowledge. In the last few weeks, two operations were apparently botched up by Egyptian doctors. In one case, a young woman’s bowels were completely ruined. Major reconstruction surgery could barely return her to normal.

“This is very scary,” said the specialist. “We take them in without knowing what they’ve done before coming to this country and we send them to places like Langkawi, Sabah and Sarawak where it is hard to monitor them.” The professor who wrote the letter to the PM says she has encountered foreign doctors who could not be bothered to remember patients’ names — “if you see them many times, surely you would know their names, right?” — and who refused to turn up for night duty.

But not all is lost.

A sizeable number of dedicated, disciplined, caring and brilliant doctors — trained locally and abroad — are still plugging away in government service.

Whether they are on contract or permanent, let’s keep the ones we have.

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Sleeping with the enemy is sure death

A COMPANY is looking for support from the Malaysian Association of Youth Clubs for its campaign against youths below 18 from using a particular product.

Is there any other association that would grab the opportunity as the MAYC did with two tobacco companies recently? The company may not be as famous as the two tobacco companies, but the product is almost similar to cigarettes. In fact, there is virtually no difference, except that this product cannot be smoked because it is a drink. Otherwise, everything else is similar, including the price and the packaging. More specifically, it too contains at least 4,000 chemicals, about a dozen confirmed toxic to the body, and some known to be cancer-causing. To show how dangerous it is, on one side of the packing is a clear health warning that the product can endanger health. So, under the circumstances, there is certainly nothing wrong in supporting yet another campaign, especially if it will further bolster the name and “fame” of the MAYC as a responsible organisation that cares for the health of its members affiliated through more than 500 youth clubs. And especially when the majority are Malays, known to be the major users of similar toxic substances, including hard drugs.

Oh yes, before one forgets, this product has been documented to have addictive properties as well — equivalent to some of the hard drugs, such as heroin — the country’s number one enemy for the last three decades. But that should not matter, if cigarettes do not! In any case, unlike cigarettes, this new product is documented not to cause environmental pollution or second-hand smoke that has resulted in millions of innocent deaths. But make no mistake, it can still cause the same range of diseases — notably cancer and heart diseases — so it should rank with smoking as the leading cause of death among Malaysian youths and adults. This figure stands at about 10,000 per year, although the youths may be somehow “spared” because of the so-called campaign. Unfortunately, not their parents, uncles and aunts, grandparents or their loved ones — as long as they are adults. The product has the licence to “kill” adults. This is based on the campaign tagline that confirms the use of the product an “adult choice”! It is prohibited only for youths. Here is the major snag. In fact, this has been the one single question that must seriously be considered. Ever since the oxymoronic tagline was launched it has boggled the minds of youths. For example, the youths ask: Doesn’t the product induce the same cancer in adults?. Or, for that matter, a host of other diseases associated with the product? If so, why is it prohibited for youths, but not so for adults?” The MAYC may want to share its wisdom on how it reconciled these stark contradictions. How did it convince hundreds of thousands of members to accept such double standards? To quote the words of the MAYC president during the recent launch of its anti-smoking campaign: “The companies realise that only adults are more aware of the health hazards from smoking and can make a decision and choice on that matter.” This is a familiar line propagated by the tobacco companies that MAYC failed to probe more deeply. It is a flawed argument debunked by many bodies across the globe, including the World Health Organisation years ago.

Let us make it clear yet again: there is no such thing as “adult choice” when it comes to any substances that causes addiction. For example, what choice do addicts have in controlling their habits? Similarly, for those addicted to cigarettes, which is why there are so many of them; the majority of whom are unable to stop or quit despite knowing the dangers, though belatedly! The previous Minister of Youth and Sports spoke about this publicly recently. Maybe the MAYC has missed it, otherwise it would have shown more concern and not endorsed a dubious campaign doomed to fail.

Because of this, the youth of Malaysia have been ridiculed by their counterparts all over the world. They clearly saw the foolishness of what the MAYC is trying to do. This is the same group who applauded the Prime Minister when he launched the Tak Nak campaign without the involvement of tobacco money. But, today we are sending a very different signal, that it is okay to sleep with the enemy! In this case, tobacco is the enemy, and it definitely kills — youth and adults alike! It is very important for the MAYC to reflect on its recent move so that its leadership role is not called into question.

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Seeking cure for doctor shortage

More than 3,600 doctors left for the private sector in the last 10 years, and there are now vacancies for 3,300 general practitioners and 700 specialists. Alarmed, the Health Ministry may now make it compulsory for private sector doctors to work part-time in government hospitals. But is this the right prescription? YONG TIAM KUI reports

OVER the years, the Government has come up with a number of ad hoc measures to deal with the shortage of doctors in the public health sector. These include hiring foreign doctors on a contractual basis, hiring retired doctors to work in rural areas and allowing government doctors to work part-time in the private sector. Unfortunately, these measures have not worked for the simple reason that they do not address the grouses of frustrated doctors in government service. Their complaints are endless: long working hours, bad working conditions, low pay, lack of opportunities for further education and poor promotion prospects for non-Bumiputeras.. And government doctors are definitely not exaggerating when they say they are overworked. They handle 48 million outpatient cases and 1.7 million in-patient cases a year. The country’s 16,000 medical specialists and doctors are about evenly split between the public and private sectors. But, while government doctors have to attend to 32,000 beds, their private counterparts only have 9,000 beds to attend to. They are also paid much less than their private sector counterparts. A government doctor who wrote to the New Straits Times letters page recently says a doctor who has been working in the private sector for 10 years can earn between RM10,000 and RM15,000 a month. A doctor working for the same number of years in the public sector would only be earning RM3,500, a monthly housing allowance of RM160 and a ridiculously low call allowance of RM1.61 per hour on weekdays and RM1.04 on weekends. Obviously, the Health Ministry will have to look at these factors if it wants to retain experienced medical staff. “The root of the problem — why doctors are leaving the public sector — needs to be addressed,” says Association of Private Hospitals of Malaysia (APHM) president Datuk Dr Ridzwan Bakar. Health Minister Datuk Dr Chua Soi Lek has acknowledged that there is a need to improve the salary and working conditions of government doctors, and will be holding discussions with the Malaysian Medical Association on this matter. But, it is difficult to see how improvements can be made unless the national health budget is increased or if public hospitals and clinics start charging patients more. As it is, the Health Ministry is carrying out cost-cutting measures which include using cheaper generic drugs and deferring the construction of 11 hospitals which were scheduled to start this year. Dr Chua also challenged doctors and specialists in private hospitals to voluntarily work part-time in government hospitals and universities. “Over the past five years, we have only received seven volunteers. This is the worst form of tokenism ever. I am now throwing a challenge to them: Are they willing to serve on a voluntary basis?” he asked. Dr Chua says the Government may make it compulsory for private sector doctors to work part-time in the public health sector if volunteers were not forthcoming. Under such an arrangement, doctors would be required to work a certain number of hours per week if they want their Annual Practising Certificates (APC) renewed. After all, says Dr Chua, doctors and specialists have to show continuous performance development to renew their APC. “What better place is there to have their continuous professional development than in government hospitals?” The minister’s harsh words have angered doctors and the threat to link APC renewals to part-time work in government service has met stiff opposition from the MMA. Its president, Datuk Dr N Arumugam, says doctors should not be forced to work in the public sector because they are already shouldering their social responsibilities as medical practitioners. He notes that medical graduates are already required to work in the government service for three years and many doctors have worked for the government for 10 years or more before leaving for the private sector. “It should be voluntary with appropriate incentives. It should not be linked to the renewal of the Annual Practising Certificate. People who work under compulsion will not do their best work. “I do not know of any examples of a country forcing doctors to work. Like any other citizen in a free society, doctors are entitled to their free time.” Dr Arumugam says many doctors and specialists would welcome the opportunity to serve on a part-time basis in the public sector if a proper system was put in place by the ministry. “We can meet the ministry to draw up guidelines. If a system can be worked out, many doctors would be willing to offer their services,” he adds. Dr Arumugam’s view about the need for guidelines and a systematic approach on the part of the ministry was shared by Dr Ahmad (not his real name), a private sector doctor who lectures at a public university several hours a week. Dr Ahmad, who taught medicine for more than 20 years before leaving for the private sector, says many ex-academicians have not lost their interest in teaching and would be more than happy to offer their services if there was a systematic approach to integrate them into the public university system. “I am sad that the minister has come out with such strong words challenging doctors in the private sector. The minister shouldn’t threaten us by linking it with the APC. He should follow Pak Lah’s philosophy of come and ‘work with me’. “The onus is on the ministry to work out a systematic programme that links the public and private sectors. The people who need help is the ministry not us.” “What kind of recognition and privileges are we going to be given? “Will our former status as professors be recognised or will we be known only as temporary visiting lecturers?” he adds Dr Ahmad says the ministry also should do something about the hostility, jealousy and mistrust that private practitioners face in government service. “The ministry should do a survey of heads of department of government institutions to find out whether they are really willing to take us in. “Once we leave government service, there is a tendency for people who are still in government service, especially those who hold high positions, to have the attitude that they don’t need us. There is anger and hostility against us for leaving. That has to change.” Dr Wong Jun Shyan who wrote to the NST letters page says he offered his services to a public university but they didn’t even bother to reply. He says his case is by no means an isolated one as he has colleagues who have had similar experiences with university authorities. “I left a university-based hospital last year after establishing a tertiary referral unit for complex cases in my area of specialisation. “Realising the scarcity of this speciality here, I offered my time as a visiting lecturer, but I have yet to receive a reply. I know of other instances where my ex-colleagues too offered to do the same,” says Dr Wong. Meanwhile, Consumers Association of Penang president S.M. Mohamed Idris suggests that the ministry make better use of foreign doctors to reduce the critical shortage of medical practitioners. He says the current system of contractual employment for foreign doctors should be revamped to encourage them to stay on in the country. One of the measures that can be adopted would be to offer permanent resident status to foreign doctors after they have served in the country continuously for a stipulated period, he adds. This can be scrapped once the country is no longer short of doctors. “After all, the Government is head-hunting foreign experts to serve government-linked companies (GLCs), so why not use the same concept for recruitment of foreign doctors?” says Idris. The shortage of doctors is most severe in rural areas. The doctor patient ratio in Kuala Lumpur is as high as 1:420 but in Sabah it is just 1:2,800. The Government is trying to improve the situation by encouraging retired doctors to serve in rural areas. So far, only 34 retired doctors have accepted re-employment in rural health centres. Dr Arumugam says the ministry should consider requiring medical students who are sponsored by the Government to work in rural areas for one or two years upon graduation. He says the Government can also entice foreign doctors to work in rural areas by offering them permanent resident status after a certain number of years of service. Dr Arumugam says the Sabah and Sarawak State Governments should consider allowing doctors from the peninsula who have worked in the government service in their respective states or a certain number of years to stay on and open private clinics. The Health Ministry is trying to train more doctors so that the country can reach a doctor patient ratio of one to 650. At present, Malaysia has one doctor for every 1,400 people. Dr Chua says about 1,000 new doctors enter government service every year but another 350 doctors resign or retire as well. So, the net increase is only about 650 doctors each year. However, it is difficult for public universities to churn out a higher number of medical graduates because they are desperately short of teaching staff. Like public hospitals, public universities have also been losing large numbers of experienced staff to the private sector. Universiti Kebangsaan Malaysia’s medical faculty, for instance, lost 45 medical lecturers in the past three years. APHM is working out a deal with the ministry to allow former university lecturers who are now working in the private sector to lecture part-time in public universities. “They are willing to lecture part-time and this is our commitment to alleviate the shortage of lecturers at public medical schools. “The specialist skills of these doctors are not fully utilised in terms of their specific area of expertise,” says Dr Ridzwan.

He says the details will be worked out in a meeting between APHM and the Ministry on June 21. “Malaysia is unique in the sense that the public and private sectors are working rather independently of each other. “This has resulted in duplication of services and inefficient usage of resources. This is why the APHM is promoting private/public partnership.”

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Filed under: Uncategorized — malaysianmedicine @ 11:42 am

New pharmacy option at IMU

STUDENTS intent on pursuing pharmacy can now save costs as the International Medical University (IMU) is offering a degree programme that can be completed locally.

IMU’s Bachelor of Pharmacy (BPharm) is the first local pharmacy programme conducted entirely by a private institution to receive approval from the Higher Education Ministry.

Prof Peter Pook, dean of the school of pharmacy at IMU said: “We hope that the many students who missed the opportunity to pursue pharmacy at a public university would consider doing it at IMU.”

He added that tuition fees for the BPharm would be about RM100,000. “It is a cost effective programme as we are planning to charge RM13,000 per semester over eight semesters. The course can be completed entirely in Malaysia. The first intake is scheduled for July 21. IMU would be approaching the National Higher Education Fund Corporation (PTPTN) for approval of study loans.

“The BPharm is timely as there is a growing need for pharmacists to employ their unique knowledge and skills in direct patient care,” said Prof Pook. He added that the views of employers in the industry were taken into account in developing the outcome-based curriculum.

The Bachelor of Pharmacy programme is largely based on body systems and integrates the study of these systems in health and disease with the study of drug treatment.

Students will be systematically exposed to community, industrial and hospital pharmacy practice, culminating with extended clinical pharmacy attachments.

“A scientific ethos and rigour will be developed in the students as Semester 7 is devoted to research,” said Prof Pook. Core disciplines such as pharmacology, pharmaceutics, medicinal chemistry and microbiology are integrated with the study of human body systems in health and disease, health education and promotion, dispensing skills and behavioural aspects of practice. IMU has offered a pharmacy twinning programme since 1996 with the University of Strathclyde in UK and 400 students have graduated so far.

The Master of Pharmacy (MPharm) programme conducted with Strathclyde has been very successful with a large proportion of each graduating class achieving upper Second Class Honours. In recent years, the Anthony Macmillan Prize, the top award for the graduating year, has gone to an IMU student.

Intake for the BPharm programme is limited to 75 students and the minimum entry requirement for STPM holders is “B+, B+, B+” in any three science subjects while A-Level holders would need to have `BBC’ in any three science subjects. Matriculation holders would need a Cumulative Grade Point Average of at least 3.0.

The programme is also open to students with Australian Matriculation/Canadian Grade 12/13/ UEC and other equivalent qualifications. Students who meet the entry requirements must undergo an interview. The closing date for applications is June 30. Interested applicants can call 03-8656 7272/73, fax: 03-8656 1018 or e-mail: enquiry@imu.edu.my

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Filed under: Uncategorized — malaysianmedicine @ 11:41 am

Hospital gets go-ahead for liver transplant

KUALA LUMPUR: The Subang Jaya Medical Centre has been given the go-ahead for a liver transplant on a 15-month-old girl, following an assessment by the Health Ministry’s ethical committee that the prospective donor is genuine.

Health Minister Datuk Dr Chua Soi Lek said the committee concluded on Friday that the SJMC could proceed with the operation on Nur Atiqah Najwa Mohd Shariff.

He was responding to a report in a Malay daily yesterday that the infant was in a critical condition.

The report said that despite having a donor, Nur Atiqah’s surgery at the SJMC was delayed because of bureaucracy on the part of the ministry.

The report said her parents had collected enough funds to undergo the transplant but the ministry allegedly wanted to conduct a meeting on the case first as donor Ahmad Khairi Al Hadi, 27, was not related to the baby.

Nur Atiqah is suffering from biliaryatresia. Her condition was reported to be critical with her mouth foaming and her stomach swelling yesterday.

She was reportedly given sleeping pills to ease her pain.

Dr Chua said the SJMC referred the case to the committee last week for evaluation because, as a rule, all public and private hospitals had to refer such cases to the committee.

”We have to impress on the donor the risks involved and also ensure that the donor is not doing it for other reasons, such as for monetary gains,” he said after opening the Miss Fitness Malaysia 2004 in Genting Highlands last night.

Dr Chua noted that many countries, including Singapore, Britain and the United States, had ethical committees to prevent abuse of non-related donor for organ transplant.

“The committee is necessary to assess if the donor is genuine and not trading organ or tissue under economic or social pressure.

“However, the Health Ministry will review to see how the procedure can be shortened, perhaps to between three and four days,” he said.

Dr Chua added that under critical situation, a doctor could actually go ahead with the transplant while waiting for the application to be approved, provided there was clinical justification.

Responding to the same report in the daily, Prime Minister Datuk Seri Abdullah Ahmad Badawi said bureaucracy should not delay Nur Atiqah from undergoing a life-saving surgery.

Abdullah said that the delay should not have occurred because Nur Atiqah urgently needed the treatment and the family had collected enough funds. He added that he would contact Dr Chua on the case.

June 19, 2004

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Filed under: Uncategorized — malaysianmedicine @ 3:42 pm

Hospital hurt by low cash

KUANTAN: The Tengku Ampuan Afzan Hospital here has not been able to carry out blood tests for diabetes and several types of cancers in the past few months.

It was learnt that the reagents needed to carry out such tests had not been available due to “lack of budget”.

Patients are unaware, for instance, that the HBA1C, a test done to check the control of diabetes over a period of three months, is unavailable.

“The test is a routine one for all diabetic patients and such tests have been conveniently omitted without the knowledge of the patients each time they turn up for their check-ups,” according to a source.

This has disrupted the management of patient care in the public hospital.

The source revealed that the hospital had been equipped with the latest and most advanced equipment for blood assessments but without the reagents these machines were “white elephants”.

Certain tumour markers – to assess the progress of patients being treated for cancers of the ovaries (CA125), breast (CA15.3), nose or nasal pharyngeal (EBV), stomach (CA19.9), colon (CEA) and prostate (PSA) – are also not available.

Calls made to the hospital authorities drew comments like “we are not at liberty to give press statements as only the hospital director has the authority to do so”.

However, when the director’s office was contacted, his secretary said he would be away for a seminar in Fraser’s Hill followed by a visit to Pulau Tioman.

Calls to the hospital deputy director and deputy director of medical services also drew a blank.

The matter was relayed to state Health, Welfare and Orang Asli Affairs Committee chairman Datuk Ishak Muhamad about a week ago.

“I have enquired about the matter and was told that the ministry will take care of it,” he said.

When pressed, he said he would look into it again.

Checks with several private practitioners revealed that the cost for the HBA1C tests at private clinics cost about RM25 per test while each tumour marker costs RM60 or more.

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