Tuesday, June 29, 2004

Few of 128 scorers accept offers to medical schools

PETALING JAYA: Only a few of the 99 top scorers given places in private medical schools have taken up the offers despite the government’s favourable loan terms.

As of Sunday, the deadline for registration, the schools saw tepid response from the students, some of whom have opted to accept the initial offers of places to study non-medical courses at public universities.

However, all 29 of those offered places at public universities have registered for their courses.

Deputy Higher Education Minister Datuk Fu Ah Kiow was clearly upset that the students had rejected the offers because they were unhappy with the terms of the loan.

“Nowhere else can they expect a loan with the very low interest rate of 3% and a 15-year repayment period. We have also made it very clear that the loans may be converted into scholarships if their performance is equivalent to a first-class degree.

“The only thing we have yet to disclose is the classification of ‘excellent’ for medical degrees. However, this should not be a factor in their decision to accept or reject the places,” he said, adding that the ministry was in the midst of finalising the number of students who had accepted the offers.

Fu was speaking to reporters yesterday after witnessing the presentation of ISO 9001:2000 certification to the International University College of Technology Twintech.

Only four of the 50 students provided places in the Allianze College of Medical Sciences in Penang have accepted the offers.

The college's president and chief executive officer Datuk Dr Ishak Thamby Chik said 23 had rejected the offers while the other 23 had not even responded.

“It is very disappointing because everyone, from the Government to the colleges, has bent over backwards for these students. We turned away many other applicants because the ministry had asked us to accommodate these 50.

“We even sent out our offer letters by express post,” he said.

Most of those who rejected the offers, Dr Ishak added, wanted a guarantee that their loans would be converted to scholarships.

“How can they have a guarantee when they have not even started the course? If they want to study medicine so much, they should accept the offer and work hard for it to be made a scholarship,” he said.

International Medical University marketing and communications manager Ooi Lay Tin said students had delayed registering at the university because of uncertainty over the loans.

“A total of 17 students responded to our offer and passed our entrance interview. However, none have confirmed their acceptance as they are waiting for details on the financing,” she said.

At the Asian Institute of Medicine, Science and Technology, only two of five students have taken up the places offered.

“Another two rejected us and we have not heard from the fifth. I think the two who rejected our offers have decided to take up the initial offers to study Dentistry and Pharmacy at Universiti Kebangsaan Malaysia,” said an admissions officer from the college.

On another issue, Fu said the ministry had set up a committee headed by secretary-general Datuk Adham Baba to look at its role within the National Integrity Plan. He, however, declined to disclose further details as discussion was still at an early stage.

UMMC service a boon to organ transplants

KUALA LUMPUR: The University Malaya Medical Centre (UMMC) has developed and made available a service that will help improve Malaysia’s transplant programme involving major organs like kidney, heart and liver by identifying potential recipients according to risk.

The service involves measuring a potential recipient’s reaction to a type of protein, known as anti-human leucocyte antigents (anti-HLA), which is unique and different for each individual, much like a person’s fingerprint.

A computer can read the reaction between the potential recipient’s antibodies and the proteins.

Prof Dr S.Y. Tan, consultant nephrologist and transplant physician of UMMC’s Renal Unit said the measurement of these anti-HLA antibodies, also known as Panel Reactive Antibodies (PRA), is important as it helped to identify patients who have greater risk of rejection before and following a transplant.

“The most important and well-proven use of the PRA test is its ability to identify high risk patients who would then be given a higher ranking on the waiting list as the chances of finding a suitable matching donor is reduced compared to low risk patients,” he said.

Prof Tan
“There is also evidence that monitoring a patient’s PRA after transplantation could help identify patients who may subsequently develop rejection even when they have been classified as low risk prior to transplantation.

“It, therefore, is able to predict to some extent whether the patient will do well or not after a transplant because the main complication is organ rejection,” says Tan, who heads UMMC’s Renal Unit.

He said a major challenge for transplant physicians is the choice of drugs to be used to reduce rejection.

“Drugs which provide maximum protection against rejection, are, generally more powerful, more expensive, and may have more side effects. The use of such drugs, however, may be necessary and justifiable.

Medical insurers drop plan for policy-holders to bear part cost

MEDICAL insurers has dropped a proposal requiring medical policy-holders to bear part of the cost incurred in a medical treatment due to the improving claims ratio.

“We have decided not to purse with the proposal and it is now up to each company to pursue the plan on their own ,” said Sonny Tan, chairman of a joint committee on medical insurance.

The joint committee was represented by members of the National Insurance Association of Malaysia, General Insurance Association of Malaysia and Life Insurance Association of Malaysia .

Tan, who is also the deputy chief executive officer of Pacific Insurance (M) Bhd, said claims ratio had been brought down to about 70% in the first quarter of this year. Pacific Insurance is one of the leading medical insurers in the country.

The claim situation was better for individual medical policy but remain high under group policy, he said.

The improving claims ratio had enabled most insurers to break even or even make some profits, a big improvement from the previous year, he said.

Another factor which contributed to the marked improvement in claims ratio for medical insurance was the higher premium charges by insurers, following the approval by Bank Negara in April last year, he said.

Given the improving scenario, the joint committee had taken steps to make medical insurance more viable and accessible in the future, said Tan.

“We have met with the central bank last week to coordinate and standardise the term used in medical policy to ensure that policy-holders do not get confused about their insurance coverage,” he said.

The changes would take effect immediately and would ensure that policy-holders understand the protection they would receive for the amount of premium paid.

Monday, June 28, 2004

Jakim teams up with ministry to promote organ donation

MALACCA: The Department of Islamic Advancement (Jakim) has agreed to a request by a Health Ministry committee to get imam to talk on organ donation during Friday sermons.

Tan Sri Lee Lam Thye, who chairs the ministry's public education committee on organ donation, said Jakim had agreed in principle to this request after the panel sent a letter on the issue to the department in January.

He said the move would help increase the awareness of organ donation among Muslims.

Currently, Muslims make up just 8.9% of some 78,150 people who have pledged to donate their organs. Among the others, 66.3% were Chinese, 21.8% Indians and 2.9% others.

Jakim was drawing up the text of the planned sermon, which would be released to imam nationwide, Lee told reporters after launching an organ donation seminar at the Malacca-Manipal College here yesterday.

The committee would hold similar campaigns in rural areas, starting in Sepang, Selangor, in September.

A Jakim official from Putrajaya, Ustaz Asmawi Umar, said it was all right for non-Muslims to donate their organs to Muslims, and vice versa.

“There is no restriction on this,” he said.

A medical transplant co-ordinator, Dr Sahimi Sulaiman, cited the experience of Saudi Arabia in the field of organ transplants.

He said the Saudis started their programme in 1986 and over the next two years recorded 950 kidney donors, 165 heart donors and 163 liver donors.

Malaysia, which started organ transplants in 1976, only had 43 kidney donors and four heart donors up to 1988, he said.

Bio-piracy and law of jungle

HAVE you heard the story about the pharmaceutical giant and the delicate flowering plant? It is an oft-quoted tale but one worth repeating.

In the early 1950s, following clues from indigenous medicine men in Madagascar, researchers at Eli Lilly pharmaceuticals extracted two powerful cancer-fighting alkaloids from the rosy periwinkle: vinblastine and vincristine. Global sales of the two substances, patented by Eli Lilly, earned it hundreds of millions of dollars, but not a sen went to Madagascar or the medicine men.

A notorious example in a long history of such incidences, the rosy periwinkle case would today be termed bio-piracy. It put tropical countries, home to much of the world's biodiversity, on high alert and cleanly divided them from the developed countries, which had the capital and capability to turn resources like plants, into life-saving, money-making medicines. The divide has also marked India's long war to rescue extracts of neem and tumeric from being patented by biotechnology powerhouses who know it as a medicinal plant, not a part of life. Years after the end of Eli Lilly's patent, the rosy periwinkle story and others like it serve as cautionary tales for resource-rich countries competing for biotech dollars — countries like Malaysia. Earlier this month, Science, Technology and Innovation Minister Datuk Dr Jamaludin Jarjis met industry players at Bio 2004, the biotech industry's annual conference and exhibition.

He was part of the Malaysian delegation to San Francisco, looking to attract possible partnerships in the field and investments in Malaysia.

The companies that did show an interest were the world's biggest biotech group, Amgen, another pharmaceutical giant, Chiron, and Novartis, which ranked seventh on the US Top 10 Sellers of Prescription Drugs in 2003.

Among resources on offer to investors were excellent facilities at competitive rates, support agencies, a strong information-technology base and our tropical rainforest.

The offer of such a precious and depleting resource seemed the sort of thing that should make us dizzy with paranoia but apparently not, says Forest Research Institute Malaysia director-general Datuk Dr Abdul Razak Mohd Ali.

Taking a practical view to things he says, we are already losing such resources to thieves masquerading as tourists, who pick up a leaf or shoot and take it home for testing. "That's all they need. They don't need a kilo." Furthermore, FRIM has long been receiving requests for samples, from institutions with offers of payment, but FRIM has refused. "If they (the institutions) discover something and patent it, we would stand to lose a lot.

"It is better to bring them here in an organised manner, sign good agreements and have our researchers participate in the project." Technology Park Malaysia's chief executive officer Datuk Salleh Ismail thinks along the same lines. He believes setting up a biodiversity centre in Raub to bio prospect and conduct research, is just about being systematic and organised.

Located within minutes of a tropical forest reserve, the centre will have a resource centre, herbarium, offices for research and development activities and on-site laboratories for analysing and processing samples.

Research here will be focused on rare medicinal plants, particularly those reputed for their anti-cancer properties. About 12 have been identified and research will soon begin, says TPM.

In the near future, the centre could be opened to expeditionary scientists, both local and foreign, to utilise it as a base out in the fields, while they conduct key research. Are we declaring open season on our genetic resources? Salleh was asked, and he said "no".

"Drug discovery no longer means going down the jungle track. For big research institutions, it is all about work in laboratories.

"Malaysia though, must also not miss the opportunity to explore the treasures for ourselves." Salleh concedes that things could go wrong but says that not all scientists are thieves.

TPM will require institutions carrying out research at Raub to sign agreements and register each sample they take out of the forest. He adds that TPM, already big on biotech research, will carry on with its programmes whether foreign researchers come or not, he says.

At the Raub centre, TPM researchers will have help from indigenous people. A storehouse of information on the healing power of herbs, the history of drug discovery is replete with stories of their knowledge being sought but rarely compensated.

This traditional knowledge system is not recognised by existing laws, says University of Malaya law lecturer Gurdial Singh Nijar. Co-editor of Indigenous People's Knowledge Systems and Protecting Biodiversity, Gurdial says allowing corporations to use this knowledge and own it with intellectual property rights means marginalising alternative knowledge systems.

The knowledge, he points out, is as essential as the plants and herbs are. One is useless without the other. Recognising it in law, ensures it is preserved.

Another concern raised following Malaysia's offer to foreign biotech firms, was that Malaysia is without a national biotechnology policy.

In an exclusive interview with New Straits Times last week, Jamaludin assured that one such policy was in the works. However, pulling in investors before setting down goals and strategies, raises the question of whether we know where we are headed and how we want to handle problematic issues.

"We need this policy," says Third World Network's Chee Yoke Ling, "and the public should have a chance to comment on it." Have we considered how we want to deal with issues of bio prospecting, safeguarding of traditional knowledge and possible mishaps from the use of biotechnology? Chee asks.

She also expresses concern about a lack of key legislation like a Biosafety Act and an Access and Benefit Sharing Act that would address environmental and health problems as well as economic loss that could arise from venturing into biotechnology.

Even the Convention on Biological Diversity stresses the importance of domestic legislation. Enacting laws to govern resources is one way host countries can control foreign access to their genetic resources.

This is especially so when it comes to working with US-based firms, because the country is not a signatory to the convention.

But the greatest doubts raised thus far is whether we are operating on the wrong assumption — that everything we touch in the forest will instantly turn to gold.

On making money out of biotech, an Associated Press report on Bio 2004 quoted economist Joseph Cortright as saying that luring biotech in the hope of saving a community's economy, is a laughable notion.

He explained that San Francisco, host to the conference and the centre for biotech in the US, finds industries concentrated there because of the built-in venture capital community, vibrant academic institutions and highly educated workforce. They cluster around universities and each other, so they could easily swap technology and scientists, making it difficult for other regions to launch such industries from scratch.

But for all its promise, said the report, the biotech industry has lost a combined US$40 billion (RM152 billion) since its inception in 1976. Last year, it lost US$5.4 billion, said an Ernst and Young study.

Combined annual revenues of the biotech companies were about US$30 billion. That's the same amount a single pharmaceutical giant — Pfizer Inc — took in last year.

The performance of our own Bio Valley has also been less than spectacular. Reports in April showed that only three companies had signed up to establish plants there thus far. "There is a lot of disquiet about the biotechnology industry among consumers and business," says Gurdial.

He wonders if we are not going down the same road as we did with rubber and tin: inviting big corporations, which will use up the resource and leave or like many other industries, fall because a cheaper production centre has opened elsewhere.

"Are we using the tried and failed formula of competing with every other Third World country for the limited amount of foreign direct investments available? We must be cautious not to be seduced by promises," he cautions.

It is obvious that Malaysia is pinning its hopes on biotechnology. The sector was identified as the new wealth-generating technology under the Eighth Malaysia Plan.

Chee asks if anyone has done an economic viability study on the biotech industry and this is a valid question, considering that on a global scale, all is not well for biotech.

The landmark 1991 bio prospecting between pharmaceutical giant Merk and Costa Rica's National Institute of Biodiversity ended in 1999 after the failure to produce a single commercially viable drug, The Scientist reported last year.

Painful proof that not every herb and tree turns into a money-spinner.

The term "stiff competition" is an understatement in this industry. It has to be when authorities offer to change adjust parking requirements to suit the needs of biotech investors.

Governors and mayors from across the US were offering this in addition to tax breaks, government grants and help in securing permits at the same convention in which Malaysia was wooing investors.

In a battle like this, says Chee, it may come down to a race of who can give away more, namely give up rights over valuable resources.

Already, Razak warns against Malaysia being too strict with regulations. Investors can go elsewhere. Intellectual property lawyer Teoh Bong Kwang also feels legislating access and benefit-sharing may inhibit the growth of the industry. It should be in the form of agreements.

So, will we be left doing the ground work and simply facilitating things for the big firms? Will the greatest draw end up with these firms having being access to our genetic resources? Salleh says, this will not happen. He is confident that if we can create a more efficient system, consolidate research facilities and invest in bright minds, we have every chance of making inroads into the admittedly tough arena.

But both Salleh and Razak say that Malaysia does need to look into the nuts and bolts of the system, look beyond building facilities. We need a centralised mechanism for permits, a one-stop application processing centre, patent lawyers who understand both science and the law in order to ensure we get a fair deal in research agreements.

More importantly, we need to boost funding, manpower and equipment of agencies that are already doing good work; agencies like FRIM, Mardi, the Institute for Medical Research and scientists in all our universities, says Razak.The Government has also got to start dealing with the difficult issues and public concerns regarding biotechnology, says Chee.

As society advances, they will be confronting administrators and legislators with ethical questions about biotechnology, questions about genetically modified foods, privacy issues with regards to personal genetic data, clinical trials and cloning.

They have to be able to discuss these issues with a citizenry that is growing more informed by the day and yet remains deeply religious and traditional in many ways.

By all means, let's get onto the biotechnology bandwagon, but let's us do so with a well-thought-out plan and our eyes wide open.Considering all we know, it would be tragic if Malaysia ends up as the next unfortunate example everybody cites.
Tongkat Ali and pegaga go international with patent awards

Tongkat Ali, a herb known to almost every adult in this country, may be the choice of treatment for male infertility and sexual dysfunction by the French, Mexicans or the Finns in a few years.
Research on Tongkat Ali and another common herb, pegaga, has resulted in three international patents for Malaysia, including one that could eventually see extracts of these herbs in pharmaceutical preparations abroad. The three inventions by the Malaysia-Massachusetts Institute of Technology (MIT) team have been patented in the United States, Europe, Japan and Malaysia since research on the herbs began in 1999, said Forest Research Institute of Malaysia (Frim) director-general Datuk Dr Abdul Razak Mohd Ali.

The patents are jointly held by the Malaysian Government and MIT. All benefits arising from the royalties will be shared by the Government and the MIT-Malaysia team.

Frim hopes to complete all its basic research and development work by 2006, after which efforts to commercialise discoveries will begin.

The Malaysia-MIT Biotechnology Partnership Programme is an effort between MIT and researchers from the Malaysian Agriculture Research and Development Institute (Mardi), Universiti Sains Malaysia, University Malaya, Universiti Kebangsaan Malaysia, Universiti Putra Malaysia, Institute for Medical Research, Standards and Industrial Research Institute of Malaysia (Sirim) and Tropbio Sdn Bhd, a private research company.

Frim is the implementing agency and the National Biotechnology Directorate, the designated authority of the project.

Funded by the Government, the programme on natural product discovery focuses on two common local medicinal plants — Centella asiatica (pegaga) and Eurycoma longifolia (Tongkat Ali). Tongkat Ali is traditionally used as a general tonic to treat high blood pressure, tuberculosis, fever, diarrhoea, jaundice and dysentery. It is widely believed to have aphrodisiac properties. Pegaga is traditionally used to treat high blood pressure, fever, toothaches and to improve memory. In Kelantan, it is used to treat malaria.

Patents procured under the programme cover:
* The process of isolating asiatic acid from pegaga (Malaysian patent #: PI 20003987). Initial studies have shown the acid to be effective in inhibiting cell proliferation, in particular, cancer cells.
* The bioactive fraction of Eurycoma longifolia (Malaysian patent PI 20003988). Trials have shown the bioactive fraction to be suitable for the treatment of male infertility and sexual dysfunction.
* The genetic markers for Eurycoma species (Malaysian patent PI 20031565). This invention features methods of identifying which Tongkat Ali plants have the desired characteristics. It can also be used to differentiate the various Tongkat Alis in a country.
The second phase of the programme beginning this year, will see advanced research and development of Tongkat Ali, leading towards product discovery, said Razak.

Scientists will also begin studying its anti-malarial and aphrodisiac properties during this phase.

To address the critical issue of irregular supply of Tongkat Ali plant in the wild, Frim has embarked on a cultivation project.

Sunday, June 27, 2004

More nursing schools coming up

MUAR: More training centres for nurses will be built to overcome a shortage of some 6,000 nurses in government hospitals nationwide.

Health Minister Datuk Dr Chua Soi Lek said the plan was being looked into following the additional allocation announced by Prime Minister Datuk Seri Abdullah Ahmad Badawi.

The ministry would also use its allocation to improve health facilities in rural areas, he told reporters after opening the Muar MCA division general assembly here.

Dr Chua said: “In the Eighth Malaysia Plan, the ministry received about RM9.5bil in allocation but there were projects not carried out. We hope that with the additional allocation, we will be able to do so.”

He said the ministry would also focus on building more health clinics in Sabah and Sarawak and on improving health related facilities in rural areas.

“We will not use the additional allocation to build new and bigger hospitals as our aim is to improve health facilities and outpatient departments throughout the country,” added Dr Chua.
More bite needed to ensure clinical trials meet high ethical standards

SCIENCE and Technology Minister Datuk Jamaludin Jarjis announced last week that pharmaceutical companies in the US are interested in conducting their clinical trials in Malaysia.
And Malaysia, in return, has offered these companies excellent facilities at competitive rates. Clinical trials have always been plagued with issues relating to unethical and illegal trials, especially in countries without ethical approval or where legislation may either be inadequate or not implemented.

In India, for example, an independent pharmaceutical journal, Monthly index of Medical Specialities in India, reported that last year local generic drug firm, Sun Pharmaceuticals, had tested an anti-cancer drug on 400 women without their knowledge, to see if it induced ovulation. The drug, a copy of Novartis' patented drug Letrozole, was prescribed to women who were trying in vain to have children.

The Letrozole trial is one of the many shocking examples of the extent drug companies would go to. A survey by the US National Bio Ethics Advisory Commission of more than 200 health researchers found that about 25 per cent of clinical trials conducted in developing countries do not undergo ethical review. The findings of the survey were published in the February edition of the Journal of Medical Ethics.

In Malaysia, though there is no legislation governing clinical trials in Malaysia, there is, however, the Guidelines For The Application to Conduct Drug-Related Clinical Trials in Malaysia.

Under the guidelines, principal researchers must have Good Clinical Practice Certificate approved by the National Committee for Clinical Research, says deputy director-general of Health Datuk Dr Ismail Merican. Dr Ismail, who also heads the Ministry of Health's Medical Research Ethic Committees, says the ministry is also trying to establish National Ethics Board to especially look into clinical trials on human subjects.

"Clinical trials are getting more complicated and there is an urgent need to not only safeguard the rights of human subjects, but also to ensure that trial data is credible and valid." The ethical committee of the ministry monitors clinical trials in government hospitals. Private hospitals, on the other hand, need to have their own committees for clinical trials in their hospitals. "The private hospitals, however, must disclose the composition of their ethical committees to ensure that there is some one to safeguard the interest of the human subjects." Nevertheless, Dr Ismail says, the guidelines alone aren't sufficient without the means to enforce them. "If researchers were to breach the guidelines, the most we can do is to blacklist them." He calls for legislation to regulate clinical trials conducted by foreign companies in Malaysia. "The current regulations do not have the bite," says Dr Ismail

Saturday, June 26, 2004

Smoke from Indonesian fires stirs fear of health and economic crisis

Government officials are warning of a potential new health and economic crisis as a blanket of smoke haze from uncontrolled forest fires in Indonesia spreads across neighbouring Malaysia and Singapore.

The haze this week shrouded Kuala Lumpur and its Petronus twin towers, and large areas of peninsular Malaysia, delaying flights and forcing authorities to consider shutting schools.

In Singapore, an acrid pall enveloped the entire island, and ships in the Straits of Malacca, one of the world's busiest sea lanes, were instructed to use their navigational lights.

Satellite images identified 293 fire hotspots across Sumatra on Thursday, compared with 33 on Tuesday. Malaysia's Environment Ministry warned that haze levels could surge this weekend, depending on prevailing winds.

Environmentalists fear a reprise of the 1997-98 crisis when illegal land clearing in Indonesian Sumatra and Kalimantan burnt out more than 10 million hectares and caused about $A14 billion in economic losses.
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The severe haze triggered a wave of respiratory illnesses across the region, and the United Nations Environment Program estimated that 20million people were exposed to harmful levels of pollution.

Malaysia is demanding a meeting of regional officials to combat a problem it blames on the failure of Indonesian authorities to control village farmers slashing and burning forest areas to plant oil palm and other cash crops.

The Government-controlled Straits Times newspaper in Singapore yesterday criticised the failure of Indonesia to control the fires despite tough new forest protection laws.

"Weak enforcement and its corollary, corruption to circumvent the law, have to be suspected. It is reasonable to ask if the real problem is a vicious conjoint of liberal forest cutting and non-existent policing," the paper said.

But Indonesia's Vice-President Hamzah Haz said Malaysia and Singapore shared the blame for supporting unlicensed logging that was destroying forests across Indonesia.

"There are lots of illegal logs that get smuggled out of here to Malaysia and Singapore. They have to acknowledge their responsibility in this. So they have to help us, so that we won't create the smoke and haze."

Malaysian authorities will not publish air quality statistics because of concerns about the economic impact if tourists are turned away.

The Deputy Prime Minister, Najib Razak, defended the secrecy this week and said undue publicity could worsen the economic impact of the haze.

Friday, June 25, 2004

Promote health tourism, private hospitals urged

Kuala Lumpur: Health Minister Datuk Dr Chua Soi Lek called on private healthcare institutions to assist the Government to promote the country’s health tourism sector.

He said these institutions could, among else, set an international benchmark to gain confidence of foreigners to obtain medical and other healthcare services in Malaysia.

“If possible, private hospitals should co-operate with the insurance sector to enable foreigners treated here to obtain insurance cover.”

He told reporters this after opening the 12th International Healthcare Conference, organised by the Association of Private Hospitals Malaysia (APHM), here, Thursday.

Dr Chua said apart from a special unit set up by the Health Ministry to promote the country’s health tourism sector, the Tourism Ministry had agreed to organise roadshows in several West Asian nations and China.

“The co-operation framework has been agreed and I have requested the Tourism Minister to hold a meeting to facilitate implementation and avoid overlapping of work,” he said.

Dr Chua said over 100,000 foreigners sought treatment at private hospitals last year, earning the country some RM67 million in foreign exchange.

He also said the Health Ministry had initiated several measures to improve healthcare services in public hospitals.

This included reducing the waiting time for patient registration, consultation and dispensing of medication by half and improving counter registration through the use of information and communication technology.

Dr Chua said the other initiatives were to set up special clinics for patients with cardiovascular diseases like diabetes and hypertension, special counters for senior citizens, pregnant women and the disabled.

He said government doctors were encouraged to serve at accident and emergency units in public hospitals after their working hours for which they would earn RM30 an hour.

“The Ministry is negotiating with private doctors for them to voluntarily serve at public hospitals as part of their social obligations,” he said.

Dr Chua said the outpatient charges for foreigners at public hospitals had been increased from RM2 to RM15 except for workers in the plantation sector and the specialist fees raised from RM5 to RM60.

“This is to encourage them to seek treatment at private hospitals and reduce the burden at government hospitals,” he said.

He said public hospitals treated 48 million outpatient cases last year. - Bernama
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.


Wednesday, June 23, 2004

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.

Tuesday, June 22, 2004

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.
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.

Sunday, June 20, 2004

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.
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.

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."
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

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.

Saturday, June 19, 2004

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.
Queue in hospitals report completed

JOHOR BARU: The report on ways to reduce waiting time in hospitals has been completed and will be tabled in the Cabinet at the end of this month.

Health Minister Datuk Dr Chua Soi Lek said he would disclose the details including the recommendations after presenting the report to the Cabinet.

“Let the Cabinet have the report first, then I will make public the necessary details,” he said after visiting Sultanah Aminah Hospital here yesterday.

Dr Chua said a special committee headed by Deputy Health Minister Datuk Dr Abdul Latiff Ahmad had compiled the report.

On the recently completed Sultan Ismail Hospital in Pandan near here, Dr Chua said it would be fully operational next year, and that only the haemodialysis unit was opened now.

After opening the SK Felda Tenang Parent-Teacher Association's annual general meeting in Labis, Dr Chua said between 50 and 100 doctors and specialists from Myanmar would be hired soon to overcome a shortage of medical officers in public hospitals and clinics.

He said he would go to Myanmar soon to discuss the recruitment plan with authorities there.

He said the ministry could hire 1,124 foreign doctors and specialists and it had currently recruited about 630.

On another matter, Dr Chua confirmed beef sold locally were now free from beta-agonist, a banned growth stimulant.

“The chemical is only found in pork as breeders had wrongly used it to reduce fat content. The Government has told them to stop using it immediately.”

Thursday, June 17, 2004

New entrance procedure for top scorers

KUALA LUMPUR: A three-tier admission procedure is likely to be introduced for top scorers intending to further their studies in critical courses in public universities.

Higher Education Minister Datuk Dr Shafie Mohd Salleh said that for a course like medicine, qualified students might be taken on hospital visits and made to undergo interviews to gauge their aptness for the profession.

“We want to be sure that the student will make a good doctor, not only academically but also in his or her attitude towards people,” he told reporters after chairing his ministry’s post-Cabinet meeting.

Dr Shafie said that only students who passed the visit-and-interview phase would be asked to sit for a proposed Medical School Admission Test.

This was as among the proposals he presented to the Cabinet yesterday to avoid a repeat of this year’s situation where 128 top scorers were denied places for courses of their choice in public universities.

Dr Shafie said a ministry committee would be set up to study this and other proposals.

Another area that would be looked into was the welfare of medical teaching staff, including their workload, promotion system, salaries and staff management system.

Also to be studied by the committee are the facilities in public universities, the promoting of studies in other critical courses such as bio-technology and physiotherapy and the development of a symbiotic relationship between the Higher Education Ministry, Health Ministry and Public Services Department (PSD).

Dr Shafie said of the 128 top-scoring students, 99 had been offered places in private universities and the remainder in public universities.

On the criteria for the 99 students to qualify for convertible loans offered by the PSD, he said they would have to obtain first class honours or equivalent for the loans to be converted into scholarships.

Asked about the fate of the PSD scholars whose Japanese medical degrees were not recognised by the Malaysian Medical Council (MMC), Dr Shafie said that the Cabinet had agreed that they would have to undergo a six to 12-month training stint at Universiti Sains Malaysia (USM).

“The students were first asked to undergo training in UKM (Universiti Kebangsaan Malaysia) but it has no space,” he added.

Meanwhile, the Japanese embassy here has expressed surprise over the MMC’s non-recognition of medical degrees from two universities that are highly sought after in Japan.

The two universities, Chiba and Akita, have very strict entry requirements and even Japanese students found it difficult to qualify for their medical schools, the embassy’s First Secretary for Education Koji Takahashi said.

“We are very surprised. We do not know the details why the degrees are not recognised while there are government-sponsored students there.

“We are contacting the PSD to find out more,” he said in a telephone interview.

Meanwhile, the Japan Graduates’ Association of Malaysia has called on the government to recognise more Japanese degrees.

It said in a statement that based on a list published by the PSD in 2002, the medical degrees of only 10 Japanese universities were recognised by the government and MMC.

Wednesday, June 16, 2004

Lawyer: Doctors must talk to patients

KUALA LUMPUR: Doctors should be taught to communicate with their patients to minimise allegations of “wrong treatment” and negligence suits against hospitals and their staff, said a committee member of the Asean Law Association of Malaysia.

Association honorary secretary S. Radhakrishnan said: “Communication between doctors and patients is as important as a doctor’s ability to diagnose.”

“Medical schools should emphasise this, apart from medical excellence,” he said at a press conference after Irish Ambassador Daniel Mulhall launched a seminar on Legal Issues in Medical Law: Strategy for the Future yesterday.

Radhakrishnan, who has been defending doctors in negligence suits for 25 years, said non-communication and unsatisfactory explanations were among the factors that contributed to negligence suits.

He said many patients told him that they were not informed about what had gone wrong in a medical procedure.

“Doctors have the highest string of post-graduate qualifications but they don’t talk. So, patients rather sue the doctor to find out.”

Radhakrishnan also noted that many doctors were reluctant to talk because they did not have the time and they believed that “they knew what was best for their patients.”

He said doctors should provide sufficient information to help patients make informed decisions.

He pointed out that although there were no proper statistics on negligence suits against those in the private practice, records from the Health Ministry showed that between 18 and 20 negligence suits were filed against government hospitals in 1999.

On a proposal by Health Minister Datuk Dr Chua Soi Lek for doctors in private hospitals to serve several hours in government hospitals to ease the shortage of personnel, Radhakrishnan said studies should be done to find out why there was an exodus in the first place.

“There should be concrete steps taken to resolve problems faced by doctors, specialists and other medical personnel and to find out why they leave the public sector after 15 years of service instead of introducing ad hoc suggestions,” he said.

Association of Private Hospitals of Malaysia (APHM) honorary secretary Datuk Dr Jacob Thomas said the association was ready for talks to see what could be worked out.
Rural doctors

THE Health Ministry is banking on the desire of many senior doctors to continue working past the mandatory retirement age to provide partial relief to the doctor shortage which has hit rural Malaysia the hardest.

Indeed, many are in their prime and are not broken-down old horses ready to be put out to pasture. The Health Minister says 34 retired doctors have already accepted re-employment in rural health centres and hopes to persuade even more to follow in their footsteps. However, unless country life rather than city living is their old-age idyll, and they have established roots in rustic communities, it remains a moot point whether the pastoral charms of rural medicine will prevail over the pragmatic enticements of urban private practice. In the Malaysian medical scene, when doctors decide to move, it has always been in the direction of the private sector and to towns and cities. There has been a steady and continuous exodus at the rate of one doctor per day for the past 10 years.

What this means is that while there has been no shortage of stop-gap measures — hiring retired doctors and foreign doctors, getting private practitioners to put in a number of hours in government clinics, etc — these will be insufficient to mitigate the losses, let alone replenish the stock. It is not because we are not training enough, although, of course, we need to increase the number of medical students. The fact is we don’t pay government doctors enough. The antidote to the haemorrhage lies in a pay-and-perks package potent enough to immunise them against the allure of the private sector and strong enough to attract and retain them in public service.

Tuesday, June 15, 2004

Chua: Private doctors must volunteer and not just talk

KUALA LUMPUR: Private medical practitioners should not pay mere “lip service” in helping to resolve the shortage of doctors in government hospitals, Health Minister Datuk Chua Soi Lek said.

He said these doctors should offer their services to the public sector, just as they had pledged during a dialogue with the Association of Private Hospitals Malaysia here last week.

“At the meeting, the doctors said they were willing to help in public hospitals, but I hope there will be more this time. When we asked for their services three years ago, only eight doctors came forward,” he said after launching the inaugural World Blood Donors Recognition Day at the National Blood Centre here yesterday.

Dr Chua said private hospitals had 8,000 doctors and 9,000 beds, as compared to the public sector’s 9,000 doctors and almost 32,000 beds.

“There are 8,000 doctors in the private sector and if each doctor can spend two hours per day (in government hospitals), that will amount to 16,000 hours or over 500 working days,” he said.

He also said the ministry would introduce a mechanism to overcome the shortage of nurses and medical support staff in public hospitals.

“Doctors in private service complained that there was a lack of nurses and medical support staff in public hospitals and that was why they were reluctant to offer their services there,” he said.

There are now over 20,000 vacancies in public hospitals, which include positions for 3,300 doctors, 5,000 nurses, 700 medical specialists, 600 pharmacists and 500 dentists.

Earlier, the minister presented awards to 16 frequent blood donors and 17 blood donation campaign organisers.

Dr Chua said blood donations in the country had increased by almost 110% since 1992, from 202,241 units to 423,046 units last year.
Move to overcome shortage of doctors and varsity places

KUALA LUMPUR: Russia has offered to help Malaysia overcome the shortage of doctors and places for medical courses.

For a start, the Russian Government is seeking recognition for medical degrees from 10 more of its universities.

The country, where about 1,000 Malaysian students are currently studying medicine, has also offered the services of its medical professors and lecturers to overcome the shortage of academic staff and doctors in the public sector.

Its Ambassador to Malaysia Vladimir Morozov said his government has submitted a request for Malaysia to recognise the degrees from 10 more of its universities.

“It is well known that Malaysia needs more doctors and is trying to expand the medical courses offered by local institutions to meet the increasing demand for places.

New students registering themselves at Universiti Sains Malaysia in Penang on Sunday. Thousands of students and their family members had arrived early morning for the big day. It was the same scene at all the universities throughout the country.
“Russia has the expertise to help and we are ready to do so,” he told The Star.

Last week, officials from the Moscow University of Friendship were here to promote its medical programme.

The Public Service Department at present recognises five Russian medical institutions – the Moscow Medical Academy, Russian State Medical University, Nizhny Novgorod State Medical University, Volgograd State Medical University and Kursk State Medical University.

Morozov said Russian medical insti-

tutions were noted for their high quality education, with the World Health Organisation and Unesco rating the Moscow Medical Academy and Russian State Medical University as among the best in the world.

There are now over 1,000 Malaysians studying medicine in Russia, from the initial batch of 100 in 2001. The cost of studying for a six-year Russian medical degree ranges between RM130,000 and RM180,000, compared to between RM500,000 and RM800,000 in other countries.

English is the medium of instruction for medical degree programmes in several Russian universities, but students need to be able to speak Russian by their fourth year.

Morozov said several Russian institutions were also interested in setting up medical faculties here, adding that the Nizhny Novgorod State Medical University was one of them.

“Our medical professors and lecturers are ready to offer their services here. We are prepared to discuss terms for Russian doctors to come and fill vacancies at hospitals here,'' he said.

Responding to the offer, Health Minister Datuk Dr Chua Soi Lek said his ministry was willing to recognise more medical degrees from Russian universities if they fulfilled the criteria set by the Malaysian Medical Council (MMC).

Dr Chua said the strict criteria maintained by MMC were to ensure that Malaysian doctors would also be recognised internationally.

He also advised students to consult the MMC and the ministry to verify the status of the degree courses before venturing overseas.

Malaysian Medical Association (MMA) president Datuk Dr N. Arumugam said the Russian universities must go through the processes stipulated by the ministry and MMC before they could be considered for recognition.

“They not only have to fulfil the criteria set by Malaysia but the courses offered must also be checked for quality or be integrated with local courses.”

Dr Arumugam said the Russian universities must also match the quality of courses offered in local universities to ensure graduates were of high standard.

Russia's honorary consul (Northern Region) Teoh Seng Lee, whose company Russian Resources Sdn Bhd represents four of the recognised Russian medical universities, said he had so far sent about 600 Malaysian students to the universities.

Almost all the students gave positive feedback on their Russian experience, he said, adding that about half of them were straight A students sponsored by the Malaysian Government.

Monday, June 14, 2004

Place doctors under a special scheme

KUALA LUMPUR: To address the perennial problem of shortage of doctors, the Government must follow the basic rule — keep your employees (doctors) happy! This should be the "bottom line", a private medical practitioner said concerning the on-going debate between the private medical fraternity and the Health Ministry over the latter's call in requesting doctors to serve several hours weekly at government hospitals.

"For a start, doctors must be looked at as a special entity and not lumped together with all the other government servants," he said.

"Besides, there must be a scheme in place to match their expertise and needs so as to keep them productive and long enough in the service.

"Remember, doctors, though being civil servants, have a market outside. So pay them the market's worth and keep them happy, or the market outside will lure them." He said that resorting to ‘cliches‘ like the mere Hippocratic oath, mandatory three-year service (excluding one year's housemanship), serving for suffering humanity and now compulsory service when renewing doctors Annual Practicing Certificate (APC), would mean the issue is not looked at from the whole perspective.

"So what you get in the end is a shortage of doctors, which has always been a perennial problem. It is simply that human resources (doctors) have not been managed well all along," said the doctor.

It was reported recently that Health Minister Datuk Chua Soi Lek had proposed that doctors from the private practice offer their services for a few hours on a weekly basis at government hospitals to address the problem of shortage of doctors and the lack of medical lecturers at government institutions.

Dr Chua also said the Ministry will study the feasibility of some 8,000 private doctors serving and providing training at government hospitals as a pre-requisite for renewing their APC.

However, said the Minister, the plan would only be carried out if the call for doctors in the private sector, especially in hospitals and polyclinics to come forward to help the government in providing training and offer their expertise, received a lukewarm response.

Meanwhile, another doctor said no amount of dialogues and meetings will bring about a change, unless the government backed the doctors with benefits that would ensure their welfare was not overlooked.

"Doctors are willing to serve the government as they also get to see a variety of cases, but their welfare must be ensured," she said.