Materia Medica Malaysiana

Nurses may get higher allowances

KUALA LUMPUR - Faced with a critical shortage of nurses, Malaysia is considering increasing allowances in a bid to attract more people to the job.

About 4,000 of the country's 27,000 nurses retire annually while only 2,500 new graduates a year are coming through, Deputy Health Minister Abdul Latif Ahmad told a nursing-college audience. The imbalance could cause problems if comprehensive plans are not put in place.
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Besides the option of increasing allowances, the government has allocated RM140 million (S$63.5 million) to upgrade facilities such as hostels and lecture halls at nursing schools.

Yet another measure is allowing foreign students to take up nursing courses and to serve here upon graduation, he said at the Seremban Nursing College.

'We will also consider taking in foreign nurses. However, this will only be a last resort.'

The country could be turned into a teaching and training centre for foreign nurses but an in-depth study is needed, he added. -- New Straits Tim

Mercy Malaysia Needs RM1.5 Million For Relief Mission To Sudan

KUALA LUMPUR, July 30 (Bernama) -- What does a Malaysian get with RM5 today? A plate of nasi lemak and teh tarik perhaps? Or simply the fee for parking in some area of Kuala Lumpur?

In Sudan, with RM5 one can provide a malnourished child with therapeutic feeding for a day which includes milk and nutrients.

This was told to the media by Malaysian Medical Relief Society (Mercy Malaysia) president Datuk Dr Jemilah Mahmood Friday.

She said her organisation had been requested by the United Nations (UN) agencies to lend medical assistance to the country's Internal Displaced People (IDP).

"Basically we need about RM200 monthly to treat one malnourished child, and RM1.5 million to have and run a decent therapeutic feeding centre for six months," she said during a media briefing on Mercy Malaysia's six-month relief mission to the war-torn African country, beginning next month.

She said with that amount of money, Mercy Malaysia could treat at least 180,000 Sudanese at IDP camps in El-Geneina, west Darfur region.

At present the town was populated by 1.2 million of IDPs with 88 percent of them without shelter and 75 percent are children and women.

"According to the United Nations agencies, 10,000 people are expected to die by next month if they still cannot get access to basic medical supply," she said adding that most roads to the region were inaccessible at this time of the year due to the damage caused by rain.

Dr Jemilah said Mercy Malaysia would send a team of four people this Monday, to assess the situation in the city.

"We will make preparations on what is needed based on their report, and where we are actually going because the camps cover a large area, and we need to be where we are needed most," she said.

Six relief missions would be sent to the country from next month till February next year, involving about 60 Mercy Malaysia staff and volunteers, with the first team to be deployed in mid August, said Dr Jemilah.

"We appeal to Malaysian medical staff and practitioners to be our volunteers. This will be a good learning experience for them because we are going to deal with the condition of malnourishment, a condition we don't have here," she said.

These six teams, said Dr Jemilah, were to establish a basic therapeutic feeding centre as well as to provide primary health care.

"If we can, we will continue with the second phase which is to provide mental health care as well as strengthening the basic health care system," she said.

People interested in making donations or who wish to be volunteers can call 03-42569999, 012-9162579 or 019-6366595. Donations are tax exempted.

-- BERNAMA

Health Director Talks On Strategies To Destroy Aedes Mosquitos

Vector surveillance, case surveillance, health education and promotion are the strategies to control and destroy aedes mosquito breeding.

Dr Zainol Ariffin bin Pawanchee, Director of Health in Kuala Lumpur, Malaysia, highlighted this at a session on diseases carried by mosquitoes at the health seminar yesterday.

The vector surveillance is to identify dengue sensitive areas, using mosquito larva trapping devices to decrease mosquito population in residential areas, create special anti-dengue epidemic control team in out-break areas and mobilise members of the community for aedes control.

Meanwhile, case surveillance is to determine occurrence of cases according to grid areas and to determine place of transmission such as residential, school, work place and others. Health promotion, on the other hand, is to determine the target groups and information for dissemination.

At the same session, Dr Siti Romlah binti Haji Mohammad Jais, Veterinarian Officer at the Agriculture Department, stressed on the danger of pets and livestock to human health.

She said the factors in preventing all such hazards are cleanliness for the animals and visits to the veterinarian at least once a month for health checkups.

At the session, it was also revealed that houses nowadays cannot guarantee 100 per cent safety to occupants.

Many types of accidents can happen at any time. For example, fire hazards caused by carelessness that can result in loss of properties and a place to stay, injuries and even death.

This was disclosed by Awang Osman Jailani, the Public Relations Officer of the fire services department, in his working paper entitled "Hazards in domestic setting".

He said every house should have a systematic plan to prevent fire and save lives during a fire.

Meanwhile, Dr. Pengiran Haji Khalifah, Acting Senior Medical Officer of the Health Work Practice Section, Ministry of Health, in his talk on "Workplace, health and safety", revealed that according to the 2003 Annual Report from the Occupational Health Division, 139 cases of accidents at work were reported during the period from June to December of last year.

He said the workplace should implement hazard controls. -- Courtesy of Borneo Bulletin

Sarawak Housewives Face Increasing Risk Of HIV Infection

KUCHING, July 29 (Bernama) -- Housewives are at an increasing risk of getting HIV infection as heterosexual transmission is now the main cause of AIDS cases reported in Sarawak.

Sarawak General Hospital (SGH) Sexually Transmitted Diseases and AIDS Unit head, Dr Oui Siew Kim said Thursday it was the main mode of HIV infection unlike elsewhere in the country where drug abusers and sex workers were at a higher risk.

"When AIDS cases were first detected in Sarawak in 1989, it was initially reported among foreigners, mostly Thai fishermen but now more and more Sarawakians are contracting HIV infection," she told reporters after the opening of an HIV/AIDS Awareness Campaign For Women by Sarawak Women's Bureau director Norjanah Razali here.

Dr Oui, who is also the State Health Services Assistant Director, said a total of 424 HIV cases had been reported in Sarawak, including 174 AIDS cases and 89 AIDS-related deaths since then.

Up to June this year, she said 34 new HIV cases, 19 AIDS cases and nine deaths were reported in the state compared to 75 HIV cases, 49 AIDS cases and 13 deaths last year and 55 HIV cases, 26 AIDS cases and 14 deaths in 2003.

She advised those with multiple partners or were in doubt of their health status to undergo counselling and medical screening at any of the government health clinics, which were free of charge.

Earlier SGH Obstetrician and gynaecologist Dr Wendy Loh said women constituted 5.5 percent of the estimated 58,000 HIV positive people in the country.

Dr Loh, who is Sarawak Family Planning Association (SFPA) Honorary Treasurer, said the number of women, who were newly infected went up by over 10-fold to 673 cases from 66 new cases in 1993.

On the campaign being funded by the Ministry of Women, Family and Community Development, she said it was to create awareness and understanding among women on HIV/AIDS.

She said it was also aimed at promoting healthy lifestyle that could reduce HIV transmissions and enable women to make responsible choices with regards to the promotion of their general wellbeing.

-- BERNAMA

Debate on private wings

Having private wings in public hospitals to stop brain drain may leave the poor with inadequate healthcare, reports LOH FOON FONG.

PUBLIC hospitals all over the world have to deal with the problem of brain drain. In Malaysia, it has become more acute in recent years and to discourage doctors from leaving the civil service, private wings in Government hospitals have been opened to improve the incomes of doctors.

However, public interest groups say setting up private wings will overstretch the already limited resources in government hospitals and possibly jeopardise the health of poorer patients.

S.M. Mohamed Idris, president of the Consumers Association of Penang (CAP) says concerns regarding the set-up have been raised to the Health Ministry but they have not been addressed. For instance, there are at least 3,000 vacancies for government doctor positions. As a result of this shortage, medical officers are overworked.

There is concern that patients' healthcare may be compromised for monetary benefits with the advent of private practice in government hospitals.
“If there is an overall manpower shortage, how is the hospital going to deploy staff to the private wing and still cope with the ever increasing number of patients?” he asks.

“There is also a shortage of first-class wards in the general hospitals, so how do we accommodate the influx of private patients into the general hospitals? There is concern that the beds may be converted for the use of private wings,” he says.

In University Malaya Medical Centre (UMMC) which has public and private wings and the corporatised Institut Jantung Negara (IJN), the cost of medicines, procedures and laboratory charges has gone up. The waiting time for heart patients who are unable to afford surgery in private hospitals can be two years or more, he says.

CAP has called on the Health Ministry to scrap the system. “Introducing private practice in government hospitals has the potential to drastically change the face of the present healthcare system. The healthcare of patients should not be compromised for monetary benefits,” says Mohamed Idris.

Citizens’ Health Initiative coordinator Dr Chan Chee Khoon fears that the needs of the poor will be neglected even more under the system.

He cites the case of a janitor at Universiti Sains Malaysia who underwent colorectal cancer surgery at Penang Hospital in 2002. She earned RM500 monthly and received no hospitalisation benefits from her private sector employer. When she was discharged from her third-class ward, she was billed RM1,662 for a stapler device for re-joining her colon after surgery and RM141 in ward charges.

“Some months later, I brought this up with the hospital director, who in turn replied that this was in line with a government directive to increase cost recovery to about 20% of the operational costs of the Health Ministry’s hospitals,” he says.

As part of the Malaysian government’s corporatisation policy, government hospitals were directed to increase the rate of their cost recovery, he says. That is because patients at government hospitals contributed about 5%-10% of the hospitals’ actual operational costs. The government’s medical services were being subsidised up to 95%.

“It is clear that our under-financed public healthcare will become even less effective for the poor when more private wings are set up in government hospitals as human and material resources are re-allocated in line with the market needs rather than the desire to serve the needs of the poor,” he says.

It is predictable that private wings will soon be encouraged to service the regional health tourism market as well, he says.

“The Citizens’ Health Initiative has repeatedly voiced its concern over such developments. We are not against foreigners benefiting from our healthcare capabilities. Indeed we can take pride in this, but we are concerned when more and more of our local health resources are diverted to serving regional and national healthcare priorities as dictated by market demand, rather than on need basis,” he says.

“The proposal to introduce private wings in government hospitals is an unworthy idea which is rife with conflict of interests. It should be definitively scrapped,” he says.

A doctor who does not want to be named says setting up private wings does not guarantee that specialists will not leave the public sector.

“There are specialists who earn a lot of money from the private wing of UMMC but some of them still leave for private practice. One reason is that they have to work long hours. The specialists can only serve in the private wing after 5pm. So they serve in the public hospital during the day and continue to work at night to earn the extra income and find that they have no life,” says the doctor.

Moreover, he says, research work that is commonly carried out in teaching hospitals may be neglected when doctors do not have time or earning incentive to carry out the task, he says.

“In Singapore, this system seems to work better. The Singapore government is more successful at keeping doctors possibly because there are more direct rewards for them. The doctors are paid well.

“The best way to retain doctors in the public sector is to give them a better salary,” he says.

Although the Malaysian government subsidises more than 90% of public healthcare costs, Chan notes that it only spent 2.04% of the Gross Domestic Product (GDP) on public healthcare in 2001. The World Health Organisation recommends that national health expenditures be 4%-8% of GDP.

He urges the Health Ministry to implement the Prime Minister’s call for transparent, accountable healthcare governance, where there is open, competitive tendering to ensure cost-efficient use of public finances for healthcare, and that resources are directed to those areas which can deliver better gains in primary health care.

He adds that the fees schedule in the private sector should also be regulated to reduce the disparity in earnings between the public and private-sector doctors.

Mohamed Idris says charges for specialist and in-patient treatment at government hospitals can be raised slightly to bring in more revenue. “Those who cannot afford to pay full rates should be given discounts or in the worst case, free treatment. Patients in the second and first-class wards should pay a greater percentage of the costs of treatment.”

Raising the current charge of RM1 for outpatients at government facilities to RM5 can bring in another RM100mil which can go towards financing healthcare, he says.

At the same time, the Social Security Organisation’s (Socso) services can be extended to include medical care in general, rather than just restricting it to industrial accidents and occupational diseases. The annual profits of Socso can be transferred to the Health Ministry through hospital payments, thus easing the financial strain of the ministry, he says.

If the contributions are still insufficient, employers and employees can each contribute RM1 a month and that will yield at least an extra RM200mil a year in Socso contributions which can be used to finance medical treatment, he says.

The United Kingdom experience has shown that the private wing system is detrimental to the rights of poorer patients. In 2002, The Observer discovered that of the more than 10,000 private patients treated in Britain’s National Health Services’ hospitals, around half came from overseas and were treated in preference to local patients, who were left on waiting lists. The private patients were treated by the same NHS doctors and nurses and often slept on the same beds and used the same equipment.

Docs: CCTVs no help during robberies

The safety of patients and staff is more important than security mechanisms, said doctors who are not in favour of opening their clinics round the clock.

Dr Koh Geok Leong said that CCTVs could not help in stopping robberies. "What's the use of fixing CCTV when robbers can ask you to climb up to remove the recorder and your life is probably at stake?" he asked.

Dr Koh, whose 24-hour-clinic in USJ, Subang Jaya, was robbed on two occasions two to three years ago, stopped operating after midnight since January this year.

"The nurses are scared to work at such hours and the risk of falling prey to criminals is much higher after midnight," he said.

"We tried installing a peephole through which staff could 'check out' patients before letting them in but it did not work."

Echoing his views was a doctor in Bangsar who shortened his operating hours after an attempted robbery.

"Our clinic used to run 24 hours but two months ago we cut down on the operating hours because the security guard quit and our staff felt it was not safe. CCTV will not help because even banks get robbed," said the doctor, who did not want to be named.

The clinic, which opened some 18 years ago, is currently operating from 7am to llpm to minimise the risk of getting robbed.

"We learnt from the experience of other clinics and try to prevent it from happening here," he said.

However, a clinic manager at Jalan Pudu said that her clinic continues to operate 24 hours daily, as they did not want to disappoint those who came for treatment. "We have not faced any problems so far," she said.

Criminals, who are only slightly deterred by safety measures taken by clinics, also target those operating normal hours, said Malaysian Medical Association (MMA) president Datuk Dr N. Arumugam.

"It is widespread at clinics located in Damansara, Petaling Jaya or Klang. Sometimes, the incidents happen at clinics which close at 10pm or midnight."

Bernama had reported Dr Arumugam as saying on Saturday that 30% of 2,000 licensed 24-hour clinics in the Klang Valley were closing at midnight for fear of being robbed.

When asked to comment on a media report last week that the Internal Security Ministry was prepared to study the possibility of setting a special force to curb robberies at 24-hour clinics, Dr Arumugam said that while MMA welcomed the move, details would have to be worked out. He also said that installing CCTVs or employing private security firms was too expensive.

"If someone takes out a knife and points it at a doctor or nurse, how would they react? We welcome the idea but we need to know what help they can give to combat criminals," he said.

He added that more 24-hour clinics were closing by midnight because it was getting increasingly difficult to get staff who were willing to work late hours.

"Females make up about 90% of clinic staff and it is getting more difficult to get staff to work," he said.

New policies on treatment of mental patients soon

Kuala Lumpur: Policies on the treatment of mental patients and those who suffer from mental health problems are being revamped.

Health Minister Datuk Dr Chua Soi Lek said there were certain components that were neglected in the existing policies such as education, curative, rehabilitation and after-care.

“There has been a neglect of mental health and as we progress I can foresee more and more people with mental health problems,” he said.

A committee headed by Director-General of Health Tan Sri Dr Mohammad Taha Arif will prepare a working paper on mental health problem.

The Ministry’s finding showed that mental illness cases have doubled in six years - from 11,120 outpatients last year compared with 5,687 in 1998.

Also, it was found that 10 to 15 per cent of these patients are suicidal or could harm other people and that 20 per cent of the population have mental health problems, but many are reluctant to seek treatment.

It was also revealed that one in four families has at least one member suffering from a mental or behavioural disorder.

Working Malaysians, increasingly prone to job-related stress, risk developing personal problems, anxiety, psychosis, schizophrenia and multiple personality disorders. In fact, 10 per cent of mental health problems are related to work and social life.

Dr Chua said people who did not know how to channel their emotions, pent-up frustrations, anxiety and depression often end up turning to drugs and psychotropic pills.

He added that gambling was also a part of manifestation of anxiety.

“People who suffer mental health also turn to Ecstasy pills, drug addiction, rape, incest and even commit crimes,” he added.

Dr Chua said depression leading to suicide topped the list worldwide with more people being killed than all the wars combined in any one year.

“It is estimated that 65 per cent of non-communicable disease in the world can be prevented, including mental health.”

To meet the increasing number of mental health cases, the Ministry would build two new mental hospitals, one costing RM300 million to replace the Permai Hospital in Tampoi, Johor, and another costing RM400 million to be constructed in Aman Jaya, Kedah.

Besides Tampoi, the other mental hospitals are the Bahagia Hospital in Tanjung Rambutan, Perak, and one each in Sabah and Sarawak. There are 108 family medicine specialists (FMS) under the Ministry trained to diagnose, treat and manage patients with mental disorder.

Until April, 52 FMS were trained in the diagnosis and treatment of depression.

Dr Chua said the Ministry would be working closely with the media, Education Ministry, NGOs, publications and politicians to make health promotion one of their activities.

“When we conducted a survey, it came as a surprise to us that 76 per cent of Malaysians were concerned about their health but did not know how to maintain their health.

“They did not know much about healthy eating and living, stress management and, most of all, where to get health-related information,” he added.

He said the survey also revealed that many did not read and that was why the Ministry has decided to give emphasis to promotion of health and on preventive aspects of health under the Ninth Malaysia Plan.

UKM researchers: High levels of bacteria in Tasik Chini

PEKAN: Tasik Chini, the country’s second-largest freshwater lake, is contaminated with high levels of e-coli, the bacteria that may have caused rashes and diarrhoea among the orang asli living near it.

This has prompted the state government to warn the 400 villagers, including 100 children aged six and under, not to drink water from the lake and wells.

Universiti Kebangsaan Malaysia (UKM) researchers in their recent expedition to the lake found high levels of e-coli, salmonella and other bacteria, collectively known as coliform, in the 202ha lake and ground water.

There are five settlements – Kampung Gumum, Tanjung Puput, Chendahan, Melai and Ulu Gumum – on the shores of the lake, which is famous for legends of lost kingdoms and dragons.

51 health projects completed

Kota Kinabalu: Fifty-one projects or 31 per cent of the 164 health-related projects identified for Sabah under the Eighth Malaysia Plan (8MP) have been completed, Health Minister Datuk Dr Chua Soi Lek said.

The projects included two hospitals in Keningau and Lahad Datu besides rural clinics and other facilities, he said.

He said 26 other facilities scheduled for implementation were under construction, including hospitals in Pitas, Kuala Penyu and Kunak while 87 other projects were still at the planning stage.

“Overall, Sabah received RM1.2 billion from a total of RM9.5 billion under the 8MP allocations to the Ministry, which is the biggest compared to other states,” said Dr Chua.

On Queen Elizabeth Hospital’s re-development projects, Dr Chua said it had begun since 1992 over a period of 18 years.

As of now, RM51 million had been spent for various facilities including a post-graduate centre, a car park complex, renovations to the surgical hall, the intensive care unit, as well as upgrading infrastructure such as the sewerage system.

A RM74 million specialist clinic on a four-storey block would also be part of the re-development project.

“Piling works for the block had been completed but construction has not started yet. There has been a delay...it is not true that the project has been halted due to lack of funds. The construction will start either end of the year or early next year,” he said.

Specialist complex project ‘not abandoned’

THE Health Ministry on Saturday denied that the proposed specialist complex at the Queen Elizabeth Hospital had been abandoned because the Federal Government has run out of funds.

Health Minister Datuk Dr Chua Soi Lek said the development that will cost RM74 million was a little delayed as some changes had been made to the scope of work. The changes are to ensure optimal utilisation, especially in terms of flow of patients, he said.

“We want to make it more efficientÖthere are also changes in the IT component,” he said.

In this respect, he hoped the project, the foundation phase of which has already been completed, would take off by the end of this year or the latest by early next year.

According to Dr Chua, the Health Ministry was also trying to get allocation for the development of the 9-storey two tower blocks and a 5-storey podium.

When completed, the complex, located just adjacent to the QEH’s Post-Graduate Medical Centre (PGMC), would house all the government specialists under one roof.

Meanwhile, Dr Chua said Sabah was the largest recipient of healthcare allocations under the Eighth Malaysia Plan (8MP), getting about RM1.2 billion from the RM9.5 billion allocated to the Ministry.

He said the funds were for 164 projects in Sabah of which 31 per cent had been completed, while 26 projects were ongoing and another 87 planned, including the building of health clinics.

As for the QEH, he said from 1999 up to now, about RM51 million had been spent, namely for the PGMC, renovation of operation wards, ICU and ICCU (among others).

Asked on the development of Sabah Medical Centre (SMC), which was taken over by the Federal Government to be turned into a Women and Children Hospital, he said: “It would be operating once the renovation is completedÖhopefully by another year’s time.”

Govt may ban cigarettes in small packs

KOTA KINABALU - The government is considering banning the sale of cigarettes in small packs to discourage smoking, especially among youths, said Health Minister Chua Soi Lek.

Dr Chua said the move was appropriate as it would make it harder for youths to buy cigarettes.
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'We are also considering banning the sale of loose cigarettes in public places,' he said after opening the 32nd Malaysia Youth Movement annual meeting at the Sabah Trade Centre in Likas near here yesterday.

Dr Chua also slammed cigarette agents who used youngsters, especially primary schoolgirls, to sell cigarettes.

This practice is currently prevalent in certain states in Malaysia.

However, he said that in a recent dialogue with cigarette companies, the corporations had promised to look into the matter and stop their agents from continuing the practice.

The minister said the amendment to the Tobacco Act would also include more public areas as no-smoking zones.

'As soon as it is passed, we will ensure each pack of cigarette includes a note on the dangers of smoking. When smokers open the pack, they can read all about the harmful things related to the habit,' he said. -- Bernama

10,000 teenage pregnancies a year

ABOUT 10,000 adolescent girls in Malaysia get pregnant and give birth every year.

This is a cause for concern and there is a need to empower girls with both education and access to methods that help prevent unwanted pregnancies, said Dr Ravindran Jegasothy (right) of the Malaysian Medical Council’s ethics committee.

These girls are also at risk of maternal mortality which is two to four times higher in adolescent mothers than in those in their 20s, he said. Infant mortality is also estimated to be about 30 per cent where adolescent mothers are concerned.

Dr Ravindran, an obstetrician and gynaecologist, was presenting a paper at a four-day regional roundtable conference on population, sexual and reproductive health and poverty, held at Istana Hotel, Kuala Lumpur, from last Tuesday.

“What we need to do is to get away from the moralistic attitude that sex doesn’t happen in this group,” he said.

Dr Ravindran said religious education was important to send the message that sex was not something to be freely indulged in but at the same time, its existence among youngsters should not be ignored.

A 2000 study on adolescent pregnancies in a semi-rural clinic in Malaysia also showed that 65 per cent of adolescent mothers were unmarried, not well educated and had a low usage of contraceptives.

A pilot anonymous HIV-screening programme in Johor also indicated that adolescents, or those aged between 13 and 19 years, were involved in activities that put them at risk of contracting the virus.

“Despite religious education and despite our social values, there are girls and boys in the country who are having sex and we know from the experience of other countries, that this figure is going to increase,” Dr Ravindran said.

The good news is that the school health programme today is providing basic information on reproductive health, he said.

“Girls are being told how they can become pregnant, nobody is hiding the fact anymore and that is good.”

Boys, too, are being told how to avoid getting their partners pregnant and how they can avoid contracting sexually transmitted diseases.

It must also be emphasised that hospitals in Malaysia do not discriminate against unmarried mothers as some people might assume, said Dr Ravindran.

While not denying that unmarried mothers faced social stigma when they sought treatment, Dr Ravindran said the girls were generally treated with empathy.

“They are usually referred to social workers and NGOs, who will continue to provide the emotional and sometimes financial support that these young girls need,” he added.

Anti-smoking drive yet to reach its mark, says Chua

KUALA LUMPUR: The RM100mil “Tak Nak” anti-smoking campaign is not achieving much success but has instead raised cries of dissatisfaction from healthcare-related NGOs.

Health Minister Datuk Dr Chua Soi Lek said the private company running this five-year campaign had not contacted any of the NGOs ever since its launch.

“It was agreed earlier that activities between the NGOs and the company would be co-ordinated but there has been no initiative shown.

“The ministry agrees that this campaign has not reached a level of success that we can be proud of,” he told a press conference after the Health Dialogue Council 2004 attended by 20 NGOs yesterday.

The NGOs, Dr Chua said, had raised this matter during the dialogue.

The participants also raised concern over sensitivity to female victims of abuse and rape among the ministry’s officials, including health experts and support staff.

“We will have programmes to increase sensitivity of our staff to needs of female victims.

“There will be an official launch and awareness campaign to promote the One-Stop Crisis Centre (OSCC) in September or October,” he said.

The centre, which provides medical and follow-up care such as counselling and shelter to survivors of violence against women and children in state hospitals, will also be set up in district hospitals in the next two years.

“Victims will have a simple form to fill in to prevent any missing information needed for legal action later,” said Dr Chua.

He also said the 9th Malaysia Plan would place emphasis on education, treatment and aftercare of mental health patients, quoting a research conducted by the ministry that 13% of children aged five to 15 have mild mental health problems.

“The director-general has been appointed to look into these and to see if there is a need to build half-way house for borderline cases,” he said.

Half-way homes for mentally ill patients

KUALA LUMPUR July 23 - The Health Ministry will introduce half-way homes for mentally ill patients who are not suitable to be placed in mental hospitals.

Its minister, Datuk Dr Chua Soi Lek, said the project would be implemented in 2006 under the Ninth Malaysia Plan (9MP) and was necessary to cope with mental patients having mental stress.

It was also hoped that the half-way homes would help those with mental stress to prevent them from having a tendency to commit suicide, he told a media conference after chairing the Health Dialogue 2004, here Friday.

Dr Chua also revealed a study by the ministry that found 13 percent of children aged between five and 13 were experiencing mental health problems.

He said the problems were detected when the affected children had difficulties in sleeping, refused to go to school, felt uncomfortable and experienced phobia.

"The percentage, even though small, is worrying enough," he said, adding that mental health problems, if left untreated could result in mental illness.

Besides that, Dr Chua said his ministry planned to set up a One-Stop Crisis Centre in all government hospitals to help rape and violence victims.

Dr Chua said the one-stop crisis centres were expected to be completed in two years but for a start, a centre were already operational in the Kuala Lumpur Hospital since the end of last year and had received a total of 75 cases to date.

He said all medical officers and supporting staff in government hospitals had been directed to give special attention to woman and girl patients, especially for rape and violence cases.

For easier treatment for Down Syndrome patients, Dr Chua said the patients would be issued a special card known as the Disabled Self Identification Card, which was hoped to help the patients to obtain early treatment and repeat treatments in any hospitals nationwide.

Saudi, Malaysian Firms Sign Joint Venture Deal in Health Care

JEDDAH, 22 July 2004 — A major joint venture agreement in the field of health care was signed yesterday between Saudi Arabia’s Al-Sharif Group and Malaysia’s Pantai Medivest.

“Both parties believe that the Saudi health care market is large and stable. The market is looking for quality services, which we intend to provide,” said Abdulaziz Al-Naser, CEO of Al-Sharif Group, after signing the agreement with Azman Ibrahim, managing director of Pantai Medivest.

“We wish to benefit from the strong experience and expertise of Pantai and emulate their success in the Saudi market,” he added.

Naim Abdul Rahman, Malaysian vice consul and assistant trade commissioner, and Zalizam Zakaria, director (overseas) Malaysia Tourism Promotion Board, based in Jeddah witnessed the signing.

Al-Sharif Fayez said that with the increasing need for better health care facilities and services in the Kingdom, Al-Sharif Group has decided to take a major leap in the sector with Pantai.

His group searched for about three years for the right partner. Pantai have seven hospitals in Malaysia — in Kuala Lumpur, Selangor, Melaka, Perak and Penang — with a total capacity of some20 , 000beds.

Al-Sharif Group plans to build two hospitals — one in Makkah and another in Madinah, each with200 -bed capacity.

“We are a comprehensive private health care provider, the largest in Malaysia, and hope that with this joint venture we will be able to explore, together with Al-Sharif Group, all aspects of the health care market, particularly hospitals and management in the Kingdom,” explained Ibrahim.

Established 29 years ago, Pantai has grown to include hospitals and clinical support services such as laboratory and blood bank services, clinical waste disposal, hospital maintenance, cleaning and laundry services, nursing school, and health tourism.

Al-Sharif Fayez said the group also planned to build a medical institute to train Saudis in all areas of hospital requirements including x-rays, laboratory work and blood banks.

“We want to contribute to the Saudi economy, provide jobs for locals, and with the best of health care available locally, encourage people to stay in the Kingdom for medical treatment.”

He said Al-Sharif Group, established nearly two decades ago, has diversified from trading and construction into such areas as electrical power generation plants, and distribution systems, property, commercial centers and health care

Private wing fees would be lower

Source: New Straits Times Wednesday, July 21, 2004

Kuala Lumpur, Tues. -
Malaysians are assured that treatment at the proposed private wings of public hospitals will be cheaper than at private hospitals.

Health Minister Datuk Dr. Chua Soi Lek assured Malaysians today that the new fee schedule for private wings would ensure this.

"We will examine fees charged by the private sector. We cannot charge the same fees as the private sector. Government service must always have an element of subsidy," he said in an interview.

He cited the example of Magnetic Resonance Imaging (MRI) which costs an average of RM1,200 in private hospitals but only RM150 at government hospitals.

He said the ministry wanted to introduce a more equitable rate for such specialised procedures.

"We have not worked out the details of the new rates yet. There is a lot of red tape to look into," he said.

He said a team headed by ministry secretary-general Datuk Ismail Adam and Deputy Health Minister Datuk Dr Abdul Latiff Ahmad has been appointed to look into the matter.

Dr. Chua, who acknowledged that private hospitals were not happy with the decision to set up private wings in public hospitals, said they should not worry about the financial bottomline.

"Market forces will determine, especially in a service industry like health, where people will go. Health is a very personal and important matter and will affect every family."

He said there should be sufficient business for both public and private hospitals as the economy expanded and the public became more affluent.

He said the new schedule would not have to go through Parliament as it was not an amendment to the existing fee structure under the Fee Act (medical) 1994.

On the variables in determining the new fee structure, he said payments to doctors and nurses would top the list.

"We have to look at how much to pay doctors and nurses. We also have to look at the insurance aspect and who should pay for it.

"We also have to look at how many hours doctors and nurses are allowed to work," he said.

Dr. Chua said there was also the issue of where private wings should be located.

"This is a huge issue to be tackled. There are many variables involved and I need a few months to put everything in place."

Dr. Chua yesterday announced that private wings would be set up at public hospitals next year, adding that a pilot project would begin once administrative matters are settled.

Under the Act, government hospitals can charge maximum surgical fees of RM200 for third class, RM1,200 for second class, and RM3,000 for first class patients. This does not include ward, food, medicine and other charges.

Meanwhile, the Association of Private Hospitals of Malaysia (APHM), which is against the move, said the private wings would create a "two-tier" system, where patients' access to treatment would depend on their ability to pay.

CAP: Poor patients will be shortchanged

The Consumers’ Association of Penang (CAP) today decried the government’s move to set up ‘commercial private wings’ in public-funded hospitals, warning that the move would end up shortchanging other patients who use subsidised services.

Its president SM Mohamed Idris pointed out that privatising hospital wings would not solve the manpower shortage in public hospitals - there are currently about 3,000 vacancies for doctors.

“As a result of this shortage, medical officers are very much overworked. How is this to be addressed with the commencement of the commercial private wings?” he said in a statement,

“How are hospitals going to deploy staff to the commercial private wings and still cope with the ever increasing number of patients?”

Mohamed also asked how general hospitals - which have a shortage of first class wards - would accommodate additional patients.

He said the move raised concerns that poor patients could be deprived of treatment, if beds are converted for more profitable use in the private wings.

“CAP regrets that the Health Ministry is going ahead with its plan...in spite of various concerns raised by CAP and other parties. So far, these concerns have not been addressed,” he added.

Higher fees?

Mohamed pointed out that corruption may also become an issue once a two-tier system is implemented in public-funded hospitals.

“Corrupt doctors could see patients in the commercial private wings but admit them to the public side for procedures. He could then pocket fees illegally by offering a concession to the patient. This practice is rampant in places like India and Egypt where there is a public-private mix,” he said.

He also noted that once public hospitals adopt private wings, it would likely adopt private sector practices of charging high, marked up prices for services.

“If the aim is to increase remuneration for medical staff, then there are a number of means whereby additional income for the government could be generated,” he said.

“CAP calls on the ministry not to go ahead with the plan to start private wings in public hospitals. All the concerns that have been raised should be addressed.”

KL to send medical team to Iraq


KL to send medical team to Iraq
By Roger Mitton

WASHINGTON - Malaysia is ready to send a medical team to Iraq and mobilise an international Muslim force to rehabilitate the war-torn country, said Prime Minister Abdullah Ahmad Badawi on Monday, after talks with US President George W. Bush.

Datuk Seri Abdullah, who is chairman of the 57-member Organisation of the Islamic Conference (OIC), said the world will risk another failure in nation-building if Iraq is left in the cold at this stage.

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'We are prepared to rally support among Muslim countries for OIC participation in rebuilding Iraq and strengthening its institutions of governance and its economic system,' he said.

The meeting between the two leaders came after a long period of strained ties between the US and Malaysia - and went well apparently.

Datuk Seri Abdullah said: 'Bilateral relations between the United States and Malaysia are certainly very strong.'

On many levels, that is unquestionably true. Economic ties have never been better. Malaysia is now the 10th largest trading partner of the US.

Cooperation in defence and security matters has improved tremendously. And compared to his predecessor, Tun Dr Mahathir Mohamad, Datuk Seri Abdullah is much appreciated in Washington.

Mr Peter Singer, director of the US-Islamic World relations programme at the Brookings Institution, said: 'He's far less controversial and so therefore it makes the relationship a lot less bumpy.'

Mr Bush also thanked Datuk Seri Abdullah 'for the cooperation on counter-terrorism efforts'.

Ms Angel Rabasa, a senior policy analyst at the Rand Corporation, said: 'The perception in Washington is that Malaysia's cooperation has been quite good in countering terrorism. So they each have a vested interest in putting their best foot forward.'

That said, some felt the Malaysian leader deserved a higher profile reception. He was squeezed in for barely half an hour between Mr Bush's lunch with the Chilean President and his photo-shoot for an American automobile race.

As a result, the US media gave his visit little, if any, coverage. That reinforced a common perception that the US has failed to fully utilise the example of Malaysia and other moderate, pro-development Muslim nations.

However, Datuk Seri Abdullah did not shirk from reiterating his country's opposition to recent actions by the Bush administration.

Malaysia opposed the invasion of Iraq from the start. It was an action that has 'inflicted a terrible blow to international relations', he said.

He said Muslims still doubted the good faith of the US in tackling the root causes of terrorism, but he also welcomed recent developments, notably the setting up of an Iraqi interim government.

Private wards in govt hospitals next year

Kuala Lumpur: The Government has agreed in principle to set up private wards in selected government hospitals by next year, Health Minister Datuk Chua Soi Lek said Monday.

“We had some meetings and probably we need to re-look at some of the government general orders that may have to be amended before government hospitals can charge the full rate that the private hospitals are charging,” he said.

He said the proposal was made because currently, patients referred to government hospitals by private hospitals were charged government rates.

“For example, in Penang and Sarawak, the cardiology unit is doing a lot of operations (in cases) which are actually referred by private hospitals but we cannot charge them the full rate because our fees are controlled by the Government,” he told a news conference in Seri Kembangan, near here.

Earlier, he witnessed the signing of an agreement to promote a health-based tourism programme between Hotel Palace of the Golden Horses (POGH) and Ken-Air Leisure Sdn Bhd (Ken-Air).

The trial project would involve government hospitals in several locations nationwide, Chua said, adding, “...maybe one in the north...two in the central and one in the south and even in East Malaysia, maybe one in Sarawak and one in Sabah.”

He said his Ministry and the Tourism Ministry were collaborating to promote medical tourism.

“We have started in Indonesia and we are going to promote to the Middle East. We have calendar events for promotions overseas which we will distribute to 35 private hospitals recognised by the Government as hospitals which can accept tourists for medical services.

These hospitals had to provide either ministry with information like the patient’s bills, place of origin and type of medical service so that the ministries could plan promotions and marketing more effectively, he said.

However, the response was not encouraging because each month, only half of the 35 hospitals involved provided the information, he added.

He said they had been given another six months to provide the information, failing which they would be dropped from the list of 35 recognised hospitals and would not be included when the Health Ministry, with the help of the Tourism Ministry, conducted promotions overseas. - Bernama

Medical City to solve shortage of doctors, says UiTM V-C

PUTRAJAYA July 18 - Despite being a beginner in the teaching of medicine, Universiti Teknologi Mara (UiTM) has come up with a vision to create a Medical City, from which it can train and offer a pool of medical experts and officers to the country.

"I am talking about our aspiration, vision. We want to offer (through the Medical City concept) the best medical service to the country.

"We are offering an idea for UiTM to build the so-called Medical City," said UiTM Vice-Chancellor Datuk Seri Dr Ibrahim Abu Shah.

If the concept were to materialise, then the Medical City would be the first (such development) in the country, he told newsmen here at the closing ceremony of the three-day 7th Annual Conference on Advances in Cardiology and Cardiovascular Therapeutics.

The UiTM's vision, he said, was to create the Medical City by 2020, or at the soonest, 2010.

"As far as I know, only some Western countries have this Medical City concept. Elsewhere, Dubai (United Arab Emirates) has come up with the same idea," he said.

Dr Ibrahim's intial plan was to have the Medical City to be set up in the university's second faculty complex in Puncak Alam, which was still under construction.

"It (the Medical City) would be a very advanced concept. We will amalgamate, merge with all the areas that are related to medicine, not only medicine per se, but also in pharmacy, business, engineering, hotel and tourism," he said.

On its medical faculty now based at its main campus in Shah Alam, he said it was progressing smoothly with the latest enrolment of 63 students as against 20 taken in last year.

Government stops recognising five traditional medicine groups

PENANG: The Health Ministry has stopped recognising the five traditional medicine groups as representatives of genuine practitioners.

Instead, the ministry will soon form the Traditional Complementary Medicine Council to streamline the activities of such practitioners.

Health Minister Datuk Dr Chua Soi Lek said the ministry stopped recognising the five groups since July 9.

They are the Federation of Chinese Physicians and Medicine Dealers’ Association of Malaysia, Federation of Traditional Malay Medicine of Malaysia, Society of Traditional Indian Medicine, Malaysian Council for Homeopathic Medicine and Malaysian Society for Complementary Therapies.

“We have received many complaints, especially against the Federation of Chinese Physicians and Medicine Dealers’ Association of Malaysia.

“There were claims that some of these organisations had used the Health Ministry’s logo in official letters and certificates without our approval, besides conducting courses without proper accreditation.

“Some have used the terms ‘doctor’ and ‘clinic’ and solicited funds for unreasonable earnings,” Dr Chua told reporters during an official visit to the Penang Hospital yesterday.

He noted that the ministry had received several complaints against traditional medicine practitioners and consultants, claiming to have academic certificates from China that were recognised by the ministry.

“While the ministry drafts the Traditional and Complementary Medicine Act, which we hope to implement by 2006, we will soon form a Traditional Complementary Medicine Council to protect the interests of traditional medicine practitioners.

“This council will look into the registration, accreditation, ethics and training of traditional medicine practitioners as well as the quality of their products,” he said.

Dr Chua said the ministry had recently formed a 28-man division to monitor the quality and services provided by such practitioners.

It had been reported that there are now more than 3,500 such practitioners, of whom 2,221 were Chinese, Malays (300), Indians (84), homeopathy practitioners (687) and 409 who were grouped as practitioners of complementary medicine.

About a third of 24-hour clinics in Klang valley close early

KUALA LUMPUR July 17 - About 30 percent of the 2,000 clinics operating 24 hours in the Klang Valley have taken precautionary measures by closing at midnight for fear of being robbed, said Malaysian Medical Association (MMA) President Datuk Dr N. Arumugam.

He said most of these clinics were situated in night spots where many night clubs and 24-hour restaurants operated.

The clinics resorted to such measures for fear of being robbed by those posing as patients, he told reporters after opening a seminar on physical abuse, including abusing maids in Malaysia here.

"It is a dangerous situation as in most instances, a clinic is only manned by a doctor and two assistants and they may all be women," he said.

Meanwhile, Women, Family and Community Development Minister Datuk Seri Shahrizat Abdul Jalil who opened the seminar said she would submit a memorandum to the Cabinet for all entertainment outlets close to residential areas to be closed by 2 am.

"If the local authorities still insist on allowing them to be open until the morning, they must ensure the safety of those who patronise such places by increasing police patrols," she said.

She said closing such outlets early would also prevent youths from patronising such places until the wee hours, which might lead to other social ills.

Malaysia says may send medical team to Iraq

KUALA LUMPUR, July 15 (Reuters) Muslim-majority Malaysia is considering sending a  medical  team to Iraq as a contribution to a multilateral force in the country,  Prime Minister Abdullah Ahmad Badawi said today.

''That is a subject that we have to think very carefully (about),'' Abdullah told a news conference.
He said Malaysia might consider some form of participation, suggesting it might be in the form of providing medical services.
Abdullah, who is due to meet US, French and British leaders within the next week, speaks both as national leader and chairman of the Organisation of the Islamic Conference (OIC) and Non-Aligned Movement (NAM).

Asked about prospects for a peacekeeping force led by Muslim nations in Iraq, he said that was also being looked into. ''I think Muslim countries can make some contributions,'' he said.

Atiqah's death not due to bureaucracy, says Dr Chua

KUALA LIPIS July 15 - The death of 15-month-old Nur Atiqah Najwa Mohd Sarif at the Subang Jaya Medical Centre (SJMC) before undergoing a liver transplant was not due to the Health Ministry's bureacracy said its minister Datuk Dr Chua Soi Lek Thursday.

He said Nur Atiqah's surgery was postponed due to health complications, as it was very risky to continue with the procedure.

"The Health Ministry's policy is not to allow any organ transplant, including liver (transplant) if the procedure poses a risk for the receiver or donor," he said.

"Liver transplants pose very high-risks - only one out of 100 surgeries are successful," he told reporters after visiting the Lipis Hospital here.

Nur Atiqah, who had billiary atresia (inflamed liver) died at 6.24 am on Wednesday from massive bleeding of the oesophagus (gullet).

On the decision to have Nur Atiqah's surgery at a private medical centre, Dr Chua said the ministry too provided many sophisticated facilities for the public at the Selayang Hospital for a reasonable cost.

The hospital has also employed the services of Australian liver transplant specialist, Dr Russell Strong.

"We only charge RM500 for every surgery, so there is no reason for the public to prefer the far more expensive services of private hospitals," he said.

Dr Chua said his ministry had trained many doctors at the Selayang Hospital to specialise in liver surgery.

"I accept there are weaknesses, but the ministry is constantly making efforts to rectify them and make improvements," he said.

Hospitals under the Health Ministry treated about 48 million patients a year.

Nur Atiqah Najwa dies before undergoing operation

KUALA LUMPUR July 14 - Fourteen-month-old Nur Atiqah Najwa Mohamed Sharif, who was transferred to the Subang Jaya Medical Centre (SJMC) on June 21 to undergo liver transplant surgery, died early Wednesday morning from massive bleeding of the oesophagus.

SJMC executive director Datuk Dr Jacob Thomas said Nor Atiqah, who was admitted to the paediatric ward for stablisation, suddenly developed massive bleeding from oesophageal varices and was transferred to the Intensive Care Unit (ICU) of the hospital at 11.20 pm on Tuesday.

She was given immediate aggressive treatment including blood transfusion but died at 6.24 am, he said.

Dr Thomas said Nur Atiqah was placed in the Paediatric Ward to be stablised but was not in a fit condition for major surgery such as liver transplant.

"Nur Atiqah had low body weight for her age and was being managed to increase the weight. In addition, her condition was still poor and she developed bronco-pneumonia and treatment was in progress to improve her lung condition," he said in a statement here.

Prior to this, Nur Atiqah's parents were told that she had to wait another two weeks before undergoing the operation because the doctors wanted to see her condition improve and weight increase to 7 kg.

Her father, Mohamed Sharif Abdul Hamid, 27, when met in his mother's house in Taman Desa Mahang, Jeram, Kuala Selangor, said the ventilator on Nur Atiqah was removed at about 6.20 am and he was not allowed into the ICU after that until he was informed that she had died at about 6.30 am.

Though he said it was fated, he was disappointed over the delay in carrying out the operation and hoped that it would not happen to others.

He thanked the media and caring Malaysians for their contributions in whatever form. So far, RM305,000 had been raised for the operation,

Meanwhile, Ahmad Khairi Al-Hadi Mohamed Yusop, 27, who had agreed to donate part of his liver for the transplant, said he was sad not to be with Nur Atiqah when she died for he had grown fond of her during the time they spent together raising funds for the operation.

Nur Atiqah was buried at the Muslim cemetery in Kampung Parit Mahang, Jeram, Kuala Selangor at noon.

Meanwhile, Health Minister Datuk Dr Chua Soi Lek, who conveyed his condolences to Nur Atiqah's family, denied that her death was caused by government red tape regarding her treatment.

He said she was transferred to a private hospital from the University Malaya Medical Centre for further treatment weeks ago.

Nur Atiqah's transfer to the SJMC was delayed because the Health Ministry stuck to medical ethics requiring potential donors who are not related to the patient to get its approval.

Malaysia ready to offer healthcare services to foreigners

HONG KONG : Malaysia is ready to offer a wide range of healthcare services, from medical screening and treatment to cosmetic surgery, International Trade and Industry Minister Rafidah Aziz said.

She said Malaysia was capable of offering the services given its advanced medical facilities, and medical specialists, with 70 percent of them having received their training from top medical schools in Britain, United States and Australia.

Ms Rafidah was speaking at a seminar on "Business Opportunities in Malaysia". She is leading a trade mission to Taiwan, Japan and Hong Kong.

In 2003, a total of 102,946 foreign patients received treatment in the private hospitals of Malaysia.

Malaysia's Anwar Seeks Permission to Go Abroad for Medical Treatment

Anwar Ibrahim, Malaysia's jailed former deputy prime minister, has been moved to a Kuala Lumpur hospital after a lingering back problem reportedly deteriorated. His lawyers have renewed calls for the government to allow him to undergo an operation in Germany.
Mr. Anwar was moved to the government-run Kuala Lumpur General Hospital late Tuesday after he started complaining of a loss of feeling in one of his legs.

His lawyer said an examination by doctors showed that a slipped disc had caused damage to his spinal column, which in turn caused a swelling of his kidneys.

Mr. Anwar's family has been pressing the government to allow him to be treated at a specialist clinic in Germany since he developed back problems in 2001.

Anwar family lawyer Sankara Nair says his client needs urgent attention.

"He was admitted at about 11:30 last night. His condition is not good," he said. "Various complications are beginning to show. It was explained three years ago that if he does not undergo surgery and treatment for his back pains for slipped disc, he will suffer other complications like bladder and kidney dysfunction, and it is already starting."

But the administration of Prime Minister Abdullah Ahmad Badawi has so far stood its ground on the issue, saying Mr. Anwar could receive treatment in Malaysia. Mr. Anwar maintains that the surgery he would undergo in Germany would be less intrusive.

Mr. Nair, the attorney, said there was no sign that the government was willing to budge.

"At this stage it does not appear to be so, but I have made an application, and we have made applications before, and that application stands. If they have conclusive evidence of further deterioration, there is no excuse," he said.

Mr. Anwar was fired as finance minister and prime minister-in-waiting in 1998 following accusations by his boss, then-Prime Minister Mahathir Mohamad, of corruption and sodomy. The two men fell out over the government's response to the Asian financial crisis of 1997 and 1998.

The move by Mr. Mahathir to dismiss Mr. Anwar and prosecute him triggered the worst political riots in the country's history.

Mr. Anwar, who has always maintained his innocence, eventually received jail terms totaling 15 years.

Study on eating habits to help preventive care

KUALA LUMPUR: The worrying rise of diet-related diseases has shifted the government’s focus towards preventive care as the cost of curative treatment is already eating up 65% of the ministry’s RM6.38bil annual budget.

The Health Ministry is undertaking a comprehensive research on current eating habits of Malaysians to plan new strategies to encourage a healthy lifestyle.

Deputy Minister Datuk Dr Abdul Latiff Ahmad, who announced this yesterday, said there had been no such research over the last 40 years although lifestyles and eating inclinations had changed drastically.

“Instead of burning off the additional calories, Malaysians are consuming 21% more calories per person per day compared with two decades ago,” he said at the launch of Nutrition Month Malaysia 2004 here yesterday.

The campaign themed Eat Healthily, Work Excellently targets working adults, especially female factory and office workers, and students. Dr Abdul Latiff said that in the past, it was normal for people to have a heavy breakfast, including rice, because they burned their calories while working in the bendang (padi fields).

“Nowadays, people eat more but they do not go to the bendang and do not burn the calories,” he added.

The ministry would now focus on educating the public on preventive measures against diet-related diseases such as cardiovascular ailments, stroke, diabetes and cancer.

He said strategies like awareness campaigns, forums and counselling sessions would be carried out once the root of the problem was identified.

M'sia quarantines 600 over bird flu fear

KUALA LUMPUR (AFP/dpa) - Health officials in Malaysia's northern Perak state have quarantined 600 pupils after 25 came down with fever following the deaths of 90 chickens in a compound at their school, a report said Sunday.

The Mingguan Malaysia, a Malay language daily, said health authorities had issued the quarantine order immediately due to fears over the spread of bird flu.

However, Hawari Hussein, director-general of the Veterinary Services Department, told AFP that the blood and other samples taken from the dead birds had proved negative for avian influenza.

Tan Chin Meng, chairman of the state health committee, said all students at the Technical Secondary school in Teluk Intan had been ordered to undergo a blood test at a public hospital. The birds died on Friday, and 25 students suffered symptoms of fever and flu on Saturday.

There has not been an outbreak of bird flu in Malaysia despite outbreaks in neighbouring Southeast Asian countries.

China, Thailand and Vietnam have all reported new cases in recent days, sparking fears of a resurgence of the winter outbreak that left 24 people dead and devastated the region's poultry industry.

However, experts in China found no sign of mutation in new samples of the avian influenza virus taken from infected birds in eastern China's Anhui province, state media said on Sunday.

"The laboratory test proved that the virus was the H5N1 strain, which is a stable type of the bird flu virus," the official Xinhua news agency quoted Wei Jianzhong, an expert from the provincial bird flu control office, as saying.

The strain identified in the latest outbreak was the same as that found earlier this year, when bird flu infected poultry in four areas of Anhui, Wei said.

Some scientists had expressed concern that the bird flu virus may mutate and form a new influenza strain that could spread among humans. The latest bird flu outbreak, the first in China for four months, hit a hillside poultry farm near Anhui's Chaohu lake.

Workers slaughtered 22,000 birds and immunized 120,000 in a bid to prevent the spread of avian influenza from the farm.

Officials were still monitoring human influenza and pneumonia cases, but had found no people infected by bird flu, the agency said.

Doctors placed under observation 37 people who had close contact with infected birds, but none showed flu-like symptoms and all 37 were released on Saturday.

Bringing solace to the very ill

KUALA LUMPUR: Clinical specialist Dr Richard Lim, who treats and cares for terminally-ill cancer patients daily, is thankful for life and lives it one day at a time.

“It is a gift that I am able to breathe and live to do the things I like to do everyday. It is a blessing even having dinner with my wife. When you care for cancer patients, you realise that in dying, there is so much denial.

“After working here, it has taught me not to take life for granted and to live it to the fullest with my wife and week-old baby boy. I appreciate what I am doing,” the 33-year-old said in an interview on Saturday.

Dr Lim, who is with Selayang Hospital's palliative care unit, has worked there since it opened on Dec 17, 2002.

Consultant anaesthetist Dr Mary Cardoza heads it with a staff of two medical officers and 12 nurses.

Palliative care mainly provides relief to a terminally-ill patient through symptom and pain management.

This includes relieving the suffering and improving the patient's quality of life through a holistic approach and providing support not only to patients but their families.

Dr Lim is among several Malaysian doctors who have decided to pursue this field, saying that he realised that life was precious.

“When I look at a very sick patient, it is very saddening and if I was in that situation, I would hope that I have enough support.

“People who face difficult situations need support and that is why I hope that palliative medicine will be more developed soon,” he said.

Dr Lim added that palliative care was synonymous with hospice care, which provides care at home.

“The (palliative care) unit tries to stabilise patients with severe symptoms of advanced cancer.

“After stabilising the symptoms, we try to teach family, relatives or carers how to cope or empower and treat the ill at home because inevitably, most would rather pass away at home,” he said.

As palliative care was a relatively new concept in Malaysia, Dr Lim said that the Selayang Hospital unit hoped to provide more support to patients with advanced cancer.

“We hope to develop a centre with fulltime staff and doctors who treat palliative care as a career and not part-time.

“The patients are dying but they are not dead yet. There is still a lot of living to do,” he noted.

The unit has eight beds and hopes to restart its day-care area where patients can have light exercises like stretching and games such as “Win, Lose or Draw,” which encourages interaction among patients.

Staff nurse Balbeer Kaur, 49, said that working for the unit involved a lot of interaction with patients as they had many needs.

“Sometimes, when you are talking to them, you can tell that deep down they have problems. You can find out what is bothering them. Sometimes, it could be their family who is worrying them.

“Then you realise that if you have a problem, it is very small compared with what they are going through,” she added.

She also said that she loved talking and listening to the patients as she learned a lot from them.

“It is a pleasure and I do not feel tired. You learn empathy and one has to be strong (when a patient dies). You also help their families.

“Sometimes when you see pictures of them before they had cancer, it makes you realise that you do not know what is in store. So, I learnt to make the best of every day,” she added.

Malaysian soldiers dying of obesity and heart disease

KUALA LUMPUR (dpa) - More than 20 per cent of soldiers in Malaysia's armed forces are suffering from chronic lifestyle illnesses like heart disease and obesity, a study revealed Tuesday.

Out of the 1,488 soldiers who have died in the past 10 years, more than 20 per cent died from heart disease, high blood pressure or other forms of chronic diseases, the study by the armed forces' health services division revealed.

The results, which have sparked concerns that the health of security personnel is increasingly declining, have prompted the government to introduce incentives for soldiers to stay healthy.

"This is a worrying trend," Defence Forces chief Mohamed Zahidi Zainuddin was quoted as saying by the official Bernama news agency.

One of the new incentives put in place would be to reward obese soldiers who are successful in losing 10 kilogrammes of their weight in a six-month period, Zahidi said.

He said a proposal to ban smoking at all army training camps was also in the pipeline, adding that a whopping 55 per cent of army personnel are smokers.

Shafie: Cabinet to receive faculties’ expansion plans

KUALA LUMPUR: Plans to expand the various critical faculties in public universities will be presented to the Cabinet next month and allocations for it will come under the Ninth Malaysia Plan.

Higher Education Minister Datuk Dr Shafie Mohd Salleh said among the proposals being considered was the hiring of foreign lecturers, especially those from Commonwealth countries, to meet the demand for teaching staff.

“We have many vacancies but not enough people to fill them,” he said yesterday.

He added that the committee drawing up the proposals, comprising officials from the Higher Education and Health ministries, would also come up with a budget and equip universities with enough facilities to meet the increasing demand for places.

“The Cabinet has directed us to come up with a working paper,” he told reporters after opening the Universiti Malaya (UM) dental faculty’s new pre-clinical building here yesterday.

At present only three universities offer dentistry – UM, Universiti Kebangsaan Malaysia and Universiti Sains Malaysia. Plans are underway to open two private medical faculties – one in the Asian Institute of Medicine, Science and Technology and another in the Penang Medical College.

In his speech, Dr Shafie reiterated the ministry’s plan to rate the various faculties of public universities so the public would have a better gauge of the strengths and weaknesses of each university, and to promote healthy competition among them.

Earlier, the minister visited the new pre-clinical dentistry building – which cost RM13mil – named Balai Ungku Aziz, after UM’s former Vice-Chancellor Royal Professor Ungku Aziz.

Bird flu checks at Malaysian poultry farms

KUALA LUMPUR (AP/dpa) - Health officials will start checking poultry farms, pet shops and bird sanctuaries near the border with Thailand to prevent a new outbreak of bird flu spreading to Malaysia, a minister said Thursday.

"Now we are on full alert - the highest level, it is red light," Malaysia's Agriculture Minister Muhyiddin Yassin was quoted as saying by the Bernama national news agency.

Thailand and China on Wednesday confirmed new outbreaks of bird flu, which swept Asia's poultry industry and killed 24 people earlier this year. Mass culling of birds have begun, and nations in the region have gone on alert for signs of the disease.

Officials said Malaysia escaped the outbreak that hit at least 10 Asian countries earlier this year, and a ban on poultry imports from neighbouring countries remains in place.

The government will intensify security at the northern border separating the two countries to ensure that infected poultry does not enter the country, said Agriculture and Agro-based Industries Minister Muhyiddin Yassin.

Thai officials admitted Wednesday that avian flu, which killed eight people in the country early this year, had re-emerged.

Deputy Agriculture and Cooperatives Minister Newin Chidchob said samples taken from a chicken farm in Pakhai district of Ayutthaya province, 70 kilometres north of Bangkok, confirmed the presence of the avian influenza virus.

Muhyiddin told reporters that while Malaysia has so far been free from the disease, the government will remain vigilant against any possible outbreak, he said.

The bird flu outbreak which affected some 10 Asian nations killed at least 23 people. The disease also led to the culling of millions of chickens.

Diabetes expedition to allay unfounded fears

Kota Kinabalu: Many Malaysian diabetics live excessively sheltered lives because the complications have been blown out of proportion, said Dr Melinda Tong, chairperson of the Malaysian Medical Association Sabah branch.

Launching a joint diabetic expedition dubbed “Total Jungle Challenge” by Youth and Sports Minister Datuk Masidi Manjun, Tuesday, she said one such unfounded fear was the belief that a slight cut can kill.

On the contrary, she believed “diabetics can live an active and full life with precautions and especially motivation to maintain a good glucose level.”

To knock out such excessive fears, UK-based youth charity Raleigh International has joined hands with Diabetes UK and the Malaysian Diabetics Association to mount an unprecedented 16-day expedition to Kampung Terian in the Crocker Range.

It would involve 11 diabetics from the UK, in addition to a doctor, a nurse and a couple of Raleigh staff. But Drew Boswell, Raleigh Country Director for Malaysia, lamented that much as they tried, there were no takers from the Malaysian diabetic side.

Diabetes afflicts a staggering 9 to 15 per cent of the Malaysian population, 95 per cent of which were Type 2, according to consultant physician Dr Heather Yong, who is also Vice Chairman of the Malaysian Diabetic Association.

Although such statistics were mainly findings in Peninsular Malaysia, “I am sure Sabah is not much different. There is nothing to suggest this is a different population,” said Dr Heather Yong.

The major reasons for such rising trend are change towards a sedentary life style where kids sit down a lot more in front of the TV, computer, eating more fast foods and less fruits and vegetables.

UK’s diabetics constitute about 3 to 4 per cent of its total population, 80 per cent of whom are Type 2, according to accompanying nurse, Claire Bushnell. “Even that we consider quite high,” she said.

As such, Dr Tong said she attached great “significance” to the diabetic expedition, which is to draw attention to these unfounded fears and help change the mindset of a rising diabetic population.

Briton Philip Haydon Jones, a diabetic since age 3, rated the expedition as “the first trip of its kind in the world”. The fact that not all expedition members are diabetics is part of the awareness raising strategy to enlarge understanding of the disease, he said.

Expedition doctors will keep a close monitoring of the blood glucose level of each diabetic expedition member to ensure their welfare and also to study how each may differ in their reaction to stress, said Jones.

Their project in Terian, which has a population of about 200 in 20 families, is to help build a micro hydro power generator, after which they will scale Mt. Kinabalu. All the expeditioneers are excited because this is their first trip to Southeast Asia.

Meanwhile, Masidi agreed with Dr Tong that Malaysian diabetics are far too “withdrawn” and appealed to them to come out in numbers to participate in next year’s expedition.

Manjun praised Raleigh International, Pacos and the Malaysian Diabetes Association. “You are doing a lot of good. We are very proud of you. The real gain is to do good to some body who deserves it” and gave philosophical advice “not to leave this world without making a difference to those who deserve help.”

Philip Lasimbang, Member of Parliament for Moyog, said the expedition “means a lot.”

While community development is being looked into, bringing people from outside adds a different dimension to it when they come to help construct a hydro project.

He said his constituency has about 500 people households living below the poverty line and education, creativity and putting in infrastructure are some of the measures to eradicate poverty

Pantai to take in more overseas patients

The Pantai Group of Hospitals entered into an agreement yesterday with BUPA International, a global healthcare organisation, to give international patients access to all seven Pantai hospitals in Malaysia.

In a statement, Pantai Holdings Bhd chairman Datuk Dr Ridzwan Bakar said the agreement would also enable Pantai hospitals to reach out to international patients who are BUPA members.

This would further promote health tourism initiatives in the country, he said, adding that Pantai was now receiving an increasing number of foreign patients, especially from Indonesia, West Asia and Japan. – Bernama

The bald truth

TURNING bald in your 20s may have an emotional effect on some men but not on Azman Hashim (not his real name). He started losing his hair when he was 23. Now at 29, he is almost bald.
Instead of running to the nearest doctor or hair specialist to remedy the situation, Azman shaved his head instead.

"My father also lost his hair at a young age so I guess it is genetic. I don't have any problems with being bald. My friends do not tease or make fun of me." He is not seeking any treatment because he does not see it as a major issue.

"Why should I spend money on a hair transplant, wig or any of those products that claim to help your hair grow back?" Azman is among two million Malaysian men who have male pattern baldness, scientifically known as Alopecia androgenetica. It is the most common cause of hair loss in men.

Dr Steven Chow, a consultant dermatologist and president of the Malaysian Society of Hair Sciences, says that as long as the baldness is not affecting the person's quality of life, seeking treatment is entirely a personal choice.

"Hair loss can be treated. But as long as you do not mind the baldness, it is perfectly okay if you do not want to seek treatment.

"Though hair itself is not a vital organ, it has a major impact on your emotions. There are important social and cultural factors determining what is normal and what is personally acceptable." Dr Chow says Alopecia androgenetica is responsible for about 90 per cent of hair loss in men over the age of 50.

"Some men can experience hair loss as early as in their late teens. In this group of people, they will lose their hair progressively with time if left untreated." Dr Chow says that the common male pattern hair loss affects men regardless of race. "There is no statistical proof that one race is more predisposed than the other." There is usually a family history of baldness in the parents or close relatives. Hence the tendency to be bald is genetically determined.

The common male pattern hair loss starts with a receding frontal hairline. Gradually the hair on top of the head (the crown area) also begins to thin. Eventually, the two balding areas meet to form a bald patch, leaving a typical U-shaped hair-bearing area around the back and sides of the head. The hair at the back of the head and the side usually is not affected.

Men who suffer from baldness can blame it on testosterone. In the hair root, this hormone is converted to dihydrotestosterone (DHT) by an enzyme called 5-alpha reductase. DHT is an even more potent form of the male hormone and this acts on the hair forming cells in the hair root.

The hair growth cycle occurs via three main phases. The first is known as the anagen phase, in which the hair undergoes a phase of continuous growth and can last up to six years. This is then followed by a short resting phase or catagen which lasts for between two and four weeks. The last is the telogen stage in which old hair is gradually shed from the scalp. This phase usually lasts from three to four months before the anagen phase resumes.

"DHT will act on the hair follicle cells during the anagen phase and accelerates it into the telogen phase, thus limiting the duration available for active growth. What happens is that with each cycle, the hair that is formed is gradually thinner than the previous one. Eventually only miniature hairs are produced, resulting in baldness." For male pattern hair loss, men have a choice of using oral medication, external lotions or a surgical hair transplant.

The drug Finasteride has been proven to treat male pattern hair loss. Taken once daily, it slows down the hair loss process and produces regrowth and thickening of miniaturised hair.

Another form of treatment is the 5% Minoxidil lotion which is applied on the affected areas of the scalp, says Dr Chow.

Originally used to treat high blood pressure, studies have shown that 5% Minoxidil may help grow hair significantly in up to 20 per cent of those who use it while slowing the rate of loss for up to 90 per cent of users.

Male pattern hair loss can also be treated with surgical procedures which involves removing hair follicles from unaffected areas of the scalp and transplanting them to the balding areas. The cost is about RM10,000 per session.

"You may need to transfer at least 3,000 to 5,000 hairs to cover the balding frontal area. It is important that men who choose this procedure have enough hair in the donor area before they undergo the operation.

"It is effective but costly because some people may need two or more sessions. Also the success depends entirely on the expertise and skill of the surgical team. In inexperienced hands, it can be disastrous."


It afflicts women too


IF you think only men can go bald, think again. Women too can suffer from common pattern hair loss.

"Female pattern baldness is just as common but the onset is usually at a later age compared to common male baldness," says Dr Steven Chow, a consultant dermatologist and president of Malaysian Society for Hair Sciences.

According to the society's website, 31 per cent or 2.36 million of the adult women in Malaysia are believed to suffer from varying degrees of female pattern hair loss.

Female pattern baldness begins around the age of 30, becomes more noticeable at 40, and can be even more evident after menopause. This type of hair loss is permanent.

Women can also suffer from hair loss due to severe physical and emotional stress, surgery, serious illness , thyroid irregularity, hormonal imbalance following childbirth and following the stopping of birth control pills.

Hair loss also occurs quite commonly in women who are on crash diets and lose a great deal of weight over a short period of time. Dr Chow says in some situations, pattern baldness in women is associated with an endocrine or glandular problem. This is particularly so in women with polycystic ovarian syndrome where baldness is also associated with infertility, obesity, diabetes mellitus, acne and excessive facial hair growth.

Women with this problem have relatively high levels of male hormone activity, he says. The excessive production of the male hormones, androgens can be from the adrenal glands, the ovaries or from metabolic conversion in fat cells. Among other things, this results in an androgenic form of hair loss.

The pattern in female hair loss is different from that in males. Women usually have hair loss limited to thinning at the front, sides or crown, but it rarely progresses to total or near baldness as it does in men.

Female pattern hair loss can be treated with 5% Minoxidil lotion. Hormonal modulation with an androgen-blocking agent can be prescribed for those with a hyper-androgenic syndrome. In selected patients, hair transplant is also a possibility.

However, many women may not seek treatment for hair loss "particularly so if it occurs at an age when they can also suffer from other illnesses. So seeking treatment for the common hair loss is not necessarily the first thing in their minds," says Dr Chow."

In most cases, except due to menopause, hair re-growth will resume after the patient returns to a normal diet or health.

Online system will cut processing time by half: Fomema

FOMEMA Sdn Bhd, the company granted a concession by the Government to monitor and supervise the medical examination of foreign workers in Malaysia, has tied up with DBIX Systems Sdn Bhd and Hewlett-Packard (M) Sdn Bhd to develop a new integrated online system (NIOS) which would reduce by 50% the processing time of such medical examinations.

The web-based system would enable the registration of foreign workers nationwide. Fomema's panel of doctors, laboratories and medical facilities would then be able to collaborate on the medical examination results electronically over the Web. The system is expected to be implemented in October.

“The RM3mil project aims to speed up nationwide processing of foreign workers' health examination results and thus reduce waiting time. This will benefit the country's human resource requirements. Other benefits include a higher rate of customer satisfaction as a result of the faster processing of medical examinations of foreign workers,” said Datuk Dr Abdul Aziz Mahmood, chairman of Fomema.

Abdul Aziz was talking to the press after a signing ceremony between Fomema, DBIX and HP in Subang Jaya.

He said Fomema has been looking into ways of upgrading its online system for some time and was confident that with DBIX and HP, the NIOS would lead to greater efficiency and productivity.

Fomema's role here is to ensure all foreign workers hired legally undergo a medical examination for various communicable diseases such as tuberculosis. Only after they are deemed fit for employment would the foreign workers be issued with work permits by the Immigration Department.

Currently, Fomema's medical examinations are only conducted after the first year of a foreign worker's employment and not upon initial entry into Malaysia.

“However, even with the current practice, Fomema has detected numerous foreign workers with communicable diseases. Those cases were reported to the relevant authorities and subsequently the foreign workers were sent home.

“Strict examinations of all foreign workers and proper health records has significantly helped in preventing the outbreak of these diseases,” said Abdul Aziz.

He was confident that the public would welcome the NIOS as it would allow them to download registration forms online and check the status of medical examinations as well.

“With these services in place, we hope more employers will take the opportunity and initiative to register their workers for medical examinations directly, thus reducing dependence on a third party to do so on their behalf. This will lead to even greater savings for employers, and hopefully encourage them to be more vigilant as far as medical examinations are concerned,” he added. – AHMAD ZUBER IBRAHIM

60 youths pick up smoking habit daily

AN AVERAGE of 60 youths pick up the smoking habit daily in the country, Mingguan Malaysia reported.

The newspaper quoted Deputy Health Minister Datuk Dr Abdul Latiff Ahmad as saying the majority of the smokers would be addicted to the habit upon reaching adulthood.

“The direct and indirect cost of supporting the habit through the buying of cigarettes and lighters and medical treatment is RM5,544 per smoker,” he said.

Dr Abdul Latiff said the rise in the number of young smokers was due to the marketing strategy of cigarette companies.

“The group is easily influenced by the stylish lifestyle portrayed in cigarette advertisements,” he said.

Taking it out

With increasing legal costs, mediation may be the way to go to settle medical legal suits in Malaysia, reports LOH FOON FONG.

IN Malaysia, mediation has never been used as a way to resolve medical legal cases even though some cases have been settled out of court.

Since the Malaysian Bar Council set up the Malaysian Mediation Centre (MMC) in the 1980s, MMC’s role has been limited to com- mercial disputes.

Compared with other dispute resolution methods such as litigation and arbitration, mediation is an informal and non-confronta- tional method. There are minimal procedural and documentary requirements and it is cheaper and quicker than the other two methods.

A mediator only facilitates a case and does not judge like an arbitrator. Although parties involved may appoint a mediator of their choice, often a lawyer’s service is employed.Parties are not barred from other methods if mediation fails.

In mediation, patients’ qualitative needs can be addressed. “Often, they want to know that the practitioner cared and understood the stress they went through, and that they admit fault as well as reassured that steps are taken to prevent similar mistakes from recurring,” said Robert Lazar, a lawyer who presented a paper on Medical Mediation: Litigation vs Mediation at a recent seminar in Kuala Lumpur on Legal Issues in Medical Law:Strategy for the Future, organised by LexisNexis and Asean Law Association of Malaysia.

Professor Denis Cusack, a lecturer from the Department of Forensic Medicine, University College Dublin, who also spoke on the topic, noted that in 2001, the National Audit Office in Britain reported that the annual cost of settling claims for the National Health Services (NHS) had risen seven-fold since 1995.

“There’s too much litigation and too little health,” he said.

Last year, the Chief Medical Officer of the UK Health Department proposed reforms to the NHS approach to clinical negligence.

Alternatives to litigation have also been proposed including efficient complaints and redress procedures, clinical risk management programmes, alternative dispute resolution (mediation and arbitration), no-fault compensation schemes, injury assessment boards and pre-litigation screening of cases.

Some of these reforms and alternatives have been implemented with limited success, said Cusack.

“The rising cost of medical suits has made the need for change all the more pressing. Mediation is one of the possible solutions,” he said.

Hendon Mohamed, chairman of the Alternative Dispute Resolution Committee of the Bar Council, said lawyers tend to think that mediation is a threat to their rice bowl.Lawyers fear that if they take on disputes in mediation, they may lose the chance of earning money by taking on the case as a court case.

However, Hendon said mediation is not suitable for all cases but it is effective if both parties are willing to mediate and not have negative feelings towards each other.

“In Singapore, the method was used following a tremendous backlog in the courts in the 1980s. It has worked out well and solved 30%-40% of the court cases. Here judges are still bogged down with cases,” she said.

“Even after mediation fails, that bit of mediation helps because the parties would have come to an agreement on some issues. It expedites claims,” she said, adding that mediation should just take a few hours and not more than a day.

Should mediation be made compulsory since it helps to reduce backlog cases in court? After all, in some states in the United States, mediation is required as a preliminary step before litigation can be initiated.

Most of the speakers said mediation should not be made compulsory because the method is not suitable for all cases, especially those that are too complex and involve large amounts of compensation.

“Cases that may be suitable include situa- tions where the patient or patient’s family seeks to understand what went wrong, where a request for a medical report is not acceded to and where patient’s complaint is about fees charged. Suitable cases may be resolved without going through disciplinary procedure set out by the Medical Regulations 1974,” said Lazar.

Datuk Dr N. Arumugam, president of the Malaysian Medical Association, said media- tion should not be compulsory because peo- ple may do it just to waste time, especially when they are already determined to take the matter to court.

Mediation is useful not only to patients but also to doctors. Most doctors do not wish to be entangled in long court proceedings because of the stress involved.

“They prefer to settle the case immediately and would rather pay off the patients than fight it out in court. It’s also cheaper to settle out of court as they don’t suffer a loss of income. After all, their insurance companies pay off the compensation,” said Lazar.

However, their reputation and practices are compromised. As such, mediation is a better way to resolve disputes, he said.

Unfortunately, it will be a long time before mediation becomes common in Malaysian medical litigation and one basic issue that has not been resolved is the right of patients to doctors’ case notes, said Lazar.

“If we can’t even give the case notes to patients, how are we to even make mediation a success since it requires a lot of give and take?” he said.

“This issue is well settled in Britain – they have no qualms that patients have the right to case notes. In Malaysia, this is divided – in the legal as well as medical profession,” he said.

The reason for doctors’ hesitation boils down to the fear that patients will use the case notes against them.

Said Darryl Goon, a lawyer from Kuala Lumpur: “The more you hide the notes, the more patients will tend to think that the doctors are negligent or have issues with misconduct.”

In his paper Medical negligence litigation – trends and the law, Goon said under current common law, patients do not have a right to demand for doctors’ case notes. However, in litigation process, the law gives patients the right to the notes.

“Many common law countries have now made disclosure compulsory under data pro- tection legislation. The Malaysian Data Protection Bill caters for compulsory disclo- sure of documents that would probably include case notes. There is also suggestion that case notes should be made available upon demand under the regulations to the Private Healthcare Facilities and Services Act 1998,” he said.

However, he said there are several ques- tions that need to be answered: since the notes are meant for doctors’ personal use, should any inference be made from it? How detailed should case notes be and will they become too onerous? Is it safe for anyone to draw any conclusion based merely on notes? Isn’t a patient’s right to a comprehensive medical report sufficient? Is there any risk of the notes being used to device a claim?

Another issue in the medico-legal circle is the test applied in determining whether a doctor has breached his duty owed to a patient.

In Malaysia, the test on the standard of proof of medical negligence used is the test formulated by McNair J in Bolam vs Friern Hospital Management Committee (1957) which states that the doctor is not guilty of negligence if he has acted in accordance with a practise accepted as proper by a responsible body of medical men skilled in that particular art.

However, Goon said that in England, the judge has the right to conclude that the body of opinion is not reasonable or responsible if the professional opinion is not logical.

In Australia, the standard is not determined solely or mainly by a responsible body of opinion in the relevant profession or trade. Even in the sphere of diagnosis and treat- ment, the Bolam principle has not always been applied, said Goon. More importantly, particularly in the field of non-disclosure of risk and the provision of advice and information, the Bolam principle has been discarded and instead, the courts have adopted the principle that, while evidence of acceptable medical practise is a useful guide for the courts, it is for the courts to adjudicate on what is the appropriate standard of care after giving weight to “the paramount consideration that a person is entitled to make his own decisions about his life.”

At the gut of the problem

IT has been “clinically” proven that bosses can be a real pain in the butt! A study conducted at Queen Elizabeth Hospital in Kota Kinabalu, Sabah, showed that this unflattering remark could have stemmed from real biological problems related to dealing with irritating authoritative figures.

After interviewing 402 patients with irritable bowel syndrome (IBS), Dr JHK Lee and his colleagues concluded that employees were more at risk of suffering from this medical condition. The majority of patients (66%) were employees, and 55% of them were between 35 and 54 years of age.

Dr Lee’s team also concluded that there was no significant association of the disease with socio-economic standard, educational background and ethnic origin.

The findings were documented in a paper titled “IBS in East Malaysia: Does socio-economic status make a difference?”, which is included in the June supplement edition of the Malaysia Medical Journal.

The findings were also presented at the four-day Gut 2004 annual scientific meeting organised recently by the Malaysian Society of Gastroenterology and Hepatology (MSGH) at Shangri-La’s Rasa Sayang Resort in Penang.

But pain in the butt could also be self-inflicted, said a group of researchers from Hospital Universiti Kebangsaan Malaysia, Kuala Lumpur.

The group reported two cases where patients were rushed to the emergency unit with aerosol spray canisters “accidentally” lodged in their rectums.

Dr A. Kalyani said some individuals inserted foreign matter into their rectum, penis and vagina for sexual gratification, while some did it to satisfy a psychological perversion.

Apart from discussing the topic of aching butts, the meeting attended by 400 participants also covered the treatment and complications of various types of hepatitis, and cancers of the liver and gastrointestinal organs.

”Seventy-five per cent of the 350 million people chronically infected by the Hepatitis B virus are Asians,” said Health Ministry deputy director-general Datuk Dr Mohd Ismail Merican, who presented the inaugural Panir Chelvam Memorial Lecture.

The lecture is held in memory of the society’s founding member Dr Panir, who died of myocardial infarction in March.

“The outcome of treatment of hepatitis infection is affected by a number of factors,” said Dr Mohd Ismail.

These include risk of developing cirrhosis and liver cancer, limitation of existing therapies, and treatment initiated by generalists with limited skills in managing adverse events.

“Other realities include inefficient patient referral mechanism, inaccessibility to latest diagnostic and monitoring tools, high cost of treatment, and scarcity of basic and clinical research on liver diseases,” he added.

Dr Mohd Ismail also talked about the epidemiology of hepatitis in Malaysia and the government’s commitment to reduce the burden of the disease.

The setting up of a liver registry and expanding vaccination programmes were among the practical solutions to check the hepatitis threat, he said.

“Tremendous progress has been achieved in the treatment of chronic hepatitis C and the virus causing this disease can be eradicated,” he said, “but the hepatitis B virus can only be suppressed.”

Participants also shared their views and expertise on gastric cancer, which is the second most common cause of cancer-related deaths worldwide, according to Prof Kwong-Ming Fock, who heads the Department of Medicine at the National University of Singapore.

The incidence rates are highest in Asia and South America and lowest in North America, Europe and Australia.

The Chinese ranked the highest on the incidence scale of gastric cancer, followed by Indians and Malays, and males were more predisposed to the disease, he said.

“Studies suggest that genetic predisposition, Helicobacter pylori bacteria infection, and other exogenous factors such as diet can be associated to temporal sequence of pre-cancerous changes leading to development of gastric cancer,” he said.

University of Hong Kong associate professor Jia-Qing Huang said studies had suggested that 80% of gastric cancers were attributed to H. pylori infection.

Dr Robert Ding said nine patients who did not respond to the usual H. pylori eradication regime were successfully treated with a “rescue therapy” using dual high-dose Lansoprazole/Amoxicillin.

Eradicating H. pylori has been identified as one of the ways to prevent gastric cancer, but some studies are now showing that this strategy might lead to other implications.

H. pylori might have a protective impact against Barret’s oesophagus and adenocarcinoma, said University of Arizona Gastrointestinal Motility laboratories director Assoc Prof Ronnie Fass.

Assoc Prof Fass also advised doctors to be absolutely sure before diagnosing Barret’s oesophagus (changes in the oesophageal epithelium), saying that insurance companies in the United States would not provide medical coverage for such patients.

Barret’s oesophagus was not common in Asia, he added.

Cancer of the oesophagus carried a grave prognosis, said Chinese University of Hong Kong’s Professor of Surgery Sydney Chung.

“This is because the tumour would already be at an advanced stage by the time diagnosis is made, as symptoms do not appear until the tumour has grown to a considerable size,” said Prof Chung.

There had been a dramatic increase in the incidence of colorectal cancer over the decade, said University of Hong Kong Department of Medicine Assoc Professor Benjamin Wong.

He attributed this to the “Westernisation” of Asia, and also to the low level of public awareness about the disease.

“Public awareness on the need for early screening is very low. But even the doctors are confused because colorectal cancer screening is more complicated compared to screening of other types of cancers because of the various screening methods available,” he said.

“Faecal occult blood testing is the simplest non-invasive method for effective colorectal cancer screening.”

Assoc Prof Wong said identification and removal of adenoma (a benign epithelial tumour of glandular origin) was crucial to reduce the risk of development of colorectal cancer.

“After the removal procedure, it is important to perform surveillance colonoscopy periodically to check for new adenomas,” he said.

But gastroenterologists had yet to agree on suitable intervals to conduct periodic checks for various reasons, he pointed out, citing fear of malpractice as one of the reasons for this inconsistency.

A joint survey by Penang Medical College and Penang Hospital showed that respondents were not willing to undergo colorectal screening although a substantial number of them had relatives (13.3%) and friends (23.3%) who were afflicted with colorectal cancer.

Peter Lee, Professor of Surgery at the Penang Medical College, said the advent of high quality imaging had increased the accuracy of pre-operative staging and enabled more logical decisions to be made regarding the treatment options.

“Major surgery and possible permanent stoma formation could be avoided, as with improved staging techniques and transanal microsurgery, local resection for early rectal cancer can be considered,” he said.

On the possibility of using minimally invasive laparoscopic to cut colon and rectal tumours, Prof Lee said: “Although technically feasible, the place of laparoscopic surgery in colon and rectal cancer remains controversial.”

Tele-health project to help rural doctors

KUCHING: Doctors in small hospitals and health clinics in rural towns will soon be able to consult specialists in bigger hospitals on health problems of patients by telephone or e-mail under a tele-health project.

The Health Ministry will carry out a pilot project in Johor and Sarawak next year, said its minister Datuk Dr Chua Soi Lek.

He said the RM24mil project was aimed at addressing the shortage of medical specialists.

If proven successful, the project would be extended to other parts of the country, Dr Chua said here yesterday.

He said he had briefed Chief Minister Tan Sri Abdul Taib Mahmud about the project on Friday.

During his three-day visit here, Dr Chua was briefed on the state’s health and medical services at the Sarawak General Hospital.

His visit was to help the ministry prepare for the next Malaysia Plan.

Medical studies come alive

STUDYING about human anatomy from a textbook can be daunting, especially when you're staring at a picture of a heart and trying to visualise the complicated cells in the organ.

Medical students will soon be able to tap into new ways of learning, using 3D visuals with multimedia technology to make organs “come alive.”

“Most teaching and learning materials today are still available in 2D format, which does not make it easy for students to visualise,” says International Medical University (IMU) Assoc Prof Dr John Paul Judson.

In an effort to promote the development of multimedia learning materials, IMU and Multimedia University (MMU) have jointly set up the Centre for Advanced Medical Multimedia Research (CAMMR).

“The aim of CAMMR is to conduct research in systems programming and multimedia, as well as to develop computer-aided teaching applications to support medical education,” says IMU president Tan Sri Dr Abu Bakar Suleiman.

To kick-start the centre's research activities, the centre will first come up with teaching and learning materials for the cardiovascular system. This will be made part of an Intelligent Multimedia Archiving System initiated by both universities.

“MMU has been conducting research and indexing based on visuals; we will definitely inculcate this new technology into the projects undertaken by CAMMR,” says MMU president Prof Dr Ghauth Jasmon, after signing the Memorandum of Understanding (MoU) with IMU.

The centre will bring together faculty members, support staff and development teams from both IMU and MMU. There will be two main offices, one in IMU Bukit Jalil and the other in MMU Cyberjaya. It is expected that the centre will boost local and international participation in medical multimedia research and development.

“IMU will spearhead the medical research while MMU manages the development area. This 'marriage' will help us realise our objective to make Malaysia a regional centre of excellence in education, and allow it to become a key player in the dissemination of quality education to countries in the Asia-Pacific region,” says Dr Abu Bakar.

“It is logical that each institution contributes its area of strength and collaborates to promote e-learning,” he adds.

MMU Faculty of Creative Multimedia dean Dr Ahmad Rafi Mohamed Eshaq says that the move to produce and incorporate interactive e-learning elements such as animation, video and graphics into teaching materials and modules for medical and allied health students and professionals is timely.

“Multimedia has always leaned towards the entertainment industry but it will now be used for something more serious,” he says.

Among the projects proposed to be handled by the centre are the Advanced 2D and 3D Reusable Learning Objects, which support delivery of the Virtual Medical University (VMU) applications.

Dr John, who is also VMU's associate dean, says VMU encourages IMU students and faculty to play an interactive role in the learning process. Initiated three years ago, VMU currently comprises nine major applications that can be used independently or inter-dependently.

“We hope that components in the project can be made available to other universities abroad for the training of medical and allied health professionals,” says Dr Abu Bakar.

He adds that IMU has already invested over RM4mil in research activities under VMU.

The centre will also look into 4D animation in advanced imaging in cardiology, obstetrics and gynaecology, as well as in other related medical disciplines for the teaching and practice of clinical medicine.

“We are also eager to begin work on the Museum of Life, which is expected to commence in a few months and should take about three years to complete,” says IMU chief knowledge officer Kahlil Anwar Kamal.

The Museum of Life project uses various applications and simulators to highlight medical cases, and includes e-exhibitions and multimedia movies.

Dr John Paul also speaks enthusiastically about the possibility of a human body 3D-Navigator.

“The navigator is a 3D simulation prototype that allows the user to navigate through the human body and access information. This will help activate various scenarios in the teaching of clinical anatomy,” he explains.

Lawas may get a hospital under 9MP

KUCHING July 2 - After three decades, Lawas in the northern region of Sarawak may get a hospital under the Ninth Malaysia Plan (9MP), Health Minister Datuk Dr Chua Soi Lek said Friday.

"This proposal is, however, still at the discussion stage and is part of ongoing efforts to upgrade the existing 22 hospitals and clinics in Sarawak," he told reporters after visiting the Kuching General Hospital.

He said an urban outpatient clinic with 20 beds would be built in Bintulu while Belaga, which is about the size of Pahang in Peninsular Malaysia, would get a clinic with 20 beds, a laboratory, X-ray room and pharmaceutical unit.

On having a doctor for Belaga, he said: "Doctors are not interested to serve in rural areas. This is an ongoing problem we will try to solve. Sarawak is still short of doctors with a ratio of 1:6,500," he said.

Under the Eighth Malaysia Plan, he said, Sarawak was allocated RM549 million from the health ministry's RM9.5 billion allocation.

A total of 47 projects had already been completed while 14 were under construction and 58 in the planning stage, he said.

Dr Chua said the Kuching General Hospital, the busiest in the state, would have its facilities upgraded in stages under the 9MP.

"This includes two linear accelerator units costing RM12 million for the radio therapy unit. As it cannot cope with the number of patients, being the only one in the Sarawak, they are referred to Nilai hospital," he said.

He said Sarawak received 63 new ambulances costing RM3.5 million and an allocation of RM7.5 million for the "Water Supply and Environmental Health" programme.

Plan to build nine new hospitals put off

PORT DICKSON: The construction of nine hospitals under the Eighth Malaysia Plan will be deferred and the RM10bil allocation used to address the shortage of support staff in existing ones instead.

Health Minister Datuk Chua Soi Lek said this proposal was made under the revised list of priority projects submitted to the Cabinet recently in which the ministry had recommended the money be spent to build more training facilities.

“We felt that parallel to the development of hospital and polyclinics, there is also an urgent need to equip the support personnel with the appropriate knowledge.

“That's why we decided to shelve the hospital projects to use the allotted funds for manpower training,” he said here Wednesday night.

1,000 illegal practitioners in the country

IT IS estimated that there are over 1,000 unregistered Chinese physicians in the country, Nanyang Siang Pau reported.

According to the Federation of Chinese Physicians and Medicine Dealers Association of Malaysia secretary Thong Choong Khat, this figure was derived based on a study conducted three years ago.

He told the paper he believed that the number would have been reduced now that the Government was looking into the issue.

He said the federation could only make recommendations but it was the Health Department that grant permits to foreign Chinese physicians to practise here.

He said the Immigration Department would issue a working permit to a foreign physician once it has obtained a clearance letter from the Health Department, he said.

“Foreign physicians without professional training and certification will not be able to practise in the country,” said Thong.

He said those physicians whom the federation recommended would display their permits in their clinics.

Thong advised the public to look for such permits to avoid going to unregistered practitioners.

Deputy Home Minister Datuk Tan Chai Ho said physicians who work without a permit in the country would be blacklisted and barred from entering Malaysia again.

He urged the public to alert the authorities if they know of any unregistered physician.

The paper also reported that Dong Jiao Zhong (United Chinese School Committees Association) would organise a monthly forum for Chinese educators to discuss education issues.

Dong Zhong chairman Quek Suan Hiang said the first forum would be held on Friday at the association's premises in Kajang.

According to a report in Sin Chew Daily, Dong Zhong and other Chinese associations were hoping to meet Prime Minister Datuk Seri Abdullah Ahmad Badawi to discuss issues concerning the Chinese community before submitting a memorandum on Chinese education to him.

The daily said Dong Zhong and other Chinese associations had reached a consensus on the general content of the memorandum on Chinese education but had not agreed on the way it is to be presented or the timing.

Fomema invests RM3m on systems upgrade


Pantai Holdings Bhd subsidiary Fomema Sdn Bhd will invest in a RM3 million new integrated on-line system (NIOS), which will enable wider public access to its registration process for the medical examination of foreign workers.

NIOS will also allow Fomema’s panel of doctors, laboratories and medical facilities to collaborate on foreign workers’ medical examination results electronically over the web.

The system would be implemented over the next three months, which will include application software, server hardware, wide area network infrastructure equipment and off-site disaster recovery systems.

Speaking to reporters after the signing ceremony between Fomema, DBIX Systems Sdn Bhd and Hewlett-Packard Sales (Malaysia) Sdn Bhd (HP) in Subang Jaya on July 1, Fomema chairman Datuk Dr Abdul Aziz Mahmood said with NIOS, waiting time at its counters would be reduced by 50% in future.

Fomema holds a 15-year concessionaire to carry out monitoring and supervision of medical examination of all legal foreign workers in Malaysia. It has examined 900,000 individuals this year.

Subsequent results are transmitted to the Immigration Department and Ministry of Health.

Fomema is also in the final stages of negotiations with several solutions provider for short messaging service (SMS) system, through which employers can check on the medical status of their foreign workers.

Meanwhile, HP country general manager Badlisham Ghazali told FinancialDaily that HP would bring its capabilities to other countries that needed such solutions, upon the successful implementation of NIOS here.

He said of its RM1.4 billion business in Malaysia, about 75% was derived from various partnerships such as the one with Fomema and DBIX Systems.

Apathy an obstacle

The number of people infected with HIV keeps going up, and Malaysia needs to intensify prevention and education efforts in HIV/AIDS work, reminded Tun Dr Siti Hasmah Mohd Ali, as nominations are called for the Dr Siti Hasmah Award which recognises excellence in HIV/AIDS work. IVY SOON reports.

BY the time the first case of HIV/AIDS was reported here in 1986, former First Lady of Malaysia Tun Dr Siti Hasmah Mohd Ali had retired from practising medicine. She was, however, well aware of the challenges in educating the public on the new epidemic as she had been involved in teaching rural women about family planning and other health issues.

The statistics on new HIV infections – which recorded an increase from three cases in 1986 to 4,597 in 1996 and to almost 7,000 last year – is worrying.

“It seems like no one is paying attention to the epidemic, if we look at the statistics. But it is not that; sometimes it is also due to individuals’ weakness. We need to talk to everyone about HIV/AIDS, not only to the youths but also older people.

“What is also worrying is the increase in heterosexual transmissions. HIV-positive (HIV+) husbands are passing the infection to their wives. So, we need to educate them on HIV prevention, on safe sex, on prevention tools,” said Dr Siti Hasmah, in stressing the need for everyone to be involved in the fight against HIV/AIDS.

As a doctor, she believes that prevention is better than cure, and education is key to prevention.

As First Lady, and chairman of the Regional Steering Committee for the Advancement of Rural and Island Women in Asia Pacific (RSC-AP), Dr Siti Hasmah has always spoken about women’s vulnerability to HIV infection.

Educating women on the disease is crucial, but Dr Siti Hasmah pointed out the need for targeted approaches.

“We have to approach women in ways that are acceptable to them. When I was introducing family planning to women in villages, and talking to them about sexual health, I found that it was not effective to talk to them in big groups in the open. It was better to talk to the women privately, sometimes one to one, or with other women family members.

“We have to explain simply and use words they can understand. We also have to persevere. It is not enough to just talk to them once. There must be follow-up (sessions), so that the women will be comfortable in asking questions.”

Condom used to be a taboo word, recalled Dr Siti Hasmah, even though it was one of the tools for family planning. “When we started teaching women about family planning, they would not even look at the condoms. The wives would think that condoms would encourage their husbands to be unfaithful; that their husbands would use the condoms with other women, not with them.”

There was no HIV/AIDS then, but now the condom has been recognised as one of the tools to prevent HIV infection. “Some people still object to the use of condoms, but we have to tell them that it is not only to protect themselves, but also to protect the children they are going to bear.”

People are more educated now than in the 1960s and 1970s, but traditions that prevail continue to render women vulnerable to HIV infections.

“We are not facing ignorance. But in many homes, men still have a say in everything. Wives must attend to their husbands’ needs, and give way to their husbands. We are concerned about mothers whose husbands are infected, with no power to say no to their husbands. Wives must have a say in their marital lives, and we need to counsel wives, who find out that their husbands are infected, on what to do to protect themselves.”

Dr Siti Hasmah is especially concerned about infected mothers – mothers who are infected by their husbands, and mothers with infected and affected children.

“This is the missing generation. When HIV+ mothers die, who will take care of their children? Prevention of mother-to-child transmission (during pregnancy and childbirth) is vital. We must prevent mothers from passing their infection to their children, but we cannot just stop with the mothers.

“It is a vicious cycle we must break. We cannot just stop at treating mothers. They get their infections from husbands, and their husbands get infected from other sources.”

The biggest obstacle in HIV/AIDS prevention work is apathy. AIDS is an infectious disease, Dr Siti Hasmah said, and we must not think that it will not happen to us. Everyone should play their role in fighting the epidemic, and an integrated approach is needed.

Hence, she hoped that the Siti Hasmah Award would inspire the public to get involved.

“We want the public and various groups, in cities and villages, to be aware of the HIV and to take it seriously. We hope for people to be more involved in prevention efforts. We need the media and other groups to disseminate information on HIV because education is important.

“The recipient of the last Dr Siti Hasmah award was a person living with HIV/AIDS, and we hope to recognise more infected individuals. We want to highlight how they help prevention efforts by going public about their condition so people also see the positive side of HIV/AIDS.”

The Dr Siti Hasmah Award was established in 1996 by the Malaysian AIDS Foundation (MAF) and highlights outstanding contributions made by organisations and individuals in addressing HIV/AIDS in Malaysia. Winner of the award, given biennially, will take home a trophy, cash prize of RM10,000 (organisation) or RM5,000 (individual), and a certificate of excellence.

Two Special Mention Awards will also be presented, one for prevention education and another for care and support.

Today is the last day for submitting nominations for the award. More information and entry forms can be found at www.malaysianaidsfoundation.org.my, or call Azita Azlan at 03-40451033.