ECOLI

Housemen not over-worked in hospitals

2010-01-26T20:55:00.001+08:00

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

2010-01-16T00:02:00.002+08:00

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

2009-12-24T00:12:00.001+08:00

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

2009-02-03T23:23:00.001+08:00

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’

2008-08-03T18:45:00.001+08:00

‘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’

2008-07-30T19:55:00.001+08:00

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

2008-07-26T08:28:00.001+08:00

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.

Government offers perks for doctors

2008-07-25T13:37:00.001+08:00

Government offers perks for doctors

By EMBUN MAJID

The Star, 25th July 2008

ALOR STAR: The Health Ministry spends about RM400mil a year on human development programmes which include scholarships for doctors and nurses to further their studies.

Health Minister Datuk Liow Tiong Lai said this provided doctors and nurses an opportunity to improve themselves.

Centre of attention: Kedah Sultanah Tuanku Haminah Hamidun, accompanied by Sultan Abdul Halim Mu’adzam Shah (partially hidden beside her), playing with baby Khairunisa Dayana during their visit to the Sultanah Bahiyah Hospital in Alor Star yesterday. With them is Liow (left).

“This is one of the benefits provided by the ministry for Malaysian doctors who are working in the country, and we hope this will attract Malaysian doctors working abroad to return home,” he said.

Liow said this when asked to comment on a statement by Deputy Minister in the Prime Minister’s Department Datuk Mohd Johari Baharum that 236 medical graduates studying overseas under Public Service Department scholarships refused to return home to work.

Mohd Johari was quoted by a Malay newspaper yesterday as saying that the Government spent nearly RM1mil to provide overseas training for each doctor.

He said the Government had no other choice but to take legal action against graduates who refuse to return home.

Liow, met after the opening of the Sultanah Bahiyah Hospital by Kedah Sultan Abdul Halim Mu’adzam Shah here yesterday, said the ministry was working closely with the Human Resources Ministry to get medical graduates to return.

He said the two ministries had set up a one-stop centre that would have a database of Malaysians working abroad as doctors or studying medicine overseas.

“There is about 40% vacancy for doctors at hospitals in the country, and I hope medical graduates will return home to serve the people,” Liow said.

The RM552mil hospital, which was built to replace the Alor Star Hospital, began operations on July 23 last year.

Minister: Plan to double locally-trained specialists

2008-06-09T19:40:00.001+08:00

Minister: Plan to double locally-trained specialists

By NG CHENG YEE

Star, 9th June 2008.

KUALA LUMPUR: There are only 1,800 medical specialists in both the public and private sectors and the Government hopes to raise the figure by 100% by training them locally, said Health Minister Datuk Liow Tiong Lai.

He urged specialist bodies to train more members in the various fields and expand the number of medical experts in both district and state hospitals.

“Currently, the country has a critical shortage of cardiologists and oncologists,” he told reporters after attending the Malaysian Association of Plastic, Aesthetic and Craniomaxillofacial Surgeons Fellowship Night here yesterday.

He said the country was facing such shortages because many medical professionals had resigned and left for private practice before completing their specialist courses.

“Every year, the ministry allocates RM430mil on training nurses, doctors and specialists and we are putting in an effort to narrow the ratio of these professionals in the public and private sectors,” he said.

As for plastic surgeons, he said there were 42 such specialists nationwide and there were three to five new ones being trained every year.

Liow said the country had all the facilities and requirements to become a centre for beauty surgery, which was gaining popularity worldwide and all that it lacked was a high number of specialists in the field.

“The cost of getting such service is relatively lower compared to those offered by hospitals in the United States and European countries, where patients have to wait for three to five years before getting treatment.

“We (the Government) hope to churn out more such specialists as plastic surgery

has great potential to help make Malaysia a popular medical tourism destination,” he said.

On another matter, Liow said the ministry was drafting the Cosmetic Bill to regulate the country's 140,000 establishments in the beauty field.

“We hope to table the bill by either the end of this year or early next year so that we can set a good standard when providing beauty service to our rakyat,” he said.

Govt hospitals getting ready for higher traffic

2008-06-09T19:33:00.001+08:00

Govt hospitals getting ready for higher traffic

By SIM LEOI LEOI

Star, 9th June 2008

PUTRAJAYA: Public hospitals are being geared up to expect a higher volume of patients seeking their services now that the price of fuel has been increased.

Health Minister Datuk Liow Tiong Lai said the ministry had already taken a few steps to recruit more doctors and nurses as well as upgrade hospital facilities.

"We have already decided to extend our services to after office hours and on Saturdays. If need be, we may even open our clinics on Sundays because there are too many patients.

"We are also trying to attract Malaysian doctors working overseas to return and we are looking for ways to engage private doctors into working at public hospitals.

"At present, most private doctors with us are only offering outpatient treatment and there are very few specialists. I think our terms are not attractive enough so we'll have to re-look our conditions again," he told reporters Monday after launching the breast cancer pathology update at Putrajaya Hospital here.

Liow said many private doctors had indicated to him their interest in working in public hospitals due to the more challenging nature of the cases.

Asked if he expected public hospitals to come under strain from the increase in patients, Liow said many district hospitals were already facing difficulties.

"I know of certain hospitals which have only five or seven doctors working," he said, adding that the Government service loses some 300 doctors and 50 specialists each year.

Public hospitals are 98% subsidised by the Government. Last Wednesday, Prime Minister Datuk Seri Abdullah Ahmad Badawi had announced a 78 sen increase for each litre of petrol.

Liow also said National Healthcare Financing Scheme would not be implemented any time soon as a report on its economic viability would not be ready by year-end.

On breast cancer, Liow said 3,738 new cases had been reported since 2003, 64% of these were patients between 40 and 60 years of age. "Breast cancer makes up 31% of newly-diagnosed female cancer cases," he said, adding that the ministry would continue to advocate breast self-examination among women as one method of early detection.

Liow said currently, there were 55 public hospitals treating breast cancer and more tests would be available soon to detect the ailment among women.

85 complaints made against petrol stations

2008-06-07T20:20:00.000+08:00

85 complaints made against petrol stations

KUALA LUMPUR: The Domestic Trade and Consumer Affairs Ministry has received 85 reports of petrol stations that stopped selling oil on Wednesday night after the announcement of the fuel price increase.

Ministry director-general for enforcement Mohd Roslan Mahayudin said Kelantan recorded the highest number of complaints with 30 cases, while Johor had 15.

He said his department was investigating all the complaints.

Meanwhile, Minister Datuk Shahrir Abdul Samad said the prices of petrol and diesel were unlikely to change in the next two months.

He said this was because the monthly monitoring of global oil prices had not started.

Asked about the rise in sugar price, he said it had nothing to do with the fuel hike.

“This could be due to supply problems caused by panic buying. The situation will return to normal.”

He said sugar was a controlled item, which came under the Price Control Act.

Any complaints can be directed to the ministry’s hotline at 1-800-886-800, or via e-mail to aduan@kpdnhep.gov.my.

In Muar, Umno Bandar A branch chairman Datuk Kadar Shah Tun Sulaiman said Shahrir should not make anymore announcements on fuel prices as it would only frustrate the rakyat.

He added that Shahrir had recently said there would be no increase in fuel prices until August but the Government had raised the prices in June, taking the people by surprise.

Public transport, school bus operators warned against raising fares

2008-06-06T20:06:00.001+08:00

Public transport, school bus operators warned against raising fares

By IZATUN SHARI

SHAH ALAM: Public transport and school bus operators which are using fleet cards have been issued a stern warning not to increase fares.

Entrepreneur Development Minister Datuk Noh Omar said the Commercial Vehicle Licensing Board (CVLB) must approve any fare hike by public transport operators.

He said CVLB had been instructed to step up enforcement against public transport or bus companies which deliberately increased fares by suspending or revoking their licence.

“I would like to stress that public transport and school bus operators are not affected by the fuel hike because they are entitled to diesel at RM1.43 per litre and they are given fleet cards. There is no reason why they should increase their fares as announced by the bus operators association today,” he told reporters Friday after attending Umno retreat at a hotel here.

“I appeal that bus companies do not take advantage of the situation. We will not compromise with them.”

He was commenting on reports that some bus companies in Puduraya had raised fares by RM10.

Noh said his ministry along with the Domestic Trade and Consumer Affairs Ministry and Treasury held a meeting Friday morning with representatives from bus companies to help overcome problems faced by bus and public transport operators.

He said public transport operators, such as rented cars, taxis, workers’ buses and tipper lorries, which were not using fleet cards had been asked to apply for one from the Domestic Trade and Consumer Affairs Ministry.

Noh said the Government was considering giving the full diesel quota to public transport operators who were already using fleet cards and subsidising public transport including taxis, buses and lorries, which were using petrol.

Currently, public transport companies using the fleet card are getting only 70% of the diesel quota for their operations.

Noh also urged public transport operators to be patient as the Government was considering their appeal to increase fares, which would have to be approved by the Cabinet.

He called on the public to lodge a report with the CVLB if they know of any school bus and public transport companies which had increased fares by calling 1800 88 9600 or sending an SMS to 39900.

Domestic Trade and Consumer Affairs Minister Datuk Shahrir Abdul Samad gave the assurance that his ministry would ensure that public transport operators, including school and express buses, would get the full quota for diesel and petrol through the fleet card system as the current 70% quota would only last for about three weeks.

He said his ministry was also looking at the possibility of giving diesel subsidy to workers’ buses.

Parents refuse to honour children’s pledge after their deaths

2008-05-15T22:16:00.000+08:00

Star, 15th May 2008

PENANG: Some parents are refusing to honour the pledge of their children who have agreed to donate their organs upon their death.

This is one reason for the low number of cadaveric donors (deceased donors) in the country.

Penang Hospital Nephrology Services head Datuk Dr Rozina Ghazalli said according to Health Ministry records, 112,300 Malaysians had pledged to donate their organs from 1997 till March 31 this year.

“However, the actual donors was only 214 from 1976 till March 31 this year,” she told The Star in an interview here on Tuesday.

Dr Rozina said some parents refused to allow doctors to remove the organs of their beloved ones because they were in doubt of the wishes of the deceased.

“Even if a person pledges his organs, his relatives are still required to give consent upon the donor’s death before the organs can be harvested,” she said.

Dr Rozina said another reason for poor organ harvest was the failure of doctors to explain to the family the meaning of “brain dead” – the patient is technically dead but the family members still want to hold on.

“In such instances, the doctors do not want to be seen as vultures waiting to get the deceased person’s organs or to be seen as not doing their best to save the patient’s life,” she said.

Dr Rozina said although all religions encourage the act of compassion to save lives, Muslims in particular were still reluctant to donate organs.

“They think it is disrespectful for the dead to be buried with organs missing although there is a fatwa which allows Muslims to donate their organs,” she said.

Dr Rozina pointed out that with the numerous campaigns organised by hospitals and the Tissue and Organ Procurement teams in the 16 government hospitals, the number of pledges by Muslims had increased from 2% in 1997 to 12% in 2007.

The highest number of actual donors were Chinese (52.4%), followed by Indians (26.6%) and Muslims (6.1%).

Those interested in becoming a donor can contact the National Transplant Resource Centre at Kuala Lumpur Hospital at 03-2615-6576 / 2694-2704 or the Transplant Resource Centre at Penang Hospital at 04-222-5780.

Retirement age now 58

2008-05-11T09:43:00.000+08:00

Star, 11th May 2008

PUTRAJAYA: The mandatory retirement age for civil servants has been extended from the current 56 years to 58, effective July 1.

Civil servants now have a choice of opting to retire at 56 or work until they reach 58.

Among the goodies announced by Prime Minister Datuk Seri Abdullah Ahmad Badawi was discontinuing the written test for Grade 1 to Grade 16 officers under the civil service Efficiency Level Assessment (PTK).

He, however, said the PTK would not be abolished but its methods would be improved from time to time.

The PM also said effective Jan 1 next year, the calculation of pension for pensioners and pension recipients would be based on a maximum of 30 years of service compared to the current 25 years.

However, the recalculated pension will only be paid from Jan 1 next year without any arrears.

Abdullah said the decision to increase the retirement age was made based on Malaysians’ current lifespan.

He added that based on a government study, extending the retirement age would not affect the employment opportunities of fresh graduates.

“The new generation of public employees should not feel there is a slimmer chance for career development; instead, it should be better,” Abdullah said during the public sector Workers Day celebration here yesterday.

Abdullah also announced the abolition of the depreciation of derivative pension received by the next of kin, starting Jan 1 next year. Currently, the next of kin receives only 70% of the pension after a lapse of 12½ years.

“Studies showed that this had posed a financial burden for families with young children, so the Government agreed to abolish the depreciation of the derivative pension, meaning that 100% of the pension will be paid to the next-of-kin,” he said.

The Government, he said, agreed that parents of civil servants who had passed on without leaving behind any heir would get a lump sum ex-gratia payment.

On Cuepacs’ other demands such as a review of the housing allowance and the absorption of contract employees as permanent staff, he said the Government was still studying them and would announce its decision before tabling the 2009 Budget in Parliament in August.

He said the Government always had the people's interest at heart.

“If I can make you all happy and enjoy a better standard of living, why should I deprive you of this? If today I cannot (give what you demand), I hope I can do so later,” he said.

Come back and we’ll treat you right, Malaysian medical specialists told

2008-05-11T09:38:00.001+08:00

Star, 11th May 2008

Health Minister Datuk Liow Tiong Lai said the ruling was being reviewed as the Government wanted to attract Malaysian doctors home.

Currently, all doctors are required to undergo three years of public service in government hospitals.

“We are making it easier for Malaysians who want to come back and practice. A one-stop centre has been set up to help facilitate their return,” he said.

Liow said there was no way that the Government could match doctors' salaries offered at private healthcare institutions.

He said about 1,500 medical students graduated from public universities each year, and another 1,500 from private institutions. “We have housemanship and the compulsory service, but after that, they leave for private practice, so we are short (of doctors).”

Liow said only 60% of the positions for doctors in Government hospitals and clinics were filled, and encouraged doctors in the private sector to help ease the shortage.

“Giving more money (higher salary) is not the way to solve the shortage. We need to find a mechanism where private and government doctors can work hand-in-hand,” he said.

Liow said private doctors who helped out at public hospitals were paid RM80 per hour, and added that they should consider the act as a social obligation and national service.

“They can come (help) on their day off,'' he said after launching Sunway Medical Centre’s outpatient satellite clinic in Damansara Heights.

“Let us keep in mind that the practice of medicine is a noble art, not a trade; a calling, not a business.”

Later, when launching World Lupus Day in Bandar Utama, Liow said that a national registry of systemic lupus erythematosus (SLE) patients would be set up to monitor the disease among Malaysians.

He said the exact number of SLE (commonly known as lupus) patients in the country could not be ascertained as there was no registry. “It is important to diagnose and treat lupus early because it can cause disfiguring rashes and scarring, multiple miscarriages, kidney, heart and lung failures, impaired neurological function, strokes, heart attacks and even death,” he said.

Liow said SLE was an auto-immune disease in which the body produces antibodies that attacked its own organs. It can affect virtually any system in the body, particularly skin, heart, lungs, kidneys and brain.

“It is like a self-allergy where the body’s immune system runs riot.''

Liow said the Ministry would grant RM250,000 to the SLE Association to help kick-start the formation of the registry.

Health Ministry did act on complaint

2008-05-02T19:04:00.000+08:00

Health Ministry did act on complaint

Star, 2nd May 2008.

I REFER to the letter “No action taken to nab bogus doctor” (The Star, April 30). I would like to respond to the comments made with regard to the Private Healthcare Facilities and Service Act 1998 (Act 586) and the issue related to insurance companies.

He stated that the Act “seems more interested in penalising genuine doctors than bogus doctors”.

He notified the Health Ministry (MOH) about a bogus doctor working in the emergency department of a private hospital. We acknowledge receiving such a complaint and would like to clarify matters.

The complainant first wrote to the Malaysian Medical Council (MMC) on Sept 20, 2007, to inquire about the registration status of one foreign doctor, a Myanmar citizen, formerly employed by Universiti Malaya Medical Centre.

MMC referred the case to MOH for investigation. Subsequently, the MOH received another letter from the complainant regarding this matter.

The enforcement team of the Health Department of Federal Territory, Kuala Lumpur, visited one of the facilities of the alleged group hospital but could not trace the said doctor.

Another team from the Selangor State Health Department went to another hospital of the same group but was told that the service of the said doctor had been terminated.

Following this, the MOH issued a warning letter to the private hospital not to employ any non-registered medical practitioners. The latest follow-up visit by MOH officials on March 13, 2008, revealed that the group hospital has stopped engaging him.

I would like to remind all private hospitals and clinics to check the registration status and Annual Practising Certificate of any locum doctors they wish to employ.

It is the responsibility of the licensee or the holder of the certificate of registration to ensure that this requirement of engaging doctors be complied with, as provided for under Section 31(1)(c) of Act 586.

To date, the MOH has acted on 37 healthcare facilities with 39 offences (with one facility having two offences), 17 of which were operating without registration/licence and another 13 guilty of employing unregistered practitioners.

Three cases have been prosecuted. One pleaded guilty and two others are being heard. The rest of the cases are awaiting prosecution by Deputy Public Prosecutors.

Act 586 is effective in ensuring that bogus doctors are not wilfully employed by private hospitals or clinics. However, the law does not provide powers to prosecute bogus doctors directly.

To address this anomaly, the Medical Act 1971 is being amended.

With regard to the insurance issue raised in his letter, the MOH is addressing this issue by registering all Managed Care Organisations (MCO), including insurance companies that deal with patient care.

In addition, we will gazette them as health-related services, which will then allow us to regulate the MCOs under Act 586.

I hope the writer can contact me directly via e-mail (ismailmerican@moh.gov.my) or any of my officers should he have more information regarding any hospital or clinic that employs unregistered doctors. I also welcome any suggestions to improve our healthcare services.

TAN SRI DR HAJI ISMAIL MERICAN,
Director General Of Health, Malaysia.

Hospital review apt in costly times

2008-05-02T18:52:00.000+08:00

Hospital review apt in costly times

COMMENT
By TOMMY LEE

Star, 2nd May 2008.

The staggering fees charged by private hospitals and the competency of doctors at 24-hour clinics are matters that the new Health Minister needs to deal with to ensure good and affordable healthcare reaches the rakyat.

THE recent statement by Health Minister Datuk Liow Tiong Lai that private hospital charges for room, equipment and medicine will be reviewed is certainly timely, especially when the rakyat is faced with spiralling prices of goods.

Although the announcement augurs well for the people, the minister must show the public that he means business and is not just paying lip service.

He should walk the talk and see to it that these hospitals balance their profit impetus with compassion by providing affordable health care for the people.

There have been far too many complaints of patients being charged exorbitant fees after undergoing treatment at private hospitals.

I remember a friend telling me sometime ago that her grandmother was taken to a private hospital in Sungai Petani where the doctors removed a fish bone stuck in her throat.

The bill came up to a whopping – and absurd – RM3,000. Any patient would have choked on seeing the bill.

It was a non-invasive procedure. I was told that the doctors knew the lady was from a rich local family.

Here is a fine example of overcharging. Similar laws and punishment meted out on traders profiteering from overpriced goods could perhaps be introduced for hospitals to check indiscriminate charges.

Then there was also a case of either wrong diagnosis or was the doctor suffering from “money face” disease?

Another friend went to a private hospital in Penang complaining of severe stomach pains and diarrhoea.

After examining her, the doctor told her that she has to be immediately admitted for surgery for acute appendicitis.

Not knowing what to do, she called her father who advised her to get a second opinion.

She went to another private hospital and, to her relief, was told she was suffering from an upset stomach as a result of some food that did not agree with her. It has been three years now and her appendix is fine.

These are just some anecdotes. There must be many, many more. Can the ministry do something about it?

Last week, the minister said that he would instruct his director-general to set up a committee to conduct a thorough study on the issue of private hospital fees.

He should get this committee established and functioning soon. It would be better if the committee is also given the task of drawing up a list of reasonable charges.

Of course these charges would vary as hospitals might argue that their rooms were of five-star quality and so forth.

A watchdog body, along the lines of the government hospital board of visitors, could perhaps be set up to ensure private hospitals adhere to a list of fair charges. Complaints could also be channelled to such a body.

However, not all hospitals are overly profit-conscious. There are compassionate hospitals that set aside funds to help the needy. One notable one is the Penang Adventist Hospital that has so far sponsored 450 heart surgeries.

Its community relations coordinator Chin Hsien Hui said the hospital set up its heart fund in 1988 and has so far disbursed RM5mil for heart surgeries for the needy.

Another matter the minister might want to look into is the 24-hour clinics in the country.

They should be well equipped to handle emergency cases and have proper equipment to deal with common emergencies such as heart attacks and strokes.

More importantly, attending doctors should also be competent and able to cope with emergencies such as this at the clinics.

This competence can be critical. Ten years ago, on the first day of Chinese New Year, I rushed my father to the nearest 24-hour clinic after he complained of chest discomfort after dinner. I thought he had indigestion. He certainly had no history of heart disease.

The doctor took his blood pressure and took some blood for tests, then he asked my father to go to the next room to have a chest X-ray.

My father sat down on the bench after the X-ray and suddenly began gasping for air.

I immediately called the doctor who rushed out and did not appear to know what to do.

He looked helpless and kept saying my father was having a stroke. Someone must have called an ambulance, because it came 20 minutes later while the panic-stricken doctor had earlier placed some kind of breathing apparatus over my father's mouth.

I followed the ambulance in my car and when I arrived at the hospital, I was told my father had passed away. My experience could be an isolated case and out there thousands of patients visit 24-hour clinics everyday.

If doctors are competent and such clinics are better equipped, we can be assured of proper treatment. This is another area the minister might want to look into.

As for private hospitals, it is time to consider some “national service” or better still, call it “dana”. It is good for the soul. As they say, it blesses him that gives and him that receives.

No action taken to nab bogus doctor

2008-05-01T07:00:00.000+08:00

No action taken to nab bogus doctor

Star, 30th April 2008.

I REFER to the various articles in The Star on the PHSFA (Private Healthcare Services and Facilities Act). In my opinion, the Medical Act 1971 is enough; the only thing lacking is enforcement.

Sad to say, the PHSFA is lacking in enforcement to catch bogus doctors. It seems more interested in penalising genuine doctors than bogus doctors.

This has been demonstrated in the case of a bogus doctor working in the emergency department of a private hospital for the past few months. The MOH was notified but refused to conduct any raid to catch him.

The bogus doctor was let off without even a warning and so was the private hospital. The bogus doctor nearly killed a few patients because of his lack of knowledge.

The MOH refused to act even though it had been informed of the days and time the bogus doctor was working. The private hospital even promoted the culprit responsible for hiring the bogus doctor, who is still around working in various clinics.

The MOH can still act to persecute the hospital as the bogus doctor has worked in the hospital emergency department for several months, and all the records, his signature on prescriptions, medical certificates, death certificates are there. Witnesses are aplenty – consultants, doctors, nurses, attendants, patients – they can testify that he worked there.

The reluctance of the MOH to persecute is baffling. Is it due to political influence or is it trying to cover up?

The same private hospital has also been cheating patients and insurance companies by charging patients for non-existent products that the patients never used. Patients have not complained because they are not aware of this as their bills are paid by the insurance companies.

Even though the insurance companies pay because the patients are covered by insurance, it is still cheating the patients because the patients have an annual limit. The insurance companies should blacklist and boycott this hospital.

The specialists in the hospital also cheat the insurance companies by admitting patients for general check-ups and altering the diagnosis of patients.

There is widespread cheating of the insurance companies by specialists. Consultants charge exorbitant fees and make unnecessary visits amounting to five or six times a day. Patients are charged consultant fees even for a simple hello by the consultant. In the end, the public suffer as the premiums go up.

ANOTHER DOCTOR,
Kuala Lumpur.

Health Ministry to test drive-through project at Penang Hospital soon

2008-04-27T09:31:00.000+08:00

Star, 27th April 2008.

PETALING JAYA: Patients with chronic ailments may soon enjoy “drive through” facilities to collect their medication instead of having to wait at government hospital pharmacies.

Health Ministry director-general Tan Sri Dr Ismail Merican said a pilot project would begin at the Penang Hospital in three months to study its feasibility.

The service, which would also operate after hours, would be enjoyed by those who suffered from illnesses like diabetes and hypertension.

“They will not have to come on their work day. They can get their medication after office hours or on weekends,” he said.

Ismail said the move was to make pharmacies at the hospitals less congested.

He said patients would be able to make a telephone call or send an SMS to the pharmacy ahead of making the collection.

“Right now, we do not give medication out every three or six months anymore. It is now on a monthly basis and patients have complained that this is inconvenient,” he said.

Furthermore, he said patients with chronic ailments would not need to see the doctor if it was merely repeating one’s medication.

Dr Ismail said “e-prescribing” – the computerisation of medicine prescriptions – had seen a decrease of the number of prescription errors.

The programme has been implemented at the Putrajaya, Selayang and Sungai Buloh hospitals.

Teaching hospitals like Hospital Universiti Kebangsaan Malaysia and University Malaya Medical Centre have also recognised the benefits of computerisation and e-prescribing, he said.

Ismail said there were now more pharmacists in government hospitals particularly after September 2005 when compulsory service for them was introduced.

By the end of last year, 78% of vacancies for U41 pharmacists had been filled. He said there were 2,288 pharmacists in the public sector.

'Patients want their pills from clinics'

2008-04-24T06:12:00.000+08:00

'Patients want their pills from clinics'

NST, 23rd April 2008

KUALA LUMPUR: The number of patients who visit private clinics may drop if doctors are not allowed to dispense medication, said the Dermatological Society of Malaysia.

Its president, Dr Allan K.C. Yee, said Malaysians usually see a doctor to get medicines.

"Malaysians generally do not believe in paying consultation fee for nothing, if they know they are not going to get medicines from the doctor," he said.

This is one of the reasons why the 70-plus member society is against the idea of separation of functions of doctors and pharmacists which would also apply to dermatologists, who are medical doctors by profession, said Yee.

He added that dermatologists are more qualified than pharmacists in advising patients in applying topical medicines which is frequently the common treatment for skin problems.
"Dermatologists are better qualified to show the patients how to apply the medicine to the affected skin, how much of the medicine to use and how to store them," he said.

The patients might also be shy to ask the pharmacists how to use the medicine in a pharmacy, especially if the problem is around the private parts, he said.

Yee admitted that dermatologists' profits will drop if the separation takes place but said the consultation rate will not change.

He also said the condition of the topical drugs is compromised when drugs are sold in bulk packaging and then repacked by pharmacists.

"Customers are the ones who lose out because they would not be able to keep the medicine for long as it would be either spoilt or become ineffective," he said.

How some Asian nations handled dispensing split

2008-04-24T03:50:00.000+08:00

How some Asian nations handled dispensing split

By : Rina De Silva

NST, 23rd April 2008

KUALA LUMPUR: Dispensing of medicine by pharmacists and not doctors is not just a western practice. It is the norm in several Asian countries, including India, Korea, the Philippines and even Indonesia.

It became legal in Indonesia in 1964, the Philippines in 1969, India in 1988, and in South Korea in 2000.

It is common to find 24-hour pharmacies in these countries.

Besides 24-hour pharmacies, the Philippines' 72 public hospitals also render 24-hour pharmaceutical services, said Romeo L. Manalo, assistant secretary of the Office of Standard Pacific Affairs at the Philippines' Department of Health.

"The hospital pharmacies run on an eight-hour shift not only for the inpatients and outpatients but also for the general public," he said.
In Mumbai, India, there are at least twenty 24-hour pharmacies, said Subodh Priolkar, immediate past president of the Indian Pharmaceutical Association.

If the pharmacy is closed, the patients can purchase the prescribed medication from hospital pharmacies which are open 24 hours, he said.

There are about 1,000 government hospitals there, he added.

The only exception to the law is in the rural areas in India where clinics there would purchase medicines in bulk from pharmacies, he said.

The exception to the law is also allowed in rural areas in Indonesia, said Eka Suripto, the head of communications at the Indonesian Embassy here.

In big cities, where there are more than one pharmacy, each will take turns to operate 24 hours, he said.

Although the separation of functions is now a norm, the practice came with its share of problems initially in Indonesia and South Korea.

As doctors could not dispense their own medicine some started to acquire their own pharmacy and the pharmacists' role was reduced to merely following the orders of the owner, said Eka.

He said due to the increasing number of such cases, the government issued an additional regulation in 1988 which barred doctors and dentists from dispensing or preparing medicine, except injections.

In South Korea, the separation of functions was strongly opposed by physicians who were afraid of losing an income source, said Prof Dr Soonman Kwon, chairman of health policy and management department at the Seoul National University's School of Public Health.

"Following a wave of strikes, the government was forced to modify the reform package and to raise the doctor's consultation fees substantially to compensate for the physicians' income loss," he said.

Prior to the mandated separation of functions, both physicians and pharmacists were prescribing and dispensing medicine which resulted in the overuse and misuse of medicine, he added.

"After the separation of functions, pharmacists are not happier because they cannot prescribe anymore," he said.

In India, the separation of function made no difference to the doctors' consultation fee, said the spokesperson from the media division of the Indian High Commission here.

In private practice, the consultation fee of 50 to 200 rupees (about RM4.20 to RM16.50) remained the same.

Subodh said the separation of functions worked because only pharmacists have the knowledge and training to dispense medication and counsel patients on how to take the medication.

"In the event of possible effects of drug combination, pharmacists have the right to ask for a medical history," he said.

He added that doctors usually prescribe the best medication for the patient based on the patient's medical history.

There has been an improved therapeutic compliance in the Philippines as a result of the separation, said Manalo.

"Pharmacist as dispensers serve as the second technical person in contact with the public by providing the necessary information and counselling on drugs and other related matters," he said.

News Focus: Doctors or pharmacists?

2008-04-24T02:45:00.000+08:00

News Focus: Doctors or pharmacists?

By : Annie Freeda Cruez

NST, 23rd April 2008

KUALA LUMPUR: Complement each other, not fight. This is the advice given by Health Minister Datuk Liow Tiong Lai to doctors and pharmacists who have been arguing over the right to dispense medicines.

"We are talking about two professional bodies. They should complement each other and not be competing with each other."

He said it could not be denied that both were specialised in their respective fields of work.

Right now, Liow said, the system was such that doctors handled all the functions.

On the issue of separation of duties in the dispensing of medicine, he said: "I had a meeting with the Malaysian Medical Council last week and I will be meeting representatives from the Malaysian Medical Association tomorrow. I will meet representatives from the pharmaceutical industry next week."
Liow said he would decide on the matter after the meetings.

For almost 20 years, pharmacists have been fighting for the return of their right to dispense medications but have been unsuccessful for various reasons.

The ministry had planned to conduct a pilot project on the separation of functions between clinics and pharmacies in selected major towns before implementing it nationwide.

However, even before the pilot project could kick off, there have been protests by doctors.

Long wait to see govt specialist

2008-04-18T15:12:00.000+08:00

Long wait to see govt specialist

By YENG AI CHUN

IT was a long wait for more than 200 patients at the specialist clinic in the Seberang Jaya Hospital.

Patients who started to queue up as early as 7am found themselves waiting for more than four hours to see a medical specialist.

During a check on Monday, disgruntled marketing executive M. Gopinathan, 33, who was accompanying his father S. Mariasoosay, 62, to see the orthopaedic specialist, said they had been waiting since 7.45am.

“The queue is terrible. The waiting room is packed and people have to wait outside the corridors.

Crowded: The waiting room at the specialist clinic in Seberang Jaya Hospital is packed with patients and their family members.

“Today is especially bad and the doctor only saw my father after 12pm. Usually, it would only take two hours but today, I had to tell my employer that I could not report for work as I had to wait for my father’s medical appointment,” he said when met at the hospital.

Just last month, Health Minister Datuk Liow Tiong Lai announced that he hoped to shorten the waiting time at government hospitals to 30 minutes.

Housewife Mehbuba Yusou, 28, said it was normal to wait for a long time to see a doctor.

“Sometimes the doctor sees you on time. Sometimes not, it depends on your luck but many patients cannot wait long as they have to get back to work,” said Mehbuba, who had been waiting since 7.30am.

State health director Dr Teh Lei Choo said there were more patients than usual at the hospital that day.

She said the specialist clinic saw 290 patients that Monday compared to the usual of about 220 to 240.

“We would also like to see a shorter waiting period but it is not easy due to factors like patients arriving late and physical factors such as doctors sharing rooms to see patients,” she said, adding that Mondays were the among the busiest days.

Star, 18th April 2008.

Dispensing medicine: Patients should be given a choice

2008-04-16T05:57:00.000+08:00

Dispensing medicine: Patients should be given a choice

By : DR HAFIZ LAW, President, Penang Medical Practitioners' Society

NST, 15th April 2008

THE Penang Medical Practitioners' Society (PMPS) would like to respond to the statements made in the media regarding the right of doctors to dispense medicine.

The PMPS views the statement attributed to the past president of the Malaysian Pharmaceutical Society with great regret and concern.

To say "a pharmacist spent four years acquiring knowledge about medicine compared with a doctor who has none" is irresponsible, uncalled for and bordering on absurdity.

Doctors are knowledgeable in clinical pharmacology, which is part of the medical undergraduate curriculum, and doctors spend a greater part of their working life treating patients with medicine.

All doctors are familiar with the usefulness, interactions and side-effects of drugs. If a patient develops adverse reactions from any medicine, he sees a doctor to diagnose and treat the side-effects not a pharmacist.
It is also not true that doctors only prescribe branded medicines. Most general practitioners and hospitals prescribe generic drugs if the patients choose the cheaper generic drugs.

Doctors are aware of the economics of healthcare and try to deliver effective and efficient care at affordable costs.

As a body of medical doctors, we believe the interests of the patient are of primary concern. Let the patients decide if they would like to collect medicine from the doctors or pharmacists.

In all government hospitals and many private hospitals, doctors do not dispense medicine. However, general practitioners should be allowed to dispense, maintaining the status quo allowed by the Poisons Act 1952.

Of course, patients should always be allowed to collect the prescribed medicine from their preferred pharmacists should they wish to do so.

Grads prefer to stay on overseas

2008-04-13T09:37:00.000+08:00

By SIM LEOI LEOI

newsdesk@thestar.com.my

Star, 13th April 2008

PUTRAJAYA: More and more medical students sent abroad to study on government scholarships, many costing more than a million ringgit each, are breaking their 10-year bond by refusing to return and serve in public hospitals.

“This is a sore point with us. In 2006, 21 medical students in Britain did not return. Last year, the number was 63. For those studying in Ireland, three students did not come back in 2006 while last year, 27 did not return,” said Human Capital Development division director Datin Madinah Mohamad.

She said these students cost the Government up to RM1.1mil each in funding for the five-year course.

“The number has been steadily increasing each year since 2003. The excuse these undergraduates often give is that they want to do their two-year housemanship over there and continue with sub-specialisation courses.

“But when they do so, they may then get employed and become eligible for registration in Britain. With the pay they are getting there, it’s highly unlikely they will come back and serve here,” she said in an interview here yesterday.

Since 2003, 145 students from Britain and 85 from Ireland have not come back. However, only three from Russia, two from Jordan and one from Japan failed to return.

Another reason many students chose to stay back could have been due to PSD’s perceived lenient treatment of such students in the past and a paltry penalty of RM160,000 each before 2003, she said.

“It encouraged undergraduates, who have seen many of their seniors being let off, to follow suit,” she said.

Although the department had officers in Britain and Ireland to track down errant medical students, some in the last year of studies ignored notices and others did not bother to show up when called for interviews.

She said tougher measures were needed to make them come back and serve or pay their bond.

The department was now seriously considering suggestions to make errant students repay twice or thrice the sum of their scholarships as punishment.

“We need to study this recommendation,” she said, adding the department had also handed 30 such cases since 1989 to the Attorney-General’s Chambers for legal action and had even declared one former student bankrupt.

But legal action was slow and guarantors would be taken to court only as the last resort, she said.

Since PSD’s Overseas Scholarship Programme started in 2000, RM2.15bil in scholarships had been given to 10,485 students up to the end of last year.

Unrecognised medical graduates

2008-04-11T04:12:00.000+08:00

Hope yet for med grads

Star, 10th April 2008

By AUDREY EDWARDS

PUTRAJAYA: Medical graduates from overseas universities not recognised by the Government now have the option of transferring their credits to recognised local establishments to pursue their goal of becoming doctors.
This option is being given on a one-off basis instead of them sitting for a competency examination.
Health Minister Datuk Liow Tiong Lai said yesterday that this was useful for those who had failed the examination for a maximum of three times.
He said the easing of the rule was until Dec 31 this year for graduates who completed their studies by Dec 31 last year.
“The Cabinet has agreed that graduates from unrecognised institutions, especially those who have exhausted all chances of sitting for the exam, be given the chance to continue their studies via credit transfer to recognised institutions,” he told reporters yesterday.
Under the Medical Act, only medical graduates from recognised institutions are allowed to register with the Malaysian Medical Council to practise legally.
Those who graduated from unrecognised institutions are required to pass a competency examination under the Medical (Setting Examination for Provisional Registration) Regulations before they can register.
He said that under the new arrangement they would have to undergo one year of pre-clinical studies and two years' clinical studies, adding that this period depended on courses they had taken previously.
Liow added that the students could transfer their credits to institutions like the Asian Institute of Medical Sciences and Technology.
A group of about 200 students, most of whom had sat for the examination three times, had recently appealed to him to be allowed such credit transfers, he said.
Once they are accepted for the credit transfer, the students will be absorbed into the recognised institutions, sit for examinations as usual and become housemen at hospitals.

National health financial scheme

2008-04-10T03:58:00.000+08:00

Liow: Open forum to discuss health scheme

Star, 9th April 2008
By AUDREY EDWARDS

PUTRAJAYA: The Health Ministry is keen to have a public debate on the National Health Financing Scheme.
Minister Datuk Liow Tiong Lai said a public forum would be the “best way” to address issues and problems on the implementation of the scheme.
“I would like to have a public debate. Let us talk about it,” Liow said in an interview on Monday.
“This is something which will help the people and the Government have better health services in the country.”
When the idea was first mooted 25 years ago, certain parties raised concerns about how the scheme would be implemented.
The proposals included having it modelled after the EPF and Socso schemes where “eligible” employees make monthly payments through a deduction from their salary and both the scheme and the National Health Financing Authority overseeing it would be non-profit and not privatised.
Former Health Minister Datuk Seri Dr Chua Soi Lek announced in 2004 that Prime Minister Datuk Seri Abdullah Ahmad Badawi had given approval and the “general principles” had been agreed upon.
Consultants were also appointed to look into the details of the mechanism and there were even calls for a Royal Commission to be set up to get broad feedback before it was introduced.
Liow admitted that it was not going to be easy for the Government to have such a scheme because it might not be a popular decision.
However, he said the Government “did not have much choice” where the present system has left it subsidising almost 98% of healthcare in the country.
He, however, said it would take about three to four years before the scheme could be implemented.
A plus point of having the scheme was that the people would be able to get treatment either in the private or public sector where the Government would be able to use all existing doctors instead of the current system, he said.
“One way to solve this problem is to have an insurance scheme. It does not matter whether you go to the government or the private sector. The doctor will treat you and the insurance will pay,” he said.
A minus point, however, would be the risk of the government or insurance company going bankrupt because the public had developed a “buffet mentality”.
Asked who was likely to take charge of the scheme, he said it did not matter because the most important thing was for the people to enjoy the benefits.

Separation of doctor/pharmacist duties: 'Patients shouldn't suffer'

2008-04-04T04:33:00.000+08:00

Separation of doctor/pharmacist duties: 'Patients shouldn't suffer'
By : Shuhada Elis

NST, 3rd April 2008

KUALA LUMPUR: The separation of duties between doctors and pharmacists would only be implemented if it does not burden the public.
Deputy Health Minister Datuk Dr Abdul Latif Ahmad gave this assurance yesterday and said the matter was still being studied."We are still conducting research on the matter but it is impractical if the people are adversely affected," he said.Last week, the New Straits Times had quoted the ministry's director-general Tan Sri Dr Ismail Merican as saying that the move to separate the duties of doctors and pharmacists was in the pipeline.Dr Ismail had said that the pilot project would be implemented in major towns where there were pharmacies located near clinics.
Dr Latif said although the separation of duties had been carried out in other countries, Malaysia might not be able to do the same as there were not enough pharmacists.The NST had reported that there were about 5,000 registered pharmacists practising in some 1,600 pharmacies in the country."Maybe you will not experience the inconvenience if you live in the Klang Valley because you can go to a pharmacy nearby. But in rural areas, like in my village, there's only one pharmacy serving a population of 1,000." He stressed that the public's welfare would always be the ministry's priority. He said at present, doctors were still allowed to prescribe and dispense medicine, adding only practitioners in Malaysia and Singapore did not separate the two functions.On another matter, Dr Latif said the ministry had seized seven herbal products from the market this year.He said the syndicates had deceived consumers by labelling their products as health products with herbal ingredients but checks found that they also contained harmful ingredients.He added that those found guilty could be fined up to RM5,000 or two years' jail or both

Separation of doctor/pharmacist duties: Diverse opinions on plan

2008-04-04T04:28:00.000+08:00

Separation of doctor/pharmacist duties: Diverse opinions on plan
BERNAMA

NST, 3rd April 2008

KUALA LUMPUR: "You have tonsillitis. This is your prescription slip and you can obtain the medication at any pharmacy."
The conversation above may well be too familiar in the future if the Health Ministry decides to allow doctors to only issue the prescription with patients having to get the medication at pharmacies.According to a recent news report, the Health Ministry will soon launch a pilot project on the separation of functions between clinics and pharmacies, where, in the future, dispensing medications may be the exclusive rights of pharmacies."I think Malaysians are not ready for the separation of functions between clinics and pharmacie," said consumer activist Gurmukh Singh. Gurmukh said the Health Ministry should consider several factors.
"First, at the moment, I don't think there are pharmacies that open round-the-clock."If your child suddenly develops fever or diarrhoea in the wee hours of the morning and you rush him to a 24-hour clinic. "Imagine your annoyance when the doctor only gives you a prescription slip and asks you to get the medication from a pharmacy."After that, your blood pressure shoots up when you can't find a pharmacy or any which opens at that particular hour." Mother of three Zaidah Zainal, who stays in Green Valley Park near Rawang in Selangor, said there were not many pharmacies in her neighbourhood."In my area, there are five clinics, but only one pharmacy is in operation. "If the health authorities decide to separate the functions, then we should have more retail pharmacies around to cater for the expected higher demand." Contrary to what people may say, separating the functions can be costly to consumers, said social activist Fatimah Mansur."The doctor has to charge consultation fees. If you get your medication at the clinic, the total amount charged is definitely less than the whole amount charged for separate consultation fees and medication," she said.The Malaysian Medical Association (MMA) recommends a minimum fee of RM30 for a doctor's consultation, but most of the time private practitioners charge less than this amount.Fatimah said the public prefer to go to only one place, and at present, the clinic serves as a one-stop centre."You can get your medical check-up at the clinic. Your blood test can be done, as well as X-rays. "By the time the doctor has finished with them, the patients maybe too tired to go elsewhere to get their medication." And the move, if implemented, would be time-consuming and related costs would rise."Imagine after seeing your doctor, you have to drive around to look for a pharmacy. "You may find one, but then the medication required could be unavailable, and you have to look for other pharmacies." Thus, the actual cost is higher, as the public may have to spend more on petrol for their vehicles, she said.According to Health Ministry's statistics, there are about 1,600 pharmacies nationwide.Educationist Ikmail Ahmad Borhanodin said the public should allow the Health Ministry to conduct a study to determine whether the separation of functions is suitable for Malaysians."Allow the consumers to make their own choice, as at the moment they let the doctors dispense the medication. They have the choice on whether to get branded or generic drugs, so they can save money."Ikmail said there are some good points to such a move.He said doctors are only familiar with medicines that they often prescribe, while pharmacists are always in touch with the drugs industry."But, bear in mind that the doctors have the knowledge on medical problems as well as their causes. And they are familiar with the patients too". The priority is for the public to have good healthcare services, said Gurmukh."The pharmacies must improve their services. Sometimes when consumers walk into a pharmacy, the pharmacist is not around and nobody else can dispense the drugs. This is wasting the public's time." Gurmukh said for a start, the "pharmacist not in" syndrome should be discarded."In Malaysia, there are many clinics appointed by employers for the convenience of their sick workers. Employers want to make it easy for themselves and their workers." Under this concept, employers will foot the medical bills of their sick workers. Usually the employers would pay the panel clinics monthly, after receiving the respective invoices."Do we need to have panel pharmacies later?" asked Gurmukh. -

Dispensing medicine: Address the central issue

2008-04-02T06:03:00.000+08:00

Dispensing medicine: Address the central issue

By : DR MILTON LUM, Petaling Jaya

NST, 1st April 2008

I REFER to the reports on the issue of dispensing medicine ("Doctors to be disallowed from dispensing medicine" - NST, March 29 and "A need for 24-hour pharmacies" - NST, March 31) and the misrepresentations in the statements attributed to John Chang, past president of the Malaysian Pharmaceutical Society (MPS).

Among his claims were:

- With serious risks to health due to improper medication, it made better sense for patients to get their drugs from a pharmacist who would have spent four years acquiring the knowledge rather than from a doctor who had none.

- Doctors stock drugs they prefer to prescribe and, more often than not, these are the ones which give them (more) profit. If the system (separation of functions) is introduced, doctors cannot hold patients to ransom any more.

- The separation of functions is almost like allowing the patient to have a second opinion from a pharmacist.
Pharmacology is not synonymous with pharmacy, although the two are sometimes confused in everyday usage.

Pharmacology, which is the study of the interaction between drugs and humans to produce a change in function, is part of a medical undergraduate's training and continues throughout the medical course.

Pharmacology encompasses drug composition and properties, drug interactions, toxicology, therapy, and medical applications of drugs.

On the other hand, pharmacy is the study of medicinal substances and drugs, their origin, nature, properties, formulation, production and effects, and their use in humans and animals. Depending on the university, pharmacology may or may not be part of the pharmacy course.

There is also confusion between prescribing and dispensing.

Depending on the illness, a doctor prescribes treatment, which may or may not include drugs, subsequent to making a diagnosis, after taking a history, doing a physical examination and/or carrying out diagnostic investigations.

A prescription is a written instruction authorising a patient to be issued with drugs and/or other treatment.

Dispensing refers to the preparation and supply of drugs prescribed by doctors.

Because of the nature of their training, doctors are legally permitted to prescribe and dispense, and pharmacists are legally permitted to dispense but not to prescribe.

The only healthcare providers who see and treat adverse drug reactions are doctors. Nurses also see adverse drug reactions and they assist doctors in treating them. However, pharmacists do not usually have practical knowledge about adverse drug reactions unless they are practising in hospitals, where they may see and assist doctors.

Drug interactions can be minimised when there is knowledge of the patient's medical, surgical, drug and family history. Such information is usually provided by patients to their doctors. This information is usually unavailable to pharmacists or, if available, insufficiently detailed.

Drugs are prescribed and dispensed by doctors. Some are branded drugs while others are generics. Many branded drugs do not have generic equivalents. Not all generics have the same efficacy as the branded drugs. It is a fact that the bioequivalence of most generics are unknown, unlike the branded drugs.

Many doctors are already prescribing and dispensing generic drugs.

When bulk purchases of drugs are made, bonuses may be given by suppliers to the purchasers, irrespective of whether they are doctors or pharmacists.

Patients seen in private clinics have a choice of having their prescriptions dispensed by the clinic or by a pharmacy. Doctors who dispense incur costs for providing the service, i.e. carrying cost for the drugs and staff salaries.

The claim that doctors prescribe and dispense expensive medicines because of profit and hold patients to ransom is inflammatory.

Claims that doctors have no knowledge about drugs, adverse drug reactions and drug interaction are mischievous and irresponsible.

The proposed pilot study by the Health Ministry should answer a fundamental question: Who decides where patients should get their drugs from; doctors or pharmacists? Or is it the patient's right to make his own choice? The MPS president's advocacy that patients be deprived of his right of choice in the dispensing of his drugs, needs an answer from the people who are affected, the patients.

No decision to stop doctors from dispensing medicine

2008-03-31T04:38:00.000+08:00

No decision to stop doctors from dispensing medicine
By : Rina De Silva and Dharshini Balan

NST, 30th March 2008

KUALA LUMPUR: The Health Ministry has not decided to disallow doctors from dispensing medicines.

Health Minister Datuk Liow Tiong Lai said yesterday he would like to meet the Malaysian Medical Council, doctors and pharmacists to discuss the matter.Liow said he was aware of the Malaysian Pharmaceutical Society's proposal for pharmacists to dispense medication to patients. "At the moment, we are still looking at the proposal. We have not made any decision yet," he said after his first official visit to the Kuala Lumpur Hospital yesterday.
Liow was commenting on a New Straits Times report yesterday headlined "Doctors to be disallowed from dispensing medicines" that quoted health director-general Tan Sri Dr Ismail Merican as saying that the move was in the pipeline.He had also said that a pilot project on the proposal would be launched soon.He said the move could not be implemented earlier because of logistics problems, especially the shortage of pharmacies and pharmacists. Liow said the most important thing was for the people to have a good healthcare system. "That is the responsibility of the government. We do not want to burden the rakyat with extra costs," he said.The Malaysian Medical Association is against the proposed move to disallow doctors from dispensing medicines.President Datuk Dr Khoo Kah Lin said the public should decide if they wanted to get medication from either pharmacists or doctors.He said a doctor's primary role was to diagnose and treat which included giving appropriate medication to patients."Therefore, doctors cannot give up their right to dispense medicine," he said.Dr Khoo said doctors were already separating the consultation fee from the cost of medication, to avoid being accused of profit-making in dispensing medicines.The MMA's recommended fee for consultation is RM30 for minor ailments. However, doctors generally provide consultation and medication for less than RM30.Dr Khoo said pharmacists should not be allowed to prescribe medications without a doctor's prescription.In another development, a senior medical consultant, who declined to be identified, said some pharmacists were already dispensing medicines and treating patients, especially after checking their glucose level and blood pressure."This is already affecting our business," he saidHe said pharmacists should refer patients to doctors for diagnosis and treatment."Their work is only to dispense medicines prescribed by doctors. Pharmacists cannot become doctors. They cannot prescribe medicines based on basic tests," he said.A doctor in Klang, who only identified himself as Dr Rahim, asked if pharmacies would be open around the clock to cover prescriptions issued by doctors at 24-hour clinics. "So who is going to dispense medicines in this context, the doctor or the pharmacies?" he asked.The Malaysian Dietary Supplement Association, however, said the proposed move to disallow doctors from dispensing medicines was long overdue.Its president, Jagdev Singh, said pharmacists were best suited to dispense medicines because they were more knowledgeable about "drug to drug interaction, drug to health interaction and adverse reactions".

No decision on docs dispensing medicine

2008-03-30T04:47:00.000+08:00

No decision on docs dispensing medicine
By TEH ENG HOCK

Star, 29th March 2008

KUALA LUMPUR: The Health Ministry has denied a report which said doctors would be prevented from dispensing medicine.
Health Minister Datuk Liow Tiong Lai said the article, which was published on the front page of a local English daily on Saturday, was not true.
"We have not made any decision at all. We are conducting a study, but it is only at a preliminary stage," he said.
The report said a pilot project on the separation of functions between doctors' clinics and pharmacies would be launched by the Health Ministry.
It also said that the pilot project would be launched at selected major towns, with the ministry closely monitoring the strengths and weaknesses of the system before implementing it nationwide.
Liow said while the Ministry was considering the request by pharmacists, the study had yet to be completed and a pilot project might not even be launched if the findings were not encouraging.
"If we find that people will be affected (negatively), we might not even carry out the pilot project," he said.
He added that he wanted to meet up with doctors and pharmacists to understand more about the issue.
"But most importantly, at the end of the day, the people must enjoy good medical services," he said.
Liow was speaking to reporters after visiting the Kuala Lumpur General Hospital on Saturday.

Move will not necessarily cost patients more

2008-03-29T06:07:00.000+08:00

Move will not necessarily cost patients more

By : Regina Lee

NST, 28th March 2008

KUALA LUMPUR: Contrary to public perception, separating the doctor's function as a healer and as a provider of medicine will not necessarily cost patients more.

Malaysian Pharmaceutical Society president John Chang Chiew Pheng said this was because consumers would have the choice of drugs.

"Many doctors usually dispense the more branded and expensive medicines simply because they get incentives and bonuses from the drug companies.

"When the consumers get their medication and make up their minds whether to get branded or generic drugs, they end up saving money.

"The Poisons Act 1952 allows for doctors to dispense drugs because there were hardly any pharmacists when the law was passed," he said.
There are now roughly 5,000 pharmacists and 13 pharmacy schools in the country that produce an average of 600 graduates every year.

Chang also said that with serious risks to health due to improper medication, it made better sense for patients to get their drugs from a pharmacist who would have spent four years acquiring the knowledge than from a doctor who had none.

"Doctors are only familiar with medicines that they often prescribe, not knowing adverse reactions and drug interactions. However, pharmacists are constantly in touch with the drugs industry," he said.

With the separation of functions between clinics and pharmacies, Malaysia will join the ranks of other developed countries around the world which separate the role of doctors and pharmacists.

In the last 30 years, Asian countries like Japan, South Korea, Taiwan, the Philippines and Indonesia have implemented the separation with varying degrees of success.

When South Korean health officials enforced the separation in 2000, tens of thousands of doctors took to the streets and forced clinics around the country to close for three days.

The various countries also experienced teething problems such as administrational confusion when charging corporate patients seeking treatment in panel clinics or claiming health insurance.

Separation laws in several countries also had loopholes, abused by pharmacists who were in cahoots with doctors for patient referrals in exchange for kickbacks.

All this, Chang admitted, could very well also happen in Malaysia if the separation was not closely enforced and scrutinised.

Move will not necessarily cost patients more

2008-03-29T05:06:00.000+08:00

Move will not necessarily cost patients more
By : Regina Lee

NST, 28th March 2008

KUALA LUMPUR: Contrary to public perception, separating the doctor's function as a healer and as a provider of medicine will not necessarily cost patients more.

Malaysian Pharmaceutical Society president John Chang Chiew Pheng said this was because consumers would have the choice of drugs."Many doctors usually dispense the more branded and expensive medicines simply because they get incentives and bonuses from the drug companies."

When the consumers get their medication and make up their minds whether to get branded or generic drugs, they end up saving money."The Poisons Act 1952 allows for doctors to dispense drugs because there were hardly any pharmacists when the law was passed," he said.

There are now roughly 5,000 pharmacists and 13 pharmacy schools in the country that produce an average of 600 graduates every year. Chang also said that with serious risks to health due to improper medication, it made better sense for patients to get their drugs from a pharmacist who would have spent four years acquiring the knowledge than from a doctor who had none.

"Doctors are only familiar with medicines that they often prescribe, not knowing adverse reactions and drug interactions. However, pharmacists are constantly in touch with the drugs industry," he said. With the separation of functions between clinics and pharmacies, Malaysia will join the ranks of other developed countries around the world which separate the role of doctors and pharmacists.

In the last 30 years, Asian countries like Japan, South Korea, Taiwan, the Philippines and Indonesia have implemented the separation with varying degrees of success.When South Korean health officials enforced the separation in 2000, tens of thousands of doctors took to the streets and forced clinics around the country to close for three days.

The various countries also experienced teething problems such as administrational confusion when charging corporate patients seeking treatment in panel clinics or claiming health insurance.

Separation laws in several countries also had loopholes, abused by pharmacists who were in cahoots with doctors for patient referrals in exchange for kickbacks.

All this, Chang admitted, could very well also happen in Malaysia if the separation was not closely enforced and scrutinised.

Doctors to be disallowed from dispensing medicines

2008-03-28T17:13:00.000+08:00

Doctors to be disallowed from dispensing medicines
By : Annie Freeda Cruez

NST, 28th March 2008

KUALA LUMPUR: Soon, doctors will not be allowed to dispense medicines. Doctors will only be allowed to prescribe medications but patients will have to get the medicines from pharmacies.

Currently, doctors diagnose the disease, prescribe the medicines and their own clinics dispense them. For almost 20 years, pharmacists have been fighting for the "return" of their right to dispense medications but had been unsuccessful for various reasons.

A pilot project on the separation of functions between doctors' clinics and pharmacies will be launched by the Ministry of Health. It is scheduled to be launched at selected major towns with the ministry closely monitoring the strength and weaknesses of the system before implementing it nationwide.

Director-General of Health Tan Sri Dr Ismail Merican said the ministry was not able to implement this system earlier due to logistics problems, especially the shortage of pharmacists and pharmacies in the country.

"We also have to take into consideration the welfare of patients. If we have the separation, then patients must have easy accessibility to pharmacies to get their prescribed medications," he told the New Straits Times.

He said the ministry had conducted a detailed study, "Pharmacy and clinic Mapping" on various issues ranging from welfare of patients, facilities available and capability of pharmacies to meet the demand."

We found that the logistics problem is still an issue and needs to be resolved as we do not want patients to be running around looking for pharmacies with the doctors' prescriptions," said Dr Ismail.

Furthermore, he said, the pharmacies should be able to provide quality care. He said the ministry had been doing the study with various stakeholders, focusing on the spread of community pharmacies or pharmacy outlets in major towns, rural and remote areas.

Some 5,000 registered pharmacists are actively practising in some 1,600 pharmacies nationwide. In 2004, there were only 3,927 registered pharmacists with about 1,540 retail pharmacies or one for every 16,445 persons.

Dr Ismail said the pilot project would be implemented in major towns based on the study where there were pharmacies near clinics.

"If the pilot project is successful, we will have to look into the existing laws to allow for the separation," he added.India, South Korea and Taiwan have implemented the separation.

Malaysian Pharmaceutical Society president John Chang Chiew Pheng said the ministry's move to conduct a pilot project was definitely a positive development which would enhance the level of healthcare delivery. The separation, he added, would benefit patients as doctors could now focus on their clinical, diagnosing, counselling and prescription, while pharmacists could focus on educating patients on how best to optimise the usage of medicines prescribed.

Furthermore, Chang said, pharmacists could help patients choose between generic and branded drugs based on their financial situation.

"With commitment and determination we can overcome teething problems and patients can understand their medicines," he added.He said if the government went ahead with the separation, then more pharmacies could be set up near clinics for easy accessibility to patients.

Suicidal

2008-03-11T22:02:00.001+08:00

Moment of tense looking at the photo. Just wonder what major issue prompted her to take such stupid action. Different versions reported. Some said she had an argument with a colleague, other said she had a quarrel with boyfriend.

Housing allowance for civil servants to be doubled

2007-12-10T16:56:00.000+08:00

Star, 1oth December 2007.

SEREMBAN: The housing allowance for graduate civil servants will be almost doubled from RM210 to RM400 effective Jan 1.
Those in the DG43 and DG44 categories would benefit from this, said Public Service director-general Tan Sri Ismail Adam.
He said graduate civil servants in the DG41 and newly created DG42 categories would see their housing allowance increased from the present RM210 to RM250. The move would benefit an estimated 150,000 civil servants.
“However, this benefit will not include police, prisons, fire and rescue services and armed forces personnel as they have their own schemes,” he said in a circular.
Police officers with the rank of inspectors and chief inspectors now get RM420 for housing allowance. Ismail said the increment would also benefit eligible civil servants in local authorities, statutory bodies and state governments and agencies.
In a separate circular, Ismail said civil servants who were fluent in certain foreign languages would be given a monthly allowance of between RM100 and RM150 if this helped them in carrying out their official duties.
“If they can speak a foreign language, it will certainly benefit our nation which has trade and diplomatic ties with many countries.
“This benefit will be given to Malaysian civil servants based at our missions abroad as well as to those working here and are required to deal with foreigners,” he said. He said the foreign languages were Arab, Mandarin, French, Russian and Spanish.
Ismail said those who had basic knowledge of a foreign language would be paid RM100 while those who were fluent would be given RM150 every month.
“They will have to submit their certificates to their department heads for consideration,” he said.
Cuepacs president Omar Osman said the increase in housing allowance should also be extended to civil servants in the Support Group who now received RM180 in housing allowance every month
“The bulk of the civil service is made up of employees in the Support group. Although we welcome the government’s decision to raise the housing allowance for graduates, why have those in the Support group been left out?” he asked.
Omar said the PSD should increase the housing allowance for this group to RM230.

Rules on nip-and-tucks

2007-11-24T11:47:00.000+08:00

Star (23th November 2007).

PUTRAJAYA: To ensure that beauty treatments do not turn ugly, the Health Ministry has drawn up a set of do’s and don’ts on aesthetic medicine.

With immediate effect, private general practitioners are not allowed to carry out procedures such as breast implants, liposuction, eyelid surgery, laser and light-based therapies and hair transplant.

They also cannot deal with unapproved agents, inject non-evidence based products like Vitamin C, placental extract, stem cells and growth hormones.

The list, drawn up following a meeting last month with relevant stakeholders, will be included in the Private Healthcare Facilities and Services Act 1998 under the director-general’s directive.

A definition of aesthetic medicine has also been drawn up. It states it is a branch of medicine dedicated to creating a harmonious physical and psychological balance using non-invasive and minimally invasive treatment modalities.

The modalities have to be evidence-based and scientifically proven on matters such as the anatomy and skin physiology.

Director-general of health Tan Sri Dr Ismail Merican said yesterday that only trained and credentialed personnel could do Botox treatment.

He added that the general practitioners could, with proper credentials and training from a recognised institute, advise on matters such as medical cosmetology, chemical peels, cellulite control, hair removal and nutrition.

“It does not mean the general practitioner has no role but they should be concentrating on procedures which are not invasive,” he said.

He added that because aesthetic medicine was not a recognised medical speciality in Malaysia, the word “aesthetic” was not allowed to be displayed on signboards.

Dr Ismail added that a proposal would be submitted to register specialists in aesthetic practices in the registry being compiled by the Malaysian Medical Council and Academy of Medicine.

He said it was necessary to draw up such guidelines because the ministry was concerned about developments in the field and wanted to keep unscrupulous practices at bay.

“If you want to look pretty, do it the right way. Make sure the right people provide you with the services,” he said.

MMR link.

Move to make sure all doctors have required skills

2007-11-23T11:53:00.000+08:00

Star (22nd November 2007)

By AUDREY EDWARDS

PUTRAJAYA: Newly-qualified doctors will have to undergo two years' compulsory housemanship from next year.

Currently, they only have to do a year of housemanship.

Health Minister Datuk Seri Dr Chua Soi Lek, who announced the Cabinet decision yesterday, said the move was considered important to increase the knowledge, skills and experience of graduate medical officers.

“This will improve the quality of services and healthcare standards,” he said.

A rotation system of four months in six departments will be implemented. With the newest inclusion being the accident and emergency department, the rest are medical, paediatric, general surgery, orthopaedic, obstetrics and gynaecology.

“We have observed that in the past few years, about three to five per cent of graduate medical officers do not get full registration because they have weaknesses in knowledge or skills,” he told reporters before chairing his ministry’s post-Cabinet meeting.

“We cannot let this continue. We hope the move is seen as a positive one by future graduates and we are confident the rakyat (people) will support us.”

After the two-year housemanship, the doctors would have to serve their three years' compulsory service with the Government or its agencies, he said.

Dr Chua said the ministry would apply to the Government to place them under the U43 grade upon completing the two years' housemanship compared to the current U41. The U43 pay scale is RM500 more than U41.

He said the doctors would be able to pursue their specialist courses or Master’s after serving two years' compulsory service compared to the current situation whereby they can only apply to further their studies after three years.

About 1,200 local medical students graduate annually.

Dr Chua also announced the Cabinet’s decision to disallow the future setting up of private cord blood banks because while it was a new service with huge potential to treat specific diseases, there were still ethical issues to be scrutinised.

He said the existing centres would have to apply for a licence from the ministry within the next two months and would be registered under the Private Healthcare Facilities and Services Act 1998.

MMR link.

eMedicine Case Study

2007-10-29T00:20:00.000+08:00

BACKGROUND

A 52-year-old man with no clinically significant medical history presents to the emergency department (ED) with a chief complaint of a “rash” on his penis. The patient states that the rash first appeared 1 week before presentation. He denies any dysuria, urethral discharge, pruritus or pain in the area of the lesion. This is the first time he has had such a rash. He admits to having had several recent sexual partners.

On physical examination, his vital signs are normal. The patient has a well-demarcated, ulcerated lesion on the ventral aspect of his penis (see Image). The lesion is not tender to palpation. No other lesions are noted, and no discharge is observed from the urethra. The findings of his testicular examination are unremarkable, with the exception of bilateral prominent inguinal lymphadenopathy. The remaining physical findings, including the cardiac and abdominal findings, are unremarkable.

What is the diagnosis, and what empiric treatment is necessary?

ANSWER.

Wet Hand Club

2006-11-02T21:28:00.000+08:00

About Wet Hand Club in MMR.

Doctor suspended over love affair

2006-10-11T00:53:00.000+08:00

10 Oct 2006 (NST)
Annie Freeda Cruez

PUTRAJAYA: Love is fine but he was a doctor and his lover was his patient.

He forgot his professional code of ethics in the heat of the moment earlier this year and will pay dearly for it.

The 44-year-old will not be able to practise for the next two years for breach of ethics.

The Malaysian Medical Council (MMC) found him guilty of the offence after an enquiry where he admitted the liaison.

In doing so, he also admitted abusing professional privilege and acting in a manner derogatory to the profession.

The MMC found that the doctor’s behaviour had resulted in disruption in the lives of the patient’s family besides distress to them.

The doctor has appealed to the High Court.

He is one of 18 registered medical practitioners suspended since 2003 after being found guilty of ethical offences.

Director-general of Health Tan Sri Dr Ismail Merican, who is also MMC president, told the New Straits Times that 15 doctors had received reprimands.

Between January 2004 and August this year, the five Preliminary Investigation Committees (PIC) in MMC investigated 344 cases, with 181 yet to be resolved.

At council level, 45 cases had been acted upon while 18 cases were pending.

Other instances of a breach of ethics included:

• A 47-year-old doctor at a clinic in Johor being suspended for two years after being convicted for offences under the Poisons Act and fined varying amounts or imprisonment in default.

• A 34-year-old doctor running a private clinic in Taman Sri Manja, Petaling Jaya, who was suspended for six months after being found guilty of circulating leaflets entitled Kempen Percuma announcing free services at her clinic.

• A 58-year-old doctor with a maternity home in Johor being reprimanded for forging the signature of another person on a loan document.

He was charged in Sibu, Sarawak, and on appeal was sentenced to a day’s jail and fined RM10,000 in default four months jail.

The MMC also decided in its meeting yesterday that it would publish the names of errant doctors even if they had appealed to the High Court.

Previously, it did so only if an appeal had not been lodged or if an appeal had been overturned.

Of the 15,797 practising medical practitioners, less than one per cent are engaged in unethical practices.

Dr Ismail said the council could not take action on occasions against doctors as some complainants did not want to appear before an enquiry, information given was inadequate or the complainant could not be contacted.

No reason to lift the ban

2006-10-09T21:36:00.000+08:00

NST: 06 Oct 2006
S.M. MOHAMED IDRIS, President, Consumers Association of Penang

THE Consumers Association of Penang is shocked that the ban on the highly toxic weedkiller, paraquat, would be lifted.

This is in spite of calls from various concerned parties urging the government to not only maintain the existing prohibitions on paraquat, but to issue a final outright ban.

The reason for the decision is nothing short of ridiculous. Pesticide Control Division director Nursiah Tajul Arus said: "We want to do an extensive study on paraquat, on its harmful effects and positive aspects, before the date is set for its total ban in November next year."

Studies done both globally and locally have already demonstrated the serious adverse effects of paraquat.

It is one of the most toxic herbicides to be marketed in the past few decades. There is no known antidote treatment for paraquat poisoning.

Health problems such as severe dermatitis, second degree burns, kidney failure and respiratory failure have been linked to this chemical.

It has also been known to damage the lungs, heart, kidney, adrenal glands, central nervous system, liver muscles and spleen, causing multi-organ failure.

In addition, paraquat has been associated with developmental and reproductive adverse effects, as well as links to skin cancer.

The Pesticide Board carried out consultations with the relevant government departments, the academia, the industry and researchers before it made a decision to ban paraquat in 2002.

There is no justification now to expose the whole country to this toxic chemical for the sake of conducting studies.

The government’s decision, and especially the Pesticide Board’s recommendation for the ban was a courageous move that was noted worldwide. The authorities should not waver in their decision.

CAP calls on the government to immediately overturn the plan to temporarily lift the ban this Nov 1. The arrangement for the ban should be followed through.

The public should join in by urging the government to not go back on its earlier decision to phase out paraquat.

There is no justification for jeopardising the health of the public by allowing the registration of paraquat for all crops to facilitate studies.

Set up wards for the old

2006-10-09T00:44:00.000+08:00

By NIK KHUSAIRI IBRAHIM (The Star, 4th Oct 2006)

The government has been urged to set up special wards in hospitals for elderly people.

Asean NGO coalition of ageing president Lawrence Cheah Seong Paik said ideally, every hospital should have a geriatric ward.

“We need geriatric specialists to treat elderly patients in view of their special needs.

“With the rising ageing population, the government needs to look into this seriously,” he told newsmen during the Se-nior Citizen health awareness campaign at Caring Society Complex recently.

Lioness Club of Penang and Penang Senior Citizen Associa-tion organised the day-long event that was opened by Health Parliamentary Secretary Datuk Lee Kah Choon.

The health programme att-racted some 200 senior citizens.

Cheah, who is also the Penang Senior Citizen Association pre-sident, said for now senior citizens had no choice but to seek treatment from general practitioners.

“Many of the elderly are complaining that they have to see so many different doctors be-fore they are diagnosed,” he ad-ded.

“Better and faster treatment could be accorded to the elderly patients if they are treated by geriatric specialists,” he ad-ded.

Lee said Universiti Hospital in Kuala Lumpur and Seremban Hospital had set up special units to treat senior citizens.

“But they have yet to set up special wards for the senior citizens,” he said, adding that about 5% of the 26 million population are senior citizens.

Lee also said that there was shortage of urologists in the country.

“Now we only have 60 urologists in the country, we need an additional 300 to cater to the population,” he said.

Lee said the three most popular fields for specialists are cardiology, obstetric and gy-naecology, and paediatrics.

Ban on paraquat lifted for study

2006-10-09T00:38:00.000+08:00

By M. KRISHNAMOORTHY (The Star, 3rd Oct 2006)

KUALA LUMPUR: The ban on the herbicide paraquat will be temporarily lifted from Nov 1, to allow a comprehensive study on its many uses.

The Pesticide Control Division under the then Agriculture Ministry banned the weedkiller for its hazardous effect on health in August 2002.

The decision to temporarily lift the ban by the Agriculture and Agro-based Industry Ministry now was made following appeals from farmers and manufacturers to look at the greater uses of the herbicide.

“We want to do an extensive study on paraquat, its harmful effects and positive aspects, before the set date for its total ban in November next year,” Pesticide Control Division director Nursiah Tajul Arus told The Star.

Although the ban was imposed in August 2002, paraquat products such as Syngenta's Gramoxone, which were previously registered for use, were being phased out in stages by November 2007.

“If it is proven that paraquat’s usefulness outweighs its negative impact, we may have to review its usage.

“The Agriculture Department wants to review paraquat’s effectiveness on various plants and cash crops,” she added.

To facilitate the study, the Pesticides Board is now allowing registration of paraquat for all crops.

Federation of Malaysian Conumers Association consultant for health and environment Josie Fernandez said: “It is surprising that the Government is reconsidering the ban on the one of the most hazardous poisons in the world – and it has no antidote.

“Paraquat causes a litany of problems to plantation workers and farmers including severe illness and death.

“The Government should not compromise on the safety and health of poor workers.”

Fernandez said some corporations in Europe had declared that they would not import palm oil from nations that use paraquat in plantations as the palm oil might carry traces of the poison.

A study by the National Poison Centre in 2002 showed that women using paraquat suffered nosebleeds, tearing of the eyes, contact dermatitis, skin irritation and sores, nail discolouration, dropping of the nails and abdominal ulcerations.

Pesticide Action Network Asia and the Pacific executive director Sarojeni V. Rengam said: “It is lamentable that the Government has taken a step back on this dangerous chemical.

“It has come to our attention that the industry has been putting pressure on the authorities to repeal the ban.”

“The total ban should have taken effect in 2005, but a phase out period has been extended till 2007 after appeals by the industry,” she said.

The PHFS Act (1998) and Regulations (2006) – an update

2006-09-17T10:47:00.000+08:00

The PHFS Act (1998) and Regulations (2006) – an update

BY Dr CHANG KENG WEE (Star, 17th Sept 2006)

IT has now been about four months since the Private Healthcare Facilities And Services (PHFS) Act 1998 And Regulations (2006) has come into force. The various open dialogues between the Health Ministry, the Federation of Private Medical Practitioners’ Association of Malaysia (FPMPAM) and other relevant stakeholders have culminated in a relatively easy registration process for private medical practitioners (see table).

For existing clinics (before May 1, 2006), registration can be made using Form A or online at http://medpcs.moh.gov.my. Duplicate copies of duly certified documents required include:

i) Annual Practising Certificate,

ii) Professional & or Specialist qualifications

iii) Assessment rate receipt

iv) A sketch plan that includes dimensions of physical structures

v) Contracts with any Managed Care Organisation if available

To facilitate the registration process, the various state private practitioners’ associations have been holding workshops with the co-operation of the relevant state health departments. The PMPASKL will be holding such a session on Sept 24 at the Sime Darby Convention Centre, Bukit Kiara, from 2-6pm. Doctors in the Klang Valley are encouraged to attend and at the same time hand in their registration forms to the State Health Officers who will be there to register them.

It is thus time to move on to facilitating compliance as seamlessly as possible with the specifications of the Regulations without causing undue interference to the delivery of patient care in the private sector. Implementation will have to be done gradually and without causing undue inconvenience and distress to the sick patient, the public and the doctor.

The Clinic Manual and Standard Operating Procedure (CMSOP)

One of the first important milestones in the process of compliance, which takes effect the moment a clinic is registered, is administrative compliance. The PHFS Act (1998) and Regulations (2006) requires that all private clinics shall have specific written policies and standard operating procedures to ensure that quality of care is maintained.

As part of our service to members in the private sector and to bridge the needs of the regulators, doctors and patients for better healthcare, the FPMPAM, in conjunction with the Health Ministry, has produced the Clinic Manual and Standard Operating Procedures (CMSOP), which was officially launched by the Health Minister on Sept 11 at the Marriot Hotel, PutraJaya.

The CMSOP will help private clinics streamline its administration almost immediately and to enable it to deliver better service to the patient while complying with the Act.

It is hoped that the CMSOP will set the bar for responsible and ethical clinic governance, and enable doctors to continue their good work in healing those in need while meeting the new provisions of PHFSA.

Among the many items in the CMSOP is a set format for Patient Grievance Mechanism and also a format for provision of Emergency Medical Care as required by law. The CMSOP can also be adapted for private dental clinics as well.

Four thousand copies will initially be distributed at cost to doctors via the individual state private practitioners associations that are members of the FPMPAM, with additional copies to be printed for distribution to all doctors.

Each book is priced at RM25, which covers the cost of its printing and production.

Safeguarding standards in private medical care

As the national medical body, the FPMPAM represents the interests of private medical practitioners in providing accessible, quality and compassionate patient care.

It is the stated objective of the FPMPAM to safeguard the foundations of ethical and responsible medicine while building on the sanctity of the patient-doctor relationship. Our motto, “Duty before Self”, is a testimony to this objective.

The FPMPAM is supportive of reforms to the nation’s healthcare system when they are aimed at improving the delivery and efficiency of healthcare services, upgrading facilities and treatment options available to patients, and enhancing the integrity of the medical profession.

As members of the medical profession and uncompromising advocates of our patients’ welfare, we acknowledge that there are inherent strengths and weaknesses in our current healthcare system, and that it has a large role to play in improving healthcare in Malaysia.

When the Private Healthcare Facilities Act and Regulations (PHFSA) was announced in May this year, the reaction of doctors all over the country ranged from anxiety to strong disapproval.

The profession is fortunate that the Ministry is sympathetic to the concerns of doctors and has the discretion to distinguish between healthcare policies that will likely succeed and policies that will likely do more harm than good.

Rather than a purist approach, the Health Ministry has welcomed input from parties affected by the new law, and has adopted a flexible and responsive approach in the implementation of the PHFSA.

While the FPMPAM has made significant strides in building consensus with the Ministry on the implementation of the Act, we are aware that there are outstanding issues that are of concern to doctors and patients in the country.

Important points to note for concerned parties are several proposals that are still under consideration by the Health Ministry, which aims to address the implications of emergency care, and the specific physical requirements for complying with the Act.

We look forward to a quick agreement with these proposals so as to provide a truly conducive social and clinical environment for doctors and their patients.

The Good Samaritan Clause

The PHCFS Act and its Regulations require that clinics provide emergency medical services to the occasional patient that is brought to the clinic. It is the position of the FPMPAM that patients in dire straits should not be turned away by the clinics.

However, it must be noted that this provision in its current form in the Regulations has too many grey areas which potentially will open the door to increased medico-legal litigation, an increase in medical indemnity insurance and eventually encourage defensive medicine. At the end of the day, it is the patient and the public that will have to carry this extra burden.

The FPMPAM has proposed a “Good Samaritan Clause”, which essentially states that, short of gross negligence or professional incompetence, doctors providing free and voluntary emergency care for such patients that are brought to the clinics should be protected from liability. This is only fair as the law is needed to protect those who need help, but also those who provide help.

General Provision (Regulations Part IX)

The Regulations also require many clinics to renovate extensively to comply with the general provisions of the Regulations.

Some of these provisions, like providing doors and passages to be 1.2m, is not possible in many clinics in view of the existing physical limitations of these buildings. Clinics that are located on the first floor of shop houses, including many dental clinics, will find this a major undertaking.

Furthermore, to renovate, many clinics will have to close for periods of time ranging from two to more than six weeks depending on the type of renovation that needs to be done. There will be considerable inconvenience to the patients and the public.

From the survey of clinics by the FPMPAM in Kuala Lumpur, Selangor, Perak, Perlis, Kedah and Penang, the estimated cost of renovation to the private sector will be in excess of RM250 million, not to mention a whole host of other intangible costs.

The FPMPAM is happy to note that the Health Minister, in his speech during the launching of the CSMOP, had mentioned that the Ministry will consider appeals on a case-by-case basis.

Conclusion

The medical profession is as old as age itself. Medicine, with its noble legacy of healing, is rich and momentous beyond comparison. The doctor’s duty is always first and foremost to his patients and the advancement of the patient’s health and welfare.

As a regulator, the Government can build safeguards, incentives and disincentives into our health care system, but the good and honest professional never needs to fear the regulator.

Note: Dr Chang Keng Wee is honorary secretary of the Federation Of Private Medical Practitioners’ Association Of Malaysia (FPMPAM).

Spotlight: Kidneys always on his mind

2006-09-16T12:08:00.000+08:00

15 Sep 2006 (NST)
ANNIE FREEDA CRUEZ

After 30 years of dedicated service at the Kuala Lumpur Hospital, consultant nephrologist Datuk Dr Zaki Morad Mohd Zaher is clocking out for the last time today, but don’t expect kidney diseases to be far from his mind, writes ANNIE FREEDA CRUEZ.

WHILE many people can’t wait to get out of a hospital, consultant nephrologist Datuk Dr Zaki Morad Mohd Zaher is reluctant to leave.

Not after 30 years of calling the Kuala Lumpur Hospital his second home.

When we caught up with him a few days before his retirement, Dr Zaki’s office was in a mess as he packed his medical tomes, and stacked medical CDs into boxes.

It is not that he dreads the prospect of clocking out for the last time today, but his sadness stems from the fact that he can no longer serve his patients with the same dedication he had shown all these years.

Celebrating his 56th birthday on Monday, Dr Zaki has come a long way from the day he reported for duty. Then, he was one of only two specialists in the nephrology department. The other was (Tan Sri) Dr Abu Bakar Suleiman, who later became the director-general of Health.

Recalling the challenges of those early days, Dr Zaki, who has the distinction of being KLH’s longest-serving doctor, said: "It was a depressing period as there were only two of us, six dialysis machines and a handful of beds.

"Hundreds of kidney patients were referred to us from all over the country every year, and many had to go home disappointed because there were no available beds and not enough dialysis machines."

The dialysis machines, he said, were dinosaurs which required patients to sit for eight hours, unlike today’s machines which only need four hours to do the job.

"By the time the patients finished their sessions, they could hardly walk."

What a contrast to his current surroundings where there is now an entire institute dedicated to urology and nephrology, with state-of-the-art facilities, the latest diagnostic machines and a kidney transplant team.

There are now five consultant nephrologists, six specialists, seven medical officers and a team of well-trained allied healthcare staff.

"All major hospitals in the country are now well equipped to handle kidney patients, with many providing dialysis treatment," he said, adding that this was also available in remote parts of the country, including Sabah and Sarawak.

Despite the hardship of his early days at the Kuala Lumpur Hospital, Dr Zaki was never tempted to join his peers in private practice.

"More kidney patients come to government hospitals for treatment compared with private hospitals. I felt I could serve them better if I stayed on here ."

Born on Sept 18, 1950, Dr Zaki’s aptitude for learning was evident from his school days in Langkawi, where he completed his education at a younger age due to double promotions.

He was offered many scholarships, including one for engineering overseas, but he opted to further his studies in Malaysia.

He obtained his MBBS from Universiti Malaya in 1975.

Dr Zaki started his career at KLH in 1976. He did a brief stint at the Kangar Hospital, in Perlis, before returning to KLH, where he served in the nephrology unit with Dr Abu Bakar before joining the department of medicine for two years.

He was handpicked by Dr Abu Bakar to be a nephrologist, and sent for a two-year training stint in Britain.

Upon his return, at the age of 33, he was promoted to consultant nephrologist.

Three years later, in 1987, he was appointed the head of the department of nephrology.

During his tenure, Dr Zaki introduced special areas in nephrology, and developed critical care nephrology, interventional nephrology, glomerular disease and chronic kidney disease prevention — and widened the scope of transplants and dialysis.

He also spearheaded the initiative to improve the quality in dialysis by introducing haemodialysis standards.

Dr Zaki, who headed the Clinical Research Centre in the Health Ministry from 1999, has produced a number of publications in collaboration with other researchers.

Asked about his vision, he said: "I want the government to take a proactive role in reducing kidney cases in the country by working together with primary care providers, as it’s very expensive to treat kidney patients. There is a need for a national programme."

While he may no longer be actively involved in the treatment of patients at KLH, Dr Zaki has no intention of taking things easy.

He intends to take up an offer to lecture at the International Medical University.

Dr Zaki is currently the president-elect of the Asian Pacific Society of Nephrology, a member of the Education and Curriculum Advisory Committee, International Society of Nephrology (ISN), and chairman of the sub-committee for the Southeast Asia Commission for the Global Advancement of Nephrology of the ISN.

He is also the vice-chairman of the National Kidney Foundation.

More:
Star

Anytime You Need a Friend

2006-09-14T22:40:00.000+08:00

If you're lonely
And need a friend
And troubles seem like
They never end
Just remember to keep the faith
And love will be there to light the way

Anytime you need a friend
I will be here
You'll never be alone again
So don't you fear
Even if you're miles away
I'm by your side
So don't you ever be lonely
Love will make it alright

When the shadows are closing in
And your spirit diminishing
Just remember you're not alone
And love will be there
To guide you home

Anytime you need a friend
I will be here
You'll never be alone again
So don't you fear
Even if you're miles away
I'm by your side
So don't you ever be lonely
Love will make it alright

If you just believe in me
I will love you endlessly
Take my hand
Take me into your heart
I'll be there forever baby
I won't let go
I'll never let go

Anytime you need a friend
I will be here
You'll never be alone again
So don't you fear
Even if you're miles away
I'm by your side
So don't you ever be lonely
It's alright
It's alright

Mariah Carey

ECOLI

Housemen not over-worked in hospitals

1MALAYSIA CLINICS: Lift our nurses' standards

1MALAYSIA CLINICS: Lift our nurses' standards

MEDICAL FACILITIES: Rethink 1Malaysia clinic move

Housemen lack basic know-how

Housemen lack basic know-how

‘She was ripe for the plucking’

‘She was ripe for the plucking’

By CHIN MUI YOON

Ruling ‘will not solve shortage of doctors’

Ruling ‘will not solve shortage of doctors’

Not enough specialised nurses to go around

Government offers perks for doctors

Government offers perks for doctors

By EMBUN MAJID

Minister: Plan to double locally-trained specialists

Minister: Plan to double locally-trained specialists

By NG CHENG YEE

Govt hospitals getting ready for higher traffic

Govt hospitals getting ready for higher traffic

By SIM LEOI LEOI

85 complaints made against petrol stations

85 complaints made against petrol stations

Public transport, school bus operators warned against raising fares

Public transport, school bus operators warned against raising fares

By IZATUN SHARI

Parents refuse to honour children’s pledge after their deaths

Retirement age now 58

Come back and we’ll treat you right, Malaysian medical specialists told

Health Ministry did act on complaint

Health Ministry did act on complaint

Hospital review apt in costly times

Hospital review apt in costly times

COMMENTBy TOMMY LEE

No action taken to nab bogus doctor

No action taken to nab bogus doctor

Health Ministry to test drive-through project at Penang Hospital soon

'Patients want their pills from clinics'

'Patients want their pills from clinics'

How some Asian nations handled dispensing split

How some Asian nations handled dispensing split

News Focus: Doctors or pharmacists?

News Focus: Doctors or pharmacists?

Long wait to see govt specialist

Long wait to see govt specialist

By YENG AI CHUN

Dispensing medicine: Patients should be given a choice

Dispensing medicine: Patients should be given a choice

Grads prefer to stay on overseas

By SIM LEOI LEOI

Unrecognised medical graduates

National health financial scheme

Separation of doctor/pharmacist duties: 'Patients shouldn't suffer'

Separation of doctor/pharmacist duties: Diverse opinions on plan

Dispensing medicine: Address the central issue

Dispensing medicine: Address the central issue

No decision to stop doctors from dispensing medicine

No decision on docs dispensing medicine

Move will not necessarily cost patients more

Move will not necessarily cost patients more

Move will not necessarily cost patients more

Doctors to be disallowed from dispensing medicines

Suicidal

Housing allowance for civil servants to be doubled

Rules on nip-and-tucks

Move to make sure all doctors have required skills

eMedicine Case Study

Wet Hand Club

Doctor suspended over love affair

No reason to lift the ban

Set up wards for the old

Ban on paraquat lifted for study

The PHFS Act (1998) and Regulations (2006) – an update

Spotlight: Kidneys always on his mind

Anytime You Need a Friend

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By TOMMY LEE