Malaysian Medical Resources

Last month I posted a House Officer’s survival guide with key tips for the strawberry generation of house officers who can’t seem to take stress so well
This has been updated with a tip for smartphone equipped House Officers – if you have an Android or iOS (that’s Apple for you) smartphone, you can download a free app to help you manage the day to day tasks in the ward. More details in the Palmdoc Chronicles.

I still notice some Fish Spa joints around town. Please note that the CDC has warned that Pedicure fish may harbor harmful bacteria

WASHINGTON — Back in 2008, a new pedicure trend swept the nation: tiny fish eating the dead skin off customers’ feet. Now the Centers for Disease Control and Prevention warns that the so-called “doctor fish” may carry bacteria that could cause serious infections.
Shortly after the fish pedicures began, public health agencies spoke out against the practice, prompting California, Florida and several other states to ban it.
On Wednesday the CDC published a report by the Centre for Environment, Fisheries & Aquaculture Science in the United Kingdom, which studied the kinds of bacteria carried by the Garra rufa, or “doctor fish,” an inch-long silver carp native to Southeast Asia.
“To date there has been only limited information on the types of bacteria associated with these fish,” lead researcher David Verner-Jeffreys said. “Our study identified some of the species of bacteria associated with this fish species, including some that can cause infections in both fish and humans.”
It’s no secret that water provides a fertile breeding ground for all kinds of bacteria. Mix that with bacteria living on fish scales or in their waste and even the tiniest cut from an overzealous doctor fish, and the risk of infection is very real.
Doctor fish generally are imported to salons from Indonesia or Malaysia, which can make it difficult to control the quality of the fish breeding and environment.
After an outbreak of strep bacteria last year in a shipment of the fish, the British government seized five containers from London’s Heathrow Airport to study what kinds of bacteria the fish were carrying.
“The (strep) strain we isolated typically only causes disease in fish,” Verner-Jeffreys said. “We then went on to look at other consignments of apparently healthy imported G. rufa and found some other species of bacteria that can cause disease in humans and fish.”
These bacteria included: Aeromonas, which causes wound infections and gastrointestinal problems in humans; Streptococcus agalactiae, which causes skin and soft tissue infections; and Mycobacteria, which the study reported have been responsible for skin infections in some pedicure clients in the U.K.
Furthermore, the researchers found that these bacteria often were resistant to multiple drugs and therefore difficult to kill.

Read more here

Related blog posts:
Fishy therapy
Fishy therapy II

This is the sad state of affairs in Sabah, and possibly even in other states in Malaysia. Is it that the workload is suddenly so bad despite the “glut” of housemen or that the housemen can’t cope for various reasons perhaps e.g. being the Strawberry generation or if inadequately trained in sub-standard medical schools.

KOTA KINABALU: About 50 per cent of some 500 housemen in Sabah have to undergo retraining after being found to be unable to cope with work-related stress, while some of them were suffering from depression, according Sabah Health Director Dr Mohd Yusof Ibrahim.
He said the new generation of housemen or medicine graduates undergoing supervised practical experience is not the same as the housemen many years back.
“My personal opinion, the new generation does not having the ability to cope with stress and their field of training, especially those who graduated from overseas, are unable to face the same situation in our country,” he said.
“Under the new system, housemen are only required to work for an average of 60 hours in a five-day week with two days off, which is even better compared to our times when we didn’t have days off,” he told the press after launching the Queen Elizabeth Hospital 1 (QEH1) 8th State Clinical Conference on Sports Medicine.
Yusof said that apart from failing to cope with stress, those trained outside Malaysia experienced culture shock when facing the situations in the country.
Some claimed they are overworked, but most doctors were trained like that in order to be good doctors, he said.
Yusof said that apart from the hospital authorities, parents should explain to their children that working as a doctor is tough as it involves saving lives.
He stressed that the two-year training they received is not enough for the new generation housemen because it is very common to see many of them having to repeat their training before their posting to district hospitals.

We received a message from ‘Overworked housemen’

I would like to highlight that housemen are being overworked in the medical department in Hospital Kuala Lumpur. Under the Graduate Medical Officer Flexi Timetable system, introduced last September, housemen can only work up to 60 hours a week with two days off. However, this is not the case in Hospital Kuala Lumpur. Housemen are expected to work 7 days a week with NO BREAK AT ALL, only the allocated 8 days every 4 months in each posting (including MC). And we have to do 2-4 on calls duties per week. Those who are not on call, work from 7am-5pm Mon-Fri and 7am-12pm Sat-Sun. However, on call duties are 2-4 times per week. When you are on call, it means you work from 7am today to 5pm the next day. Sometimes the call can be every other day, means you don’t even have time to rest. How can someone work non-stop. We are not robots. And nowadays even domestic maids and foreign labourers have holidays. No mention personal life, social life or family life. If you calculate our wage, we are being paid around RM8-9 per hour, which is much much lesser than what the general public without a university degree is earning. We are using the old system where we do on calls, but we are not getting any extra allowance of RM100-200 per call. We do not have rest days we do not have public holidays. We have studied so hard and would like to train to become a competent doctor in these 2 years, but we really cannot understand why are we being treated so terribly. The Employment Act 1955 (EA) mandates that overtime pay at double the normal wage-rate and triple the normal wage-rate must be paid when employees work on rest days and public holidays, respectively. Where do we stand? It is unfair and too much to expect human beings to work so long hours, It is harmful as 36 hours without sleep is detrimental to health and may cause harm to the patients. We are so tired after working so long hours and cannot think or function properly. This kind of working hours has caused 8 housemen to go MIA in the past month. And a few others are appealing to change hospitals. It is a vicious cycle. There are so many housemen that are having depression and require counseling. So can no longer smile or laugh or be happy. It is so sad and depressing to go to work daily. It is wise to look into these issues to enhance patient safety. May the relevant authority ensure that these public service doctors are happy and capable of providing the best service to the public. I really hope that our lives can be improved.

Dear Overworked Housemen,

I sympathise with your plight. The situation seems almost as bad as when I did my housemanship almost 30 years ago. I would have thought the current glut of housemen would lessen the work burden but perhaps in very busy hospitals like Hospital KL, this might not be the case.

We have recently blogged a fair bit about housemanship but you might want to read these two blog posts:

MMA : job demands long hours
House officer’s survival guide

Sincerely,

Palmdoc

The Academy of Medicine of Malaysia will be organising the 46th Malaysia-Singapore Congress of Medicine from 12th to 14th July 2012 at the Shangri-La Hotel, Kuala Lumpur. This premier scientific meeting, which used to be organised alternately between the Academy of Medicine Malaysia and Academy of Medicine Singapore, now incorporates the Hong Kong Academy of Medicine. We are also pleased to have the major involvement of the Royal College of Physicians of London and the College of Physicians of Malaysia this year, giving both local and global perspective to this meeting. Thank you very much.

Rgds

YM Kong (Ms) Congress Secretariat

For more information, please visit http://mscm.acadmed.my/

Stephanie wrote in:

I am writing to you on behalf of the Malaysia Lysosomal Diseases Association (MLDA). The MLDA is patient advocacy group that was created last year by parents of children suffering from the rare Lysosomal Storage Diseases. LSD is an inherited genetic disease that affects the cells in the body. There is no known cure and the limited treatments available can cost up to RM1million per child per year.
These parents formed the MLDA with two main missions in mind – the first is to raise awareness of this terrible disease and to educate the general public on what LSD is. The second is to advocate for a sustainable healthcare system where all LSD patients have equal and full access to the treatment available.

Today many LSD children do not get the necessary treatment because they simply cannot afford it and there is a limit to the allocations provided by the government for treatment. As they wait, the disease is
causing irreparable damage to their young bodies.

Recently the Association launched its Every Life Counts Campaign – this campaign aims to garner the support of 10, 000 people from around the country to become ‘Friends of MLDA’. By gaining these Friends, the MLDA hopes it is gaining 10, 000 advocates to help spread its message on the importance of a sustainable healthcare system. The more voices we have the stronger we are and the louder our message
becomes.

We would like to ask you to feature our story on your blog –the story of the disease, the Association and the brave families that live with it day to day and also to promote our Campaign. The topic may not be what you usually cover but your blog reaches out to many Malaysians across the country and could therefore greatly assist the MLDA in achieving and even surpassing our targets.

Please visit our website at www.mymlda.com for more information.

The MMR’s Public Societies and Associations page has been updated to include the link to the Malaysian Lysosomal Diseases Association. Lysosomal storage diseases are pretty rare inherited metobolic disorders and I would not be surprised if there are cases undiagnosed in Malaysia.

We have opened comments to the blog to readers without requiring registration. However in order to curtail spam and abuse, with immediate effect comments need to
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Anonymous comments are no longer allowed.

Thank you for your understanding.

At TEDMED Quyen Nguyen demonstrates how a molecular marker can make tumors light up in neon green, showing surgeons exactly where to cut.

Maxis and IJN have collaborated to come up with a free myHealthy Heart app for your iPhone/iPod Touch or iPad (requires iOS 5.0 and up). Malaysians with an iOS device can use this app to access free valuable heart health related information. The app also comes with useful tools, such as pedometer, BMI calculator, Framingham risk score, popular Malaysian food calorie information, common medication for certain heart conditions, medication reminders and also the latest news on heart health.

Download the free app from iTunes

via Malaysianwireless.com

On May 5, it’s time to ensure your hands are Bersih.

Save lives – CLEAN YOUR HANDS. Clean Care is Safer care

The goal of Clean Care is Safer Care is to ensure that infection control is acknowledged universally as a solid and essential basis towards patient safety and supports the reduction of health care-associated infections and their consequences.
As a global campaign to improve hand hygiene among health-care workers, SAVE LIVES: Clean Your Hands is a major component of Clean Care is Safer Care. It advocates the need to improve and sustain hand hygiene practices of health-care workers at the right times and in the right way to help reduce the spread of potentially life-threatening infections in health-care facilities.

Prof Punna Wong has written an excellent eBook, compiling some classic and instructive clinical cases which were posted in the Aequanimitas’s TJ Danaraj Month.

You can download the eBook (47Mb) here

Update: you can download a smaller (7 Mb) version here

From The Star

THE recent tragic death of a young doctor (The Star, April 12) has led to renewed discussions on the working conditions and training of housemen in Malaysia. In initial news reports, working long hours was implicated as a source of stress for the young doctor.

In fact, the complaints about “long working hours” of housemen had been forthcoming for some time and the Health Ministry implemented a flexi-hours system for housemen in the third quarter of last year.

The Malaysian Medical Associa­tion (MMA) has been monitoring the system since its implementation, and has continually sought feedback from housemen as well as from medical officers (MOs) and specialists involved in houseman training.

We have called on the ministry to carry out a comprehensive review of the new system, not just in terms of the workload of the housemen but, more importantly, in terms of how it affects their training.

Based on feedback, we are concerned about the reduction in houseman training time, resulting in inadequate exposure to patients, limited opportunities for observing and performing basic procedures and operations, and lack of continuity of care for patients.

We would like to emphasise that the housemanship training period is a critical time in a doctor’s career, the time when he/she applies all that he/she has learnt during medical school in real-life situations – fully supervised by more senior doctors.

It is thus extremely important that the young doctor uses this time to learn, and to gain as much experience as possible, as it will be the foundation of his/her future career in medicine.

The medical profession is such that one cannot work “by the clock”. Sickness does not recognise “office hours” or “shift times”.

When caring for a sick patient, e.g. someone who has just been admitted or someone who has taken a turn for the worse, a doctor has to examine, send for the necessary tests, and do the needful to resuscitate and stabilise the patient before “clocking out”.

The nature of the profession calls for such a commitment and dedication, and this culture is instilled in us during our formative years – medical school and housemanship.

Young doctors are also taught to put their patients’ interests and welfare first, before their own.

Sadly, this culture of commitment and caring seems to be getting lost in the name of improving “quality of life”.

This brings up what is, in our opinion, a more important negative impact of the flexi-hours system – the possibility that this will result in doctors lacking a sense of responsibility for a patient.

While discussing the plight of young house officers, the equally (or more) strenuous working hours of MOs and specialists in government hospitals may have been forgotten.

Training and supervision of housemen is the responsibility of MOs and specialists in the respective departments, who are already overworked with patient care.

These more senior doctors are finding it difficult to cope with training the large numbers of house officers being posted to our public hospitals, especially the many who lack basic medical knowledge and skills.

Which of course brings into question the quality of our medical graduates now. In this regard, the MMA welcomes the recently tabled amendments to the Medical Act 1971 which includes a proposal for the establishment of a Medical Qualifying Committee to look into the accreditation of qualifications of both local and international training institutions.

However, we are disappointed that the original proposal – for a common qualifying examination for medical graduates – was set aside.

We call upon the Malaysian Medical Council to carefully examine the quality of medical schools (local and international) and to take the necessary action where shortfalls in quality occur.

With regard to training of housemen, the MMA feels strongly that decisions on these matters should be left to medical professionals, with no external interference from parents, politicians or others.

As doctors, we know what training is needed to produce a good doctor, and hard work and long hours are certainly some of the necessary “evils” that we cannot escape from!

The MMA calls on the ministry to ensure that the number of house doctors posted to each unit is based on the number of trainers (i.e. specialists and MOs) available.

Only then will specialists and medical officers be able to guide each houseman in the right direction.

The MMA would also like to recognise the specialist and medical officers who have continued to train housemen despite being overworked themselves.

Dr MARY SUMA CARDOSA,
President, MMA.