In Bolehland, flip flop policies are the norm. At first we read that Senator Datuk T. Murugiah “was looking at increasing doctors’ compulsory service in public hospitals to between five and 10 years” and now the Health Minister says it may be shortened from the current 5 to 4 years.

Health Minister Datuk Seri Liow Tiong Lai said the government is studying the possibility of shortening the doctors’ compulsory service in public hospitals. He said the ministry was hoping to come up with the decision by this year.
“The ministry is looking at four years of service (two years of housemanship and two years of compulsory service) compared to five years (three years of housemanship and two years of compulsory service) now,” he told reporters after launching B-Nes Sdn Bhd, a company specialising in birdnest products, near here, today.
He was commenting on a statement made by Deputy Minister in the Prime Minister’s Department Senator Datuk T. Murugiah on Jan 27 that the government was looking at increasing doctors’ compulsory service in public hospitals to between five and 10 years to overcome the shortage of doctors.
He said the idea to extend the compulsory public service for doctors to five or 10 years from the current three in order to overcome the annual shortage of doctors in government hospitals, was not practical.
“We are looking at cutting it (the compulsory service) and making it more attractive for doctors to practice voluntarily in the sector. Forcing them to do so is not good,” he said.

What’s behind the politico-speak I wonder? Perhaps the crux of the problem is the massive number of medical graduates which will be coming out over the next few years, meaning there won’t be enough government jobs for doctors and thus the government won’t “force” you to stay on. At this rate, I think the Government in 5-10 years time will be hiring doctors on a competitive annual contract basis and no more “permanent” civil service jobs!

Spotted in the blogosphere:
Another U-turn
My Health Matters (Dr. David Quek’s blog)

While it is laudable to place incentives for organ donation, one wonders if 42 days unrecorded leave for civil servants is rather excessive. It seems like a classic “give an inch and they’ll ask for a mile” when Cuepacs thinks 42 days is not enough, and is asking for 60 days.
What about employees in the private sector? Are civil servants so special they need 42 days leave?
There is the caveat “as long as deemed necessary by a specialist” but I think this is a flexible discretion which can be used/abused to take advantage of the maximum allowed leave.
Somehow I think we aren’t going to see a flood of civil servants volunteering their kidneys or whatever so I guess this is just a moot discussion. But I suggest the powers that be spell out more specific criteria. For instance, blood is also arguably an organ (albeit in liquid form) so is blood donation also included? Lest any of you pooh pooh this idea, mind you bone marrow/peripheral blood stem cell transplantation is also considered an organ transplant.

Related MMR posts on Organ Donation

Dengue is endemic and periodically we see spikes in the number of cases, and inevitably there will be deaths. MI reports

SHAH ALAM, Feb 2 — Selangor health officials are bracing to contain an anticipated sharp increase in dengue cases following 11 deaths, eight of which happened in the state last month.
“According to the World Health Organization (WHO) the number of dengue cases spike in two year cycles and the situation this year may get out of control if not contained.” state health executive councillor Dr Xavier Jayakumar told The Malaysian Insider.
Dr Xavier, who disclosed that 1,895 cases of dengue were reported in Selangor for January, chaired an emergency meeting with state and local government health officials where he described the situation as alarming.
It is understood that changing weather patterns were among factors which cause the cyclical spike in dengue cases but Dr Xavier said authorities had a window of about a month to contain it before it peaks in March and April.
“The spike started in the last week of December and is steadily increasing.”

Related MMR posts on Dengue

Disappointed Doctor writes in to the MMR:

I am a medical doctor who was educated overseas and worked in Australia for several years and recently decided to return to Malaysia to serve the country.

As a professional working overseas I heard about the ‘Program bagi mengalakkan warganegara Malaysia yang berpakaran yang bekerja di luar negara pulang ke Malaysia’ and therefore applied for it. I was very disappointed when they rejected my application on the grounds that it was sent after I returned to Malaysia. Apparently it was meant to be sent whilst I was still in Australia.

I find this a very poor excuse given the fact that Malaysia is trying to lure back its citizens to work for them. It discourages professionals such as me from having to bear the burden to return but not have any perks or encouraging incentives. Furthermore, my parents bore my exorbitant medical tuition fees and I did not receive any governmental loans whatsoever. The “least” is something anyone would
expect.

Besides that, it took me a great deal of an effort to locate the above mentioned application form which was hidden in the catacombic archives of one of the governmental websites.
Talk about purposeful inconvenience or perhaps voluntary neglect.

I can see why many of my colleagues are hesitant to return and serve the government given the unimpressive, unattractive attitude and to top it off the obvious suboptimal remuneration and working conditions. Now, thankfully I still have the option to return to Australia and am reconsidering my intentions to continue here thanks to the above. Job well done in luring professionals back.

I agree with Disappointed Doctor. It sounds typical of bureaucrats who can’t seem to exhibit an iota of flexibility. So the applications must come from overseas and not from those who returned from overseas to Malaysia first? Absolutely ridiculous you might say but in Bolehland I am not surprised.

Related MMR posts:
Malaysian Doctors abroad not coming back? Who’s to blame?
Training abroad: are you coming home?
Turning away the brains

Reductil is an anti-obesity drug which is a prescription only item which means you should not be able to purchase it OTC (or Over The Counter) in a pharmacy. It has potential for some serious side-effects and recent news is the drug is now Banned in Europe

One of the country’s most commonly prescribed anti-obesity drugs has been banned across Europe after it was blamed for increasing patients’ chances of suffering a heart attack or a stroke.
The European Medicines Agency (EMA) ordered doctors across the continent to stop prescribing sibutramine and told pharmacists not to dispense the drug, which is marketed in the UK as Reductil.
The watchdog’s Committee for Medicinal Products for Human Use (CHMP) acted after a study of 9,800 patients said the risks of sibutramine outweighed its minimal benefits.

Contrast this with the situation in Malaysia where the NST reports the drug is Easily available

REDUCTIL is a drug that can only be bought with a doctor’s prescription.
Nobody seems to have told pharmacists about this though. Checks by the New Straits Times yesterday revealed that the medicine, in its 10mg and 15mg form, could very easily be obtained over the counter.
The outlets that sold them included large chain stores as well as neighbourhood pharmacies. No questions were asked and no prescriptions were required when the product was sold.
The 10mg boxes went for RM130 and RM150 respectively at two pharmacies in Lucky Garden, Bangsar. A 15mg box, on the other hand, cost a princely RM225 at a pharmacy in Suria KLCC.
When asked about potential health risks, though, the pharmacists listed out dry mouth, constipation, insomnia and heart palpitations as possible side effects.
Health Ministry pharmaceutical services senior director Eisah Abdul Rahman was shocked when informed.
“This shouldn’t be happening. It’s a prescription medicine,” she said, adding that she would alert the ministry’s enforcement division.

I wonder how come Puan Eisah should be “shocked”. Is she not aware that abuse of presciption-only items by pharmacies in Malaysia is not an unknown phenomenon? For example, I had a patient declare to me she could buy Tamiflu on her own (without prescription) and stockpile for her and her family’s use “just in case” at the height of the H1N1 scare last year. I am sure many of you would be aware of similar flouting of the law, and one really wonders how widespread this is.
In Bolehland lack of enforcement is the order of the day, rather than strict enforcement.

This was pointed out in the MMR Forums (Doctors section):
Does MSQH, or even MoH for that matter, realise that the use of the term or name “Clinic” when it is NOT manned by a Registered Medical Practitioner, is in violation of the law, specifically Medical Act 1971

Act 50 - Medical Act 1971 LAWS OF MALAYSIA Act 50 MEDICAL ACT 1971*
PART V GENERAL

33. (1) Any person not registered or exempted from registration under this Act who
(…)
(e) practises medicine or surgery; or
(f) uses the term clinic or dispensary or hospital or the equivalent or any of there terms in any other language in the signboard over his place of practice in purported practice of medicine or surgery as a
person registered under this Act; or
(g) uses a symbol designed by the Council for the use of registered medical practitioners only;
shall be guilty of an offence against this Act.

(2) For the purposes of subsection (1)
(a) the taking or using by any person of the term doctor or clinic or dispensary or hospital or the equivalent of any of there terms in any other language in relation to the practice of medicine or surgery shall be deemed to be the taking or using of a name, title, addition or description calculated to induce any person to believe that he is qualified to practise medicine or surgery according to modern scientific methods; and
(b) subject to regulations made under the provisions of paragraph (p) of subsection (2) of section 36, the using by any person in the practice of medicine or surgery of a sphygmomanometer, stethoscope,
hypodermic syringe or other instrument used exclusively by persons qualified to practice medicine or surgery according to modern scientific methods, shall be deemed to be the using of instruments
calculated to induce a person to believe that he is qualified to practise medicine or surgery according to modern scientific methods.

Perhaps as the MSQH suggests, the 1Malaysia “clinics” should be called “Triage Centres” instead. Or perhaps 1Malaysia Paramedical Services.
The MSQH themselves define Clinics as:

MSQH Medical Clinics Accreditation Standards (New)
“The term Medical Clinics for the purpose of these standards refer to all free standing outpatient clinic services managed by medical practitioner and cover both private and public sector clinics including specialist clinics. The term services include consultations, investigations and treatments.”

Thanks to dranony of the MMR Forums for the info.
- there’s the suggestion that it should be renamed to “1Malaysia Pondok Kesihatan”. I kinda like that.

The recent introduction of the 1Malaysia clinics has more political connotations than a genuine attempt at providing quality healthcare to the poor. Clinics run by medical assistants with the minimal of equipment is to me a waste of public funds. As a person who has worked for many years with medical assistants, I can attest to the fact that the government is toying with the health of the public in order to earn some political points.

The quality of medical assistants is suspect, from the selection of candidates to their training methods. Many of these medical assistants lack basic aptitude to practice medicine. Some are even poorly qualified. Training of medical assistants are different and hardly involves the rigours of medical schools. Their diagnostic ability is questionable. Their role in the rural community is understandable but to allow this responsibility of managing clinics in the urban areas where doctors suffice, is tantamount to dereliction of duty by the policy makers.

Would any of our VIPs visit a medical assistant for even a simple ailment? Many would flock to ’specialists’ for the best available care. Why then are we toying with the health of the general public?

The reason of providing accessible healthcare to the urban poor is a misdirection. There are many clinics in the urban area, way too many actually. It might have been more prudent to implement schemes for the poor where their visits to the general practitioner is subsidised. There are actually existing programmes in place via the Welfare Department to cater to these group of individuals where their healthcare is fully borne by the government. So what is the role of 1Malaysia clinics?

The name speaks for itself. Promoting a political agenda using tax payers money with total neglect of their wellbeing.

Recommended read

Africanisation of Malaysian healthcare- Malaysiakini

If you think 20+ medical schools are not enough for Malaysia, UTAR will be starting theirs, and the intake is in May 2010. The Star reports

Universiti Tunku Abdul Rahman’s (Utar) new Faculty of Medicine and Health Sciences will hold its first intake in May, at a cost of about RM50,000 a year, a fraction of what parents would have to pay for medical courses in other local private universities.The Higher Education Ministry has just approved the faculty’s Bachelor of Medicine and Bachelor of Surgery (MBBS) programme and the faculty will accept an initial 50 students this year.
Housed at the varsity’s Sg Long campus in Selangor, the MBBS programme will cost RM50,000 per annum and around RM250,000 for the entire five-year course.
A memorandum of agreement was also signed with the Health Ministry Friday, formalising the placement of Utar medical and health sciences students at government hospitals.
With the MoA, Utar students will undergo their practicum, industrial training or clinical studies at the Kuala Lumpur Hospital, Ampang Hospital, Sultan Ismail Hospital in Johor Baru and Raja Permaisuri Bainun Hospital in Ipoh.

I said it before and I’ll say it again. There is no acute shortage of doctors in this country. There is however a mal-distribution: rural-urban, public sector-private sector.
Addressing these imbalances and the root causes for the internal and external “brain drain” is a better long term solution than simply churning out more medical graduates.
The leak will continue…

Related MMR posts:
Yet another medical school to be built in Perak
Mushrooming medical schools pose concern

This just out in Malaysiakini:

The Malaysian Medical Council (MMC) will file a formal charge against forensics expert Dr Abdul Karim Tajudin of Hospital Serdang who conducted the first post-mortem on deceased police detainee A Kugan.
Lawyer N Surendran, who is representing Kugan’s family, told Malaysiakini that the MMC held an inquiry yesterday and cross-examined the deceased’s mother M Indra on the complaint against Abdul Karim for professional misconduct.
“They felt that there was substance in the complaint and decided to file a formal charge against him,” he said.
The complaint was lodged March last year urging for an independent investigation to probe why there were significant differences in the first and second post-mortem procedures conducted on Kugan.

Strange. According to the “independent committee” the cause of death was “myocarditis” - something which both post-mortems did not mention. Perhaps the MMC should call up everyone and clarify this most confusing situation.

Related MMR posts

Last I checked, this is an oil rich state yet I find it disturbing to read a report that Government surgical facilities in Terengganu out of action

Almost all the operating theatres in government hospitals in the state are not functioning. And Mentri Besar Datuk Ahmad Said is not amused.
Ahmad also expressed disappointment over the delay in the completion of operating theatres in several hospitals in the state, saying it was a loss to the Government and could jeopardise the lives of patients.
The operating theatre in Besut Hospital has been delayed by six years, the one in Kemaman Hospital by three to four years, while the one in Setiu Hospital has been delayed by nearly seven years.
The problems faced by other operating theatres in the state include bug infestation and leaks. It is learnt that 60 surgeons from various departments in public hospitals depended on the operating theatres.

If the Mentri Besar is not amused I wonder how the ordinary folk feel. Or is it again “tidak apa” in Bolehland?
The system sounds so sick to me.
Where did all the money allocated for the hospitals and OTs go? Why were the projects not carried out and completed? Why are we still facing bug infested and leaking OTs?
Imagine the money from stolen jet engines and funds from the PKFZ scandal which could have paid for healthcare in this country. I guess too its not just the money but whether it is spent wisely and not lost to corruption and incompetency.
Alas, something indeed is very rotten in the state of Bolehland.

Dr. David Quek asked me to post this:

There is an sms going around asking MMA members to demonstrate and hold placards within the MMA house. Please note that this has not been endorsed by the MMA Council and will not be sanctioned by the MMA, because, the majority of our leaders are opposed to such action.

YB Dato Sri Minister just called me personally to clarify, and he hoped to help clarify and reassure the doctors and GPs about this clinic issue. Pls give him a chance.

Dialogue Meeting with Minister of Health and MOH officials :

Friday 8 January 2010,
Putrajaya MOH Block E7,
Conference Room,
3.00 to 4.30pm.

Doctors and GPs are encouraged to come in droves to show our concerted strength.

Dr. David Quek

Dr. David Quek has posted some insightful comments on the Government’s 1Malaysia Clinics plan by senior members of the MMA. There are also some hints at what went on in the planning of the 1Malaysia Clinics programme.

On paper it all sounds noble but I am not sure if we can emulate the paramedical clinic services conducted in western countries where highly trained nurses (often degree holders) are given extra training for specific tasks only and given strict protocols to adhere to when conducting such “clinics”. Will there be enough of such properly trained paramedical staff in the first place? There is already a shortage of nurses in hospitals as the better experienced ones are flocking to other countries abroad where the pay is higher.

I suppose at the end of the day the programme will be bulldozed through but for the sake of patients I hope it succeeds and does not end up being a white elephant or with any disastrous consequences.