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August 2016

Berita MMA Vol. 46 No. 8


(For Members Only)

PP 1285/02/2013 (031328)

P E R S A T U A N

P E R U B A T A N

M A L A Y S I A

Vaccine
Hesitancy

MALAYSIAN

MEDICAL

ASSOCIATION

MMA EXECUTIVE COMMITTEE


2016 2017
President
Dr John Chew Chee Ming
president@mma.org.my

Contents

ExCo
4

Editorial

Presidents Message

Immediate Past President


Dr Ashok Zachariah Philip
pastpresident@mma.org.my

MMA Oration 2016

President Elect
Dr Ravindran R. Naidu
president_elect@mma.org.my

14

From the Desk of the Hon. General Secretary

15

Letter from the President MMA

20

MMA Committees

Honorary General Secretary


Dr Koh Kar Chai
secretary@mma.org.my
Honorary General Treasurer
Dr Rajan John
treasurer@mma.org.my
Honorary Deputy Secretaries
Dr Edwin Leo Suppiah
edwinleodr@gmail.com
Dr Saraswathi Bina Rai
binarai@yahoo.com
SCHOMOS Chairman
Dr Vasu Pillai Letchumanan
schomos@mma.org.my
PPS Chairman
Dr Muruga Raj Rajathurai
pps@mma.org.my
Editorial Board 2016 2017
Editor
Dato Pahlawan Dr R. Mohanadas
genmohan@gmail.com
Ex-Officio
Dr Koh Kar Chai
secretary@mma.org.my
Editorial Board Members
Assoc Prof Dr Jayakumar Gurusamy
drjkumar6@gmail.com
Dr Gayathri K. Kumarasuriar
gsuriar@yahoo.com.sg
Dr Juliet Mathew
drjuliem@hotmail.com
Prof Dr M. Nachiappan
drnachi611@gmail.com

Lead Article
24

Vaccine Preventable Diseases

SCHOMOS
28

Flying Doctor Services in the Land of Hornbills

General
30

Happy 90th Birthday Tun Dr Siti Hasmah

34

Humour

MMA in the Press


35

MMA Now Seeking Clarification

Branch News
38

MMA Penang Awards 2016

40

MMA Sibu Badminton Championship, 2016

Letter to the Editor


42

The Ideal Healthcare System

46

Mark Your Diary

Publication Assistant
Ms Thogaimalar Selvarajan
publications@mma.org.my
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ISSN 0216-7140 PP 1285/02/2013 (031328) MITA (P) 123/1/91
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beritaMMA Vol.46 August 2016

exco editorial

Dato Pahlawan Dr R. Mohanadas


genmohan@gmail.com
Editor

Kabali the movie!

hope I will not be slighted for writing an Editorial that is


unusual for a Newsletter of a professional organisation
as the MMA. However, I take courage from two events
related to the Indian Superstar Rajinikanth and KABALI!

In November 2015, I was amazed listening to our TV


Parliament Report, YB Dato Seri Abdul Azeez, the Member
of Parliament (MP) for Baling, with the blessings of the
Speaker of course, narrating the virtues of Rajini in his
movie BASHA. For a good five minutes almost, speaking
with the style and gaya of Rajini, the MP told the story,
partly in Tamil, of BASHA the gang leader who got himself
reformed into a Robin Hood style samaritan, and helped
the downtrodden. Amidst laughter and in passing, he
stated he could be considered Malaysias BASHA!
Now, to Rajinis latest movie KABALI, it made its debut
in Malaysian cinemas on 22 July 2016. The premier show
was held on the eve, Thursday 21 July and guess who
launched it? Our own Health Minister, YB Datuk Seri Dr S.
Subramaniam, (more in his capacity as the MIC President, I
believe). Whatever, I am taking cover through the above
two incidents in writing this Editorial.
I am not a regular movie-goer, in fact I hardly do. My last
movie was in 2005 at Melaka. I was staying at the Century
Mahkota apartments and the cinema was across the road
at Mahkota Parade. My good friend Datuk Athimulam
wanted me to buy two tickets for Aishwarya Rais movie
Jeans, just as well, I joined him.
On the morning of 21 July 2016, I had a pleasant surprise.
I received two invitation cards for the premier show from
a former colleague, Tan Sri Datuk Dr Mohan Swami, who
happens to be a close friend of Rajini. The premier show
was screened at the 60-year-old Federal Cinema on Jalan
Ra Laut, Kuala Lumpur.
Raja
What is so special about KABALI? Why such publicity? The
moviie was shot mainly in Malaysia, with
wit
ith Kollywoods
Ko
ollyw
ywoo
o ds icon
on
movie
Ra
ajini, the
the second
se
acto
or in
in Asia
Asi
sia
a (next
(nexxt only
only to
to
Rajini,
highest paid actor
Jack
Ja
c ie Chan)
Cha
han)
n playing
pla
laying the lead
d role
ro
ole of
of a Malaysian
M lays
Ma
ysia
ian
n Indian.
Indi
In
Indi
d an.
Jackie
A ot
An
otherr first
rst ffo
or th
this mov
ovie
e iss the
th inclusion
in
ncl
clusion
n of Mal
a ay acto
orss
Another
for
movie
Malay
actors
ato
at
o Ro
Rosy
syam N
or, Norm
rm
man H
a im,, To
ak
ony K
assim
like D
Dato
Rosyam
Nor,
Norman
Hakim,
Tony
Kassim
an d Za
Zack
i p a n. B e s i d e s , Ta
Taii wa
w n
and
ckk Ta ipa

beritaMMA Vol.46 August 2016

actor Winston Chao completes the multiracial cast of a


Malaysian theme based movie. It was a flashback to earlier
movies of the late Tan Sri P. Ramlee where he portrayed a
mixture of local languages in the dialogue. The film crew
from India spent 120 days here, and Rajini stayed for 48
days, the longest he had stayed outside India. In Malaysia,
the Superstar was warmly received by TYT Governor of
Melaka and the Melaka State Government, and about
1000 Malaysians took part in the movie. The Malay version
of KABALI is to be released on 29 July in all our local
cinemas. Thus the uniqueness of KABALI. The movie was
released all over the world simultaneously on 22 July, in
12,000 cinemas in India, 400 cinemas in the US, including
Japan, Hong Kong, Dubai and Paris.
How is the movie then? The story is on gangsterism,
Rajini trying to protect his family and business from thugs
and criminals, lands up in jail for 25 years for assault and
murder. He is released from jail, so that is 25 years of Rajini
lost, and gets back at the gang with a vengeance. More
clashes, more shooting, more killing, at one point I almost
felt a stray bullet reaching me, and another noisy scene, I
felt like a minor earthquake at my feet! Yes, lots of action
and violence, not for a weak heart! Amazingly, Rajinis wife
is found again after 25 years in India, looking as young and
pretty as when he left her. The movie will attract tourists to
Malaysia for sure, except that they may be a little paranoid
and extremely careful when moving around the city! Yes,
do watch the movie for all its hype, the Malay or Tamil
version, our younger members seem thrilled. Scanning
some postings on doctors groups, Dr Sashi Ramanujam of
the Hospital Sultan Abdul Halim, Sungai Petani considers
KABALI one of the best happenings of recent times!
mire
ed for hi
h
tyylle,
e ccharm,
ha
arm
m,
Well, at 65, Rajini has to be adm
admired
hiss st
style,
coursse superb
supe
su
p rb
b acting.
acttin
ng. That
Tha
h t iss
physical fitness, and of course
messag
me
ge for
for ourr youth,
fo
yyo
out
uth
h,
undeniable. I was looking for a message
sim
im
mpl
ple:
e Get
Get
e away
awa
w y from
frrom
and it looks like the message is simple:
Gangsterism!
n real life, Rajini is known to
o be
be a simple
siimp
mple
le and
and
nd a loving
lov
o ing
g
In
pers
pe
rson, very
very spiritually inclined
inccliline
ne
ed and
and a philanthropist.
ph
phil
hilan
anth
th
hro
ropi
pist
st. He
H is
person,
and KABALI
KABALI
AB
confirms
ms that
that the best
bald and
confi
w gs are Indian made!
wi
wigs

exco presidents message

Dr John Chew Chee Ming


president@mma.org.my
johnchew23@gmail.com
President

Elections and
Relevance

he MMA year started in May 2016 with a keenly


contested election for a new President. 400
delegates turned up in Miri for this. In 2008, I stood
against the change of voting for our President at AGM. I
saw the postal voting to be more participative and more
representative as many doctors are bound to their place
of work and would not be able to travel to the AGM.
Many felt disenfranchised and disconnected by this right
to choose their President as a Member. Postal voting was
presented as expensive and the level of participation
was low anyway. AGM attendance was dropping and this
voting at AGM was a way to increase its relevance.

In June, MMC held her three-yearly election to choose 9


elected council members. 40 candidates were nominated
for the 9 posts. The postal votes count was held on 18th
June Saturday and the valiant effort by the Secretariat of
MMC headed by Chairman of Election Committee Prof
Dr Asad, Secretary Datuk Dr Azmi and closely scrutinised
by Director General Datuk Seri Dr Nor Hisham,
representatives of the candidates and Independent
Auditor Deloitte. 6,046 votes were counted and the
tedious process of counting finished at 3.30am, a good
18 hours during the month of Ramadan with 113 spoilt
votes. At the end of the day, we have participation rate
of 15%. On the same day, two by-elections were held
in Sungai Besar, Selangor and Kuala Kangsar, Perak. The
results of the by-elections were known by 9 pm.
After a long tiring day at the MMC elections, everybody
agreed the election machinery needed a revamp.
E-voting was touted to be the solution.

Electronic Voting
After the eight long days of counting at the Australian
General Election before the final results were known, the
same calls were made to modernise the paper and pencil
ballot voting.
Electronic voting has been studied extensively over
the last 20 years. As more and more online banking of
confidential transactions become acceptable, we are
still questioning the veracity of electronic voting. Voting
is not like paying your bills. Financial transactions are
private, but not anonymous. The two parties can see
how a financial transaction is done and verified after the
deal is done. The casting of the vote can be online at any
computer or at voting centres. The veracity of the voters
have to be determined. Once the electronic vote is cast,
we cannot do a recount without losing the anonymity.

beritaMMA Vol.46 August 2016

Paper and pencil voting despite the difficulties is time


proven and trusted. Computer hackers can interfere
with the electronic voting code and with the back room
computer administrators, no vote is anonymous. It was
Joseph Stalin who said Those who cast the votes decide
nothing. Those who count the votes decide everything.
Until we have a more secure way of voting, electronic
voting for MMA will have to be deferred. For the
Australians, the goal was set at 2020 to go electronic.

Brexit
Britain voted on a referendum to leave or remain in EU
on 23th June 2016. Both parties leadership campaigned
to remain and lost. 52% voted to leave and 48% to
remain. The country divided, London voted 78% to stay
but the provincial north voted overwhelmingly to leave.
PM David Cameron resigned and a new Conservative
party leadership election was called. Boris Johnson, a
politician of charm and showmanship, the populist led
the campaign to leave. The former London mayor, a
former journalist is well known for his provocative and
controversial manner, calling Hillary Clinton a sadistic
nurse in a mental hospital. The opposition Labour party
leader Jeremy Corbyns shadow cabinet was decimated
with resignations. He now faces a vote of no confidence.
Although 66% of Labour voted to remain, Jeremy Corbyn
was blamed for a poor campaign to remain in EU. The
country is divided and is now undecided what to do.
Issues like immigration, poor economy, EU regulations,
250 million per week contribution to EU. Uncertain,
insecure and lost, Britain is in search of a new identity
in the world, these are the verdicts from worlds opinion.
Brexit is a slap in the face for its political establishment.

What lessons are there for MMA?


A referendum is the ultimate in democracy whereby every
citizen has a direct say about what the country should
do. Malaysian Constitution does not allow referendum
although the Cobbold Commission was held in 1962 to
establish the views of people in Sabah and Sarawak as to
the establishment of Federation of Malaysia.
What changed in Britain over the last 25 years has
been the digital revolution whereby information
and decision making are shared rapidly and widely,
leading to better informed citizenry, and the so called
digital democratization. However, instead of better
communication between leaders and people, the
social media has contributed to polarisation, gridlock,

exco presidents message

dissatisfaction and misinformation. The social media,


working as an echo chamber tends to reinforce prejudices,
allowing views and rumours to circulate and intensify
within like-minded groups. Differing views are not
entertained as the tone of democratic politics became
nasty, brutish and short. These consequences, we at MMA
must be aware of the shortcoming of being emboldened
by our perceived invincibility as we discussed our issues
among ourselves in the social media. (Ref: The Brexit
is the first major casualty of digital democracy. Dhruva
Jaishankar, Brookings Institute. Jul 10, 2016)
We must be aware that driving our agenda through
popular jingoism and the noise via the social media will
back fire on us. In the quiet time of the day, we must
work out the pathways, the sensitivities of our political
environment to better plan a way forward for our
profession. Diplomacy and tact still rule the day in the
local context.
MMA has representative governance, and the President
is elected by delegates at our AGM. This shift from direct
postal voting in 2009 to indirect voting by delegates
in 2011 caused divisions among the members. 2009
(Sunway, Petaling Jaya) was the last year we elected
our President by direct postal vote. In 2010 (Melaka)
the delegates amended the Constitution to vote for the
President at the AGM and subsequently in 2011, the first
President was elected at the AGM.

The pre-eminence of the Election of the President at the


AGM attracted over 400 delegates to Miri. The lacklustre
attendance after the casting of votes, the lack of motions
and debates showed our AGM was all about elections.
At the recent BMA Annual Representatives Meeting in
Belfast which I attended on behalf of MMA, motions
after motions were tabled. All 160 of them helped the
Executives preparing policy papers on the motions.
These Policy Papers carry a lot of weight and are read
and taken note of by Parliamentarians in the national
debates. Relevant topics like the Privatization of NHS, 7
Days Service, End of Life Care and Assisted Dying were
hotly debated and deliberated on. These debates make
the BMA very robust and relevant. More importantly the
membership has increased to 170,000 as doctors see the
importance of joining. The junior doctors with the 7 Days
Service protest increasingly look to BMA for leadership.
These activities of BMA, we at MMA must emulate.
To sum up, MMA needs to be more relevant with wide
participation of the members. While we are not ready
for electronic voting, we must make our AGM to be
more policy making. To this end I am encouraging our
two sections, all the societies and all members to plan
and present motions and issues for debate at our AGM.
Slowly and surely we will become more relevant as we
put our thoughts onto paper.

mma oration

Medical Education:

The Fuss & The Fix!

YB Prof Datuk Dr Sim Kui-Hian, Minister of Local Government,


Sarawak
Dr Ashok Philip, President, Malaysian Medical Association
Friends & Colleagues

I thank the President and Council of the Malaysian Medical


Association for this honour.
Of late, the media has repeatedly highlighted issues surrounding
the medical profession. A new breed of experts, experts in medical
education seem to have surfaced. Almost every Medical Practitioner
considers himself an expert in Medical Education, Parents whose
children are in Medical Schools, Medical Students, non-medical
persons, almost anyone! At many functions that I have attended
lately, a hotly debated topic will be Medical Education, irrespective
of the background of the participants. The scope of this debate will
get wider, and will be on unqualified students being admitted to
Medical Schools, poor quality of graduates, oversupply of doctors,
too many medical schools, houseman training, stressed out house
officers, waiting time for Houseman postings, and the last, my son or
daughter works almost 12 hours a day, and is back home exhausted!
What a life, and you say, there are too many Doctors!
I have been closely associated with Medical Education over the
last 10 years, and listening to all these experts and observing the
media hype, I selected the topic: Medical Education: The Fuss and
the Fix for this oration. The views expressed are personal and do
not represent the views of the Institutions I am associated with. Let
me qualify, my focus will be undergraduate medical education, not
its technical aspects, but, if I may use the phrase, this will be a peep
into the politics surrounding undergraduate medical education.

The Malaysian Home:


Let me begin with the typical Malaysian home.
How does the young mind get influenced for a career in Medicine?
Parents who are in the field of healthcare, or Medicine in particular,
the Doctor Parents, does that influence their children? One Private
Specialist remarked: When we were hard at work, the children were
too small to notice that, now having given them a comfortable life,
they also desire to be Doctors. Some Doctor parents are happy
that their children prefer some other vocation other than Medicine,
simply to help them avoid the stressful and ever-demanding life that
the parents had to endure. Generally, the trend seems to be that
children of Doctor parents tend to emulate their parents.
Still in the home, besides parental influence, what are the other
influences Medical Programmes, dramas on television? It does,
say many parents, many take time to watch these, it does seem to
have an influencing factor, ER, Chicago Hope, House to name a few.
My good friend Dato Dr Apla Naidu tells me that it was programmes
like Dr Kildare in the late 60s that influenced him to pursue a medical
career, he now successfully owns a Medical Centre in Kuala Lumpur!

Major General Dato Pahlawan


Dr R. Mohanadas (Rtd)
Deputy Chairman
Cyberjaya University College of
Medical Sciences (CUCMS)

~~~

MMA Branches could


conduct forums for School
Counsellors updating
them on the requirements
of the profession, the
expectations of the
profession and the
selection of Institutions...

~~~

beritaMMA Vol.46 August 2016

10

mma oration

By the way, the current exciting local medical drama is


Suami ku Jururawat, Isteri Ku Doktor, be mindful where
you leave your stethoscope, you could get strangulated!
The other Malaysian home is the one devoid of any
medical link in the family. Bright students, average
household income, eager parents, all looking for a lift
in the socio-economic status of the family as a whole,
through a child admitted into Medical School. This is why,
understandably, when the Ministry of Higher Education
approves an Institution and a programme, there will be
a condition in its approval, i.e. consideration should be
given to students from different geographical areas and
economic backgrounds.

From Home to School:


From the family and electronic media as influencing
factors, I now move on to the school environment. This
is where academic development takes place and I will
confine to the Schools of the Ministry of Education.
These 11 years of education, and in particular, secondary
education is vital. Streaming takes place fairly early
into distinct pathways, leading to the Sijil Peperiksaan
Malaysia (SPM). Almost half a million students appear
for this all important examination, equally stressful for
the students and their parents. Rightly or otherwise, the
SPM results seem to be decisive of the students future
academic direction. But is it really so, not necessarily, but
the system thinks so! The MMC states a minimum of 5Bs
in Maths and Science subjects.
This is the period where School Student Counsellors play
an important role. MMA Branches could provide a similar
role. Forums for School Student Counsellors updating
them on the requirements of the profession, both
academic and non-academic, selection of institutions
and the expectations of the profession need to be
emphasised. The SCHOMOS, through their respective
Hospital Directors, could assist the interested students
through short attachments at their Hospitals. Prospective
medical students must be exposed to the hardships
of a medical career, and not get mesmerised with the
apparent good life!

From SPM to Pre University:


This is when Education Fairs and Career Talks become
useful. Students and parents shop around for information
on programmes and scholarships. There are many
options, depending on the SPM results, financial ability,
and the perception of the students and their parents on
the pass rates of different examinations. The Government
Matriculation and STPM courses are straight forward.
There is still much apprehension on the success rate
in STPM, though I would like to believe it otherwise
knowing many who did well and had moved on to Public
Universities. The general trend is those who can afford
a Pre-University course in a private institution will try to
avoid the STPM route.
Foundation in Science Programmes (FIS) have become
popular for probably three reasons. Firstly, it is a one
academic year programme, second, it is perceived as not
as tough as the STPM, and thirdly, there are generally
beritaMMA Vol.46 August 2016

two intakes per year, and that makes it convenient for


subsequent university admission. It comes with a price
tag, in the range of RM 12k to RM 18k. The negative
publicity here was created when a handful of FIS
programmes with a tie up with some foreign universities
offered poor quality programmes. This is history. It
must be remembered that Foundation programmes
were created at meeting the needs of students who
were unable to get admission into the limited highly
tutored Government Matriculation Programmes. FIS
Programmes are also conducted by reputable Institutions
locally. So generalising FIS programmes as of low quality
is incorrect. Many of our sponsored students go overseas
after the SPM for FIS Programmes and continue their
medical studies in those Universities.
Besides, depending on the University or country one
would like to pursue medical studies, international
pre-university programmes like Cambridge GCE A
levels, International Baccalaureate (IB), South Australian
Matriculation (SAM), Canadian Pre-U are available locally.
Thus giving school leavers a wide choice for these
bridging courses to Universities.
This is where Malaysian Medical Council/Malaysian
Qualifications Agency (MMC/MQA) has come in. The
minimum criteria for entry into Medical Schools from
the variety of Pre-University Programmes is a minimum
CGPA of 3.0.

Public Institutions of Higher Education:


Every State has at least one Public University and
several Institutions of Higher Learning established by
the Government. That is an achievement, our emphasis
on access to higher education over five decades of
Independence. There are 11 Public Universities with
Medical Schools. The last approved Public University
Medical School is that of the National Defence University.
This programme is due for full accreditation and the first
batch of 50 will graduate this year. Public University
Medical Schools take in students with CGPA 4.0 or close
to it, besides other additional criteria.
There tends to be a reversal in choice of Universities
these days, Public or Private? It may come as a surprise
that the first choice for many courses in the Klang Valley,
are the well-established Private Universities. Whilst
Public Medical Schools have remained the first choice
for Medicine, increasingly, collaborative or partnership
medical schools seem to attract high achievers. Due
to the high academic grades required to enter Public
Medical Schools, and the availability of adequate Faculty
and Teaching Hospitals, quality of graduates from Public
Medical Schools seldom raise serious concerns.

Private Institutions of Higher Education:


Public Universities are unable to cope with the
large numbers of eligible school leavers. This led to
the liberalisation of the education sector, and the
establishment of Private Higher Educational Institutions
Act of 1996 (Akta 555). The Act and Regulations are
stringent on the establishing, managing and monitoring
of these institutions. The penalty on non-compliance is
also clear, including jail sentences!

This liberalisation was closely followed by the


establishment of the National Higher Education Fund
1997 (Akta 566) to provide educational loans for eligible
students.
The above two initiatives, are our pillars for human capital
development, becoming a high income nation and
thereby achieving the developed country status. Many
thousands of our students would have missed on higher
education if not for these two developments.

Private Medical Institutions (Local):


There are 22 Private Medical Schools, offering some
25 programmes, except for Perlis, Sabah and Sarawak,
every State has at least one Private Medical School. This
number in itself has been the source of unfavourable
publicity. Some have been established in partnership
with reputable foreign medical schools, others are totally
home grown. Do we need that many Medical Schools?
Is it a demand factor? Medicine, somehow, still remains
the first choice for the majority of high achievers, 10As
in SPM, and it has to be Medicine and a Government
Scholarship! That is the crux in the large numbers of
Doctors. It may take a generation for a mindset change.
Of course, with more medical schools, more medical
programmes, and therefore more medical graduates, the
playing field has become more challenging.
The private sector has invested heavily in creating
the appropriate educational environment for medical
education. Learning and teaching facilities in some
private medical schools are comparable, or even superior
to some public medical schools.
Whilst the medical profession has publicly expressed
concerns over the large numbers of medical students,
but what are its recommendations? Just close some
schools? That would be an irresponsible response. Few
Medical Schools admit 200 students per intake, few
have two intakes a year, hence 400 a year. The recently
established schools admit only 50 students per year, a
single intake. One University College at Kepala Batas
Penang, conducting 4 programmes concurrently, wound
up by itself! It must be emphasised that it is the MMC/
MQA that decides on the intake quota based on the
facilities and faculty available at each institution. Medical
Schools will be subjected to severe censure if they exceed
the approved quota.

Private Medical Institutions (Overseas):


This is the area of much concern and negative publicity.
The Ministry of Higher Education is clear. If one does not
qualify to enter a Medical School in Malaysia, whether
Public or Private, he or she should not be admitted to
any Medical School anywhere else in the world! To
implement this policy, the No Objection Certificate
(NOC) was implemented. Students who possess entry
qualifications based on their SPM and Pre-University
results, will obtain the NOC without any issues. However,
the decision to admit a student in an overseas University
is the prerogative of that overseas University. These
Universities have their own criteria of admission, some,
like in Ukraine, Russia, Poland and Egypt conduct their

own Foundation Courses, and follow through with the


Medical Programme. In some of these countries, the
tuition fees is lower than our local programmes. This
sort of back door entry has irked our authorities and
the medical profession. At the same time, it must also
be emphasised that there are large numbers of high
achievers who resort to this route, simply because they
are unable to afford the local medical school tuition fees.
Can the Government refuse to register a Medical
Graduate from a recognised medical school overseas
because he did not have the minimum SPM grades? No,
not with the current regulations, though there have been
discussions to this effect.
I am a firm believer and always recommend students to
be trained in an environment where they will work on
graduation. There are sufficient Medical Schools within
the country.
The Medical Act 1971 has listed some 380 Overseas
Medical Schools whose qualifications are registerable
here. One who is unable to get admission locally could
still opt for any of these Institutions.
The Malaysian Medical Council (MMC) and the Malaysian
Qualifications Agency (MQA) are jointly responsible for
the monitoring of the quality of the medical programmes.
There are sufficient guidelines for the providers, regular
visits and periodic accreditation. A pool of assessors
is maintained by MQA/MMC, it is a very selective and
limited pool. The number of assessors has to be doubled
at least, and open to public and private medical schools,
both small and large, that would dispel the notion
of favouritism or vested interests by the assessors. It
would also speed up the process. Some Institutions
understandably are wary of having assessors from
competitor medical schools.
Would any Institution deliberately flout the guidelines
in a competitive medical education market? Could
one admit students below the entry qualifications? The
answer is NO, then why the fuss? The Institution will risk
losing its licence, and the student may be expelled. The
Chief Executive can be fined up to RM200, 000 and/or
imprisoned up to two years for non-compliance.
SEGI University and Taylors University Medical Schools
obtained their full accreditations recently. The PURCSI Medical Programme is the most recent to be fully
accredited by the Irish Medical Council. Thus the medical
programmes are audited for quality, it is the performance
of their graduates that will now undergo scrutiny. It would
be unfair to pre-judge these young graduates even
before they start work, just because they are from newly
established Medical Schools.
There are four more Medical Programmes which are
not due for their full accreditations: QUEST in Perak,
University College Shahputra Kuantan, Lincoln University
College and the Asia Metropolitan University. These will
be the last medical programmes.
The moratorium on medical programmes has been
extended to 2020. We already see an overall reduction
beritaMMA Vol.46 August 2016

12

mma oration

in demand for medical education thus there will be


a levelling off, and private medical schools will find it
difficult to fill the approved quotas in the future.

Oversupply?
At the 50th Anniversary Dinner of the MMA, 14 July 2010,
a very significant day for the profession, and for the
first time the Prime Minister YAB Dato Sri Mohd Najib
announced: to provide optimum quality health service
accessible to ALL Malaysians, Malaysia will need a
Doctor Population ratio of 1:600 by 2015 and 1:400 by
2020. It came as a surprise.
Currently for a population of 30 million there are 33,193
Registered Medical Practitioners issued with APCs (Dec,
2014). This excludes the House Officers.
Is this excessive? Patients at an Out Patient Department
in a Government Hospital in Klang Valley could spend a
whole day obtaining basic services. Waiting time for an
ultrasound can be two weeks, CT and MRI like 4 weeks.
The waiting time for a total knee replacement can be 6
months.
The system is at fault, is the quick answer, but we make
up the system! The public are not interested in the ratios,
they need quality services, provided courteously and
efficiently with desirable outcomes.
Australia for a population of 21.2 million (2011) has a total
of 70,200 Doctors, one third of whom are specialists. They
boast one of the best healthcare systems in the world.
The Doctor: Population ratios of selected developed
nations are in the table below:

Doctor: Population Ratio

prove to be a strangely appropriate education for a


political career. Dr Mahathir made his entry into politics
from General Practice, and became the countrys longest
serving Prime Minister for 22 years.
Tun Dr Lim Chong Eu, a Founder Member of MMA, also
left General Practice for politics, became Penangs Chief
Minister for 21 years. Other Doctors turned Politicians,
Tun Dr Ling Leong Sik, Tun Dr Lim Keng Yaik, Former
MMA President Tan Sri Dr Tan Chee Khoon, Former
Deputy Chief Minister of Sarawak, Tan Sri Dr George
Chan, and closer to home, Health Minister Datuk Seri Dr
S. Subramanian and our friend and colleague here, Prof
Datuk Dr Sim Kui-Hiani, the recently appointed Sarawak
Minister of Local Government.
Doctors are trained to observe, analyse, diagnose
and manage problems systematically, possess good
communication skills and are team players, or more
often, leaders in the team.
There is future in politics for our younger doctors.
International NGOs: Elective postings done overseas is
a good start to networking and serving with International
NGOs. Doctors from the Philippines, India, Pakistan
and Bagladesh, to name a few countries have made
their career with health-related NGOs. Public Health
Specialists and General Practitioners fit well into this
environment. You need to endure hardship though.
International humanitarian work touches the lives of the
less fortunate in large numbers and is very satisfying.
Academia: Opportunities are available for Medical
Teachers/Educationists in local medical schools. There is
hardly a Medical School in this country without expatriate
teachers. Post Graduate qualifications for Medical
Teachers need to be explored.

Australia

1 : 306

United Kingdom

1 : 356

New Zealand

1 : 366

United States

1 :408

Medical Journalism: Our training in communication


skills, role play, etc., can be extended to writing skills
and medical journalism, both for the print and electronic
media. Dr Sanjay Gupta of CNN is a Neurosurgeon.

Japan

1 : 435

CHALLENGES:

Let me move on to another area:

Employability & Exploring the Horizon:


Once considered a profession for life, today a first
Medical Degree seems to be equated to a General or
Honours Degree? There seems to be little recognition
that had traditionally gone along with such qualifications.
With about 5000 new Doctors entering the fraternity
each year, it becomes necessary to look at other related
opportunities.
Medicine & Law: Law is a suitable second degree.
Medico legal issues, Medical Jurisprudence, increasing
litigations, call for Doctors with legal knowledge. Masters
In Medical Law is gaining interest.
Medicine & Politics: Tun Dr Mahathir Mohamad in his
Memoirs: A Doctor In the House, states: Medicine would

beritaMMA Vol.46 August 2016

Several proposals are being debated to ensure quality of


graduates and there is no oversupply of Doctors.

Raising Entry Qualifications for Local


Medical Programmes:
This is being discussed widely. Proposals to as high as 5
Distinctions in the SPM Science subjects and a minimum
of CGPA of 3.5 The MOHE is the final authority, initial
reaction is, only minimal entry requirements are stipulated
and it is up to the Institutions to decide on their entry
requirements.

Graduate Entry Medicine:


In the year 2011, the MMC approved the first Graduate
Entry Medicine (GEM) Programme following the Johns
Hopkins Model. Subsequently Johns Hopkins School of
Medicine was replaced by the University of California San
Diego Medical School.

GEM came about as a result of the Flexner Report of


1910, which proposed that all candidates for a US Medical
Programme must possess a First Degree. The rationale
being mature students, more interactive, independent
learning, lower dropout rate, and indeed, the quality of
the graduates. This is followed by an almost immediate
Residency Programme in the speciality of choice.
Over the last decade, Medical Schools in the UK,
Australia, New Zealand are moving on to this model.
Across the causeway, the Duke NUS Medical School
started the Graduate Entry Programme in 2007. This
could be a model to emulate, a Public Medical School
could consider a GEM. This will automatically reduce the
intake, as only those very keen will pursue a career in
Medicine. A similar residency model as in the US may
have to be considered.

National Entrance Examination:


The MCAT (Medical College Admissions Test) is a
computer based standardised Entrance Exam for
prospective Medical Students in the United States and
Canada. In Australia, it is the UMAT, the Undergraduate
Medical & Health Sciences Admission Test for school
leavers and the GAMSAT, the Graduate Australian Medical
School Admission Test for the GEP. India nationwide, has
this year introduced the NEET, the National Eligibility
cum Entrance Test. Some 600,000 students appeared for
this exam. Some Institutions have strongly opposed this
development.
Similar suggestions have been made here to ensure
only the best get admitted, thereby the numbers also
get reduced. Others have expressed concern over the
conduct of the examinations. Will the examination be fair
and transparent?

Pre-Registration Examination:
Suggestions have been made to scrap Schedule 2 in
the Medical Act, and have a common Pre-Registration
Exam for All graduates. It seems to be acceptable to be
imposed on overseas graduates, but there is resistance
on local graduates. With the structure of MMC of 22
appointed council members from public universities/
Government, this proposal may not pass through. Private
Medical Schools feel the rule should be applicable to
all. The United States and Canada conduct their own
National Medical Licensing Exam. The United States
Medical Licensing Exam (USMLE) is compulsory for all
Graduates, be it graduates from the US or overseas.
Canada has a similar exam, known as the Licentiate of
the Medical Council of Canada.

SUMMARY:
I have attempted to share with you the evolution of
Private Higher Education in this country, complementing
Public Universities, with particular reference to the
establishment of Private Medical Schools, in meeting the
demands of high school achievers who have the passion
and desire for a career in Medicine. The liberalisation of
Private Higher Education, together with the establishment
of the National Higher Education Fund, is one of the best
landmarks in human capital development for a rapidly
developing country.
Similarly, to provide a comprehensive health care system,
with equitable access, quality and desirable outcomes
to an ever demanding public, the health work force has
to be made available in sufficient numbers. A ratio of 1
Doctor to a 400 population will be achieved as planned.
It is an appropriate ratio.
The success is not in the achievement of numbers alone,
but the quality of the workforce to deliver optimum health
services is equally important. These are all interrelated.
Identifying the weaknesses in the media demotivates the
young professionals and erodes the confidence of the
public on our health care system.
We are at a cross road, we need a comprehensive study,
similar to the Abraham Flexner Study of 1910. Incremental
and knee jerk responses will not do, our challenges are
more complex.
MMAs Objective No 3, reminds us of our role in Medical
Education. It was the Malayan Medical Association in
1960 which mooted the idea of a Medical School in
Kuala Lumpur, sent a memorandum to the then Prime
Minister YTM Tunku Abdul Rahman Putra, which resulted
in the establishment of the UM Medical Faculty. We need
to take such strong initiatives if we are truly concerned
about the current state of affairs in Medical Education.

Acknowledgements:
I wish to thank Dato Dr Azmie Shapie, Secretary MMC
and Assoc Prof Dr G. Jayakumar for their valuable input
and Ms Thogaimalar of MMA for secretarial assistance.
(Delivered at the 56th MMA AGM at Miri, Sarawak on
26 May 2016)

Compulsory Service:
Will the Compulsory Government Service of three years
be passed in Parliament again for another five years? It was
implemented due to a critical shortage of Doctors then,
and that assured Doctors of employment on graduation.
What now? With such large numbers graduating, will
compulsory Government service be of relevance?

beritaMMA Vol.46 August 2016

14

exco hgs

From the Desk of the

Hon. General
Secretary
A

nother round of MMA bashing. Instead of


words of encouragement, the usual brickbats
are being thrown towards us. Bad enough that
it is being hurled at MMA from non MMA members
who do not understand current affairs, but coming
from members within our association is another thing.
A reason being given is that we are not reaching out to
members, thus the dissatisfaction.
But is it really so? We have our BERITA, Website,
regular emails to members, Docquity and the various
WhatsApp groups. (We are at the moment facing
a small technical issue with our Facebook page
which should be resolved soon). Is it because of
information overload that makes our members miss
out on important issues? Whatever it is, it is also the
responsibility of members to want to know and to
take steps to keep themselves current on affairs of the
association.
Are MMA office bearers beyond the reach of members?
I would say not, as contact details are freely available.
A very big thank you to those who have contacted
the office bearers individually to seek assistance or to
resolve issues. Of course, most of these are not shared
on social media as it involves the individual members.
Coming to non-members, there are various reasons
for not wanting to be a member of this medical
association and their choice is to be respected. To
each his own. However to post on social media
that MMA is to consult other associations before
embarking on its own decision-making may not be
too proper. The MMA had never insisted that other
associations obtain its consent before deciding
on matters being managed by their own members.
We have cordial relationships with other medical
associations in Malaysia and will always remain so as
we are all brothers and sisters in the same fraternity.

beritaMMA Vol.46 August 2016

Dr Koh Kar Chai


secretary@mma.org.my
drcaseysurf@gmail.com
Honorary General
Secretary

Many of us do hold memberships in various medical


associations, me included. I do hold office in other
medical associations as well. Whatever problems
which assail the medical fraternity will ultimately affect
all of us.
An issue of ongoing interest is the one involving the
Inland Revenue Boards ruling on doctors registering
their clinics as a Sendirian Berhad.
The Malaysian Medical Association has been involved
in negotiations with the Inland Revenue Board since
the issue first surfaced. There had been some progress
on this and though there were concerns among
members, the matter was handled well until a recent
letter from the Director General of the Inland Revenue
Board ruling on this matter was circulated on social
media.
What this led to was the accusation that the Malaysian
Medical Association had not been proactive enough
in the handling of this matter and that information
from external sources were more efficient than the
Malaysian Medical Association itself.
Interestingly enough, this led to articles being written
in the various media by all manners of Consultants
who purportedly knew about the whole gamut
of medical specialists operating their clinics as a
Sendirian Berhad. Reading their articles led to more
confusion than revelation.
Members were quick to point fingers at office bearers
and some threatened to take things into their own
hands.
Be assured that the Malaysian Medical Association is
still in the thick of this matter. In the following pages
is the statement by our President, Dr John Chew on
what has transpired.

exco letter from the president mma

15

beritaMMA Vol.46 August 2016

16

exco letter from the president mma

beritaMMA Vol.46 August 2016

beritaMMA Vol.46 August 2016

18

exco letter from the president mma

beritaMMA Vol.46 August 2016

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20

exco hgs

MMA Committees
2016/2017

CONSTITUTION AND RESOLUTIONS


REVIEW COMMITTEE
Dr John Chew Chee Ming
Dr Ashok Philip
Dr Muruga Raj Rajathurai
Dr Ravi Venkatachalam
Ravindran Naidu

: Chairman

MMA VOLUNTEER CORPS (VOC)


Prof Dr Lekhraj Rampal
Prof Dato Dr NKS Tharmaseelan
Mej Dr Jeyaratnam Ratnavale
Dr Goh Aik Ping
Dr Sivananthan Periethamby
Dr Koh Kar Chai

: Chairman

: Ex Officio

: Chairman

beritaMMA Vol.46 August 2016

: Chairman
: Secretary

BERITA MMA EDITORIAL BOARD

Dr Gayathri K Kumarasuriar
Assoc Prof Dr Jayakumar Gurusamy
Dr Juliet Mathew
Dr Nachiappan A/L Murugavadigal
Dr Koh Kar Chai

: Editor

: Ex Officio

NATIONAL HEALTH POLICY

MMA INSURANCE COMMITTEE


Dr Rajan John
Dr John Chew Chee Ming
Dr Ashok Philip
Dr Ravindran Naidu
Dr Koh Kar Chai
Dr Hooi Lai Ngoh

Dato Dr P Vijaya Singham


Dr Koh Kar Chai
Dr B Gunasekaran
Dr T Krishnamurthy
Prof Dato Dr NKS Tharmaseelan
Dr Rajamohan Annamalai
Brig Gen (Rtd) Datuk Dr N Rajagopal
Dr Lee Yew Fong

Maj Gen Dato Pahlawan


Dr R Mohanadas (Rtd)

MMA BUILDING COMMITTEE


Dr John Chew Chee Ming
Dr Ashok Philip
Dr Ravindran Naidu
Dr Gunasagaran Ramanathan
Datuk Dr Kuljit Singh
Dr Ganabaskaran Nadason
Dr Kamalanathan Sappani
Datuk Dr N Arumugam
Dr Rajan John
Dr Koh Kar Chai

MMA ETHICS COMMITTEE

: Chairman

Dr John Chew Chee Ming


Dr T Krishnamurthy
Dr Harinarayan Radhakrishna
Datuk Dr Teoh Siang Chin
Dato Dr R S McCoy
Dr H Krishna Kumar
Dr Ravindran Naidu
Dr Rajamohan Annamalai
Dr Tevaraajan A/L Jayaraman
Dr Ashok Philip

: Chairman

MJM EDITORIAL BOARD


Prof Dr Lekhraj Rampal
: Honorary Editor
Assoc Prof Dr Victor Hoe Chee Wai
Prof Dato Dr Sivalingam Nalliah
Dr Lim Thiam Aun
Dr Chan Kok Meng, John
Dr Lee Yew Fong
Dr Koh Kar Chai
: Ex Officio

MMA Representatives to
External Organisations
Malaysian Road Safety Council
Assoc. Prof Dr Jayakumar Gurusamy

St John Ambulance Malaysia


Dato Dr Shah Kamal Khan B. Jamal Din

Malaysian Council for Rehabilitation


Dr N Shanmuganathan

NCOSH
a) JK Kesihatan Pekerjaan Di Industri Pekerjaan
Dr Gogillan Sevaratnam

Council of the Confederation of Scientific and


Technological Assoc of Malaysia (COSTAM)
Dr Koh Kar Chai
Radiological Advisory Committee, MOH
Dr Long Tuan Mastazamin Bin Long Tuan Kechik
Malaysian Society For Quality in Health (MSQH)
Dr John Chew Chee Ming
Dr Ravindran Naidu alternate representative
a) Malaysian Council on Healthcare Standard
Dr Kaliaperumal Rathakrishnan
b) Malaysian Hospital Accreditation Programme
Dr Kasturi K I Maniam Nair
Majlis Penilaian Teknologi Kesihatan, KKM
Dr H Krishna Kumar
Malaysian AIDS Council (MAC)
Assoc Prof Dr Koh Kwee Choy (James)
SIRIM
a) Technical Committee on Diagnostic and
Therapeutic Radiation (TC 5)
Dr Long Tuan Mastazamin Bin Long Tuan Kechik
b) Technical Committee on Code of Practice
of Active Medical and on LV Electrical
Equipment/System in Healthcare Facilities
(TC10)
Dr Hjh Selasawati Bt Haji Ghazali
c) Technical Committee On Ophthalmic Optic
Dr Edwin Leo Suppiah
d) Technical Committee on Anaesthetic/
Respiratory and Electrochemical Devices
Brig Gen Dr S Jegatheesan
e) Technical Committee on Disposable Devices
(TC2)
Dr Koh Kar Chai

Malaysian Red Crescent Society


Dato Dr Shah Kamal Khan B. Jamal Din
Drug Control Authority
(1st January 2017 31st December 2019)
Dr Koh Kar Chai
Dr Edwin Leo Suppiah alternate representative
Jawatankuasa Tetap Perubatan Tradisional/
Komplementari. KKM
Dr Nik Abdul Aziz Bin Nik Yacob
Dr Gayathri Kumarasuriar alternate
representative
National Professional Services Export Council
(NAPSEC), MITI
Dr Lee Han Kyun @ Joseph Lee
a) PhAMA Ethics Appeal Committee
Dr Muruga Raj Rajathurai
b) PhAMA Ethics First Level Case Review
Committee
Dr M Ponnusamy
Jawatankuasa Majlis Keselamatan Pesakit
Malaysia, KKM
(1st January 2017 31st December 2018)
Dr M Ponnusamy
Dr Ravindran Naidu alternate representative
Jawatankuasa Kebangsaan Managed Care, KKM
Dr Thirunavukarasu Rajoo
National Transplantation Council, MOH
Dr Vasu Pillai Letchumanan
Jawatankuasa Pemandu Dasar Ubat Nasional
a) Jawatankuasa Teknikal Halal
Dr Kamarudin Ahmad
Malaysian Service Providers Confederation
(MSPC)
Datin Dr Jayanthi Krishnan

beritaMMA Vol.46 August 2016

24

lead article

Vaccine
Hesitancy:
The Challenges
Ahead
Dr N. Thiyagar
thiyagarsp@yahoo.com
Head, Consultant Paediatrician and Adolescent Medicine Specialist
Hospital Sultanah Bahiyah, Alor Setar Kedah
Life Member MMA, Kedah
President of Malaysian Paediatric Association

he month of June has been a wake-up call for


doctors in medical fraternity. We were shocked
by the re-emergence of an ancient infection,
diphtheria which has killed at least five children by the
time this article was penned. Shocking indeed.
I remember seeing the last case of diphtheria with typical
pseudomembrane in the throat long ago. Indeed very
long ago in 1992. It became so rare.
A resurgence of outbreaks of vaccine-preventable
diseases (VPDs), including measles and pertussis, has
prompted renewed attention on how vaccine hesitancy
can lead to the spread of infection and negatively impact
public health.
There was a time when diphtheria was one of the most
feared childhood diseases, claiming more than 10,000
lives a year in the United States during the 1920s. Polio
paralysed thousands of children In the 1940s and 1950.
The measles affected nearly a half-million US children
every year. Fortunately, times have changed. So we
thought...
These diseases are all vaccine preventable. Vaccination
is a miracle of modern medicine. In the past 50 years,
vaccination saved more lives worldwide than any other
medical product or procedure. It reduced the burden of
many diseases caused by bacteria and viruses. Vaccination
protects individuals and also others in the community by
increasing the general level of immunity and minimising
the spread of infection i.e. herd immunity.
The concept of protecting against infection goes back
to the 1100s when variolation technique was developed,
involving the inoculation of children and adults with dried
scab material recovered from smallpox patients.

beritaMMA Vol.46 August 2016

Thanks to Dr Edward Jenner who, in 1796 discovered


vaccination in its modern form and proved to the scientific
community that it worked. He is generally credited with
the initiation of modern concept of vaccination. In 1908
the Nobel Prize in research was awarded to Paul Ehrlich
and Elie Metchnikoff for their work in the mechanism of
immunity establishing the path for clonal selection, active
and passive immunity.
A worldwide case detection and vaccination programme
against smallpox gathered pace and, in 1979, the World
Health Assembly officially declared smallpox eradicated
a feat that remains one of historys greatest public
health triumphs.
Based on the emerging success of the smallpox
programme, the World Health Organization (WHO)
launched the Expanded Programme on Immunisation
(EPI). The initial EPI goals were to ensure that every child
received protection against six childhood diseases (i.e.
tuberculosis, polio, diphtheria, pertussis, tetanus and
measles) by the time they were one year of age.
Considering the success of organised implementation
of vaccination programmes worldwide, proving that
vaccination saved and still saves millions of children
worldwide, we should be contented. Unfortunately the
re-emergence of some of these VPDs such as diphtheria,
measles and pertussis is alarming.

Why are we seeing these diseases again,


which are often fatal? Have we become
too complacent?
For ages, parents and doctors worked in unity and
vaccinating their children was just a routine process. In
fact vaccinations are carried out by nurses in our primary
health care. Parents who go for vaccination hardly have

WHO launches EPI


Goals:


six childhood diseases








tetanus toxoid

women and their
newborns

Global Alliance
for Vaccines and
/
(GAVI)

s
protects >80% of
worlds children
from six main EPI
diseases

extends reach
of EPI

new vaccines

being added to
the EPI
programmes in


helps poorest
countries introduce
new vaccines in

programmes

Strengthening immunization: WHOs Expanded Programme on Immunization

any contact with doctors unless when the nurses have


doubts about whether to defer vaccination for some
children. The evolution of immunisation programme is
aptly described in the diagram below.
Even in most medical schools, we were not taught
how to counsel parents on vaccination. Memorising
the expanded immunisation programme was all most
students did. As routine immunisation is under the
purview of primary health care, doctors in hospitals arent
actively involved in counselling either.
Recently when I was counselling a parent who had not
vaccinated her child, my house officer became agitated.
Later he asked me Why do parents worry so much
about adverse reaction to vaccine when they dont worry
as much when we prescribe other medications? Valid
question.
I had to explain to him that medications are given when a
child is sick. So, it is easier for parents to accept the need.
However vaccination is administered when the child is
actually well. So, naturally it is difficult for some parents.
STAGE 1
Pre-vaccine

STAGE 2
Increasing coverage

DISEASE

As VPDs become uncommon in the community, the


perceived adverse events receive greater public attention.
Parents start doubting the necessity to vaccinate their
children. Their refusal to vaccinate their children poses a
challenge to doctors, particularly paediatricians.
If they cant get quick answers from doctors, they
approach Dr Google. These are well-meaning but
misguided parents who may voluntarily cause morbidity
and mortality in their unimmunised children. A study
conducted in Malaysia by W.Y. Lim et al revealed the three
main reasons for refusing vaccines were, a preference
for alternative treatment, assumption that vaccines have
no effect and doubt regarding vaccine contents. Media
attention to alleged vaccine related adverse events has
afflicted further damage.
We must acknowledge that vaccine hesitancy is not a new
phenomenon. Concern and controversy over the relative
benefit versus potential harm of vaccines have been long
debated by the public, ever since Jenners use of the
cowpox virus to provide immunity against smallpox.

STAGE 3
Loss of
confidence

STAGE 4
Resumption
of confidence

STAGE 5
Eradication

vaccine stopped

OUTBREAK

Incidence

VACCINE
COVERAGE
ADVERSE (number and/or perception)
EVENTS

Eradication

Maturity of Immunization Programme


Diagram adapted from Chen RT et al. The Vaccine Adverse Event Reporting System. Vaccine, 1994: 12(6)

beritaMMA Vol.46 August 2016

28

schomos

Flying Doctor Services


in the Land of Hornbills

Dr Ramvinder Singh, Medical Officer from Klinik Kesihatan Kota Samarahan, Sarawak doing FDS duties.

Dr Pravind Narayanan
pravvino86@gmail.com
Honorary Assistant Secretary
National SCHOMOS

ealth Services in the state of Sarawak has always been nurtured towards
realising the Vision of Malaysia that we are to be a country of healthy
individuals, families and communities, through developing a health system
that is efficient, technologically appropriate and consumer-friendly, with emphasis
on quality, innovation, health care awareness and which promotes individual
responsibility and community participation towards an enhanced quality of life.
Realising this, various strategies have been implemented based on the fact that
distance and affordability to travel long distances for basic health care is still much
of a limitation in a vast area in Sarawak. Besides medical care services provided in
the 22 hospitals located across the major towns there are two other major aspects or
modality of health care services provided to the needy such as Village Health Teams
and the Flying Doctor Service.
The important aspect of the government health care delivery system in Sarawak is
the static health facilities and mobile units under the Village Health Support Team. In
1983, the Sarawak Health Department has also introduced a village health volunteer
scheme known as the Village Health Promoter Programme, to enable basic health
care to be provided to remote areas on a more continual basis. To date we have 187
rural health clinics that function as one-stop family health centres, providing an
integrated service comprising maternal and child care, general outpatient care and
environmental sanitation. All clinics have rest beds and birthing facilities to encourage
safe delivery among rural mothers. Most clinics have a Medical Officer In Charge,
the rest have an Assistant Medical Officer In Charge. Shortfalls in management have
been minimised by placing Medical Officers in most Health Clinics, enabling better
service care to the patients. Mobile teams either travel by road, river, on foot or by
helicopter, depending on the accessibility of the areas they serve. In rural areas,
Village Health Teams are based in rural health centres, while those serving peri-

beritaMMA Vol.46 August 2016

urban areas are based at the Divisional or District Health


Offices.
In 1973, the Flying Doctor Service (FDS) was introduced
to provide basic health services to people living in
remote areas. The service operates three helicopters
that are rented under a contract with a private company,
Hornbill Skyways. The helicopters are based in Kuching,
Sibu and Miri and together, they cover 141 locations in
the remote rural parts of the State with an attendance of
about 70,000 outpatients, children and antenatal mothers
every year. The FDS team comprises a medical officer, a
medical assistant and two community nurses who visit the
locations once a month or once in two months. The FDS
also provides medical emergency evacuation (MEDEVAC)
of seriously ill patients from the locality to the nearest
appropriate hospital, from rural health clinics to hospital
and from hospital to hospital. During natural disasters the
use of MEDEVAC is relevant in transporting patients who
need urgent medical attention to the nearest hospital for
treatment. During disease outbreak in the state, the FDS
helicopters are also used for quick transportation of field
investigation, transportation of necessary medications
and control medical and health teams. FDS teams
provide treatment of minor ailments, follow up of chronic
diseases (e.g. diabetes and hypertension), and detect and
prevent communicable diseases (e.g. tuberculosis and
malaria). Coverage for antenatal cases and immunisation
in children has increased through these FDS.
Besides FDS, another important sector in Rural Health
Development is the Village Health Promoter Program
(VHP). This is a community-based health program
introduced by Sarawak Health Department in 1983
to provide basic health services to people living in
remote areas. Under this program, participating villages
send two volunteers each to undergo three weeks of
structured training on a variety of health-related topics
in a nearby health facility. At the end of the training
period, the volunteers return to their respective villages
and help provide basic health care to the people there.
Medical supplies and supervisory support are provided
by staff from the nearest health facility, be it from general
hospitals or health clinics. In turn, the volunteers provide
regular reports on the types of illnesses they attend to.
Up till the end of 2001, there are 2,956 VHP throughout
the State, serving a total of 271,182 people from 1,664
villages.
Many doctors decline offers to serve in rural Sarawak
based on the fact that lack of basic amenities as well as
entertainment that they would get in the cities. Some
dread the fact of travelling to the interiors based on
rumours spread that travelling to these areas is actually
not safe. Those who are serving in the districts e.g.
Samarahan Health Clinic, have to provide services to areas
that cannot be connected via road, hence FDS is the only
method of delivering health care services to these people.
Doctors in Samarahan Health Clinic go on rotations three
times a month to the interiors for providing medications,

basic health checks and vaccination for the children. The


doctors are currently given an allowance of RM35 per day
to visit these areas and another RM35 for food allowance.
National SCHOMOS committee has discussed the matter
of payment rise for these doctors who are willing to serve
under FDS therefore encouraging more doctors to serve
in the rural areas of Sarawak.
This matter has been brought up during our National
SCHOMOS AGM lately and the current team led by Dr
Vasu Pillai is looking seriously into the matter. Discussions
with State Health Department are also concurrently taking
place via the JKNS-MMA Consultative Meetings held
once every two months and they are seriously attending
to this matter. We do hope for a positive outcome in the
near future regarding this matter as not many people
realise the importance of this important service provided
to the rural people of Sarawak. Infectious diseases
of which respiratory tract infections, gastrointestinal
infections, helminthiasis, skin infections, and more
amongst the rural population is of much concern to the
Public Health Sector in our country and these services do
help in ensuring that emergence of new problems from
rural populations in the context of infectious disease can
be prevented. Not only that, SCHOMOS Sarawak has
been conducting various Health Camps and Rural Visits
together with various Non-Government Organisations
such as Satya Sai Baba Association Kuching to provide
medical and dental services to areas around Kuching
up to Sri Aman division which are difficult for access to
healthcare facilities via road.

beritaMMA Vol.46 August 2016

30

birthday greetings

Happy
90th
Birthday
Tun Dr Siti
Hasmah
Interviewed & Written
by
Dr Juliet Mathew
Editorial Board Member
&
Dato Pahlawan Dr. R. Mohanadas
Editor

er love and passion for the profession of MEDICINE


has not diminished with advancing age, or with
the many responsibilities that she has gained since
adorning the mantel as one of Malaysias most inspiring
woman. A request was made for an interview with
Berita MMA on 11 July 2016, and we were immediately
accommodated to one on the 14 July 2016 itself, despite
the many engagements awaiting her. The beautiful Tun
Dr Siti Hasmah Mohd Ali turned 90 on 12 July 2016, and
she gifted us instead with the most memorable two hours
that we had in her company. As graceful and loving as
always, Tun narrated her many experiences in healthcare
within her own brand of humour, mesmerizing us with the
minute details from each experience with keen passion.
Her amazing memory astonished us!

The Budding Medical Student


Tuns first chosen career pathway had been journalism, as
she had enjoyed many endless hours writing articles for her
school magazine and the Young Malayan in her younger
days while studying at St. Marys School, Kuala Lumpur.
Her interest in medicine swelled after seeing her mother
endure the perils of either severe dysentery or cholera
(as noted on hindsight) which was rampant during the
Japanese occupation of Malaya. Seeing her mother so ill
and crouched all the time changed her life. Therein she
realized her true capabilities in bravely and passionately
facing the challenges that comes with caring for the sick.
She also seems to naturally attend to any emergencies
within the family very quickly, and was more inclined to look
after people. I was not afraid, she says proudly. Hence,
she changed her direction of ambition and marched forth
to pursue her medical studies in the only medical school in
Singapore then, the King Edward VII College of Medicine,
Singapore (1947-1949) then in Faculty of Medicine,
University Malaya, Singapore (1949-1955).
beritaMMA Vol.46 August 2016

The New Doctor


After graduation, Tun started her housemanship at the
General Hospital Kuala Lumpur (GHKL) in 1955. The starting
salary was RM 400 per month, which was raised to RM401
after a few months in order to be qualified to receive the
Employees Provident Funds (EPF), it was of no concern to
her. The Medical Officers salary then, was starting at RM
730 per month. Married women doctors were at that time,
either recruited on a month-to-month basis or on a three
years contract with gratuity. It could be extended. Later
in 1970s, the government offered permanent employment
but she refused it as she had reached her maximum salary of
RM 2300 per month by then. Tun also refused promotions
and transfers and remained in Alor Setar. When Tun was
officially transferred to Institut Kesihatan Umum (IKU) in
1974, permanent employment was again offered, but she
declined it. She retired after her contract ended in 1979.
In GHKL, she recalls her arduous duties as a houseman
within the Paediatric Ward No 18, where, in a ward of 36
beds, one row would be lined by children suffering from
Diphtheria, and another with those suffering from TB
Meningitis. I always had houseman jinx, when I am on
night duty, they will all come! She describes the many
emergency stab and turn tracheotomy that she had to
meticulously carry out from one child to another who was
suffering from acute breathing difficulties due to Diphtheria.
It was a matter of life and death! she exclaims.
On the other side, the row of TB meningitis toddlers were
subjected to the appropriate bending and flexing positions
by the hospital assistants (HA) so that she could administer
the spinal injections carefully. We had such good HAs
then!she remarks proudly.
Tun also described the wooden box respirator treatment
that was used for polio victims back then, better known

as the Iron Lung. People were apparently afraid of as it


looked like a coffin. She describes it in her own words:It was a wooden box, longer than the patient. There
is a round opening at the top for the head to be always
outside the box. There were also round openings, two on
each side for nursing care of the patient. Other than these
openings, the actual box is a respirator which induces
the patient to breathe, as their respiratory muscles were
already paralysed and it was only a matter of months,
weeks, or days before the patient was mercifully taken by
the Almighty. Allah bless them all.
Stressing the need for immunisation in children, she said
sadly We have progressed so well, we cannot turn back!
Visibly disturbed also by the re-emergence of Diphtheria
in the country, Tun expressed her disappointment with
certain groups in rejecting vaccination for their children.
That which provides protection for an individual and the
community cannot be considered haram! she stressed.

The MONK ~ 1956 to 1974


Tun started as a Medical Officer (MO) at the
Outpatient Department (OPD) of General
Hospital Alor Setar, Kedah after getting
married to Dr. Mahathir Mohamad in 1956.
She explains how there were only two
Malay Lady Medical Officers at that time,
and Kedah was fortunate to have both
of them in Alor Setar. Dr Salmah Ismail,
her senior (later Tan Sri), the daughter of
the Kedah State Secretary was the other
female doctor; she had been a Ward MO
at the same time.
Being born and raised in Klang, Tun expressed that
she considered herself an expatriate. I, a girl from
Kuala Lumpur a town, and I am in rural Kedah trying
to understand Kedah dialect....my relatives and friends
thought that I will not last in Alor Setar as it was really rural,
but it was a challenge and I did it...I enjoyed Kedah! She
narrates amusingly how she learnt the real meaning of
Susah nak pergi ke sungai kecil atau sungai besar from

her female patients. While baffled with the terms initially,


she understood later that it actually explained the difficulty
in the process of micturition and defecation.
She narrated her experience with a strict Dr Biswas, an
Obstetrics & Gynaecology Consultant, who had once
supervised her during a Caesarean Section for a third
degree Placenta Praevia. Dr Biswas was coaxing her to
be quick as required in this case and the hurried Tun had
started to cry while doing the procedure. Her tears, she
said, had blurred her vision and were literally dropping
into the cut open wound but she had gone on still with
the gentle support of the nurses. This, nevertheless, did
not stop her passion for surgery I LOVE surgery, she
remarks happily. I would go back to the theatre to assist
even during my holidays!
As MONK (Medical Officer North Kedah), not NUN, as
she teased jokingly, she covered the outlying clinics at
Padang Terap, Kuala Nerang, Pendang and Yan. While

covering Kuala Nerang, she


explains how she needs to
report at the towns Police
Station whenever going in
and out of the town as these
were black areas during
the emergency. She was also
warned to return early because
of the Datuks that she might
meet on these roads tigers!

Cholera Outbreak
In 1963, Tun was appointed
as the Acting Superintendant
of Alor Setar Hospital. Towards the end of the same year,
there was a widespread cholera outbreak in Kedah, which
had started three months earlier in Melaka. She was directly
involved in managing it, with Dr Raja Ahmad Nordin who
was then nicknamed as the Jamban Jitra Doctor for his
role in initiating building of clean latrines far away from the
rivers. She describes him fondly as one who smiles easily
and never gets angry. He had managed to deploy the
beritaMMA Vol.46 August 2016

32

birthday greetings

Photo taken at the Perdana Leadership Foundation, Putrajaya (L to R: Dr Juliet Mathew


and Dato Pahlawan Dr Mohanadas interviewing Tun Dr Siti Hasmah on 14 July 2016).

Melaka Health Team as well as health officers from Kuala


Lumpur, and together, they had managed to help control
the outbreak kampung by kampung.
In the midst of collecting rectal swabs from contacts of
patients with cholera within the wards, Tun narrates fondly
an incident whereby a young boy had refused to get
admitted as he had to tend to his one and only buffalo,
which takes care of his padi field. In this rare occasion, due
to the situation at hand, Tun actually instructed that the
buffalo to be admitted in the hospital grounds as well so
that the boy could be duly investigated! We sometimes
have to allow these things, she explains, People will
remember you and appreciate you!
From being the first woman to be appointed as Medical
Officer in the Maternal and Child Health Department and
then the Acting Superintendant of Alor Setar Hospital, as
well as first woman as State Maternal and Child Health
Officer, she never ceased from reaching out to the needy
patients and profoundly changing their lives. Eighteen
years of extraordinary clinical work experiences thus
emerged from Kedah.

Rural Folks Crusader


Passionate about caring for the rural folks and educating
them within the correct health practices, Tun explains the
many challenges that she had faced while treating them
throughout the years. Their traditional habits and culture
is very strong, she explains, and it is perpetuated by the
traditional healers such as the Bomohs and Tok Bidans
as well as the local religious leaders. Hence, there was
much resistance in accepting treatment from the hospital.
Potong, she explains, was not an accepted word! She
had thus, experienced much dismay and frustrations
during her call of duty due to the lack of consent for many
urgently required operative procedures and delays in
seeking treatment for many conditions which could have
otherwise been successfully managed or prevented.
Family planning, she says, was a sensitive topic to talk in
the kampongs, especially in an era where only diaphragms
and condoms were available as contraceptive methods
beritaMMA Vol.46 August 2016

of choice. Tun explains the two categories of traditional


habits and culture practiced by the rural folks which must
be addressed at large. The beneficial ones like massages
during the first six weeks of post natal period and
breastfeeding for two years that must be advocated still,
and the harmful ones like food taboos and using hot stones
or besi panas on the stomach to help involute the uterus
and dry up the lochia, which must be stopped. Rural folks,
she says, are so simple and so ignorant that they must be
told. It is a matter of talking to them, she stresses slowly.

Malaria Eradication Program


During the malaria eradication program, Tun explains that
the rural folks had rejected DDT spray and did not allow it
to be sprayed in the houses because it was construed as
haram. Tun had to conduct meetings with Dato Yusof
of PAS who was her religious referral. Together, they had
gone to the Pejabat Agama with the DDT recipe to get it
accepted for use. We came out happily and sembuh balik
all the homes! she exclaimed.

Public Health Programs


Tun had participated wholly in the many public health
initiatives employed by the government then to encourage
the rural folks to incorporate healthy practices within
their lifestyles. She thus, encouraged many public health
competitions that were conducted, such as The Cleanliness
Kampong Competition which was held to promote
cleanliness and Healthy Baby Contests which were held to
encourage vaccination and breastfeeding. Tun, passionate
about Baby Friendly Hospitals, explains how she would go
to the various hospitals then to initiate the program and
educate on the importance of mothers breastfeeding their
newborns for two years. I will do it now if I am allowed
to! she quips.
While visiting kampungs and educating the rural folks
with the correct health practices as well as training rural
midwives and Public Health Overseers, Tun expressed
experiencing fear at times as there was always the risk that
these folks would not like and accept her. They can hack
me if they want; anything can happen ... However, her

steadfast, strong determination to serve these folks helped


her to march forward triumphantly. I am a Malay, a Lady
and a Doctor...God has a mission for me, I felt the calling
and I was brought to this world to serve....and I did just
that! she announces proudly.
Tun underwent training in Public Health Education in
Manila, and two weeks course in Family and Population
Planning 1996 at the University of Michigan, Ann Arbor.
In 1992, she was awarded a Fellowship in Public Health
Medicine by the Faculty of Public Health, Royal College of
Physicians of Ireland.
Tun gives much gratitude to the late Tun Abdul Razak for
recognizing the needs of the rural folks and prioritizing
rural development. He comes down to the grass root
level, she says, If not for him, we wont have opened up
the rural areas!

Vaccination Programs
Tun had been invited to Washington to relate to the
World Bank, her success stories in Malaysia within the Safe
Motherhood Initiative Programme, which had reduced
the Maternal Mortality Ratio(MMR) in Malaysia markedly
from 20 per 1000 live births to 20-40 per 100 000. She
stresses that as a result of our aggressive Immunization
Programme, the Infant Mortality Rate (IMR) also had
reduced significantly from 75 per 1000 births in 1957 to 7
per 1000 in 2003! This cleared Malaysia of Diphtheria, Polio
and Tuberculosis. Tun is, thus, saddened and disappointed
that the anti vaccine campaigns have emerged and natural
home deliveries without attendance are currently being
popularized at large.

Anti-Smoking and Anti-Narcotic Campaign


Tun is still supporting the Anti-Smoking and Anti-Narcotics
campaigns passionately, she was much involved in them
nationally during her days at IKU. She has, sadly, lost
several close friends and relatives to smoking induced lung
cancer and cardiac catastrophes ~ Dr Varughese, Director
of IKU, Dr Kingsley Oorbolf and her own nephew.
No use in saying I have stopped years ago, she stresses.
The seed has been planted when you start to smoke! Tun
connects smoking to narcotics where later, the cigarettes
are replaced and the smoker is hooked to drugs. She has
been actively involved in the National Drug Prevention
campaign and has travelled with them to meet and talk to
drug addicts and parents. In 1995, she went to Washington
at the invitation of the then First Lady, Nancy Reagan, to
represent Malaysia and brief of our programs there. She
came back and started the 1st National Drug Prevention
Conference which was organized by the Anti Narcotic
Agency, Malaysian Health Ministry and Non Governmental
Organizations. Subsequently, Tun also managed to invite
First Lady Nancy Reagan to Kuala Lumpur to show her the
national programs started in schools and such, in the bid to
fight against smoking and narcotic abuse.
I had also represented Malaysia in Conference in ICDAIT
in Vienna when Tun Mahathir became its President.

per 1000 live births to 20 to 40 per 100,000 live births.


b. Our IMR from 75 per 1000 in 1957 to 7 per 1000 in 2003.
Result of our aggressive immunisation programme
which cleared Malaysia of Diptheria, Polio and TB.

Advice to Young Doctors


Tun is happy to hear that there are many young people
who want to be doctors in this era, especially young girls.
She prays and hopes that they have chosen this path truly
because they want to serve the community and not just for
the lucrative practices in store for them. Her sincere advice
is that they will learn much early in their practice itself, not
just from the wards but from the rural areas in Malaysia, as
that is where the traditional habits and cultures are rooted
and thats something that cannot be eradicated just yet.
You want to be a doctor, also serve the rural folks! she
stresses, The rewards will come...stay and serve, you are
doing good things, it will come.
To the lady doctors, she advises that it is a pity to give
up their career after marriage or having children, as this
is such a noble profession and the country needs doctors.
Maintaining the balance is crucial, she says. They need
to divide and learn to compartmentalize their lives into
different areas of life their career, their families and
community, and their children. She encourages them to
wholly involve their husbands in their routine and sharing
of the domestic chores. Tun acknowledges happily the
open policy adopted within many hospitals, which allow
the husbands into the labour rooms to comfort their wives.
Good for husbands to see what the wives are going
through and share the feelings!
Tun stresses that the most important tools for doctors is
good communication skills and attitudes, and these must
be exercised towards all patients those from the top
levels as well as the ones from the bottom. Within the lines
of duty, she advises doctors to greet all patients, then,
mention their names at least three times during the whole
consultation process so as to incorporate the personal
touch within. She also advises strongly that the palm of the
hand is very powerful, Just go to the patient and touch
them! God has blessed us all to have this power of touch!

The Future...
Tun is extremely happy that of all the grandchildren, one
intends taking up medicine, and wishes to specialise in
Obstetrics & Gynaecology! She has followed him once
while he was doing his attachment in a labour room
and was happy to note that hospitals in Malaysia have
progressed well in their capacities, as she noted many
able doctors, nurses and others within the healthcare team
bustling around to assist patients. The idea of you helping
an injured person or anyone who is not well...that is a
blessing you know! It is the MOST noble of all profession.
Sitting proudly within her serene and resplendent aura,
she concludes our interview with this one statement,
one which she utters slowly and clearly with words that
would spring magnified emotions of pride from the heart
of anyone truly dedicated within this noble profession ~
I wish I can continue being a doctor!

I had also been invited to Washington to relate to


World Bank:

Thank You, YABhg Tun Dr Siti Hasmah.

a. Success story of Malaysia in our Safe Motherhood


Initiatives Program that brought down our MMR from 20

Happy Birthday.
beritaMMA Vol.46 August 2016

34

general

Humour

Compiled by,
Dato Wira Dr LR Chandran and
his team of jokellectuals, Alor Setar

Double Entendre

A husband and wife were very happy over a nine pound baby
boy that was born to them. Mr Brown, the father, who could
not conceal his delight, called up the editor of a famous
newspaper and reported that he had become the proud owner
of a nine pound nugget of gold. The editor upon hearing
seemingly extraordinary news, sent his star reporter to
interview Mr Brown. When the reporter came, Mr Brown was
away and his wife was alone at home. Reporter: - Does Mr.
Brown live here? Mrs Brown: - Oh! yes. Reporter:- Is he
in? Mrs Brown:- No, he has gone out for a while. Reporter:Is it true that he owns a nine pound nugget of gold? Mrs
Brown:- (Amused) Yes! Indeed. Reporter:- Can I see the
place where he found it? Mrs Brown:- Im afraid not! Mr.
Brown would surely object to it as much as I do....it is a very
private area. Reporter:- Is the place far? Mrs Brown:- No, it
is quite near and convenient. Reporter:- How many years has
Mr. Brown been digging the hole to obtain this nugget? Mrs
Brown:- I must say, just about two years. Reporter:- Is
the hole deep? Mrs Brown:- Deep enough! Reporter:- At
about what time does Mr. Brown usually start digging? Mrs
Brown:- Oh, he does his digging mostly at night. Reporter:Does he work very hard on it? Mrs Brown:- You bet....and how
he perspires. Reporter:- Is Mr. Brown the first person to dig
this hole? Mrs Brown:- Well, he thought he was.... Reporter:How would you know for sure that there was someone ahead
of him? Mrs Brown:- Im in good position to say so,as I
solely own the place. Reporter:- Oh, I see, so did you sell the
place to Mr. Brown? Mrs Brown:- No, but for the present
moment, he has the legal authority to the site. Reporter:- Has
Mr. Brown had any helper when he works? Mrs Brown:- Yes,
I help by working under him. Reporter:- Do you think Mr.
Brown will ever sell the place? Mrs Brown:- I dont think so
because he really enjoys working on it. Reporter:- Can I see
the nine pound nugget of gold? Mrs Brown:- Yes, certainly
! As Mrs Brown shows the reporter the precious nine pound
baby boy, he faints on the spot!

Devil Level
Just minutes before a prayer service was
about to begin, and the congregation was
sitting silently and praying, a sudden
flash of light bolted across and Satan
appeared. Everyone started screaming and
running for the exits, trampling each other
in a frantic effort to get away from the evil
incarnate. Soon the prayer hall was empty
except for one cowboy who sat calmly in his
place without moving, seemingly oblivious to
the fact that Gods ultimate enemy was in his
presence.
So Satan walked up to the cowboy and said,
Do you know who I am? The cowboy replied,
Yep, sure do. Arent you afraid of me?
Satan asked. Nope, sure aint. said the
cowboy . Dont you realize I can kill you with
one word? asked Satan. Dont doubt it
for a minute, replied the cowboy, in an even
tone. Did you know that I can cause you
profound, horrifying AGONY for all eternity?
persisted Satan. Yep, was the calm
reply. And you are still not afraid? asked
Satan. Nope, said the cowboy. More than a
little perturbed, Satan asked, Why arent you
afraid of me? The old cowboy calmly replied,
Been married to your sister for 48 years.

Double Trouble
According to a new study done among married men across Malaysia,
talking to the wife is apparently the most relaxing communication
method ever discovered in medical history as it improves the life span of
men remarkably. Data shows that it reduces stress by 90 percent and
the risk of heart attacks by 80 percent, specifically in men above 60. The
study also mentions that this is a notably more healing and relaxing hobby
compared to golf and watching television. But, it does not say whose wife.

beritaMMA Vol.46 August 2016

mma in the press

35
xx

beritaMMA Vol.46 August 2016

38

branch news penang

MMA Penang Awards


2016

Dr Ong Joo Howe was awarded


best student prizes for Medicine and
Forensic & Legal Medicine

Dr Megat Mohammad Fakhri Bin


Kamaruzaman was awarded the best student
prize for Psychiatry

Dr Kiranpreet Kaur a/p Rabindarjeet


Singh was awarded the best student
prize for Ophthalmology

MA Penang Branch once again awarded prizes during the Penang


Medical College Conferring Ceremony for the 16th cohort of students
held on Sunday 19 June 2016 at the Eastern & Oriental Hotel, Penang.
The Branch had been providing best student awards every year since the
inception of the College.

Dr H
D
Hooii L
Laii N
Ngoh
h
drhooi.hooi@gmail.com
Chairman
MMA Penang Branch

Dr Saraswathi Bina Rai, Honorary Secretary, MMA Penang Branch, gave away
the prizes consisting of a cheque for RM500 and a Certificate of Achievement
for 1st place in eight subjects as follows:
Medicine

Ong Joo Howe

Surgery

Ew Ju Vern

Obstetrics and Gynaecology

Khoo Chee Shean

Paediatrics

Thum Ying Ying

Psychiatry

Megat Mohammad Fakhri Bin


Kamaruzaman

Ophthalmology

Tan Chin Ning

Otolaryngology

Kiranpreet Kaur A/P Rabindarjeet Singh

Forensic and Legal Medicine

Ong Joo Howe

Penang Branch of the MMA wishes all prize winners and graduating
students from the Class of 2016 the best in their future careers and hope
that they will be active members of MMA.
beritaMMA Vol.46 August 2016

40

branch news penang

MMA Sibu Badminton


Championship 2016
Dr Ng Ling Seow
NG_SEOW@hotmail.com
Secretary
MMA Sibu Sub-Committee

The Organising Committee and the Maeltree crew

he very first MMA Sibu Badminton Championship was organised by the MMA
Sibu Sub-Committee together with the Maeltree Team on 14th May 2016 at the
Thumbs Up Badminton Academy situated at Level 12 of the Multi-Storey Car Park,
Central Market Sibu, Sarawak.
The objectives of this event are to encourage more doctors to become MMA members,
build rapport between doctors from private and government sectors, forge a close
bond among staffs in KKM and lastly to discover hidden talents among the doctors to
represent MMA Sarawak in coming MMA Sarawak-Sabah Games.
The categories held in the championship included Singles, Doubles for men, Mixed
Doubles and VIPs Doubles (UD 48 and above). The event attracted a total 78 teams.
The participants included Specialists, Medical Doctors, Medical Assistants, Staff Nurses,
JMs, Medical Lab Technicians, Radiology Technicians, Pharmacist Assistants, PPK, etc.
The Men Doubles was the most popular category with 34 teams competing intensely
to prove who is better. Women Doubles had 9 teams participating in the championship.
The Maeltree Team rendered technical support with umpires and linesmen providing a
fair and professional environment for the 78 games that were played. Fortunately, there
were no reports of injury during the event
For the Mens Singles, Dr Muhamad Muhaimin was the champion, followed by 1st runner
up, Dr Douglas Chu and 2nd runner-up Terence Untol & Mohd Arfizul Bin Mohamad Nor.
For the Mens Doubles, Dr Muhamad Muhaimin & Dr Douglas Chu emerged as the
winners, Mohd Arfizul Bin Mohamad Nor & David Lim were the 1st runner-up and Arthur
Asak & Winchester Kijun, Zainal Bin Hamdan & Harun Bin Zainuddin were the 2nd
runner-up.
For the Womens Doubles, Farzianal Bt Abd Tain & Fatin Hanani Bt Sufia were the
champions, followed by Norhidayati Abdullah & Normah Bt Kuko as 1st runner-up, Aliza
Bt Mohamad & Afifah Bt Daniel and Hannah Yap Jun Lin & Cheng Mun Yee as the 2nd
runner-up.

beritaMMA Vol.46 August 2016

The winners for Mixed Doubles were Dr Muhamad


Muhaimin & Dr Lee Rou Theng. Mohd Khalid & Mary
were the 1st runner-up while Jiminan & Hii Chai Choo
and Hannah Yap Jun Lin & Andy Bin Kahar were the 2nd
runner-up.
The winners for VIP Doubles (UD 48 and above) were Mr
Ooi & Dr George Wong. Mr Sashi & Dr Andrew were the
1st runner-up while Dr Lau Chiong Kim & Dr Wong See
Chiong were the 2nd runner-up.
On behalf of the Organising Committee, Dr Lim Kim Ying,
Chairperson of MMA Sibu Badminton Championship
2016 would like to take this opportunity to thank all of
the participants and the Maeltree Team for making this
event a success.

Dr Muhaimin performing his deadly jump smash

Through this event, we hope to create a new platform for


healthcare staffs to enhance their talents in badminton.
This is the first but certainly not the last event of MMA
Sibu Badminton Championship as the committee will
ensure the continuation of such an event in the future.
Lastly, we would like to urge all doctors to join Malaysian
Medical Association, the largest association for doctors
in Malaysia to not only benefit from all the privileges
available but to build a strong association to represent
the doctors.
The winners of Woman Doubles

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42

letter to the editor


The Ideal Healthcare System?

The authors are in search of what is ideal for the


development and direction of the healthcare
system in Malaysia.
As Malaysia edges closer to her 6th decade of
independence, so does her healthcare system.
Modern medicine has thrown in a spanner to
the healthcare system, from the diversification of
healthcare professionals, expansion of services and
increasing expectations from the public.

Background
Malaysia has a two-tier healthcare system, a robust
government healthcare system which includes public
hospitals, university hospitals and health clinics
(Klinik Kesihatan or 1 Malaysia). A supporting private
healthcare system inclusive of private hospitals
and general practitioners provides for a big piece
of the pie. Malaysia boasts approximately 7000
registered private primary-care clinics distributed
demographically throughout the country but their
services are underutilised. They have been in
existence since independence and have a very good
track record in providing healthcare services that
are accessible, affordable, sustainable and good
quality of service.
The authors prefer to term the Malaysian system as
a hybrid instead of a two-tier system. This is because
both the government-based and private-based
healthcare providers complement each other to serve
the growing population. Moreover, we have seen
the inclusion of holistic medicine into the practice of
Malaysian medicine, further hybridizing the pie on the
table.
This article serves to tickle healthcare professionals
and encourage a conversation on the direction of our
healthcare in the future especially among clinicians
whom as many will call; the stakeholders of the
system. Stakeholders may fit the term but as clinicians
and doctors serving the people, the authors would
like to term us, clinicians in the community or hospital
setting as healthcare providers; as we provide for the
betterment of health.
Therefore what can be termed ideal? Two healthcare
practitioners brainstormed over coffee on what was
available abroad, including benefits and limitations.
They then scribbled their thoughts down after a
gruelling MMA branch meeting.

Healthcare insurance
Thumbs up: Healthcare insurance, either
governmental or private in nature is the key forward
for those without healthcare support such as pension.
Although it may first be unpopular among the public
(lets be honest, no one likes paying more out of their
pockets for benefits they are unable to appreciate
short term). However, in the long run, its benefit

beritaMMA Vol.46 August 2016

outweighs its burden. Healthcare is an expensive


business, and it only gets more expensive.
A national healthcare insurance forces people to start
saving earlier for rainy days in the future. Moreover,
by saving earlier, it is makes healthcare especially
that of private more accessible to the middle class
at the least. Therefore, the public whom previously
were unable to, will be able to afford healthcare at
their general practitioners, thus reducing the rates of
Emergency Department green zone abuse. Certainly
a win for both the public and private sectors. Although
the government does subsidise heavily for healthcare
at public hospitals and clinics, such reliance cannot
be expected to continue as there will be a time
whereby subsidies will have to be withdrawn to allow
for economic expansion. A story similar to vehicle fuel
subsidy.
Thumbs down: If an insurance system is to be
implemented on a national basis, there needs to be
a thorough review and regulation. Questions such as
how much premium one should pay; how much one
may claim; are claims based on contribution etc., are
challenging to address.
The National Health Service is finding it difficult to
sustain itself with limitations on claimable procedures
and Medicare in USA has its own critics. Other
downside is healthcare providers either government
or private may considered employers; having to claim
and tune to various insurance companies. Therefore
there must be regulations.
Issues include:
1. How will it be funded?
2. Who will be managing the fund?
3. Who are they answerable to?
4. What is the management cost of managing the
fund?
These will have to be addressed. It must have a clear
system of auditing based on the foundation of good
governance, transparency and accountability as it
involves financial contribution by the nation.

Continuity of Care
Thumbs up: Patients want continuity of care to ease
them from having to revisit or repeat their healthcare
ordeal to a new clinician on each clinic visit. There
should be a national health database; allowing for
the secured sharing of healthcare information among
hospitals and primary care physicians. This allows
patients discharged from the hospitals to be managed
effectively in the community without a break in care
pathway.

The primary care physicians on the other hand will have


electronic access to the patients discharge summary,
proving information on admission diagnosis and
alterations to medications on repeat prescriptions.
This prevents repeat of investigations and extra costs
to the patients as investigation results can be shared
among the various healthcare providers attending to
the patient.
Initial investigations and basic procedures are to
be encouraged at primary care clinics to reduce
the patient overload at public hospitals. Primary
care physicians should be given incentives when
risk stratifying their patients and managing chronic
diseases within acceptable parameters. This avoids
complications from non-communicable diseases with
referrals reduction. The salient saying of prevention is
better than cure still holds true!
Thumbs down: Cost is required to maintain a national
database and may translate into a subscription fee to
healthcare providers. Confidentiality with password
and smartcard access is not bulletproof.
Primary care physicians will be required to upgrade
their facilities. They will require qualification for
necessary competency in skills for specific procedures
that can be carried out at their practice. Again this
may translate to an increase in cost in short term but
does save tax payers money in the long term.

Regulating Junior Doctors Changeover


Thumbs u p : The United Kingdom, United States of
America and Australian system employs junior doctors
into rotation jobs in government and/or private
training hospitals on an annual basis. This occurs in coordination with local university graduation or summer
breaks. Malaysian Ministry of Health and universitybased hospitals receive doctors on postings all year
round in contrast to the speciality training programme
regulated to receive doctors twice-yearly in Malaysia,
(July and December, with the latter only applying to
selected specialities).
A regulated intake of doctors to once or twice a
year allows for a coordinated rotation of doctors in
public hospitals. This overcomes the shortage or
oversubscription of junior doctors (house officers
and medical officers) on floors at a given time in a
particular department. Junior doctors will be rotating
at the same time as per batch of employment. This
allows every junior doctor spot to be fulfilled with
fixed numbers as per hospital requirement.
Such a system is only possible if the intake is
based on a coordinated national job allocation
programme such as the house officer application
in Malaysia. The government does not have to be
burdened for house officers or medical officers waiting
for placements on a monthly basis as the system
provides for regulated entry in view of increasing
numbers of junior doctors and limited job availability;

a situation faced and managed effectively in the UK


and USA.
Thumbs down: Although a two yearly intake does
cater for international Malaysian graduates graduating
at different times as compared to the Malaysian
graduates; junior doctors must be prepared for some
interim time prior to employment. It is not all doom
for unsuccessful applicants as they may reapply for
the following intake term.
Note: A junior doctor is a doctor at any position
ranging from a house officer to a registrar, resident or
non-resident.

Overproduction of Junior Doctors


Thumbs u p : The Medical School system which
mushroomed during the 1990s should be revisited
and drastic, practical but sustainable measures
should be taken. The number of medical schools in
Malaysia should be less than twenty. A suggestion
is current medical schools should merge. Medical
schools should not just be a mass production centre
but a centre that focuses on research of international
standards.
More centres of excellence should be allowed to focus
on subspecialty services that can cater for the region.
We need to retrain our doctors towards research and
development with the medical need of patients in
mind.
Thumbs down: Some may argue that limiting the
number of medical school seats may indirectly deny
gifted young Malaysians from medical training.
Moreover, it may be unfair to many private medical
institutions that have made large financial investments.
Financial compensations are going to be a tricky and
costly affair.

Primary Care
Thumbs u p : The future should encourage more
doctors operating private or public primary care
services to obtain a Diploma in Family Medicine.
Parallel channels should be opened allowing better
access. Local healthcare institutions should offer such
courses at affordable rates. As clinicians have irregular
working hours, a course with flexible hours is greatly
appreciated.
Besides, zoning of private primary care clinics based
on population should be formulated. Incentivize
those who are opening in the rural areas. Primary care
accessibility is still a dilemma in rural Borneo due to
geographical contour.
Opening of new clinics in saturated zones should
be discouraged to avoid unhealthy competition
between practitioners. Instead the government
should provide incentives for primary care clinics to
upgrade themselves into primary care centres with the
availability of a multidisciplinary team of healthcare

beritaMMA Vol.46 August 2016

44

letter to the editor

Thumbs down: Nil significant.

delivery of healthcare and safeguarding the interests


of patients. Malaysia is certainly scoring well here
with the availability of CPGs by Academy of Medicine
and also trending among hospital based healthcare
institutions.

Vaccination

Thumbs down: Nil significant

providers such as pharmacist, physiotherapist and


occupational therapist to better serve the needs of
the community.

Thumbs u p : Vaccinations are provided by the one


thousand Klinik Kesihatan and 7000-odd private
primary care clinics in Malaysia. However a large
portion of private primary care clinics have been
denied the continuity of vaccine supply over the past
three years due to nationwide shortage. Available
supply was only focused to public health clinics (Klinik
Kesihatan).
The private primary care clinics should be given
a more important role in the vaccination program
by granting a predetermined pricing from vaccine
suppliers in the hopes of reducing the cost of
vaccination to the public. Primary care physicians not
only act as a gatekeeper, but are in the position to
educate and convince patients on the importance of
vaccination, a task they have been carrying out since
independence. A National Vaccine Registry will allow
the tracking of vaccine coverage and enforcements
(strictly speaking, vaccinations cannot be enforced as
it is yet to be mandatory by the law!)
Thumbs down: Vaccination programmes should not
involve any third party pharmaceuticals or vendors
but the Ministry Of Health themselves. There should
be a continuous supply of vaccines.

Practicing Insurance:
Thumbs u p : All clinicians including junior doctors in
the UK and USA are encouraged to purchase medical
practising insurance for individual cover regardless if
they are hospital employees. This is in line with the
recent increase in medico legal awareness among the
general population in Malaysia, a trend we have seen
in the west and with our neighbours in Singapore. Out
of court moderation and arbitration in medico legal
claims may be a less costly option.
Thumbs down: There is a need to manage the rising
costs of insurance for our colleagues in the Obstetrics
& Gynaecology and Neurosurgical specialities in
Malaysia, which has been skyrocketing recently.
A discussion held by the Medico-Legal Society
of Malaysia revealed that insurance policies are
increasing for certain specialities in view of increasing
pay-out claims being awarded to patients by the
courts based on professional input on maintenance
claims based on life expectancy and prognosis with
loss of income.

Clinical Guidelines
Thumbs u p : Clinical Practicing Guidelines (CPG)
based on evidence based medicine forms the
substructure of clinical practice for the effective

beritaMMA Vol.46 August 2016

The above are of general pointers in comparison to


other systems and not exhaustive. There are several
other healthcare issues such as national screening
programmes, consultation fees and healthcare costs
that can be considered.
After two hours of discussion, we took a last sip of our
coffee; already at room temperature. As we place our
coffee mugs on the table, we could not help but to
notice that there is no ideal or perfect coffee. It is an
individual taste, as some may prefer their coffee bitter
or sweet. The ideal healthcare system in Malaysia,
similar to our coffee, should be ours, i.e. a Malaysian
agenda.
Healthcare providers from primary care to hospital
based setting should be engaged to initiate a
conversation in the road towards an affordable,
accessible, sustainable healthcare system. Both the
private and public sector have their own strength
and weakness; we should work towards bridging
the gap and complementing each other. Indeed our
healthcare system is unique as one certainly needs
the other.
It is innate to not want change, but change for the
betterment of the people in the name of progress
should be encouraged. Like the human body, we
will eventually adapt. The blueprints of healthcare
achieved by the developed nations above can be
used as a guide on the direction we take, adopting
some and eliminating some. What must be certain
is that the direction we embark should reduce the
burden of health to the nation; as we as healthcare
providers today will be at the receiving end someday.
Individualising our system to the Malaysian needs is of
great pertinence. We are of no wealth without health.
Malaysia celebrates her 59th year of independence
in August and so does her healthcare system. In line
with Vision 2020, we have shy of four years left to
shape our healthcare to that of a developed nation.

By
Dr Hardip Singh Gendeh
hardip88@hotmail.com
Member MMA, Wilayah
Dr Thirunavukarasu
drarasu@cahayaclinics.com
Life Member MMA, Wilayah

46

mark your diary

YEAR 2016
AUGUST
THE 19TH FAMILY MEDICINE SCIENTIFIC CONFERENCE 2016
Theme
: Excellence in Primary Care. Make It Matter, Make It Better
Date
: 10 13 August 2016
Venue
: Dorsett Grand, Subang Malaysia
Contact : Dr Noor Hasliza Hassan/Dr Nur Amani Ahmad Tajuddin
Tel
: +603-3141 1242
Fax
: +603-3141 2235
Email
: fmsconference2016@gmail.com
Website : www.conference2016.fms-malaysia.org
THE MMA PAHANG BRANCH 6TH ANNUAL SCIENTIFIC MEETING
& REGIONAL MEDICAL UPDATES 2016
Date
: 13 14 August 2016
Time
: 8:00 am 5:00 pm
Venue
: The Vistana Kuantan, Pahang.
Contact : En Mohd Ariff Hazami Elliazir
Enquiries : mmapahang@gmail.com
Facebook : https://www.facebook.com/mmapahangbranch
BACK TO BASIC: LAPAROSCOPIC SURGERY IN THE LOW
RESOURCE SETTING BY O&G DEPT, HSAH SP KEDAH
Date
: 17 August 2016
Venue
: Hospital Sultan Abdul Halim, Sungai Petani, Kedah
Contact : Sister Normiza Binti Zainal Abidin
Tel
: +604-445 7333 ext 2800
SPIROMETRY FOR PRIMARY CARE WORKSHOP
Date
: 21 August 2016
Venue
: Skills Laboratory, UiTM Selayang Campus
Secretariat : Malaysian Thoracic Society
Tel
: +603-2856 9539
Fax
: +603-2856 9539
Email
: mts_lft@yahoo.com
Website : http://www.mts.org.my/download/Spirometry%20for%20
primary%20Care%202016.pdf

SEPTEMBER
41ST ANNUAL DERMATOLOGY CONFERENCE
Theme
: New Horizons in Immunology and Dermatology
Date
: 15 18 September 2016
Venue
: Pullman Kuching Hotel, Kuching, Malaysia
Enquiries : Mr Eric Chan
Tel
: +6012-268 3163
Email
: pdmreg@gmail.com
Website : http://www.dermatology.org.my/annual%20meeting.html
19TH PENANG TEACHING CONFERENCE FOR GENERAL
PRACTITIONERS ORGANISED BY MMA PENANG BRANCH
Date
: Pre-conference workshops on 15 September 2016
: Conference 16 18 September 2016
Venue
: Bayview Hotel Georgetown, Lebuh Farquhar, Penang
Contact : Mr SP Palaniappan (Secretariat) +604-222 9188
Tel
: +604-226 6699 & Fax: +604-229 2379
Fax
: +604-222 9188/+604-226 2994
Email
: 19gpcourse@gmail.com, drhooi.hooi@gmail.com
MEDICAL CERTIFICATE IN CLINICAL HYPNOSIS
Date
: 24 September 2016
Venue
: University of Malaya, Kuala Lumpur
Phone
: +603-7960 6449/+6011-2662 4623
Email
: info@hypnosis-malaysia.com
Website : www.lcch.asia
MEDICAL REVIEW OFFICER (MRO) COURSE AND CERTIFICATION
Date
: 24 25 September 2016
Venue
: Vistana Hotel Kuala Lumpur
Contact : Ms Hema
Organiser : Academy of Occupational & Environmental Medicine
Malaysia
Tel
: +603-4051 8211/+6012-602 0778
Email
: malaysia.aoem@gmail.com

beritaMMA Vol.46 August 2016

MALAYSIAN ASSEMBLY OF BRONCHOLOGY & INTERVENTIONAL


PULMONOLOGY (MABIP 2016)
Theme
: Exploring New Frontiers to Revolutionize International
Pulmonology
Date
: 29 30 September 2016
Venue
: Auditorium, Queen Elizabeth Hospital, Kota Kinabalu
Sabah
Enquiries : Dr Muhammad Redzwan
Email
: mabip2016@gmail.com
Website : www.mabip.com

OCTOBER
HIGH DOSE RATE (HDR) GYNECOLOGICAL BRACHYTHERAPY
Date
: 5 & 6 October 2016
Venue
: Hotel Armada, Petaling Jaya, Selangor
Contact : Ms Norolhidayah/Ms Nadia
Tel
: +603-7949 4181/3965
Email
: norolhidayah@ummc.edu.my/nadiahmh@ummc.edu.my
Website : www.ummc.edu.my
NEONATAL RESUSCITATION PROGRAM (NRP) 2016
Date
: 18 19 October 2016
Venue
: Neonatal Intensive Care Unit,
Level 1 Kompleks Kesihatan Wanita & Kanak-kanak @
KWKK University Malaya Medical Centre (UMMC)
Contact : Ms Norolhidayah/Ms Nadia
Tel
: +603-7949 4181/3965
Email
: norolhidayah@ummc.edu.my/nadiahmh@ummc.edu.my
JOINT CONGRESS OF ASIA PACIFIC ASSOCIATION OF ALLERGY,
ASTHMA AND CLINICAL IMMUNOLOGY (APAAACI) AND ASIA
PACIFIC ASSOCIATION OF PEDIATRIC ALLERGY, RESPIROLOGY
AND IMMUNOLOGY (APAPARI) 2016
Date
: 17 20 October 2016
Venue
: Shangri-La Hotel Kuala Lumpur
Contact : Sue Wong
Website : www.apaaaci-kl2016.org
Email
: info@apaaaci-kl2016.org
MULTIMODAL IMAGING COURSE 2016
Theme
: Interpretation, Diagnosis and Management of
Ocular Disease
Date
: 22 23 October 2016
Venue
: Vivatel, Cheras, Kuala Lumpur
Organiser : Department of Ophthamology, PPUKM
Enquiries : Mrs Norsyariza Razak
Email
: syarazak@gmail.com

NOVEMBER
1ST NATIONAL MAMMOGRAPHY QC COURSE &
4TH INTERNATIONAL DAY OF MEDICAL PHYSICS
Date
: 4 & 5 November 2016
Venue
: University of Malaya Medical Centre
Time
: 8.00 am 5.00 pm
Contact : Ms Norolhidayah
Tel
: +603-7949 4874
Email
: mammoqc2016@gmail.com
MASPHOS 21ST ANNUAL SCIENTIFIC MEETING
Theme
: Improving Care for Childhood Solid Tumours
Date
: 5 & 6 November 2016
Venue
: Berjaya Times Square Hotel, Kuala Lumpur
Tel
: +603-2615 5555 Ext 6891
Fax
: +603-2694 8187
Email
: maspho.asm2016@gmail.com
website : www.maspho.org
13TH PRIMARY CARE SYMPOSIUM MMA WILAYAH
PERSEKUTUAN BRANCH
Date
: 19 & 20 November 2016
Venue
: To be confirmed
Contact : Dr Bala +6012-379 0944
: Miss Josephine +6016-223 8079
Email
: mmawilayah@yahoo.com
Website : mmawilayah.org.myw