Materia Medica Malaysiana

Few of 128 scorers accept offers to medical schools

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

UMMC service a boon to organ transplants

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

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

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

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

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


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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Jakim teams up with ministry to promote organ donation

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

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

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

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

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

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

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

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

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

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

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

Bio-piracy and law of jungle

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Tongkat Ali and pegaga go international with patent awards

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

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

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

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

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

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

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

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

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

More nursing schools coming up

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

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

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

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

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

“We will not use the additional allocation to build new and bigger hospitals as our aim is to improve health facilities and outpatient departments throughout the country,” added Dr Chua.

More bite needed to ensure clinical trials meet high ethical standards

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

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

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

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

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

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

Smoke from Indonesian fires stirs fear of health and economic crisis

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

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

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

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

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

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

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

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

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

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

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

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

Promote health tourism, private hospitals urged

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Malaysia fears providing pollution figures amid haze will hurt economy

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

- AFP

Taking care of rural health

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Delays stall toddler’s liver transplant

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

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

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

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

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

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

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

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

Organ donation: ministry will stick to medical ethics

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

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

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

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

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

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

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

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

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

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

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

She would undergo surgery on June 26.

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

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

Rigidity that kills medical service

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

But not all is lost.

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

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

Sleeping with the enemy is sure death

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

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

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

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

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

Seeking cure for doctor shortage

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

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

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

New pharmacy option at IMU

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

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

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

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

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

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

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

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

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

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

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

Hospital gets go-ahead for liver transplant

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

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

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

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

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

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

She was reportedly given sleeping pills to ease her pain.

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

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

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

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

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

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

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

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

Hospital hurt by low cash

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Queue in hospitals report completed

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

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

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

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

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

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

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

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

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

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

New entrance procedure for top scorers

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Lawyer: Doctors must talk to patients

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

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

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

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

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

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

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

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

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

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

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

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

Rural doctors

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

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

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

Chua: Private doctors must volunteer and not just talk

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

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

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

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

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

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

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

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

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

Dr Chua said blood donations in the country had increased by almost 110% since 1992, from 202,241 units to 423,046 units last year.

Move to overcome shortage of doctors and varsity places

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

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

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

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

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

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

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

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

Morozov said Russian medical insti-

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

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

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

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

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

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

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

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

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

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

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

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

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

Place doctors under a special scheme

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

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

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

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

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

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

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

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

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

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

Cross-species infections to watch out for

In the not-so-distant future, more zoonoses or cross-species infections are likely to emerge. A stronger surveillance system is our only hope. KASMIAH MUSTAPHA reports.
THE battle against the Nipah virus met with success while the Severe Acute Respiratory Syndrome (SARS) and avian influenza are in remission. Monkeypox, mad cow disease and ebola have also made their presence felt in recent decades.

These are zoonoses — diseases that leap the species barrier from animals to human. They seem to emerge out of nowhere, spreading widespread fear as fatalities increase and the global medical community is forced to scramble for answers.

More could be coming. At a recent meeting, the World Health Organisation said the emergence of new diseases that were passed from animals to humans was accelerating.

It predicted that the next epidemic would be difficult to contain.

Most zoonoses or zoonotic diseases have the potential to spread beyond their region of origin and most countries are ill-equipped to counter the trend, it added.

Dr Rosemawati Ariffin, principle assistant director (zoonotic unit) at the Disease Control Division, Ministry of Health, says there could be "hundreds maybe thousands" of viruses, bacteria and parasites yet to be detected that could flare up at any moment.

"Unfortunately, due to our lifestyles and globalisation, new emerging and re-emerging diseases would no longer be isolated cases." The worrying part, says Dr Rosemawati, is that certain viruses can mutate and bring on new diseases.

"It is difficult for us to predict when an outbreak is going to happen," she adds.

Veterinary Services Department director-general Datuk Dr Hawari Hussein says zoonoses have been largely controllable in the past because the outbreaks occur only at certain areas and they could be identified.

"But it is different now because of the way we are living and moving around," he says.

He adds that although zoonoses have been in existence for a long time, recent cases which became a near-global epidemic has affected the way the world looks at these diseases.

"The fact that they can spread rapidly can cause people to panic, especially if the diseases cannot be contained in one area." According to experts, about 75 per cent of all new infectious diseases originate from animals.

The transmission of disease from animals to people depends on many factors, including the interactions that occur, the microbial agent involved and the environment.

Nipah virus, which got its name from the village where it first appeared, induces flu-like symptoms that often lead to encephalitis and coma. The virus, which killed 100 people, jumped the species barrier from fruit bats to pigs and then to humans in the deadly outbreak in Malaysia in 1999.

From November 2002 to July 2003, SARS triggered an unprecedented international health emergency.

Of the 8,098 people infected worldwide, 774 died from the disease.

Scientists believe the virus was passed to humans from civet cats and other mongoose-like animals that were sold in live food markets in southern China.

Experts says there are several factors that contribute to the increase in cross-species infections.

One is the growing world population as humans venture into previously undisturbed parts of the world and encounter new animals and their indigenous pathogens.

Exotic animal trade — as pets and food — is also the reason for the increased number of zoonoses.

The global movement of these animals has created what some experts say is a "viral traffic" or "microbial traffic", which encourages the shift of viruses and parasites to humans.

Dr Rosemawati says that efforts to contain diseases must involve cooperation from other countries, especially the country from which the disease originated.

"They should alert the world and take the necessary precautions if there are any known or unknown diseases emerging in their country. Prompt action will help other countries set up their surveillance system immediately," she says.

Unless the source and transmission of a disease is known, the only thing that health agencies can do is strengthen their surveillance system.

"We managed to contain the SARS outbreak because we identified the cause of transmission and quickly implemented the surveillance system." To counter the possibility of new emerging diseases, the Disease Control Division has implemented a syndromic approach in which doctors help alert the Health Ministry.

"We will then take the appropriate precautions. We are more prepared now as we have strengthened our surveillance system," she adds.

The Veterinary Services Department has also extended its monitoring and surveillance system. Previously it focused only on the point of entry and abattoir aspects. Since Nipah, however, it has implemented the farm-to-table concept.

"We will inspect livestock farms including the management, feeding and transfer of animals from farms to abattoir. We have also implemented more guidelines for livestock farmers," says Dr Hawari.

MMA: Upgrade rural hospitals first

PETALING JAYA: The Government's plan to hire retired doctors to serve in rural areas will receive good response if the Government improves existing facilities in these areas, according to the Malaysian Medical Association.

Its president Datuk Dr N. Arumugam said the plan was feasible as retired doctors could use their expertise gained over the years to serve the rural community be it part-time or full-time.

“However, a reasonable work and remuneration scheme should be worked out for these doctors,” he said yesterday.

Dr Arumugam said as a parallel move, more efforts should be made to upgrade older hospitals and existing facilities in the rural areas.

“Having better facilities and even new hospitals will help attract doctors to the rural areas, especially for those who enjoy the quiet and relaxed life in the countryside,” he said.

Health Minister Datuk Dr Chua Soi Lek said on Saturday that there was a plan to hire retired doctors for rural areas as they could help relieve the acute shortage of doctors there.

He said 643 foreign doctors would be sent to rural hospitals and polyclinics while 34 retired doctors had been re-employed to serve in the rural areas.

Malaysian Doctors' Co-operative Society chairman Dr J.S. Deo, however, felt the proposal might not be attractive.

“A lot of them will not leave their family and grandchildren to resettle in a kampung or other rural areas as coming home to their loved ones is simply priceless.

“Also, once they've reached retirement age, they have already established a certain lifestyle with their families, a home and sufficient money, making it harder for them to relocate,” he said.

Dr Deo said the Government needed to provide special incentives for these doctors to attract them as many were earning well as a locum.

The Academy of Family Physicians Malaysia president Dr M.K. Rajakumar said the key was to create top-rate healthcare centres to attract retired doctors to rural areas.

“An attractive salary, allowances for their children's education and accommodation will also help lure them,” he said.

Plan to hire retired doctors for rural areas

Wanted: Retired doctors to serve in rural Malaysia. The Health Ministry believes that this group of professionals can help relieve the acute shortage of doctors in far-flung places.

Health Minister Datuk Dr Chua Soi Lek said that one of his priorities was to improve health facilities in kampungs and estates and get more doctors to serve there.

"We have re-employed 34 retired doctors to work in rural areas and are hoping for more to join them," he said. He planned to persuade retired doctors to take up positions in health clinics and would use the relaxed and healthy environment of the rural areas as a selling point.

He also said the 643 foreign doctors recruited would be sent to work in rural hospitals and polyclinics. The ministry is also considering providing quarters and other amenities for those willing to serve in rural areas.

The Government had allocated RM460 million under the Seventh Malaysia Plan and RM862 million under the Eighth Malaysia Plan for rural health development.

The main thrust of the Eighth Malaysia Plan is to upgrade existing facilities and construct new health facilities in rural areas, but he said this objective was scuttled by the zest to build new hospitals.

More than 50 per cent of the allocation under the plan was channelled to build new hospitals, he said.

He added that the main health problems in rural areas were those related to the respiratory and digestive systems, and skin and parasitic infections.

A straw poll of retired doctors showed that most of them were not interested in uprooting their families and serving in rural areas.

A 64-year-old doctor said that many retired doctors earned more by doing locum.

Hospital stint

UNIVERSITY College Sedaya International (UCSI) has signed a memorandum of agreement (MoA) with the Health Ministry in relation to the clinical clerkship of its final-year pharmacy students.

The MoA, signed at UCSI Segar campus recently, was witnessed by Health Minister Datuk Dr Chua Soi Lek.

Prof Lai Hoi Chaw, UCSI vice-president (academic affairs), who signed on behalf of UCSI, said that the agreement would allow UCSI pharmacy students to spend two semesters in a total of 12 different clerkships at the Kuala Lumpur Hospital.

SIGNED: Dr Chua (centre) witnessing the exchange of documents between Prof Lai (left) and Ministry of Health secretary-general Datuk Ismail Adam. With the signing of the MoA, final-year UCSI pharmacy students can undergo a stint at Kuala Lumpur Hospital.
“Our students will have the opportunity of going on ward rounds with medical specialists during their clerkships, and obtain experience in various pharmacy services,” he said.

In the first semester, the final-year students will be concentrating on pharmacy service clerkships such as total parenteral nutrition (intravenous), therapeutic drug monitoring, hospital management, outpatient pharmacy, inpatient pharmacy and drug information services.

“In the second semester,” Prof Lai added, “they will concentrate on obstetrics and gynaecology, surgery, medicine, psychiatry and paediatrics.”

UCSI has been offering its pharmacy programme since 2000, in close cooperation with Universiti Sains Malaysia. Its first batch of 23 pharmacy students will graduate on Aug 6.

On the question of what makes good pharmacists, UCSI head of the School of Pharmacy Dr Yeong Siew Wei said that there was a need for more pharmacists who were professional and caring. She commented that almost 90% of the potential pharmacy students who turned up at the admissions interview were thinking mainly of community pharmacy.

“This is a worrying trend,” she said, “as pharmacists should not only think about setting up their own outlets to make money. They should also think about getting involved in areas such as industrial pharmacy, education, drug enforcement, research and hospitals. That is why the Government has introduced the compulsory service for pharmacy graduates.”

“We want our pharmacists to be all-rounders in order to provide quality consultation to their patients,” she added.

Dr Yeong also explained that UCSI was selective about accepting students into its pharmacy programme as the number of places was limited.

She said: “Parents and students must realise that there is more to pharmacy than just makin

KLH performs robotic surgery

UTUSAN Malaysia and Berita Harian reported that the Urology Institute of the Kuala Lumpur Hospital (KLH) has made a historic breakthrough by making KLH the first hospital in the country to provide robotic surgery.

Surgeries using a procedure known as the da Vinci System has the capability of reducing operation time and allows patients to recuperate within 24-hours.

The hospital did its first prostrate gland operation using the robotic surgeon, controlled by a specialist surgeon via a 3D computer screen from outside the operating theatre.

The robotic surgeon has two fine long arms with a camera that can be placed through a small surgery in the body for a wide-ranging view from within.

“Even if it was a robot performing the operation, we still need the expertise of a specialist surgeon to control the robot,” said the papers, quoting Deputy Health Minister Datuk Dr Abdul Latiff Ahmad.

“One arm of the robot will handle a hook for incision, either by electrical means or by scissors while the other arm handles the surgical forceps.

“The specialist controls the robot via a computer with a three-dimensional screen to pinpoint the surgery locations,” he said.

The robotic surgery can be used for detailed operations such as radical prostatectomy, which would require the incision of the whole prostrate gland in a prostrate cancer.

Aside that, the robotic surgery can also be used for surgeries involving the heart, kidneys and other internal organs which require intricate sutures.

According to the dailies, HKL had performed 10 operations using the robotic system.

Of the 10 operations, nine were radical prostatectomy cases for treating prostate cancer and one pyeloplasti case for pelviureteric junction. At present, there are 13 patients waiting to undergo this operation.

Dr Abdul Latiff said the ministry had purchased two robotic units costing RM5mil each, one in HKL and another in Hospital Sultanah Aminah (HSA) in Johor Baru, adding that patients were charged only RM500 for the operation.

“HKL introduces the cheapest fees in the world for robotic surgery as compared to Singapore and America with charges of S$15,000 (RM33,000) and USD40,000 (RM152,000) respectively.

“This is a sophisticated technology and we are the second country in South East Asia to use this technology after Singapore,'' he said.

He said the two robotic units were part of former Prime Minister Tun Dr Mahathir Mohamad's vision for telemedicine services to help promote a healthy society.

MMA against service ruling for private hospital doctors

THE Malaysian Medical Association (MMA) today came out strongly against the move by the Health Ministry to make it compulsory for doctors in private hospitals to serve a certain number of hours a week in government hospitals, if they want their Annual Practising Certificate renewed.

Its president Datuk Dr N Arumugam said this arrangement of part-time work in government hospitals should be on voluntary basis with appropriate remuneration and it should not be mandatory or linked to the renewal of APC.

He said the ministry’s idea of making private doctors work in government facilities to ease staff shortages must be studied carefully before implementation.

‘Unrecognised’ degree: Ministry to study claims

Kuala Lumpur: The Health Ministry will look into claims by a Malaysian graduate from Akita University in Japan that his medical degree is unrecognised locally.

Deputy Health Minister Datuk Dr Abdul Latif Ahmad said he was waiting for full reports on the issue, including that from the Malaysian Medical Council (MMC).

“I cannot comment further as the claims will be studied in detail after obtaining feedback and full reports from various parties, including MMC,” he said when contacted here Friday.

He said this when asked to comment on a Bernama report Thursday which said a 27-year-old graduate was frustrated after finding out that the MMC did not recognise his degree even though his medical course in Japan was fully funded by the Public Service Department (JPA).

JPA Deputy Director-General Datuk Zakaria Mohd Taib, when contacted, said the department would issue a statement over this issue soon.

Meanwhile, President of Japan Graduates of Malaysia Association Datuk Dr Siow Kuang Ling expressed his disappointment over the issue.

When contacted Friday, he called on the Government to recognise all medical degrees offered by Japanese universities.

Currently, over 18 universities in Japan, including Tokyo University and Akita University, offer medical courses but some of these institutions were not recognised by the MMC.

“This is very frustrating, as we know Japan is a developed country and the medical programmes there are of high quality,” said Dr Siow, a medical graduate of Fukushima University.- Bernama

Fertility rate on the decline in Malaysia

KUALA LUMPUR - The Malaysian population has grown to 25.1 million, a growth of 2.2 percentage points from 2000.

But despite the population growth, there has been a decrease in the fertility rate.
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Women, Family and Community Development Minister Shahrizat Abdul Jalil said the decline in the fertility rate of 0.2 percentage point from 3.4 per cent in 1990 to 3.2 per cent in 2002 could be due to an increasing number of people giving top priority to their careers.

'Or it could be because people are marrying late or have chosen to stay single,' she said on Thursday after launching the fourth Malaysian Population and Family Census.

The census, she said, could help shed some light as to why the fertility rate was low.

Datuk Seri Shahrizat pointed out that the number of households in the country had increased from 3.6 million in 2000 to 4.9 million last year.

But the average household size had decreased to 4.5 people per household in 2000 compared to 4.7 people in 1995.

She also said the structure of the local population was undergoing evident changes, adding that Malaysia now had one million senior citizens.

'We need to find out if we have become an ageing society so that our policies will be relevant to the studies being conducted,' she said.

The census involving some 100,000 respondents will cover areas such as single parenting, marriage, behavioural patterns, medical practices and reproductive health.

It has been carried out once every 10 years since 1974.

The respondents are married women aged between 15 and 49 and their husbands, young people from 13 to 24 years old, singles from 25 to 49 years old and senior citizens aged 50 and above.

Datuk Seri Shahrizat said the data would be used as input for the ninth Malaysia development plan. -- The Star/Asia News Network

Move to reduce shortage of doctors

Doctors in private hospitals may soon have to serve a certain number of hours a week in government hospitals, if they want their Annual Practising Certificates (APC) renewed.

This move is aimed at making the shortage of doctors in the public sector less painful.

Health Minister Datuk Dr Chua Soi Lek said: "The ministry will make it compulsory for doctors and specialists in private hospitals to serve and train in government hospitals.

"We want to tap their resources and expertise. Working in government hospitals is also a continuing professional development for them," he said after a dialogue with members of the Association of Private Hospitals of Malaysia (APHM).

He said the innovation would be invaluable for government hospitals, as doctors from private hospitals could transfer knowledge and skills to junior doctors and medical students in government hospitals.

There are some 8,000 specialists and doctors in private hospitals today, about the same total as in government hospitals.

But their workload was different as night and day, with only 9,000 beds in private hospitals and 32,000 in government hospitals.

Also, doctors in the public sector treat 48 million outpatients and 1.7 million in-patients a year.

Dr Chua said the plan would take effect only after details had been worked out among the ministry, the APHM and other parties. A committee would be set up to discuss the logistics, he said. Datuk Dr Ridzwan Bakar, president of the APHM, said there were already doctors in the private sector who were teaching and training medical students.

Researcher nominated for Nobel Prize

A Malaysian researcher’s studies on the potency of seeds, beans and cereals as natural preventive medicines has put him in the running for a Nobel Prize.

Professor Ananthan Krishnan, 53, a pharmacist, conducted six years of research into the benefits of alternative medicine, resulting in breakthrough medicinal formulae. This prompted three institutions from Canada and the US to nominate him for the Nobel Prize in Natural Medicine.

The Alternative Medicine Research Institution (AMRI), Weston Reserve University (WRU) in Canada and the American College of Integrated Medicine in the US will jointly nominate Prof Ananthan for the prize, which honours outstanding individuals in different fields for their contributions to the world.

Natural medicine is a new category, introduced only last year, so the nomination is all the more meaningful for Prof Ananthan, whose main aim is to promote a healthier alternative to allopathic ("normal" or "Western") medicine.

"As a pharmacist for 18 years, I saw sick people pumping themselves with medications which were basically chemicals that could create a degeneration of the body's major organs in the long run," he said.

"I have seen the good and bad of allopathic medicines. The drugs might work to cure a patient of his illness but they leave side effects which, over time, can have an adverse effect on the kidney, liver, lungs and heart." Dr Ananthan's search for safer alternatives led him to conduct research on natural substances with medicinal properties, consumed by humans for centuries.

Through studying traditional treatments such as ayurveda and homeopathy, he discovered that the safest and most potent substances for the promotion of good health and healing were edible spices, beans and cereals.

He set up the A. K. Pharmacy and Naturopathy Centre in 1996, and in six years treated nearly 12,000 patients for various ailments.

The results were astounding. Diabetes, hypertension, gastric problems, hormonal imbalances and allergies were some of the many health problems successfully treated.

Prof Ananthan's research was carefully documented in his doctoral dissertation on "The Use of Spices, Beans and Cereals in the Prevention and Management of Human Health Problems".

Impressed with his findings, the renowned institutions for alternative medicine decided to submit his name as a candidate for the Nobel Prize this year.

With the honour and prestige that comes with being nominated, Prof Ananthan remains modest, being interested only in promoting good health for everyone.

"I live by the policy of ‘learn, earn and serve'. What I have learnt so far is to be put to use for the good of the people," he said.

Prof Ananthan was also recently appointed to head the first AMRI in Malaysia, which will serve as a hub for alternative medicine research and studies.

Domestic Trade Ministry to cooperate in beta-agonist issue

KUALA LUMPUR June 10 - Domestic Trade and Consumer Affairs Minister Datuk Mohamed Shafie Apdal has expressed his ministry's readiness to cooperate with the Health Ministry to curb illegal use of beta-agonist by livestock farmers.

"We can help the Health Minstry by withdrawing meat tainted with beta-agonist from the market," Mohamed Shafie told reporters after officiating his ministry's annual consultation with the private sector here.

Beta-agonist, a drug used by asthma patients as a broncho-dilator, is also added to meat by livestock farmers to make it lean and more palatable.

Wednesday Health Minister Datuk Dr Chua Soi Lek said a joint committee would be formed to monitor the use of the drug on meat, amidst concerns about its possible harmful side-effects on consumers.

Meanwhile, Mohamed Shafie said one way of promoting participation of Bumiputera Small and Medium Industries (SMIs) in business was to market more locally-made products in hypermarkets.

This, he said, could enhance Bumiputera entrepreneurs'direct involvement with hypermarkets.

"We could make it a condition for hypermarkets to give SMIs a chance to market their products, and everyone concerned should cooperate by ensuring the products are reasonably priced," he said.

In his speech earlier, Shafie said the wholesale and retail, hotel and restaurant sub-sectors grew by 5.6 per cent compared to 3.1 per cent for the same period last year.

This positive development, he said, reflected increased consumer confidence with an improving economy, and augured well for his ministry's efforts to promote domestic trade.

National service for private doctors

KUALA LUMPUR: Some 8,000 private doctors and specialists nationwide will have to perform a stipulated number of hours of compulsory service in government hospitals every year.

Health Minister Datuk Dr Chua Soi Lek said their services were necessary to help lessen the heavy workload of doctors and specialists now working in government hospitals and for them to gain more experience.

“Government doctors and specialists, also numbering about 8,000, are looking after 48 million out-patients and 1.7 million in-patients nationwide a year,” he said after a dialogue with the Association of Private Hospitals Malaysia (APHM) committee members here yesterday.

To date, there is a shortage of 3,300 doctors in the government health sector.

Dr Chua said the ministry would consider making the compulsory service a condition for the renewal of the annual practising certificate.

He said a joint committee represented by the ministry and the private healthcare sector, including the APHM, would be set up to work out the details for the compulsory service.

“These include the stipulated number of hours, which hospitals they will serve and how much they will be paid.

“But I don’t think they want to be paid as it is a form of social contribution,” he said.

Dr Chua said the compulsory service was well-received at yesterday’s dialogue

Health Minister Chua Soi Lek
APHM president Datuk Dr Ridzwan Bakar told reporters later that many private specialists, who lectured at public universities before, were willing to serve part-time.

He said the logistics had to be worked out before the compulsory service could take off. Malaysian Medical Association president Datuk N. Arumugam did not want to comment on the move.

Fomca secretary-general N. Marimuthu said the Government should provide private doctors and specialists with tax incentives to compensate them for their voluntary ser-

vice in government hospitals.

He agreed that they could help ease the workload in government hospitals and cut the waiting time for patients.

“But making it a condition for them to be able to renew their annual practising certificate is tantamount to a kind of underhand tactic.

A senior medical specialist said the ministry had paid about RM25 an hour to private doctors to work as government medical officers previously but the response was not good.

“The ministry should instead send its patients to be treated by general practitioners to ease the burden on its outpatient clinics,” he said, adding that the Medical Act must be amended if the ministry wanted to make compulsory service a condition for the renewal of the practising certificate.

UMS waiting for word to recruit students

Universiti Malaysia Sabah is waiting for word on whether it will be required to enrol some of the 128 top students who want to study medicine but were not offered places to do so at public universities.
Its Vice-Chancellor, Tan Sri Prof Abu Hassan Othman, said UMS had already offered 42 applicants a chance to study medicine, two more than the planned enrolment of 40. They are expected to register with UMS for the 2004/2005 intake next week.

“We can still take in a few more but not many. In future, when we have more laboratories, facilities and lecturers, we can offer more places,” he said.

UMS enrolled its first batch of 32 undergraduates at the School of Medicine last year.

More Sabah medical students

Kota Kinabalu: More Sabahans are taking up medicine at Universiti Malaysia Sabah (UMS), said Vice-Chancellor Tan Sri Prof. Dr Abu Hassan Othman.

He said the university was offering 45 places - an increase by 10 from last year and that of this 12 were Sabahans, compared to only five last year, adding that those who qualified were excellent students who scored 4.2 CPGA.

“The intake was based on high achievement or meritocracy but the racial distribution among the Bumiputera, Chinese and Indians was fair,” he said.

Dr Abu said the UMS could only offer very limited places for medical students since its labs are only able accommodate about 40 students at a time.

The university is planning to upgrade the laboratories although facilities were still adequate to meet current needs.

On the 1,500 re-applications from students wishing to enter the UMS, Dr Abu said their cases would be dealt with accordingly. “If they meet the requirement we’ll accommodate them but we’ll also try to fill the 4,300 quota this year.”

He said the quota was for all 58 study programmes including medical, biotechnology, engineering, social sciences and economic studies.

Dr Abu, in his address, said the UMS was also targeting at increasing the intake of post-graduate students from the current eight per cent to 20 per cent in 2010.

“The ideal figure is 30 per cent but that’s a tall order,” he said.

Nevertheless, the university was confident of achieving the target after its initial effort to attract foreign students.

This year, 10 Chinese nationals were currently reading for their Master’s in Business Administration (MBA) with several more inquiries coming from China recently.

There were more than 60 under and post-graduates from 18 countries, particularly from Asian countries, studying in the UMS, including one from New Zealand.

He said the lecturers, staff and management should also work together to produce what he described as an “excellent university brand”.

“Comparatively we are as good as others (schools)…we have former students working with the Public Services Department including multi-national banks and big firms,” he said.

Based on the current enrolment, Dr Abu said the UMS campus in Kota Kinabalu had 14,763 students and 2,512 in Labuan.

Compared to the figure in 1995, which was only 621, the increase certainly reflected the university’s credibility.

To ensure that UMS continues with its effort in the nation’s development, Dr Abu outlined seven strategies, namely to:

The university must continue with the democratisation process of the education system particularly higher learning;

More emphasis on science and technology education;

Ensure the quality of education is preserved despite the increasing number of students;

Ensure marketing ethos permeating the current education system do not sacrifice the values in education;

Forge stronger relations with the industry and commerce communities to form the “synergy” in the modernisation of Malaysia;

Ensure the university focus is not only to prepare skilled workers but also contribute to research and significant innovation activities;

Ensure the university’s administration remains “autonomous”, progressive, transparent and democratic He said good governance was an important requisite to ensure UMS continued to play its important role towards national development,” he said.

‘Test-bed biotech ideas in Malaysia’

THE Malaysian Government has extended an invitation to world-class biotechnology (biotech) companies to "test-bed" their ideas and innovations here.
Science, Technology and Innovation Minister Datuk Dr Jamaludin Jarjis said Malaysia had a strong tradition in research and development (R&D) institutes and universities specialising in agricultural and medical R&D.

"We have journeyed to the land of opportunity to talk to you, to invite you to Malaysia, where you will be able to leverage and position your business in the global market," Jamaludin told them.

"We are, after all, acknowledged as one of 12 mega biodiversity countries in the world," he said.

Jamaludin is heading a 40-member delegation to the four-day Biotechnology Industry Organisation (BIO) 2004 convention here.

These remarks were contained in his message in a booklet prepared for the mission. BIO is a grouping of leading US biotech companies.

At yesterday’s ministerial session, which was also attended by his counterparts from Australia, New Zealand, the United Kingdom, India and Germany, Jamaluddin said Malaysia was an ideal location for the outsourcing of research contracts in biotechnology.

He said apart from good infrastructure and competitive manpower costs, Malaysia also had a strong related global industrial base such as in chemicals and agro-processing.

"We have invested a considerable amount of resources in building a biotech industry infrastructure," he said.

"This includes matters such as intellectual capital development, R&D expansion, talent development and a sound ethical framework."

In a sales pitch, he quipped that Malaysia was not only one of the most biodiverse nations in the world, but also the most "ethno-diversified".

Jamaludin said it would be unthinkable for Malaysia not to look at biodiversity in a big way, given the country’s long association with rubber and oil palm and its sustainable management of forests.

"We are keen to build alliances with global biotech companies. We are on the doorstep of China and India. We will help you make use of this advantage by converging and building upon our strengths in agriculture, manufacturing and ICT to deliver the biotech strategy," he told the conference.

"Think of business tie-ups," he said. "We are a fully developed entrepreneurial culture. Our businesses are straddling the world."

In his message, Jamaluddin said the Government had also put together the logistics under the Biotechnology Agenda to make biotech the country’s next engine of growth.

"They offer you a wide base of expertise and skills to support your R&D, technology and business development. The 30-odd universities shall provide the manpower support," he said.

In addition, three research institutes — in Genomics and Molecular Biology, Pharmaceuticals and Nutraceuticals, and Agro-Biotechnology — were being formed to further strengthen biotech R&D and technology development, he said.

"We offer a wide spectrum of financing structures, including business angel financing, venture capital financing, debt ventures and technology ban king," he said.

"We are committed to providing attractive incentive packages to biotechnology companies investing in Malaysia."

Jamaludin also said that building strategic linkages with international venture capitalists was one of Malaysia’s priorities in its biotech initiative.

Enforce act for treatment cost control, govt told

KUALA LUMPUR June 7 - The UMNO Youth on Monday reiterated its call to the government to speed up enforcement of the Private Healthcare Facilities and Services Act 1998 which was passed four years ago.

Its Public Complaints Bureau Chief Datuk Subahan Kamal said the act would enable the government to monitor and reduce medical fees charged by the private hospitals.

"By enforcing the Act, private hospitals cannot charge their patients to their whims to the extent of taxing those who really need treatment but face financial constraints.

The private hospitals should abide by the stipulated guidelines," he told a media conference on the plight of Mohd Imran Mohd Azmir, 7, (son of singer Amir Ukays) who is suffering from a complex heart ailment.

Subahan said UMNO Youth had repeatedly urged the government to enforce the Act. It had sent three memorandums to the Health Ministry and had met former Health Minister Datuk Chua Jui Meng.

Subahan claimed Chua had said the Act would be enforced early this year.

"When an Act is passed in Parliament, it must be enforced for the people's well-being," he said.

He said the movement intends to meet Health Minister Datuk Dr Chua Soi Lek soon to discuss the matter.

At the meeting, he said, UMNO Youth would highlight the plight of Amir (Mohd Azmir Mohd Yusuf) who had appealed for financial aid from the National Health Welfare Fund.

He applied for RM50,000 from the fund two months ago to supplement the cost of his son's heart operation.

Amir, who was accompanied by his wife, Noor Yusniza Yunus, and two children, said he could not afford the cost.

He claimed the fund's secretariat officials who visited his house had yet to respond to his appeal after they discovered that he was a singer.

He said his son was referred to specialists in the private hospital after the National Heart Institute refused to operate on him due to slim chance of survival.

Imran, who has a twin brother named Mohd Irman, had undergone three operations, costing nearly RM100,000, all borne by Amir.

At the media conference, UMNO Youth contributed RM1,000 to ease Amir's financial burden.

New focus for BioValley

The Ministry of Science, Technology and Innovations is taking another look at BioValley to ensure the initiative takes a more commercial approach, with a greater focus on the private sector being the driver.

It is learnt that a new thrust will be to make bio-manufacturing and related services, such as contract research and clinical trials, a key element of the initiative.
While this is lower down the value chain (compared with drug discovery), it nevertheless will act as a quicker way to kick-start the country’s biotech industry.

“It will create jobs and build up the critical mass of activities related to the biotech industry,” says a party familiar with the new plan.

The new thrust also gells with earlier calls from overseas Malaysian scientists to focus on bio-manufacturing as the country is already known for its manufacturing prowess and making the leap to bio-manufacturing is a natural step.

The plan to build three biotech research institutes is also being questioned, as the new leadership at the ministry wants to be sure that these set-ups have tangible commercial value and do not end up as white elephants.

The government launched the BioValley plan in May last year to spearhead and accelerate the process of extracting healing properties from the country’s flora and fauna and turn them into marketable medicines.

So far, three interim labs involved in the research on genomics, natural products and plant biotechnology have been set up at Universiti Kebangsaan Malaysia, Universiti Putra Malaysia and the Malaysian Agricultural Research Development Institute, respectively.

Even with the focus on bio-manufacturing, there will be challenges. For one, there is unanimous agreement that there is simply still not enough biotech personnel in Malaysia to start any such initiative. The government needs to woo biotech companies from around the world to set up manufacturing facilities here.

As a result, the long-overdue incentive package to attract companies to the BioValley is likely to include incentives aimed at making Malaysia an attractive location for bio-manufacturing.

Industry experts caution that the incentives have to be as good if not better than what is offered by other countries also targeting bio-manufacturing. In Germany, for instance, if a start-up has procured venture funding, the government will provide matching soft loans to the company.

To get a better understanding of the challenges and opportunities available, the ministry is sending a high-powered delegation to a bio-tech conference in the US next week, led by Minister Datuk Jamaluddin Jarjis.

Cheaper 3-in-1 HIV treatment

KUALA LUMPUR: The cost of the three-in-one combination drug treatment for HIV-infected patients will be reduced to between RM200 and RM220 from this month compared to the current RM1,200.

Health Minister Datuk Dr Chua Soi Lek said the cost reduction came after his ministry amended the Patent Act to enable the patented drugs to be imported from India.

“The Act comes under the Domestic Trade and Consumer Affairs Ministry and my ministry is allowed to amend it because the drugs are used for non-commercial purposes.

“With the cheaper cost, we can treat at least 4,000 HIV patients compared to the present 1,500. Patients who are entitled to free treatment are those infected after child delivery, infected children, health workers infected in the course of work and patients who were given contaminated blood products.

“To ensure commitment on the part of patients, they are required to buy one of the three drugs,” he said in an interview here.

Dr Chua said there were 58,000 HIV patients and another 8,000 AIDS patients in Malaysia and 93% of them were males.

He pointed out that the majority of them were aged between 20 and 39 and drug addicts, but the number of sexually transmitted HIV patients was on the rise.

“With 4,000 patients getting the three-in-one treatment free, Malaysia has abided by the WHO “three by five initiative” – that is providing the three-in-one drug treatment for three million patients by 2005,” said Dr Chua.

In another development, the Health Minister said the Government was set to achieve a maternal mortality ratio of 10:100,000 births by the year 2020.

He said the current ratio was 30:100,000 against 530:100,000 at Independence, attributing the tremendous improvement to the Government’s commitment and priority for good healthcare services.

The angst of having a perfect score

Entrance to public universities has long been a simmering issue. It came to the boil again in the last two weeks over the failure of 128 top students to gain places to study medicine. ELIZABETH JOHN, K.T. CHELVI and YONG TIAM KUI examine the reasons behind this seemingly perennial problem.

A FEW days ago, the perfect score and a string of As meant so little to Kua Wei Sun. It could not get her what she wanted most — a coveted place in University of Malaya's medical school. Before that ray of hope came this past week for her to get a place in medicine, she and her family were just devastated. This is the second time the Kua family has had to wrestle with the demons of the system. A few years ago, their eldest daughter Joanne failed to make it into any course despite scoring 5As in the Sijil Tinggi Persekolahan Malaysia exam. She had to appeal and wait, just as her younger sister has had to do this time.

Their story sadly shows how the same scenes of anger and anguish are replayed year after year, and how problems identified in the analyses that follows never get fixed. In arguments throughout the week, columnists and commentators showed how unhappy everyone was with the meritocracy system.

Malays claimed their representation in critical courses was falling, the Chinese were suspicious of the formula used to make matriculation and STPM results comparable and Indians were concerned about their poor overall representation in public universities.

The core problem is the two-track system.

As Rajendra Ramalu observed, the two systems were all that students discussed after receiving their offers.

He is a classmate of Kua's and one of seven straight-A students in the school who did not get into medicine.

Matriculation is essentially a one-year, semester style pre-university course, where examinations are held immediately after the subject is taught. Questions are set and marked internally.

In STPM, exams are held after almost two years of comprehensive studies and exam papers are set and marked externally, on a national level. "An A in one system cannot be equated with an A in the other as the systems differ greatly in teaching methods, content and how the exams are set and marked," says Yayasan Strategik Sosial executive director Dr Denison Jayasooria.

To introduce a merit-based system with two very different exams creates doubts that will polarise children for a long time to come.

"Instead of skirting around the issue, let's call a spade a spade," says UKM's Prof Datuk Dr Shamsul Amri Baharuddin. "The dual system is seen as a problem in Malaysia because one system caters for a hand-picked Malay majority whereas a large majority of the non-Malays take the STPM," adds the social anthropologist.

The problem lies not just with the education system but society, where almost every aspect of life is seen from the ethnic point of view, he says.

Tertiary education in Malaysia has been coloured by ethnic considerations for more than three decades; in the allocation of university places, in the award of state scholarships to study locally and overseas, says political scientist and social commentator Dr Chandra Muzaffar.

It is understandable therefore why non-Bumiputeras and even Bumiputeras view issues related to tertiary education through ethnic lenses. Chandra says it is indisputable that this has had an adverse impact on ethnic relations in Malaysia.

If nothing else, the debates over this issue this week have shown how true this statement is. Possibly the greatest disservice has been done to good Bumiputera students whose achievements have been viewed with suspicion because of ethnicity-linked entrance to universities.

It is this that has given rise to much of the vitriol in Malay language dailies of late.

Some called on non-Bumiputera students to accept what they were offered and not be demanding, but top scorers like Soo Hui Fang say that she had worked hard for her 4.0 and deserved a place in the medical faculty. While the full glare of public attention has been on the 128 top students who failed to get into medicine, several other issues have also attracted comments.

For instance, the phenomenal number of straight A students in recent years has also called into question the standards of the current grading system and its ability to discriminate between the good and the excellent.

Academicians have called for a review. Newspaper reports and educationists have also pointed out the high number of students who have met minimum requirements, but have not made it into public universities.

A large number are from poor families or rural areas, say bodies handling appeals.

STPM students have also pointed out how little they knew of the matriculation results before they filed their applications. Those interviewed said they may not have risked applying for some courses if they had known they would be facing such stiff competition.

"If everyone had known that 1,774 had achieved a perfect score, many would not have applied in blind faith for medicine," says Hui Fang. University admission is a perennial problem because the number of students getting good grades has risen tremendously while the number of seats has not risen in tandem, says education activist Datuk N. Siva Subramaniam.

It is puzzling how we know the exact number of doctors needed yet are unable to plan for it, he says.

"We now finally have a separate ministry for higher education. "They should be able to sit down with the Human Resources Department and decide on the numbers we need in critical courses and what it will take to make it happen." The issue of cost is the second reason why there is so much debate, Siva Subramaniam notes.

A medical degree in a private university that used to cost parents about RM150,000 now costs RM300,000 or more. Five years at the International Medical Universiti in Kuala Lumpur will set parents back by RM270,000 in fees alone, says May Ling Young, Provost of the medical school.

If the student were to study in the UK from day one, a parent would have to budget for about RM1 million, says May Ling who is also deputy secretary-general of the Malaysian Association of Private Colleges and Universities.

A lack of qualified staff and training facilities are the biggest problems for private and public medical schools.

If these are not addressed, the situation is going to get worse as medical colleges proliferate to meet needs, she adds.

Another issue that needs to be looked at is the lack of career counselling for students. Every year, students who excel automatically gravitate towards Medicine, Dentistry, Pharmacy, Electrical Engineering, Chemical Engineering, Law and acCountancy.

Are they being advised that these are the only courses worth considering? "At that age they do not understand the career options that are open to them," says Prof Datuk Dr Ibrahim Ahmad Bajunid, dean of Universiti Tun Abdul Razak's Faculty of Humanities and Social Sciences.

The booklets which help student fill university application forms could also carry course summaries.

This is one of the many suggestions that would go towards relieving tensions surrounding admission to university.

Others that have been proposed to help put an end to the annual national debate on admissions include settling for one entry system to universities and reviewing grading systems.

On the thorny issue of race and university entrance, Shamsul says, it will never go away because the problem is inherent in our society.

Chandra, however, says it is still not too late to make amends.

An overhaul of the present university entrance system is urgently needed to ensure that the demands of meritocracy as well as social justice are met. There have also been suggestions that candidates undergo aptitude tests or an additional entrance exam set by the university they have applied to. There is also a call to increase opportunities for tertiary education across the board.

Education is a right, says Denison, and governments worldwide are moving towards allowing as many people as possible, at whatever age and under all sorts of circumstances, to pursue tertiary education.

When this is done, admission will no longer be a sensitive issue. "It's really about providing every child who has done well, a place to study in this country," says Siva Subramaniam.

This is the thought to hold on to as the country works its way to a permanent solution to the problem.

A solution that will keep us from saying: "We'll see you again, same time next year."



Not a level playing field out there for the underprivileged

CONSIDER the case of two young students, Abel, the son of an engineer, and Muthu, the son of a labourer.

The hard-working Abel, who attended an urban secondary school and tuition classes, obtains a Cumulative Grade Point Average (CGPA) of 4.0. On the other hand, Muthu, woke up at 5am everyday and rushed through his frugal breakfast to fuel his four-mile 6.6km cycle to school.

He could not afford tuition classes and each night he studied under the dim bulb. Muthu only manages a CGPA of 2.5.

Though a CGPA of 2.5 is higher than the minimum entry requirement for most universities, meritocracy and the abundance of top scorers have made it impossible for Muthu to achieve his long-time ambition of being a graduate. Meritocracy's biggest flaw is that it promises equal access, assuming that everyone has equal opportunity, says Universiti Kebangsaan Malaysia's Professor of Social Anthropology, Datuk Dr Shamsul Amri Baharuddin. However, in reality, it is not a level playing field out there, he adds.

Muthu may well be as intelligent and hardworking as Abel, but his socio-economic background had become a huge stumbling block. Hope for underprivileged students like Muthu would only come in the form of a special concession like a quota. The quota system of the past, says Prof Shamsul, had to a certain extent given people like Muthu a chance.

"A few years ago when I was the dean of the Arts Faculty, I was asked to lower the entry requirement for a certain quota and this provided many poor students a place in university." However, political scientist and social commentator Dr Chandra Muzaffar says that the quota system could only do good if implemented from a socio-economic perspective, whereby the disadvantaged from all communities were given special assistance in securing university places.

"This way there will have been much less unhappiness among non-Bumiputeras as well as some Bumiputeras, who for years have felt the ‘Special Position' provisions in the Constitution have sometimes been abused to favour well-endowed and well-connected Bumiputeras," says Chandra. But is the quota system the best solution for underprivileged students kids?

The executive director of MIC's Yayasan Strategik Sosial, Dr Denison Jayasooria, argues otherwise.

"If there is a section of a community that is falling behind, then offer these students extra classes and any other help they need, but don't lower the standards. We should help them, not reduce their competency."

Medicine in the Ukraine

MALAYSIANS seem to be an adventurous lot when it comes to studying medicine these days. Rather than choosing traditional destinations like the United Kingdom and Australia, more are finding their way to Eastern European countries like Russia and the Ukraine.

To date, the Crimea State Medical University (CSMU) in Simferopol has trained more than 26,000 doctors in the Ukraine, including 2,000 for countries around the world.

The university first opened its doors to foreigners when six Greek students arrived to take up their studies in 1961. Today, there are students from 34 foreign countries such as India, Jordan, Lebanon, China, Greece and Morocco.

Currently, 750 Malaysians are studying in CSMU, and in the last two years, 20 have also graduated with medical degrees from the university.

Cost is often a determining factor in medical studies and CSMU is competitive in this aspect.

According to Dr Subendran Arumugam, director of Ukrainian Medical Education Sdn Bhd, which represents the CSMU in Malaysia, the tuition fees for a six-year medical programme is RM69,000.

''It works out to RM11,500 per year. In addition, accommodation in a two or three-bed hostel room is RM850 annually. Most students can survive on between RM300 to RM400 per month,'' he says.

Given that cost can be between RM500,000 to RM800,000 in other countries, Dr Subendran says, more parents are now considering the Ukraine as an option for medical studies.

Since 2001, the Public Services Department has recognised the Bachelor of Medicine and Bachelor of Surgery degrees from CSMU, so graduates need no longer sit for a qualifying examination to practise in Malaysia upon graduation.

Dr Subendran says Malaysians should not worry about the language barrier as the programme is conducted in English.

But, he adds, it is important to be able to speak Russian too as students will have to deal with patients in their clinical years from the fourth year onwards.

''During the eight-month pre-medical period, the Malaysian students will have intensive Russian language classes every day for between five to six hours a day for three months,'' he says.

After three months, when students have a basic grasp of the language, university staff will start introducing other subjects such as biology, physics, chemistry and mathematics.

The university, which was established in 1931, has five faculties, namely nursing, general medicine, paediatrics, dentistry and clinical pharmacy, divided into 60 departments.

Tests in all the subjects are also continuously held to ensure students are able to understand what they are learning.

The medical degree is divided into the basic science years (first three years) and clinical years (final three years).

Out of the 750 students at CSMU, 200 are doing their pre-medical studies. The rest are in the medical school.

Dr Subendran explains that students are divided into various groups with their own timetables. Each group has 11 students.

''To sit for the examinations, students must have 100% attendance in class unless they are sick and have a medical certificate from the university's polyclinic.

''If they do miss a class, they have to pay a fine of about RM2 and make up for the class by doing extra work for the lecturer. This is to encourage the students not to miss any classes,'' he says.

In the summer time, students can do their clinical practice in Malaysian hospitals, he adds.

Up to 85% of the Malaysian students in CSMU are living in the hostels.

''It is more convenient for the students as it is a self-contained campus. The hostels are also within walking distance from the lecture halls and laboratories.

''Students can get what they want from the shops on campus such as halal food and go up straight to their rooms without worrying about having to go into the city,'' he says.

Other facilities on campus include a stadium, swimming pool, tennis courts, polyclinic, cafés and canteens.

Giving back patient his own skin

Need skin? Malaysian researchers have a world first — skin engineered from the patient for the patient. THERESA MANAVALAN checks out the future of bespoke skin made in Malaysia.

THE skin is so like the flesh of tender coconut. White and wobbly, soft and spongy and cold.

But this science is hot. Its Malaysian inventors are burning a new trail for engineered human tissue — in this case, skin to be used on burn victims or people with ulcers and wounds that refuse to heal. What makes this skin special is that it is made in the lab entirely from the patient who needs it. By using a one-centimetre square patch of the patient's skin, the cells are coaxed to multiply and shape themselves into skin with help from that very patient's blood plasma. It has done away with the non-human components associated with previous models of engineered skin tissue.

At Universiti Kebangsaan Malay- sia's medical school, Dr Ruszymah Idrus, an associate professor of physiology, has moved five years of research in engineered skin tissue to a new reality.

In a limited trial over the last six months, four patients with hopeless foot ulcers have had those ulcers surgically removed and the area covered with skin engineered from their own skin cells. The four — three diabetics, one with end-stage renal failure — had been living with severe ulcers that refused to heal. Their next option was amputation of the foot. They had had skin grafts but that procedure had failed on them. All had refused to try skin grafts again because of the pain.

Since their surgery, the areas covered with their engineered skin have healed completely. No scars have formed yet and the borders of engineered skin have set seamlessly with the patient's own skin. The little patch of engineered skin doesn't have skin pores or sweat glands. But, because engineered skin is a living thing, blood vessels and capillaries in the vicinity of the wound are already inching their way in.

"It's been so encouraging," says Dr Ruszymah, who began working on tissue engineering in 1999. "We hope to start a large-scale clinical trial soon." HUKM clinicians continue to monitor this small group. Already, the medical community is buzzing. Malaysian plastic surgeons are asking for engineered skin tissue, so are doctors and scientists overseas willing to work with a Malaysian team.

The science of engineered skin tissue is not that new. But what separates the UKM project from others around the world is that the entire thing is made from an individual's skin exclusively for that particular individual.

Other models of engineered skin tissue include a bovine layer which works well but is not popular with patients because of that.

This feature earned Dr Ruszymah and her team a gold medal with special mention at the April Geneva Inventions Show (Salon Internationale Des Inventions Geneve). That has set off alarm bells worldwide. Already, Dr Ruszymah's office is being flooded with e-mail and phone calls from interested investors, scientists and potential collaborators.

Engineered skin tissue is expected to be an alternative to skin grafting. Skin grafting, done globally, is a workable technique with good success rates but it has drawbacks. One is the pain. Diabetics are prone to infection. It leaves a scar on the harvested area. In patients with a large surface area to cover, it's a hopeless situation. For example, someone with 80 per cent burns would not be able to offer any of his remaining skin. Skin grafts fail when blood supply to the area is short.

For many years, doctors dealing with burns and skin ulcers have asked for an alternative that would overcome these issues.

Scientists began working on various ideas for skin in the 1970s but it wasn't until the mid-1990s that engineered human skin became a viable idea. That coincided with a new understanding of genetics and molecular biology which gave rise to innovative ways of working with living cells.

Skin is one of tissue engineering's success stories although it has its share of problems, the big one being getting the layers of skin to bond in the lab. Human skin is made of two major layers: the epidermis, the skin on the outside of the body, and the dermis, a spongy layer which lies immediately below. The cell structures of these two layers are entirely different. To make new skin, a one centimetre square patch of each layer is taken and separately cultured in different growth media. A growth media is a sterile solution loaded with nutrients to make the cells grow and mulitply. This is the easy part.

The hard part is getting these two layers to bond and behave like natural skin. In the past, the only way to do that was to mix the dermis cells with something else, usually tissue from cows and, in some cases, from rats. This type of engineered skin tissue has been commercialised and is known to work well. Malaysian plastic surgeons order it for their patients. They courier the patient's skin to the centre — the nearest one being Japan — and it takes about four weeks to cultivate enough skin for surgery. A petridish of such skin costs about RM2,000.

But already, some studies are reporting rejection to the bovine component. Besides, some patients don't like animal content.

The other technical problem in tissue engineering is coaching the cells to grow into a desired shape. Getting cells to multiply is fairly easy science but as a rule, they tend to grow haphazardly and become a hideous lump. To manage this, tissue engineers use a scaffold on which the cells can grow and form that shape. Scaffolds are made from a assortment of materials including chemicals with a molecular structure that would support cell growth, plastics and silicone.

Dr Ruszymah's team began by looking back to the patient. Working with a RM2 million grant from the National Biotechnology Directorate and collaborators from Universiti Putra Malaysia, Universiti Malaya and the Institute for Medical Research, they overcame the bonding problem and the bovine rejection issue in a single move. "We figured there might be something human we could use," says Dr Ruszymah, a UKM trained medic who went on to study molecular biology. "And we found it in blood. By using a human plasma derivative, we had one solution for both problems." The human plasma derivative — a now proprietary agent made from human plasma — has a mesh like a sponge which houses the cells as they grow. The epidermis and dermis cells are cultured and allowed to set with the human plasma derivative separately and then layered on each other.

"They bonded," says Dr Ruszymah. "That was the big event. This is now 100 per cent human and it comes from that individual patient." The finished skin is then mounted on surgical grade silk. The surgeon sews down the skin by suturing the silk to the patient's good skin. It takes about two weeks to heal (about the same for any other surgical wound). The sutures are biodegradable. The silk dries, curls up and lifts off the body. The engineered skin merges with the patients' good skin.

The next challenge? Shortening the time factor by at least half. It now takes three to four weeks to make skin this way. One problem is appearance. The colour of the new skin is rather pale, especially when placed right next to lustrous Asian skin. Yet another challenge: getting hair on to that skin.

"Now that would open the market for baldness treatments," says Dr Ruszymah.

But first things first. Dr Ruszymah has filed a patent with her husband Dr Aminuddin Saim, her co-inventor and the one who led her to tissue engineering. Dr Aminuddin, an ear, nose and throat surgeon formerly at UKM, had always been interested in creating tissue components for his patients. For some of them, it would help with the simple art of breathing. So he signed up in 1990 for a post-doctoral programme at the Tissue Engineering Centre, affiliated to Harvard University's medical school. This centre made world headlines in 1997 when its scientists, led by transplant surgeon Dr Jay Vacanti and chemical engineer Bob Langer grew a human ear on the back of a mouse. It was a popular Internet download for several years, a photograph that turned the collective stomach of a public queasy about biotechnology.

When Dr Ruszymah and Dr Aminuddin were there in 1999, animal rights activists were still seething but the mouse was a bona fide celebrity and had given rise to an entire new science called tissue engineering — creating human tissue to heal the sick and wounded.

When they returned, Dr Ruszymah and Dr Aminuddin applied for a grant from Yayasan Sultan Iskandar Johor which had issued their scholarships. With RM150,000, they set up a lab and began work on ear lobes for people with deformed ears. As a rule, cartilage requires minimum blood supply and nutrient, so growing it outside the body is achievable. But as it turned out, ears grown that way could not be surgically attached to a human being. While the ear itself was flawless, the human head and its complex network of blood vessels did not lend itself for the job. So, like many other tissue engineering labs around the world, they moved on to other body parts. At Dr Ruszymah's lab, researchers are already working on bone tissue using a similar process. This is intended to create material repair bones after fracture or disease. This would be an alternative to bone substitutes like metals and ceramics.

Admission interview may be a must in future

CYBERJAYA: Students vying for places in critical courses such as medicine in public universities may in future be required to pass an admission interview to secure a place.

Higher Education Minister Datuk Dr Shafie Mohd Salleh said that if implemented, the interview would give university authorities a better gauge of whether applicants were suitable for the courses, which included dentistry, pharmacy, engineering, law and accounting.

“This is something we are looking at. But first of all, we will try to expand the number of places in the critical courses,” he told reporters after witnessing the signing of a memorandum of understanding between Multimedia University Malaysia and Microsoft Malaysia yesterday.

He was asked to comment on Malaysian Medical Association president Dr N. Arumugam’s statement on Wednesday that an admission interview was necessary to vet applicants, as not all top students were suited for a career in medicine.

After much public outcry, Dr Shafie announced on Wednesday that the 128 students who were not given places to study medicine in public universities would now be absorbed into both public and private medical programmes.

International Medical University dean of student affairs Prof Ong Kok Hai said universities should adopt a multi-tiered admission system consisting of academic performance, an interview and students’ participation in extra-curricular activities.

“A student with good grades may not necessarily make a good doctor. We need to assess their language and communication skills.

“It would also be good to know if the student is approachable and humble as it would make him or her a better doctor,” he added.

On the financial worries of some of the 128 students, Dr Shafie said the students had two options to finance their education which were the convertible loan, where it would be converted into a scholarship if students performed well, and the National Higher Education Fund Corporation (PTPTN) loans.

He said the PTPTN had allocated a sum of RM72mil for the 47,969 students offered places to pursue first degree and diploma-level programmes in public universities.

Look for ways to overcome shortage of medical places, says PM

TOKYO: The Higher Education Ministry must look for long-term solutions to overcome the shortage of places for those wanting to study medicine, said Datuk Seri Abdullah Ahmad Badawi.

“The ministry must look at how they can hire doctors who are willing to serve as lecturers, including hiring them on a contract basis,” the Prime Minister said, urging the ministry to also look at increasing the number of lecturers and facilities to open up more opportunities for those wanting to study medicine.

Higher Education Minister Datuk Dr Shafie Mohd Salleh had said on Wednesday that the 128 top scorers who were earlier denied places would be absorbed into public or private medical programmes.

The students had all attained the required cumulative grade point average of 4.0.

Dr Shafie had said that the increased enrolment into medical schools was made possible following a decision by the Malaysian Medical Council to recognise a doctor-to-student ratio of 1:6, compared to the current 1:4.

Abdullah said he was glad that a solution had been found to admit the top scorers.

“I hope the solution that we have found will be accepted by all parties. I hope parents and students will accept whichever institution the students are sent to.

“We cannot consider everyone’s preferences because of various constraints,” he told Malaysian reporters covering his two-day visit here yesterday.

In Kuala Lumpur, Deputy Prime Minister Datuk Seri Najib Tun Razak and Education Minister Datuk Hishammuddin Hussein said the decision to give places to the 128 students was not due to pressure from any group or political party.

NICK LEONG reports Najib as saying that the decision was based solely on the students’ qualifications and the ability of the universities to absorb them.

“The Cabinet found it difficult to deny places for those with nearly perfect scores (of 4.0),” he told reporters after launching the Menara Com-merce yesterday.

Najib said public universities were able to absorb more students by increasing the number students per lecturer at the initial pre-clinical stage.

He added that the Govern-ment planned to increase intake at the universities by employing more lecturers at the advanced clinical stage.

“Some private universities are able to accept the students. It is a question of financing. The Government is thinking of a way to help them,” he said, adding that the adjustments would not compromise on the quality of the courses.

Asked if the Government planned to build more medical faculties at universities, Najib said such matters could not be rushed.

“Building medical faculties is expensive. Lecturers are also required.

“They (the lecturers) must not only have the necessary qualifications but also the experience before they can teach,” he said.

ELIZABETH LOOI reports Hishamuddin as saying that nobody should exploit the issue to claim political mileage.

“The Cabinet’s decision was for the sake of the top achievers’ future and also for the country,” he said, adding that the top scorers came from different races.

Hishammuddin conceded that the problem would keep occurring, but even so, “we will always give priority to top scorers,” he told reporters after chairing a meeting at his office on the issue of gangsterism in schools.

On a related matter, he said the achievements of bumiputra students in the matriculation programme had not been good enough since the programme started.

He added, however, that the programme would not be opened to non-bumiputras in the near future because it was meant to give bumiputras a chance in science and accountancy.

“The bumiputra achieve-ments are not good enough, based on the reports I received. We should give them more time to excel in these fields,” he added.

Plan to recruit more teaching staff soon

Higher Education Minister Datuk Dr Shafie Salleh yesterday took questions on the controversy surrounding the 128 STPM students not offered places to study medicine. This is an excerpt of the Press conference.

Q: Previously the ministry had announced that all places in public universities are filled. Now, why are you saying the students will be absorbed subject to availability of places?

A: We are looking at the overall picture meaning these students will be at both public and private universities for six years, which includes two years of pre-clinical. At one time, University of Malaya had one lecturer to 10 students and the Malaysian Medical Council did not recognise the degrees. Therefore, I have discussed with MMC yesterday, and it has agreed to expand the lecturer and student ratio from 1:4 to 1:6 during clinical years. This translates to one hospital bed having six students, three on each side of the bed with one lecturer supervising. If there are eight or 10 students, those standing behind will have their views obstructed. Now, they allow the 1:6 ratio and anything more is not allowed. If we disregard the ratio, MMC will not recognise the degrees.

Q: Now the public universities use the 1:4 ratio. What about the private institutions?

A: It applies to both sectors.

Q: Does this mean that the 128 students will be absorbed into the private sector?

A: They can be enrolled in any university during the pre-clinical years because there is no fixed ratio to follow. However, during the clinical years, we are applying the ratio of 1:6.

Q: Can the students choose the universities to do their medicine?

A: No. The 128 students will be distributed to both public and private institutions. Because of the fixed 1:4 ratio by MMC, universities have used this ratio for their student enrolment throughout the six years in learning medicine. Now, we modify the system a bit to allow more students for the pre-clinical years and follow the new 1:6 ratio for clinical years.

Q: Does this mean that after their two years’ pre-clinical course, they may be transferred elsewhere to accommodate the 1:6 ratio for clinical studies?

A: Yes.

Q: Will this also apply to future batches?

A: We will cross the bridge when we come to it. That is why we are working towards expanding the facilities, getting more money from the Government and hiring more teaching staff from Commonwealth countries. We will do this because of growing interest among the people to become doctors.

Q: When can we know who will be going to either public and private universities?

A: Give me two weeks, God willing. They should apply for a place internally to their respective universities. Meaning that they still have to register in the programmes that they have been selected for initially and then submit an application for a place in the medical faculty of the same university.

Q: Those who are absorbed, do they have to bear their own cost?

A: They will be given convertible loans, meaning if they excel their loans will be converted to scholarships. They can also seek financial aid from the Higher Education Fund.

Q: How many universities offer medicine?

A: Eleven. I have been informed by (Health Minister Datuk) Dr Chua Soi Lek that he has got in touch with the private institutions and they are willing to absorb the students.

Q: How can they prove that they are part of the 128 students who have chosen medicine as their first choice? Others can make similar claims too.

A: We can check with our database. The ministry will inform the universities and medical faculties about the 128 students.
A master list will be given to the six public universities offering medical programmes.

Q: What are the criteria to determine whether they will go either to the private or public learning institutions?

A: This is an administrative matter. A discussion will be held with the deans of medical faculties.

Q: Why can’t you offer a place now to the students since their preference is known?

A: There are certain procedures to follow under the meritocracy system. We have to check the students’ grades with others applying for the same course. We run this through the computer.

Q: Does this show that the system is weak?

A: No. Due to limited places, we have to check students’ achievements from every aspect including their matriculation and STPM results, SPM results and co-curricular performances.

Q: What is your guarantee that this matter will not recur?

A: We will develop the facilities for critical areas like medicine, pharmacy, dentistry, engineering and others. We need career counsellors to explain to students that there are different fields in the health industry. For instance, bio-medical, science, dietetics, optometry and others. There is a deficit of 49,000 health experts in Malaysia now.

Q: What is the additional cost to upgrade the existing learning facilities?

A: This will only be known under the next budget.

Q: Those who get four points, are they guaranteed to be enrolled in medicine in the future?

A: Next year, we will look into it. We will ask the deans to look into this. I just do not know whether they want to do medicine because they want to do it or their parents want them to be doctors. They must understand the nature of the job as doctors.

Q: How much does it cost to study medicine?

A: For each student, the Government subsidises RM50,000 a year. The Higher Education Fund gives a loan of RM100,000 for five year

Old hospital too far from city centre – Najib

KUALA LUMPUR: Deputy Prime Minister Datuk Seri Najib Tun Razak said the 95 Kinrara Armed Forces Hospital in Puchong, would be relocated as it is too far from the Ministry of Defence (Mindef) in Jalan Padang Tembak in the city centre.

Speaking to reporters in Bangkok where he is attending the 44th General Border Committee meeting, Najib, who is also Defence Minister, said the existing staff of the military hospital would be transferred to Mindef.

Meanwhile, a Mindef official confirmed that the hospital would be closed down "soon", and its facilities and staff transferred to a temporary polyclinic in Mindef.

He said the hospital was being closed as "the facilities are not up to standard".

The temporary polyclinic, he said, would be housed in the building currently occupied by the Science and Technology Research Institute of Defence (STRIDE) which will be moving to Kajang soon.

He also confirmed that work on the new military hospital, costing about RM200 million, near Taman Melati, Gombak, had been put on hold although land clearing work on the project had begun.

"The project was approved under the 8th Malaysia Plan but we have to put it on hold as no allocation was given," he said.

On claims that the land on which the Kinrara Hospital sits had been sold to a private developer, the official said there had been several proposals to develop the land.

"However, nothing has been approved or decided." The Malay Mail yesterday front-paged a report that millions of ringgit on highly-trained specialists skills and medical equipment were going to waste due to the impending closure of the Kinrara Hospital.

Several of the specialist clinics in the oldest military hospital are almost non-functional due to the premature phasing out of their services.

The talents of the highly-qualified specialists at the hospital, who were trained at between RM6 million and RM8 million per person, are going to waste as they are under-utilised due to the phasing out of the services.

This has affected the morale of the 180 hospital staff.

The premature closing of the hospital, scheduled for Aug 1, has also been questioned as the replacement hospital in Gombak will not be completed by June 2006 as scheduled.

This is because work on the new hospital came to a stop on May 1 due to funding problems.

The Malay Mail visited the site of the new hospital project and found that work had come to a standstill with an uncompleted building and some abandoned cabins.

What Ails Kinrara Hospital?

Millions spent on highly-trainedmedical specialists and equipmentare going to waste at the 54-year-old 95 Kinrara Armed Forces Hospital in Puchong in view of its impendingclosure.The Malay Mail learnt that several of the specialist clinics in the nation’s oldest military hospitalare almost non-functional due to the premature ‘phasing out’ of theirservices.It is also learnt that the hospital will be closed and replaced by a new hospital under construction in Genting Klang which is scheduled to be completed in June 2006.Sources said that with the phasingout of services which began a year ago, patients seeking treatment at the hospital are now referred to thealready congested University MalayaMedical Centre (UMMC), Hospital Universiti Kebangsaan Malaysia(HUKM) or Kuala Lumpur Hospital should they require more specialised treatment.As a result, the skills of the specialists at Kinrara hospital, who were trained at a cost of between RM6million and RM8 million per person by the Armed Forces, are practically under-utilised.It is learnt that the hospital has some of the best medical equipment and facilities which even other Government hospitals do not have. The hospital was also a training ground for medical personnel of the ArmedForces.“It is such a waste of talent because despite having some of the best medical facilities in the country,these highly-qualified doctors are forced to provide minimal treatment which ordinary GPs (general practitioners) can perform.“For example, they have two fully equipped OTs (operating theatres) in the hospital where major surgeries can be performed, but they are onlyused to perform minor surgeries suchas circumcision, dressing and plastering.“In some departments, the medical officers and ancilliary staff have practically no work to do and theyare so demoralised that many haveleft the service, or are contemplating leaving,” said one source.The hospital, which caters to ArmedForces personnel, ex-servicemen and the public in Puchong area, used tooperate like a full-fledged public hospital with a 24-hour emergency department and a staff strength of about 180.Now, the entire facility, includingthe emergency department, operatesfrom 8am to 4.30pm only.The hospital, which used to attend to about 200 patients a day, now only sees about 50 a day due to the phasingout of services.“Although they have a fully equipped maternity clinic, and an obstretician and gynaecologist onduty, they have stopped delivering babies,” the source said.“Expectant mothers just come for normal check-ups and are referred to other hospitals for delivery. In effect, some of the staff are being paid to do almost nothing. It is very demoralising, given their expertise.”And because the hospital has become almost non-functional for the treatment of major cases, some of its specialists have been transferredout.It is learnt that one of the two anaesthetists at the hospital has been transferred to a non-medical unit at the Terendak Camp in SungaiUdang, Malacca, where he has beenassigned to administrative duties.What is more worrying is that the staff have been verbally informed that the Kinrara hospital will stop operations by Aug 1.The move to close down the Kinrara hospital is believed to facilitate the sale of the land to a private developer to the tune of about RM200 million.It is also learnt that under the deal,the proceeds from the land sale was to be pumped into the new Genting Klang Hospital.However, it is learnt that work on the Genting Klang hospital stopped on May 1 due to funding problems.“Why the hurry? Is it because the property has already been sold to the private company?” asked a source.“Why do they want to close it down so fast, especially after spending several million ringgit a couple of years ago to refurbish the hospital?”

Source: http://www.emedia.com.my

Joint council to promote healthy lifestyle

KUALA LUMPUR: Malaysians, the Government feels, are an unhealthy lot. A National Council for Fitness will therefore be formed not only to encourage a healthy lifestyle but also promote unity, sports and recreation.

Health Minister Datuk Dr Chua Soi Lek said the proposed council was the brainchild of Youth and Sports Minister Datuk Azalina Othman Said and would involve the two ministries as well as the Housing and Local Government Ministry and the National Unity and Integration Division of the Prime Minister’s Department.

Speaking at a joint press conference here with Azalina, he said Malaysians were not generally aware of the importance of exercise.

“They lead sedentary life-styles that cause diseases, such as diabetes and hypertension, to increase.

“We want to develop a nation that pays attention to individual wellness, which includes mental and physical health,” he said.

Dr Chua said exercise lowers the risk of diseases, thus reducing public expenditure on healthcare.

He said the 9th Malaysia Plan provides for the ministry to reduce diseases via preventive medication, adding that the ministry would emphasise on the eating habits of Malaysians as a form of preventive medication.

“A healthy lifestyle does not only mean being active in sports, but also practising good eating habits,” he said.

Azalina echoed Dr Chua’s concerns on the poor eating habits and the lack of exercise among Malaysians.

She said the national unity division and the three ministries were co-operating on the matter in response to a statement by Prime Minister Datuk Seri Abdullah Ahmad Badawi that the development of sports and fitness among Malaysians was the responsibility of all government agencies.

Azalina said the new council would be launched as soon as a committee comprising representatives from the division and the ministries is set up. Asked for a time frame, she said “as soon as possible”.

She said the joint collaboration, riding on the theme Sports for All, Sports for Unity and Sports for a Healthy Lifestyle, would prevent a duplication among the agencies concerned, increase efficiency of roles among them and lower healthcare costs.

Plans for 11 new hospitals deferred

The Health Ministry has deferred the construction of 11 hospitals scheduled to begin this year to cut costs.

Health Minister Datuk Dr Chua Soi Lek said hospitals currently under construction would not be affected.

It is learnt that the decision was taken following cost-cutting measures by the Treasury to achieve a balanced budget. Dr Chua did not name the hospitals affected by the move.

"We will not cut down on our priorities such as basic essential services, training and life-saving equipment, but the development of new hospitals will be reviewed," he said.

He said the construction of hospitals would probably be carried out under the Ninth Malaysia Plan. Replying to questions in the Dewan Rakyat yesterday, the ministry's parliamentary secretary, Lee Kah Choon, had said that although the ministry was implementing the cost-cutting measures, it would not compromise on the quality of medicine prescribed.

On an unrelated matter, Dr Chua said the ministry had until September to decide which companies would be awarded tenders to supply drugs and medical equipment to hospitals under its jurisdiction.

He dismissed a report in a Malay daily yesterday which said that the contracts were supposed to have been given out at the end of last year.

Dr Chua said Pharmaniaga, a subsidiary of the UEM Group, was responsible for submitting the list of potential suppliers to the ministry.

"We will then decide who gets the tenders based on quality and pricing. The list is reviewed every three years and our review for this year is expected to be completed in September.

"So far, 45.6 per cent of the concession has already been given to Bumiputera suppliers. Government policy states that not less than 60 per cent of the concession must be awarded to Bumiputeras," he said.

Yesterday's report stated that the ministry had short-listed 17 Bumiputera companies with a total contract value of only RM52.6 million, a measly 18 per cent of the whole concession worth RM336 million.

Dr Chua refuted the figures, saying Bumiputera suppliers had actually received contracts worth RM181 million. The pharmaceutical company has a 15-year contract which ends in May 2009 to supply and distribute pharmaceutical and medical products to hospitals under the Health Ministry.

Dr Chua explained that not all companies which put in a bid for the contracts would receive them. "The companies have to be patient as we need some time to decide on who to award the contracts to. It is not easy as we have over 600 types of drugs and equipment to look into," he said.

Health Ministry denies it failed to meet contracts

KUALA LUMPUR: The Health Ministry has denied allegations that it failed to meet medical products supply contracts worth some RM190mil with Pharmaniaga Bhd, causing many bumiputra medical supply companies to lose millions of ringgit and risk bankruptcy.

Its Minister, Datuk Dr Chua Soi Lek, who said that a report on the issue in Utusan Malaysia was untrue, pointed out that under a 15-year contract concerning the supply of medicines and medical products signed in 1994, both the ministry and Pharmaniaga were required to review the prices of all products supplied by the company every three years.

“The current review period, which started in August last year, is ongoing and we have until September this year to conclude this evaluation together with Pharmaniaga,” said Dr Chua at his ministry yesterday.

Pharmaniaga Bhd, a government-linked company and a subsidiary of United Engineers (M) Bhd, was reportedly given a RM336mil concession for distribution purposes to bumiputra and non-bumiputra supply companies from 2004 to 2006.

Dr Chua said: “At the last count, there are 45.6% qualified bumiputra companies participating.

“The value of this participation is approximately RM181mil. This percentage is expected to rise by September. The claim that only 18% of the contract is channelled to bumiputra suppliers is baseless.”

Dr Chua also said the concession value of RM336mil as reported was inaccurate, noting that the actual value has not been finalised.

Bumi firms risk bankruptcy

MANY bumiputra medical supply companies are losing millions of ringgit and risk bankruptcy due to Pharmaniaga Bhd’s failure to meet medical products supply contracts worth RM190mil with the Health Ministry, Utusan Malaysia reported yesterday.

It said the failure could have been caused by lack of transparency in contract distribution at ministerial level, especially involving the bumiputra quota to suppliers registered with Pharmaniaga.

Pharmaniaga, a government-linked corporation and a subsidiary of United Engineers (M) Bhd, was given a RM336mil concession for distribution purposes to bumiputra and non-bumiputra supply companies for the period between 2004 and 2006.

The daily also reported that Pharmaniaga apparently disagreed with the bumiputra supplier list given by the ministry, as it would have an adverse affect on the quota.

The daily quoted a source as urging the Government to take action as it involved the ministry’s authorisation in handling the contracts that were supposed to have been settled by the end of last year.

Approximately RM182mil worth of contracts were allocated to bumiputra companies based on the government’s policy that no less than 60% of government contracts under the concession must be channelled to these companies.

For the period, Pharmaniaga was required to submit a list of bumiputra companies which qualified for the contract to the ministry via its pharmacy department.

“It has been a year and the ministry has still failed to finalise the list following the dissatisfaction by Pharmaniaga towards the ministry’s response on the given list, especially regarding the allocation for bumiputras and non-bumiputras,” a source said.

Second shot at medicine

The dream to become doctors lives on for 128 top students. The Cabinet today approved several measures to help them study medicine in either public universities or private colleges.

It decided to offer a loan to all students who obtained a Cumulative Grade Point Average of 4.0

And the offer comes with an added incentive: if they do well in university, then the loan will be turned into a scholarship.

Scholars will be bonded with the Government after they have completed their studies.

The Government also moved to ensure that the problem of demand outstripping supply will not be repeated next year. It has decided to hire more medical lecturers from Commonwealth countries so that the proper teacher-student ratio can be maintained and more places to study medicine can be offered.

The decisions reached at a lengthy Cabinet meeting today seek to douse a controversy that has been raging since last week when admissions to universities were announced.

It also signalled a move by the Abdullah administration to tackle the endemic problem of the shortage of doctors in Malaysia.

Higher Education Minister Datuk Dr Shafie Salleh briefed the Press on the Cabinet’s decisions. He said that, in principle, all the students should be given places in public universities and private colleges.

"After deliberating at length, we decided that students with a 4.0 CGPA who didn’t obtain their first choice, which was medicine, should be given another chance," he said.

He noted that Health Minister Datuk Dr Chua Soi Lek had spoken to private institutions and they had agreed to provide places if none were available in the country’s eight public medical schools.

The 128 students will have to register at the institutions which had offered them places and, later, apply to study medicine through their respective universities.

Shafie said the public universities and private colleges intending to absorb the 128 students would be provided with a list of their names to prevent other students from taking advantage.

He said that the Government could not guarantee places to all the 4.0-pointers but hoped that medical schools would make the places available.

Medical courses are offered at eight public universities and five private institutions.

Shafie also noted that the Malaysian Medical Council (MMC) had agreed that the 1:6 lecturer-student ratio need not be maintained at the pre-clinical stage (normally the first two years of a medical degree) where subjects such as anatomy, biochemistry and physiology are taught.

At the clinical stage where internal medicine, psychiatry and paediatrics are among the subjects, the ratio had to be observed.

"The MMC feels that it will be acceptable for a lecturer to be teaching up to 10 students at the pre-clinical stage. After that, if necessary, students will be re-distributed, possibly to other schools to achieve a 1:6 ratio."

He was hopeful that the problem of demand outstripping supply would not arise next year.

"We will bring in more lecturers from Commonwealth countries and purchase more equipment," he said.

Meanwhile, MCA president Datuk Seri Ong Ka Ting said that the Cabinet made the decision in the interest of the country.

He added that the Cabinet had understood the aspirations of these students and today’s decision should put an end to the controversy.

Chua said the Cabinet’s decision could help overcome the shortage of doctors in Government clinics and hospitals.

"With the decision, local public universities are expected to produce about 1,000 doctors each year.

"It will help the Government achieve its target of having one doctor for every 650 people by the year 2015," said Chua, who is also an MCA vice-president.

Flawed choice of foreign specialists

TEN per cent of foreign medical specialists employed by the Health Ministry are incompetent.

Deputy Minister Datuk Dr Abdul Latiff Ahmad admitted there were flaws in the selection process as it failed to determine the competency level of candidates.

The candidates were interviewed in Malaysia and their country of origin but the exercise was confined to verifying their qualifications.

"Once they start working, we find out that 10 per cent are incompetent," he said.

Dr Abdul Latiff said foreign specialists were required to serve under a local specialist for six months before they were allowed to practise on their own, and that only when the local expert was satisfied with his performance. Those who failed would be downgraded to medical officers.

Replying to a supplementary question from Baharum Mohamed (BN-Sekijang), the Deputy Minister provided statistics on the shortage of doctors in the past five years.

"In 1999, there was a shortage of 285 doctors and specialists in government hospitals, 914 in 2000, 849 in 2001 and 803 in 2002. Last year, of the 2,164 vacancies, only 908 were filled," he said.

A total of 654 foreign doctors were employed on contract basis since May 1 this year.

Dr Abdul Latiff said the ministry was satisfied with the quality of foreign doctors from India, Pakistan, Canada, Iraq, Nepal, Somalia and Jordan.

To another supplementary question from Datuk Bung Mokhtar Radin (BN-Kinabatangan), Dr Abdul Latiff said until 2002, only 15 specialists had resigned, compared to almost 50 before.

Finalising legislation on new pharmacists

Legislation requiring pharmacists to serve in public hospitals for three years is close to being finalised.

The move, affecting newly registered pharmacists, would be implemented before the end of the year, said Health Minister Datuk Dr Chua Soi Lek.

"The Attorney-General is finalising the legal aspects. (The amendments) will definitely be ready by the end of this year," he said today.

Almost half of Government posts for pharmacists have not been filled as of March, a shortfall of 624 out of the 1,267 needed. Only 18 per cent of the country's 3,567 qualified pharmacists work in the public sector.The Ministry will need more than double the number of pharmacists it has now by 2020, and expects to create another 3,000 posts by then, he said. Some 870 pharmacists are expected to qualify annually by 2010.

With one pharmacist for every 7,100 Malaysians, the country is well below the World Health Organisation's benchmark of one for every 2,000 in developed countries.

The Pharmaceutical Association of Malaysia said it hoped the Government would allow foreign pharmacists to work in the private sector on contract, to ease the anticipated shortage.

The ministry should also allow each pharmacist to work at more than one pharmacy outlet, said association president Dr Choe Tong Seng.

The Malaysian Pharmaceutical Society said it would monitor the impact on the private sector.

Dr Chua said the move is expected to create a slight shortage in the private sector, but the industry is expected to stabilise in the next three to four years.

Pharmacy would become the third healthcare profession, after medicine and dentistry, to have compulsory service.

Pharmacists have good prospects, with fresh graduates earning between RM2,500 and RM3,000 in the private sector compared to RM1,800 before.

Dr Chua spoke after he witnessed the Health Ministry sign an agreement for pharmacy students from University College Sedaya International to spend two semesters attached to Kuala Lumpur Hospital.

‘Yes’ to anti-smoking pact

SERDANG: Malaysia is set to ratify an international anti-smoking convention that will allow the Government to impose further restrictions on the use and sale of tobacco products and even allow civil suits against tobacco companies.

Health Ministry parliamentary secretary Lee Kah Choon said Malaysia had already signed the World Health Organisation’s “Framework Convention on Tobacco Control” (FCTC) last September as part of its efforts against smoking.

“We are now ready to ratify the convention. We will proceed to table this in parliament so that it can become law,” he said after launching the “World No Tobacco Day 2004” event at Universiti Putra Malaysia in Serdang yesterday.

All the 118 countries that signed the convention have until June 29 to ratify it.

So far, only 16 countries have ratified it.

The convention comes into force 90 days after ratification.

The FCTC, adopted at the World Health Assembly in May last year, requires countries to impose restrictions on tobacco advertising, sponsorship and promotion; establish new packaging and labelling of tobacco products; establish clean indoor air controls; and strengthen legislation to clamp down on tobacco smuggling.

Malaysia’s ratification of the convention also means that consumers could soon file civil law suits under new laws against tobacco companies for health problems resulting from use of tobacco products.

“Our survey shows that most smokers are Malays. More women are also picking up this bad habit,” he said.

Lee later gave away prizes for the “International Quit Smoking and Win - Malaysia 2004” contest.

The first prize of RM10,000 went to Hasamuddin Mohamad, while the second and third prizes were won by Lt Muhamad Nazmy Jamal and Mohamad Mazzuan Jamaludin respectively.

The contest attracted 2,508 participants who agreed to quit smoking for at least a month.

Senai Airport eyeing lucrative health tourism market

THE Malaysian state of Johor, which is forging ahead with plans to help its Senai Airport have a bigger bite of the air passenger and cargo pie, is eyeing the health tourism market too.

The chairman of Johor's Tourism and Environment Committee, Mr Freddie Long, indicated its ambitious plans yesterday at a media conference at the official opening of Senai Airport's new lounge in Johor Baru.

The state, which has 12 hospitals, wants to increase the number of patients they get and is targeting those from Indonesia in particular.

About 55,000 Indonesians visited Malaysia for medical treatment last year.

Close to half went to Malacca for treatment.

Mr Long said Senai Airport, which is about 30km north of Singapore, would be used as the entry point into Malaysia.

The airport, Changi Airport's closest challenger, handled 600,000 passengers in the first five months of the year.

Three in 10 of its passengers came from Singapore.

By August, when its $22 million air cargo complex will open, it plans to make a push for more of the air freight market as well.

The new complex will be able to handle 80,000 tonnes of freight a year.

Mr Long stressed that the plans to transform Senai from a sleepy town into a transport, logistics and medical hub are not an attempt to challenge the might of Changi Airport or Singapore.

'Changi has its own efficiencies with world standards,' he said.

'Senai is a child and you can't compare a child with an adult. But of course a child also has his own ambitions,' he added.

Still, observers say that competition would be inevitable if Senai sets out to develop the same capabilities Singapore is aiming for.

For example, many businesses at the Johor town's industrial park now move their goods through Changi.

And it is these businesses that Mr Mohamad Sidik Shaik Osman, director of Senai Airport Terminal Services, is hoping to win over.

He told The Straits Times: 'They came because of our low costs, so why would they want to pay more and send their goods through Singapore if we can offer them good service?'

He would not discuss potential clients, only saying that talks are on about using Senai's cargo facilities.

Last year, Changi Airport saw close to 25 million passengers compared to its Senai counterpart's of about one million.

And while Senai Airport's long-term goal is to handle 500,000 tonnes of cargo a year, Changi dealt with more than 1.6 million tonnes last year.

The team that developed the Port of Tanjung Pelepas (PTP) into a world-class facility will be working to make Senai Airport 'the pride of Johor'.

Senai Airport Terminal Services, which took over the running of the airport from the Malaysian government last November, is controlled by Malaysian tycoon Syed Mokhtar Al-Bukhary, who also controls PTP.

While analysts expect some of Changi Airport's cargo business to move to Senai, they do not see Johor's ambitions posing a significant threat to Singapore's viability.

For instance, Mr Paul Coughlin, managing director of Standard & Poor's Asia-Pacific corporate and government ratings department, said: 'Competitors will come and peel off some of the business here and there, but I don't think any port or airport in the region can seriously compete with PSA Corporation and Changi.'

Singapore 'can't expect to forever dominate all market segments', he added, and while there is better connectivity in the Republic, some companies may move to Senai 'if the price is right'.

As for attracting the medical dollar, Singapore and Malaysia are not alone in their ambitions, Mr Coughlin said.

He pointed out that other countries, such as Thailand, India and Hong Kong, are also players in this 'very competitive' game.

Faculties’ resources stretched to limit

The six public medical faculties cannot accept more than the 779 students allocated places this year as their resources have been stretched to the limit.

Council of Medical Deans chairman Professor Dr Zabidi Azhar Hussin said some had vastly exceeded their capacity, with a 1:8 medical lecturer-student ratio when 1:6 was the accepted ceiling.

He cited the case of Universiti Sains Malaysia, which was meant to take in only 120 students but accepted 180 this year.

Universiti Kebangsaan Malaysia, which was meant to take in 150, took in 205.

Dr Zabidi, also the dean of USM's School of Medical Sciences, said increasing the intake any further would adversely affect the quality of teaching.

"Instead of one lecturer supervising eight students, he might have to supervise 16. So many students crowding around a patient is not good. Smaller groups are more effective as training needs to be personal.

"Increasing the present intake would be feasible, but it would not be in the best interest of the public or the medical profession. The public has a right to be reassured that Malaysia still produces high-quality doctors," he said.

He was commenting on Malaysian Medical Association president Datuk Dr N. Arumugam's statement today urging public universities to each take in three to five of the 128 students who had not received places in medical schools.

Dr Zabidi said medical courses should also be offered at more public universities.

At present, only eight of the 17 local universities have medical faculties.

Besides USM and UKM, the others are Universiti Malaya, International Islamic University Malaysia, Universiti Putra Malaysia, Universiti Malaysia Sabah, Universiti Malaysia Sarawak and Universiti Teknologi Mara.

Dr Zabidi said 70 medical lecturers left USM between 1998 and 2000. Twenty-eight of them joined the private sector , 19 other institutions and three the Health Ministry. The rest were those whose contracts had expired (11) and those who had retired (nine).

Last year, 25 lecturers joined USM.

It is understood that 45 lecturers each had left UM and UKM in the last three years. Figures for the five other universities were unavailable.

Medical support staff also insufficient

KUALA LUMPUR: The country is not only facing a shortage of doctors but also of medical support staff whereby over 20,000 posts are unfilled, said Health Minister Datuk Dr Chua Soi Lek.

Currently, he said, there was a dearth of some 5,000 nurses, 3,300 doctors, 700 medical specialists, 600 pharmacists and 500 dentists.

“So, this shortage is not only of doctors but also of support staff such as dentists and nurses. There are 140,000 positions and 118,000 are filled. The total shortage is 22,000.

“The positions are not filled because there are no people. Efforts have been taken to alleviate the problem,” he said after meeting state Health executive councillors and directors yesterday.

Among the efforts undertaken by the ministry to alleviate the problem was to implement compulsory three-year contract service, hire retired staff for contract work, recruit foreign doctors and increase the number of public and private institutions of higher learning offering medical courses, he said.

“In a year, we can train about 1,000 doctors in the country. There are about 300 who retire or join the private service. The net result is that in a year about 650 doctors are in government service,” he added.

He said about 400 students who completed their compulsory service were sent for specialist training while 1,800 doctors were promoted last year.

“There are still vacancies for promotion especially for specialists. We are also studying the issue of allowance.

“We allow them to work at the accident and emergency unit after working hours so that they can earn extra income, which is RM30 an hour. It is equivalent to what they would earn if they did locum,” he added.

It would be ideal if there was an increase of 1,000 doctors annually and there was one doctor for every 650 people by 2015 compared with the current ratio of one to 1,420 people, he said.

On the National Health Welfare Fund, Dr Chua said clarification had been given to those who attended the meeting yesterday as they did not understand the issue.

He said among the reasons for delays in getting applications approved was that the patients did not state the type of aid they needed for paying private medical fees.

On the 134 units of donated blood which were found contaminated with the HIV virus last year as reported by the National Blood Centre, Dr Chua said the blood had been destroyed.

On the distribution of hospitals and clinics, he said the coming Ninth Malaysia Plan would look into setting up more clinics in Sabah, Sarawak and Terengganu to ensure equal distribution.

On cutting down the waiting time in public hospitals, he said a report being prepared by his deputy, Datuk Dr Abdul Latiff Ahmad, was expected to be completed within two weeks and it would be presented to the Cabinet.