Housemen not over-worked in hospitals

Aidila Razak & S Pathmawathy
Jan 26, 10
11:14am

Malaysiakini

The Health Ministry has not received formal complaints from any trainee doctor (housemen) about stressful work conditions in government hospitals, said director-general Dr Ismail Merican.

He countered that, to his knowledge, some hospital wards have too many trainees who end up being under-worked.

"I'm surprised (that there are complaints)... if you go to the surgical ward, there will be 20 housemen floating around, and they will be fighting to do an appendectomy," he said in an interview.

He was asked to comment on an issue frequently raised in the 'Letters' forum of newspapers. These have highlighted work shifts for up to 36 hours if the houseman is on call - and there have been claims that call-duty could go on for 15 days a month.

Ismail conceded, though, that he has received complaints from parents of trainees, describing it as a "problem" that did not exist when he went through the system as a houseman.

"We worked much harder then and we didn't complain to (our) parents...I'm approachable, (the trainees) can e-mail or SMS me or drop by my office, but no one has complained other than the parents," he said.

In Europe, the practice of long shifts has been banned, with doctors allowed to only work a maximum of 12 hours without a break.

Housemen in Malaysia have further claimed that they are affected by bullying and the high-handedness of senior doctors, in a carry-over of treatment they themselves had suffered as trainees.

Interestingly in 2008, Ismail had revealed that many trainees cannot cope with housemanship, succumbing to neuroses (mental disorders) including anxiety, fear and anger, due to the competitive environment.

The long hours and emotional pressure are also a bone of contention, according to some trainees, because of the relatively low pay.

Their counterparts in Singapore earn S$40,000 (approximately RM86,000) a year after tax, which is almost five times more than the pay in Malaysia.

The relatively low pay has also been named as the reason for the number of doctors opting out of public service, a claim that Ismail refuted.

"A lot of government doctors and specialists are staying on because of faster promotions, better career development and perks with the civil service," he said.

In fact, he said, many private general physicians are "complaining" and "accusing (the government) of providing a better deal because (the government pays) RM80 for locum (work)", which can be undertaken in a doctor's free time.

'We won't have too many doctors'

While housemen complain that they are feeling the strain due to a shortage of doctors, Malaysian Medical Association education committee chairperson Dr N Athimulam said the country is headed for a day where doctors will need to "clamour for patients".

He said 1,200 doctors graduate from local institutions annually, with seven more private institutions to offer medical courses in the next few years.

Ismail disagreed to some extent, pointing out that the challenge is that there will not be enough doctors to serve areas in the interior of the country.

"We were thinking that perhaps by 2015 we may reach (a national doctor-patient) ratio of 1:600. But even then, I don't think it will solve the problem because there are states like Sabah, Sarawak and Pahang (which will still face a shortage)," he said.

"In Kuala Lumpur you can get a ratio of 1:300 or 1:400, better than in Britain. But if you go to Sabah, it's about 1:3,000 or 1:2,500. There's a disparity in the doctor-patient ratio," he added.

1MALAYSIA CLINICS: Lift our nurses' standards

2010/01/15

DATIN HATIJAH YUSOF, Honorary General Secretary, Malaysian Nurses Association

I REFER to the letter "Rethink 1Malaysia clinic move" by the Malaysian Medical Association (MMA) (NST, Dec 25). The Malaysian Nurses Association (MNA) supports Prime Minister Datuk Seri Najib Razak's choice of registered nurses (RNs) and medical assistants -- now known as assistant medical officers (AMOs) -- to run 1Malaysia clinics.

These clinics are to offer treatment for common illnesses, attend to minor ailments, and do follow-up treatment for well-controlled diabetes, hypertension and asthma, which RNs and AMOs have been doing for decades in rural and urban areas.

The public should be aware that RNs and AMOs have been the main providers of primary healthcare. There are simply not enough medical officers to provide healthcare to millions of Malaysians.

The MMA has expressed concern over the quality of medical care at 1Malaysia clinics. Nurses have been providing healthcare for decades, particularly in maternal and child healthcare.

They are all well-qualified public health nurses who have undergone a year's training in midwifery and another year in public health, apart from their three-year training as nurses.

The public should be aware that from day one in Malaysia, nurses and assistant medical officers have been the main providers of primary healthcare in the country for a long time. — Bernama picture

These nurses have five years of education and training and several years of experience before they take the public health course. Since 1996, nurses have not only been providing healthcare to mothers and children but also to the elderly, children with special needs, women and adolescents. We also provide mental healthcare.

As a doctorate candidate (PhD), I did field observation of RNs and AMOs in six states on their roles in early 2000.

It was obvious that RNs and AMOs were the main healthcare providers in all these clinics. While the nurses are champions in maternal and child healthcare, health education, prevention and promotion, the AMOs treat the general outpatients.

In most of the clinics, AMOs saw 90 to 100 per cent of the patients. The MMA can easily check such data at any health clinic. There are far too many patients for one or two doctors to cope without the help of these AMOs.

A morbidity survey of community health then and retrospective data of six months collected from each clinic showed that the diseases they sought treatment for were just common illnesses.

It is unbecoming of the MMA to run down nurses by saying that allowing nurses and AMOs to run 1Malaysia clinics would place "the standard of these clinics at the level of Third World countries".

The MMA is ignorant of the fact that in developed countries such as the USA, Canada, the UK and Australia, community clinics are run by nurses independently.

These nurses are known as "nurse practitioners" who are advanced-practice nurses with master's degree education or degree nurses with specialisation.

Is the MMA aware that we have several RNs who are PhD holders and that many have a master's degree? We have also quite a number with degrees and specific specialisation.

We also wish to inform that we are advocating that all RN training should now be at tertiary level. We want to be under the "professional group", not in the "supportive group".

We feel that diploma-level training is no longer suitable for RNs. Nursing colleges here should offer degree courses instead.

To give quality care, the MNA has recognised four areas of basic nursing competencies that RNs should possess.

These are problem-solving, knowledge-based practice, clinical competence, and accountability and ethical practice.

In the area of clinical practice, nurses should have clinical skills in physical assessment to detect medical abnormalities, skills in auscultation, palpation and percussion, just like the AMOs who have this special training.

Even though nurses lack clinical skills, experienced nurses would have no problem running a 1Malaysia clinic.

On the MMA's remark that we have sufficient doctors and that "2,000 to 3,000 new doctors are returning to our shores annually", I would like to ask: where are they?

The truth is, medical officers have to work very hard to meet patient care demand and are frequently on call due to a shortage of medical officers. They work straight on for 34 hours, which is inhuman. Also, apparently MOs are not keen to work in semi-urban or rural areas.

We predict that there will never be enough MOs in the Health Ministry as it is a hard life and less lucrative than working in the private sector or setting up private practice.

NST Online

MEDICAL FACILITIES: Rethink 1Malaysia clinic move

2009/12/24

DR DAVID K.L. QUEK, President, Malaysian Medical Association

WHEN the government announced in the 2010 Budget the setting up of 50 1Malaysia clinics in urban areas, the Malaysian Medical Association was perplexed. That these clinics are to be be set up at all is perhaps a good move by the government that must have genuinely felt the need to offer some much-needed goodwill to the urban folk, especially the poor and the marginalised.

However, what is disturbing is the plan to have these clinics run by medical assistants and nurses, which in effect places the standard of these clinics at the level of Third World countries, where there is a real shortage of registered physicians.

The MMA is gravely concerned that such a major shift in policy with regard to public sector healthcare should be implemented without sufficient input from and discourse with stakeholders, such as medical practitioners and perhaps even Health Ministry officials.

It has been suggested that even some health officials were taken aback by this announcement, but they have been instructed to implement the decision next month.

Firstly, let me reassure the public that the MMA is not simply protecting its turf. Of course, we are keenly interested in the welfare and wellbeing of medical practitioners, but we are also concerned about our patients, that is, the rakyat who are our reason to exist, our raison d'etre.

We welcome the government's concern about the health needs of the people. We also recognise that for many urban poor, the only recourse to healthcare is that offered by the ministry's overcrowded and understaffed outpatient clinics. That there has been much queuing and long waiting times is regrettable and wasteful in terms of productivity. Certainly, we should do better.

We also know that new ministry directives have been employed to shorten waiting time to less than 30 minutes: this has been included as part of the Key Performance Indicators or Key Result Areas announced by the government.

Perhaps this huge problem, the need to lessen the burden of fixed outpatient clinics and the logistics of manpower distribution, has prompted this new approach.

But we also urge the government to recognise that throughout the country, there are many general practitio-ner (GP) clinics available in almost every urban block of shophouses and business complexes.

There is a severe glut of GPs in urban areas, such as Klang Valley, Penang, Johor Baru, Malacca, Ipoh and other major towns. In these cities, the ratio of doctor to population is 1:400 -- better than the World Health Organisation's recommended ratio of 1:600.

While some GPs have been successful, the great majority of them simply eke out a mediocre living. Most GPs see less than 20 patients per day and are, therefore, under-utilised. This is grossly unproductive and wasteful.

The problem is learning how to manage the distribution of the doctor-patient function more efficiently.

It is with this in mind that for several years now, the MMA and the ministry have been seeking an efficient public-private partnership in shaping a better healthcare system for the country.

Unfortunately, because of the differential system of fee and/or payment mechanisms, it is proving to be rather tricky to bring about a cohesive transferable system.

Thus, there have been talks about integrating the public-private sector for primary care medical services.

This will hopefully integrate all the GPs into a primary care medical service, whereby the public can seek treatment at either the public or GP clinics, interchangeably or by choice, with a common reimbursement mechanism. This will, undoubtedly, be the way forward.

Of course, quite a few discrepancies need to be addressed, for example, differing expectations and amenities available. But this can be worked out and we are establishing common areas of standardisation which will ensure that the public can be assured of as high a standard of healthcare as possible.

In this context, the establishment of the new 1Malaysia clinics appears to be unnecessary. If the government feels that these clinics should be set up despite the protests of the medical profession, then the least it should do is to ensure that these clinics are manned by registered medical doctors.

The standard of medical care should not be compromised.

Why is this such a prerogative? Because in this day and age, it is unbecoming to offer a lesser level of care to citizens just because they cannot afford to pay to see a doctor.

Employing medical assistants and nurses to do a doctor's job is called task-shifting, a practice employed mainly in Third World countries, where there is a severe shortage of doctors. To do so in this country would be a major step backwards and, in the MMA's view, unnecessary.

Do we have enough doctors? Of course, we do. It is just the poor distribution and logistics that need to be addressed.

Recently, more than 2,500 new doctors joined the public service as house officers. It is learnt that many of them are under-employed in various government hospitals.

Owing to the mushrooming of medical schools (23 as of this year) in Malaysia and medical graduates returning from abroad, we will have some 2,000 to 3,000 new doctors returning to our shores annually.

We can certainly tap into this resource to help run our public clinics more efficiently. At the very least, the public will be better served by registered medical doctors.

Although they may only have a probationary medical licence, the fact remains that they have had sufficient training and knowledge. Medical officers, registrars and specialists can supervise these doctors.

Why is the MMA so concerned about clinics being manned by medical assistants or other unregistered medical practitioners?

Because under the Medical Act 1971, this is illegal. Because doctors who employ such unregistered persons have been charged and penalised for unprofessional conduct. Because medical assistants cannot prescribe any more than some simple medicines, cannot sign any medical leave chits or write any reports, and would become subject to medico-legal challenges with no precedents.

There should not be one law for some and another for others, even if it is approved by the government or the ministry. The MMA believes that setting up 1Malaysia clinics in urban locales is redundant, wasteful and shortchanges the rakyat. Utilising the existing GP clinics would be the better way forward.

Furthermore, the manning of these clinics by non-registered medical doctors is wrong and undermines the healthcare service, leading to a possibly poorer standard of care and many uncharted legal problems.

We urge a rethink on this project, and for the ministry to seriously look into the implications of this poorly advised move. The MMA will strive to work with the ministry to help raise the standard of healthcare for Malaysians, but not by compromising on the quality of care.

NST Online

Housemen lack basic know-how

Housemen lack basic know-how

By : Annie Freeda Cruez

NST, 31st January 2009

KUALA LUMPUR: Some medical universities, both local and overseas, are churning out doctors who cannot carry out common medical procedures, have no proper clinical exposure, cannot communicate effectively and cannot even take down the history of patients properly for diagnosis and treatment.

Senior medical consultants in government hospitals are now saddled with the task of having to retrain these people to ensure they meet the country's standard of medical practice.

Some of these fresh doctors are retained in their houseman training postings for years, some even up to six years, because they cannot meet the standards. The compulsory housemanship is two years.

In view of this problem, the Malaysian Medical Council has issued letters to all heads of department in government hospitals where housemen are posted to open a file on each of them, containing information on the university they graduated from, their performance and shortcomings.

It is learnt that by the end of the year, the MMC and Health Ministry will nail down the sub-standard medical universities and tell them to buck up.
Kuala Lumpur Hospital's Medical Department head, Datuk Dr Jeyaindran Sinnadurai, said housemen come from 300 medical colleges all over the world. These colleges churn out 1,200 doctors a year and this number is expected to increase to almost 2,000 next year.

"When they come back to work in Malaysia we have been forced to extend the period of housemanship from one year to two years in order to ensure the standard of medical practice is maintained in this country for the safety of our patients," he told the New Straits Times.

Dr Jeyaindran handles about 140 housemen a year and he noticed that some 15 per cent of them do not have enough experience to take down the medical history of patients.

"When they are taught to take the history properly and put the findings and various symptoms in a sequential order they can come to a proper diagnosis very rapidly," he said.

However, he added, this was seriously lacking in many new doctors because they have not been trained during their years in clinical exposure. Thus, during their housemanship training programme they needed to be retrained to do this properly.

"Because they have to be retrained, some of their postings are extended," he said.

Dr Jeyaindran has come up with a syllabus where a house officer must have core knowledge and experience before he leaves for his next posting.

"A houseman who comes in for training should be able to manage hypertension, asthma, diabetes and common medical emergencies appropriately based on current clinical practice guidelines, besides acquiring adequate generic skills," he added.

He said some were never taught this properly during their years in medical school and hence they were taught and assessed in a fair and objective manner during their training.

"We want doctors to examine patients properly and not take notes from the nurses' chart.

"We also do not want doctors to be over-dependent on investigative procedures which is time-consuming and expensive.

"One loses the ability to use clinical acumen to make judgment when he becomes too dependent on procedures for a result and diagnosis," said Dr Jeyaindran.

He also expressed great concern that some house officers were not able to perform even the most common procedures such as setting up an intravenous line, central line, and inserting a chest tube.

There have been complaints from patients that there were housemen who cannot even draw blood for a blood test and had to seek the help of nurses.

"Miscommunication with patients can also lead to a lot of problem and this we have encountered with housemen," he said.

"To be a good doctor it is not how much knowledge you have... it is clinical acumen and the skills developed in treating a patient.

"Medicine is not black and white but lots of grey in between and in order to identify the grey areas the only way is the more you see, the more you do, the more you understand," he added.

Dr Jeyaindran said housemen have become something like a production line.

"They come, they take some history of patients and go away.

"They never come back to check whether their diagnosis of the patient was correct or wrong," he added.

‘She was ripe for the plucking’

By CHIN MUI YOON

The Star, 3rd August 2008

This was the reason some convicted rapists gave for their crime to two researchers who visited prisons to interview sexual predators. Their recently published book sheds some light on why Malaysian men rape.

EVERY day an average of four women are raped. But we don’t hear or read about most of the cases, only the sickeningly brutal ones involving a child or ending in murder or both.

The names and faces of victims like computer analyst Canny Ong, 28, abducted from a basement car park, raped, killed and set on fire; engineer Noor Suzaily Mukhtar, 24, raped in a bus by the driver who later strangled her with her tudung and children like Nurul Huda Ghani, five, abducted and killed by a security guard in a TNB station and Nurin Jazlin Jaziman, eight, sodomised and murdered, are etched in the public’s collective mind.

We tend to believe that rapists are shadowy strangers lying in wait of an unsuspecting woman. The reality is that most victims were raped by someone they know, a friend, former partner, even a relative. Even those trusted in authority like parents, policemen, religious leaders and community elders have been charged with rape.

Rape is riddled with myths. Many perpetuate the belief that women are raped because they entice men with their dressing or behaviour. Religious leaders and politicians have fanned such myths that turn the spotlight onto the victim instead of the criminal.

Dr Rohana Ariffin, retired associate professor of Universiti Sains Malaysia Penang, and her former student Rachel Samuel, currently a lecturer with UiTM Malacca, decided to focus their research on the rapist instead.

For 10 months in 2003, both women conducted interviews with 90 convicted rapists currently detained in four prisons in Seremban, Johor Baru, Kajang and Sungai Buloh aged 20 to 72. Each rapist was asked open-ended questions to solicit their perception and attitudes towards women, sexual history and experiences.

Their findings were published in a handbook, Rapist & Rape – Who & Why which was launched by Women, Family and Community Development Minister Datuk Dr Ng Yen Yen last month. It is a follow-up on their earlier study in 1997 from interviews with rapists in Taiping and Penang.

Women, Family and Community Development Minister Datuk Dr Ng Yen Yen at the launch of Rapist & Rape – Who & Why by researchers Dr Rohana Ariffin (left) and Rachel Samuel.

“We hoped that an insight into their thoughts, feelings, perception and attitude would help reduce the number of rape incidents in Malaysia,” says Dr Rohana at a recent interview in Petaling Jaya, Selangor.

“Our study offers a socio-economic profile of the rapists and understanding their family background. We wanted to know, what precedes their crime?”

She stresses that their research had limitations.

“We were only allowed to meet with each rapist once for two hours,” she says. “As such, our study only obtained some indicators of their background and reasons for committing rape. A psychological profile of the offenders would require more extensive interviews and research.”

Who, what...

From just 138 cases in 1980 to 912 in 1994, the number rose to 2,431 cases in 2006 and 3,177 last year. Between 2000 to 2006, Selangor and Johor recorded the highest numbers of rape while Perlis had the lowest number. For 2006, Selangor recorded 421 rapes and Johor 343.

These are just the known cases reported to the Royal Malaysian Police. Researchers believe there are numerous unreported cases of incest or acquaintance rapes.

Malays commited 66.3% of reported rape cases, followed by 15.3% by “others”, who are natives of Sabah and Sarawak and foreign workers comprising mainly Indonesians. Chinese are the perpetrators in 10.5% of the cases and Indians in the remaining 7.8%.

Universiti Sains Malaysia criminologist Dr P. Sundramoorthy at his office in Penang.

Many offenders are aged between 45 and 55. The most common types of rape they committed were incest and acquaintance rape. Ironically, 82% of respondents over the age of 50 raped girls aged 16 and below. The trend continues today with rape victims becoming increasingly younger.

The majority grew up in rural areas, including Felda schemes (71.1%), and had low education levels. Most are married and reported good relationships with their mothers but not their fathers. Their views concerning females are, in general, degrading and humiliating. They see rape as a sexual act rather than as a violent crime.

...Why

“They often cited, suka sama suka, meaning they believed it was consensual sex,” explains Dr Rohana. “Or they’d say, she was ripe for the plucking. One said the victim was manja (acting cuddly and pampered) with me. But that was the rapist’s granddaughter!

“Some believe rape is where force was used. So having sex with the victim isn’t rape to them. They are ignorant that rape is also caused by persuasion, coercion, manipulation and relationship power between an older person and a young victim.”

Indeed, some of the men convicted for date rape or statutory rape told the researchers that sex was consensual and it was the girls’ parents who reported them because they disliked the men’s low-income jobs.

The rapists also blamed pornography and uncontrolled lust as the main factors which caused them to rape. Only two of them said women were to blame but over 60% agreed that women were temptresses.

Asked why they did not turn to prostitutes to release their uncontrollable lust, the rapists replied that prostitutes were “repulsive” and “dirty”.

What was it like meeting 90 rapists face to face?

“I must admit it was depressing entering a prison, but we prepared ourselves mentally and emotionally each time we set off. We could not show our feelings and kept cool at all times,” says Dr Rohana.

“Even so, I could not help feeling heated during one interview. I raised my voice at a 60-year-old man who took his little granddaughter into a palm oil estate and raped her. Another said, Jika makanan sudah dihidang, kalau saya tak makan, lalat akan turun. Biar saya yang makan (If food is served and I do not eat it, the flies will come. Let me be the one who consumes it).

“Similarly, a 55-year-old who raped his teenage neighbour as his wife had reached menopause, stated, Nak tidur, bantal pun sampai, kita pun tidurlah (Want to sleep and the pillow is here. May as well sleep on it).

“It was hardest to speak to people who had abused their positions of power, like a religious head who raped the teenage girls volunteering to serve in the temple under the full trust of their parents.”

Samuel found most of the rapists forthcoming and willing to talk.

“Most said they didn’t use force to have sex,” she says. “A music composer convicted of statutory rape against his teenaged stepdaughter passionately declared, ‘I am a lover, not a killer!’.

“He said his stepdaughter is a ‘hot blooded teenager who needed to be taught the right way to enjoy sex’.”

Many of the men committed incest while their wives were in menopause, pregnant, or unavailable for sex. When the men couldn’t control their urges, they sought the easiest women they could find.

“Most of them had a propietary attitude of ‘she’s mine anyway’,” says Samuel.

Breeding ground

An interesting point unearthed was that the median age of the Malaysian rapist was 41.7, with incest rapists at 47 and date rape perpetrators at 37. In comparison, rapists in developed nations like the United States, 80% are below 30 and 75% under 25.

“In more developed nations we find younger perpetrators and stranger rape cases. With rapid urbanisation in Malaysia, will the category of rape and the origins of rapists shift due to the ‘overcrowded rat syndrome’, with younger men coming from high density flats and condominiums?” queries Dr Rohana.

She adds, “We are breeding a culture of poverty. People grow up resenting others and they transfer that aggression to the easiest victim they find. I hope our structure of housing can be more humane and not resemble pigeon holes in the sky. We need sustainable family planning especially among the low income group. Seldom do we find a sociologist on planning boards during development.”

PAM past president Dr Tan Loke Mun

Past president of the Malaysian Institute of Architects (PAM) Dr Tan Loke Mun disagrees that confined and crowded living quarters are breeding grounds for rapists.

“We don’t find an increase of rape in densely populated cities like in Hong Kong, Singapore, China, Japan or Scandinavian countries where land is scarce and expensive,” he argues.

“Rape is due to moral decline in a society. More rapes happen in rural areas. (Ironically) imposing an unrealistic and totally inhibitive moral standard on people is more likely to turn them the other way. We may have parks for recreation but most are under-used. The old gathering spaces were parks, markets or piazzas. These spaces have evolved into shopping malls, cinemas, waterfronts and food and beverage outlets.

“Developers allocate a minimum of 10% of land into recreational space. But once it’s handed over to the local councils, that’s when you see deterioration.”

Urban decay

“Rape is a worrying trend although Malaysia still has a low rate compared with other countries,” says criminologist and Universiti Sains Malaysia’s School of Social Science lecturer Dr P. Sundramoorthy, adding that for the first time, crime was an agenda for the March 8 elections.

“A major contributing factor is urbanisation which has led to dramatic lifestyle changes. Our crime rate is a typical symptom of rapidly developing nations. We have seen more crimes in the last 20 or 30 years than in the previous century.

“As our population grows, we have more accessibility to information including sex materials. There is no conclusive research that pornography leads to rape, but a higher number of rapists tend to view it habitually so it is a contributing factor.”

Is there hope of rehabilitation for the rapist? The Malaysian Penal Code Section 376 states that offenders shall be punished with imprisonment of a term not less than five years and liable for whipping. Despite the severe punishment, many are recidivists or repeat offenders.

“Back in the mid-1990s I took some students to work on research on rapists. We were startled to see some of these men being caught for rape again after their release from prison,” says Dr Sundramoorthy.

“There have been calls to rehabilitate rapists, or to chemically castrate them as practised in some European nations. But research has shown that even with castration, the rapist still rapes habitually. What we need is to impose maximum jail time for even first-time offenders and not leave it at the whim and fancy of a judge.”

Teach respect

Despite years of progress and change, women are still objectified as commodities. They are still blamed for rape from the way they dress, talk or behave.

In June, Munirah Bahari, vice president of the National Islamic Students’ Association of Malaysia, caused a furore by stating that school girls’ white baju kurung was too sexy and lured rapists. Similarly, the Kelantan Government forbade women to wear coloured lipstick or high heels as these are deemed enticing to men.

Dr P. Sundramoorthy points out that the media is also fond of magnifying cases where attractive women are raped. It perpetuates the idea that only beautiful women get raped.

Rape is committed against women all over the world including “honour killings” which these women are protesting against.

“Blaming women for rape is a worldwide phenomenon and not just in Malaysia,” he says. “Infants, the elderly and women from various ethnic groups and religions and in all shapes and sizes have been victims. Yet, people will continue believing that dressing sensuously will cause people to rape, or going out at 3am, or other stereotyping.”

While it is impossible to obtain zero rape as deviant acts can never be achieved, Dr Sundramoorthy says society can minimise the crime, starting with education from an early age.

“People must be aware of these social issues and men especially need this education,” he says. “We must start human social behaviour education from the age of 10. And boys especially must be taught to respect women.

“The age for statutory rape should also be raised from 16 to 18. Teenagers may be physically ready for sex, but are they mentally or emotionally prepared? The age for buying alcohol should also be raised to 21. There is no conclusive study showing alcohol is a cause for rape but directly or indirectly, alcohol accessibility has been a factor in many cases.”

Women themselves have a role to play.

“Some women also accept a patriarchal system in society,” explains Dr Rohana. “They are trained from young to believe that they have to be gentle, sweet and submissive. A man rapes a woman as a way of putting her in her place.

“Additionally, our capitalist economy sells women as the weaker sex. In a conservative society, the victim is blamed. But women cannot be responsible for men’s actions! If a shoplifter is caught, do we blame the merchandise for looking too attractive?”

Adds Samuel, “In conclusion, rape is mainly a question of unequal power relations and a distorted perception and attitude towards gender or women.”

‘Rapist & Rape – Who & Why’ is published by the Education and Research Association for Consumers, Malaysia (ERA Consumer, Malaysia), a non-profit and non-political organisation. Free copies of the book are available. Contact ERA Consumer at No 24, Jalan SS1/22A or call 03-7877 4741 / 03-7876 4648 or visit eraconsumer.org

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Ruling ‘will not solve shortage of doctors’

The Star, 30th July 2008

PETALING JAYA: Discarding the mandatory three-year service in government hospitals for doctors serving abroad who want to return will not address the shortage in the public sector, said the Malaysian Medical Association.

Its president Datuk Dr Khoo Kah Lin said it would only create an imbalance between the public and private medical sectors.

“It will only open the gate for them to practise in the private sector, causing more imbalance,” he said in a statement on Monday.

“While we agree that the country needs more doctors in government service, there is much dissatisfaction in the sector, causing some 300 to 400 doctors resigning every year to practise privately.”

Dr Khoo added it would also be unfair to local graduates who need to complete three years of compulsory service and two years of housemanship.

Health Minister Datuk Liow Tiong Lai recently announced that specialists who have practised overseas for more than 10 years would be exempted from serving three years in government hospitals when they return.

The ruling applied to doctors aged 45 years and above, he said.

Dr Khoo said the reasons for the high rate of resignation included heavy workload, poor working conditions and low remuneration.

“The MMA would propose for these aspects to be improved, including creating more promotional posts, hastening the promotion process and revision of on-call allowance, specialist allowance and hardship allowance for doctors in rural areas,” he added.

Not enough specialised nurses to go around

Not enough specialised nurses to go around
By AUDREY EDWARDS

The Star, 26th July 2008

KUALA LUMPUR: The shortage of nurses in Malaysia has caused several wards and intensive care units in newer hospitals to remain closed.

Health Minister Datuk Liow Tiong Lai said among the hospitals affected included those in Serdang, Sungai Buloh, Ampang and Sungai Petani.

“Many new hospitals are not able to open wards, intensive care units and operating theatres, which need a lot of post basic nurses,” he told reporters after opening the 2nd Universiti Malaya Medical Centre Nursing Congress 2008 yesterday.

He said that as of March this year, only 85.9% of the 42,476 staff nurse posts had been filled, while 6,004 posts remained vacant.

“The need for specialised nurses is growing with increasing specialisation of medical practice,” he said.

There were 11 areas which lacked nurses with post basic training. These included intensive care, coronary care, neo-natal care, paediatric care and emergency and traumatology, he said.

Only between 30% and 40% of nurses working in the 11 areas have been given the necessary post-basic training.

In addition to this, there are also new specialist nursing areas like HIV counselling, genetic counselling and neuro-radiology intervention.

Liow added that 27 nurses from India would arrive next month following the Cabinet’s approval last year to recruit 1,300 nurses from Asean and Commonwealth countries over a period of three years.

There are currently 73,613 nurses of all categories and grades in Malaysia where 78% worked with the ministry and the rest were in the private and non-ministry sectors.

Training is being done at 17 nursing colleges under the ministry, producing about 3,500 diploma nurses yearly while private colleges have also been roped in to help.

Asked about investigations against the doctor who conducted the botched cosmetic surgery on former Labuan MP Datuk Suhaili Abdul Rahman’s wife Datin Fatimah Wan Chik who is now in a coma, Liow said he was waiting for the report to be presented to him.