Africanisation of Malaysian Healthcare

Letter by Elmina Joseph

I refer to Chris Anthony’s letter “Ensure quality at 1Malaysia clinics” in Malaysiakini and couldn’t agree more.

It appears both the Consumers Association of Penang (CAP) Chairman, S. M. Idris and the current DG of Health are clearly consumed by politics rather then ethics. Idris in particular chooses conveniently to sing where the wind blows without an iota of decency nor morality. Whatever happened to his lofty ideals of doctors being properly qualified and trained before they are even allowed to touch patients? Not forgetting the fact that he was one of the prime movers that doctors in this country be leashed by the offensive Private Health Care Facilities Act that govern all clinics.

Perhaps his memory has failed him. Or perhaps he now sees himself championing the cause of the poor even though they only get to see Medical Assistants instead of doctors. Miraculously according to him Medical Assistants who used to help in private and estate clinics are “experienced and qualified” to see patients independently. A far cry from his usual “unqualified, unregistered practitioners”. He backs up his claims now quoting various examples such as nurse practitioners he conveniently has picked from other countries where it appears to be the practice.

Before Idris gives his stamp of approval for Medical Assistants to diagnose, investigate and treat patients independently, he should perhaps wake up to the fact that Nurse Practitioners in the US have nothing less then an MSc degree. Similarly Nurse Anesthetists in the US who are frequently compared with our GA (General Anesthetic) giving MAs in Sarawak are highly qualified Msc graduates after they have gained a Basic degree in nursing and years of experience. This applies to almost every other field including Nephrology, Cardiology, Perfusion, Rehab, etc. All these health professionals possess nothing short of a Diploma, a Basic degree and eventually an Msc degree. One writer even quoted perfusionists in this country numbering close to 30 who run heart lung machines for open heart surgery based only on their MA Diplomas. Not a single of them has a Diploma nor a degree in Perfusion.

It would be interesting to analyze the mortality and morbidity results as a result of mishaps arising from MAs backing up as technicians who are unqualified in their specialty fields. The MMA appears to have already published one such article. The same applies to our anesthetic MAs in Sarawak. In the field of trauma, EMTs (Emergency Room Technicians) are adept at resuscitating patients be it in trauma and cardiac arrest after stringent training standards and qualifications both in pre and post-hospital care. This is clearly not the case with our MAs, though it is no fault of theirs. Both Idris and Merican’s contention that they are qualified to do so are politically expedient. Unsuspecting patients could be misdiagnosed, overdosed or just plainly given the wrong medication for life threatening conditions. The government no doubt will have to bear ultimate responsibility – again with tax-payers money as evidenced in the numerous deaths that occurred at our “Skim Latihan Khidmat Negara”

We are not in an African situation where there are genuinely no doctors or a Zimbabwe situation where Mugabe actually bankrupted the Healthcare system leaving thousands to die of cholera and dysentery. This country has more then 25 medical schools, far more then Britain itself which has population more then twice ours. The primary problem in this country has always been maldistribution of medical practitioners and the Health Ministry’s, especially with this DG’s, continual confrontation of all private doctors who comprise more then half the doctors in this country is the essential cause for this state of affairs.

The CAP president must ponder why then should the cream of this country’s students plod through their PMRs, SPMs, strive through A levels, trudge through 5 years of Medical School, two years of housemanship, three years of compulsory service and on some occasions another 5 years of specialist training. The answer is obvious. It is to attain a level of competency so that Malaysians are better served in safe hands. But now these 1Malaysia clinics blow all that away don’t there?

By establishing a very political branding, 1Malaysia Clinic has brought to the healthcare door the bane of gutless politics. Mismanagement and poor accountability have been the keystones for the decline in healthcare provision in Malaysia. Leaking hospitals, non-functioning IT hospitals, hospitals without operating theaters and indeed in Sabah, not even a General Hospital!

Right from this DG’s recent bungling in the H1N1 debacle where he made all of Malaysia run to Sungai Buloh Hospital instead of first being properly screened by primary care/surveillance doctors as in most countries and in the process piling up a death toll 70 if not more Malaysians till the current dengue scourge, he now seems to have advised his ignorant political partners that it is OK although illegal to provide Medical Assistants and Staff Nurses to provide “simple” medical care to poor unsuspecting urbanites. Why is it not OK to just let doctors in numerous GP clinics in urban areas see them and subsidize their bills? Even a poor Bangla Deshi factory worker gets to see a doctor courtesy of his factory. Could it be because of the DG’s intolerable abhorrence for General Practitioners? What happened to his lofty rules where every GP should adhere to all those dim-witted regulations that he and his bungling team sod down the throats of Malaysian General Practitioners.

The current DG is an acute embarrassment to Malaysian Healthcare and has now made this country a laughing stock in the eyes of the world. Before he goes off to become Vice-Chancellor or some similar position in a medical school he helped approve , this DG must remember that there will be a price to pay for ultimately misleading this country and its leaders.

With the setting up of 1Malaysia Clinics, is the Ministry of Health implying that only Medical Assistants are good enough for our urban poor and not doctors? Is it because the urban population is poor and that Medical Assistants should suffice. Or have Medical Assistants now become now equivalent to doctors in general. If that be the case we don’t need 25 medical schools do we?

Both Idris and Merican’s pathetic attempts to rationalize a poorly thought out avenue for the provision of healthcare to our urban poor in a country that clearly has the financial resources to better its healthcare is not only bound to backfire but will in the end have patients themselves ultimately paying a heavy toll, sometimes with their own lives. When the sands of the political divide eventually settle, the players responsible for this debacle, Liow, Merican and Idris will eventually have to answer to the Malaysian public.