Today, another piece of news appeared in the Star regarding the same college which I wrote about, 3 weeks ago over HERE. It is rather sad to hear that hundreds of students will likely be affected. None of their programs are yet to be accredited by MMC except the abandoned twinning program with Indonesian University. What will happen if MMC decides not to accreditate this university? Looking at the current scenario, teaching facilities and staff situation, very likely MMC will NOT accreditate this university. The worst affected will be their local program and the MD UKM program.  From my previous post, i received few comments from students who were doing the twining program with the 2 Ireland universities. It was mentioned that most of the government sponsored students were absorbed into the Ireland university’s 5 year program. If I am not mistaken, they had to start from Year 1 again.  I am not sure about the self paying students. The whole idea of twinning is to reduce cost.

Over the years, I told many students who wanted to do medicine in this university NOT to accept the offer. Right from the beginning I had doubts about this university. No university in this world can run 5 medical programs. Unfortunately, due to their “generous” scholarship offer, many students/parents were “tricked” into accepting the offer without checking the background, teaching facilities etc. The human nature is to find the cheapest possible way to make their children a doctor. As I have said many times before, doing medicine is not just about getting a degree. It is more than that.

If indeed the university is in dire need of money, the only option is to sell it or ask the state government to buy over. Sheffield university was bought over by the Perak state government when they went into financial difficulties in late 1990s. It was renamed Royal College of Medicine of Perak till it was sold to UniKL few years ago. The same situation might happen over here. It is considered a bail-out but do the government have enough money now? Furthermore, the state government is under the opposition where as the owner of this uni is considered a close ally of the federal government. This was evident from past newspaper promotional activities of the college where DPM, ex-PM attended.

From today’s article in the Star (see below), it was mentioned that students are not allowed to enter the teaching government hospitals. I am not sure what is happening but very likely the university is not paying the HODs of the hospital. Generally every university has to pay each HOD of the hospital a monthly allowance of about RM 800-1500 to facilitate teaching of the students in the wards. The HODs have every right to block the students from entering the wards if there is a conflict.

Over the years, many did not believe the advice that I gave. I talked about the reality on the ground but people get carried away with the promises given by businessman. Many would like to believe what is written in the brochure and promises by the respective marketing team. For over 4 years, I wrote about all these marketing gimmicks and yet people refuse to believe. Perdana University promised their own teaching hospital by the time the first batch reaches final year! Again, I was sceptical. To date, even the ground work has not started!! The government is to be blamed for all this mess but our society also need to wake up from their sleep. WE have an ignorant society. Many refuse to believe what is written in this blog despite facts and figures. Many feel that it is all negative and nothing positive. BUT, what is written in this blog will NEVER be told to you by anyone else. It is the reality and the truth. The truth hurts. If you want to hear positive things, just open the mainstream newspaper daily!

Anyway, I hope an amicable solution will be taken by the college for the sake of the students. Many of them may need to transfer to another college and redo their entire course. UKM may even pull out their degree. Hope everything will end well.

This will likely be my last blog entry till the MMA AGM in Johor. Please do come down to JB to attend the AGM

AUCMS students badly hit by school’s financial woes

BY RAHMAH GHAZALI

PETALING JAYA: Hundreds of Penang-based private medical school Allianze University Medical Sciences (AUCMS) students have suffered from the school’s financial crisis, which has allegedly dragged on for a year.

An employee, who spoke on condition of anonymity, told The Star Online that the students were no longer allowed to serve their practical years in some government hospitals due to the college’s poor track record.

“There are many occasions where the students are not allowed to enter the wards as the hospital’s departments refused to accept students from AUCMS.

“They complained that the quality of teaching in AUCMS has been below the standard of medical school,” he claimed.

The plight of AUCMS employees was highlighted in The Star Online on Apr 22, with some turning to loan sharks in desperation as their salaries have allegedly not been paid in four months.

Despite repeated reminders to the college’s management including a signed petition, the employee said their concerns have been ignored.

“Our patience is running thin. It’s been five months now and we haven’t received a sen yet,” he said, adding that the employees are planning to take legal action against the college.

“More than 65 employees have signed a petition letter demanding their salaries, Employees Provident Funds contributions and scheduler tax reduction are paid according to their contracts.

“However, the management still has not responded to the petition,” he said.

He also said the employees are threatening to boycott the classes due to the ongoing problems.

“Our medical faculty is also badly hit as many high-ranked and clinical lecturers have left to other institutions,” he said.

He added that the employees have decided to take legal action against the college for the unpaid salaries.

AUCMS president Datuk Dr Zainuddin Md Wazir had previously said that they were going through some “financial hiccups” and vowed to make the outstanding payments as early as this month.

When reached for comments, Zainuddin said the management is “sorting it out the issue immediately.

“We acknowledge their problems and we are in the midst of settling it,” he said, briefly.

AUCMS is a private learning institution located at Kepala Batas, Penang that runs specialised courses of study in medicine, hospitality, tourism, sports science and allied health sciences.

Read Full Post »

26th February 2014 was the day I woke everyone up. When I wrote an article with the title ” A Wake Up call? “, I never ever thought that it will go viral in social media and indeed, waking everyone up! I posted the article on 25/02/2014 at around 11.30pm. The next day I had a staggering 51 113 views in a single day, the highest ever recorded, equivalent to what I usually receive in a month! Almost 4000 came from Russia. It received almost 450 comments to date. 7 000 people shared in Facebook and 96 tweets were made. I spent almost the whole day trying to reply to many of the comments that I received,  replying mainly from my iPad and Blackberry Z10 mobile phone.

I had a lot of nasty comments but many of it were from people who did not really understand what I actually wrote. Many were accusing me of degrading Russian graduates etc. This is a problem which I commonly see among many of the younger generations. They pick a single sentence and accuse people of something. I saw many “would be” doctor’s attitude which is rather shocking and just proved some of my comments on quality! When you read an article, the interpretation should be based on the entire article and not a single sentence. The fact remains that there are many unqualified students who are doing medicine overseas, including Russia, Indonesia, China and Middle East. Some of the comments that I received proved that as a fact. This is one of the reason why the quality of products of these universities are poor. No matter what people think, you need certain level of intelligence coupled with true passion and interest to become a good doctor. This is what the entire article is all about. Of course, I did mention that there are good, hardworking graduates from Russia/Indonesia etc but majority of these graduates are those with good entry qualifications who had no choice but to go to these countries due to financial constraints or government sponsorship. This fact was again supported by many of the comments in this blog. Many comments also supported the fact that graduating from these universities are not difficult. Trust me, the same scenario is happening within our own country.Of course there are also students with good results but turn up as a “bad” doctor but the probability of these happening is very much lower than the other. This usually happens as they were not interested in medicine anyway.

Then, there was another issue on using SPM results as an entry qualification. Despite me mentioning very clearly that I would prefer a good established, standardised Pre-U course as an entry requirement into medical course, there were many who accused me otherwise. The SPM minimum requirement is from MMC and not by me! I believe that it was the SPM result that I posted in the article that attracted visitors from all over the world. Many were shocked to see a person with such a result becoming a doctor. You can argue till the cow come home but it is a fact that you need a good entry qualification (established Pre-U course), at least top 10% of the cohort, to enter a medical school in many developed countries. For those who say otherwise, why not you try to do that  in countries like US, UK, Australia/N Zealand and many of the European countries? They will ask you to fly kite! These countries also have a good quality monitoring system in place, after graduating.

It is also a known fact that the quality of doctors are deteriorating. This is due to reasons such as the one mentioned above, mushrooming of medical schools with inadequate academics and inadequate housemanship training (due to oversupply). These poorly trained doctors are then released to the community with a “license to kill”! Frankly, a doctor can kill a patient with a stroke of a pen. Many of these doctors do not even know what they don’t know (lack of insight)! Imagine a patient with Chronic Renal Failure being given high dose NSAIDS leading to a fatal Acute Renal Failure! Yes, it has happened! Imagine a postmenopausal bleed being told to be normal and discharged ! A 74-year-old lady with 1st episode of seizure being discharged after a pint of drip (Na 115)! These are just the tip of the iceberg. I can give you dozens of examples which is happening on a daily basis. These doctors who are completing the housemanship are the ones who are forming the backbone of the entire healthcare system in this country. Klinik Kesihatans, District Hospitals and even in general hospitals, MOs are the most important front liners. The deteriorating quality of doctors will bring down the entire healthcare quality of these country! Numbers does not matter, quality matters! Thus, when I said that many of these poor quality doctors will end up as GPs or chronic MOs, many GPs were unhappy with me. Again, they quoted a single sentence in my comment and said that I am degrading GPs. My sentence was from a series of comments that I was replying. I was saying that, many of these “poor quality and poorly trained” doctors will end up as GPs, and who monitors them? Once they open their clinic, they answer to nobody. Again, don’t misquote me. I know many good doctors who have become GPs. Many of them are my good friends and they know what I am talking about. I am talking about the future. We can’t compare the training that we got from what the current generation of doctors are receiving. Same goes to some of the junior specialist who leave to private sector too early without adequate experience. We need a proper monitoring/upgrading system in place.

2 days after I wrote the infamous article, I had a chance to meet up with the MMA President and Secretary in JB. They came down on 27/02/2014 to discuss our preparation for the upcoming National MMA AGM in May 2014.  Our President just attended a meeting in Putrajaya with MOH officials, WHO representative etc. He revealed a shocking information. According to WHO representative, they had never issued any statement regarding doctor: population ratio of 1: 400 for a developed country ! WTH! All these while, it was these ratio that was quoted by our government in producing more doctors and the mushrooming of medical colleges. The news appeared in the Star on 9/03/2014 (see below). The reason why WHO never made such statement is because they are well aware that quality will be compromised to achieve the ratio. That is exactly what is happening in this Bolehland………………..

AS we mourn the lost of MH370 and being in the spotlight of the world with flying bomohs, I hope we will not see a future where our people go to neighbouring and other countries to seek medical treatment!

Read Full Post »

My last blog entry on 17/02/2014 received the highest number of views in a single day since it started, 4 years ago. It achieved 11 195 views in a single day!! This goes to show that there are many who are worried about the situation. I also received few emails and blog comments from students who are doing medicine elsewhere without the minimum requirement introduced by MMC in 2011. It is very sad that our society is still a very ignorant society. Some of them are not even aware of the guideline! Are we leaving in caves?  With the information technology, there is no excuse! I would blame it on our education system!

When I read some of the comments and emails, I realize that there are many who are doing medicine with pathetic SPM results. Majority do not understand what medicine is all about.  With many dubious and mediocre medical schools out there, getting an MBBS degree is as easy as any other course. What you need is just money!! Money talks! How many students who go to Russia ever failed their 5 years medical course?  We have heard and seen many mediocre students doing medicine in Russia as well as in some other universities in Indonesia, China and Eastern European countries. I know one who got 9Fs in SPM but was doing medicine in Ukraine! Some of the comments that I received in my last blog entry just proved the scenario. The poor entry qualification is one of the main reasons why you see graduates with poor quality from Russian universities ( the talk of the town). On another note, there are good students who go to Russia, as they could not afford any of the local medical colleges. These students generally do much better when they start working. I have heard horror stories of what actually goes on in some of the medical schools!! The fact that they do not even know how to take history and examine the patient, tells you a lot. The very basic reason why you go to a medical school !

Many were tricked by agents who promised guaranteed job, similar to what happened to thousands of nurses. They were told that as long as they have a MMC recognized degree, they would get a job when they return. Well, it is true at the moment but not anymore. With limited number of post within the next 2 years, having a MMC recognized degree does not mean anything. Having a degree, which is registrable by MMC, does not mean you will get a job. It is the same in any other country. In Malaysia, job is given by SPA and Ministry of Health. MMC only provides Temporary MMC registration for you to undergo Housemanship.

With so many dubious Foundation programs organized by many universities as a “short-cut” to attract students into their medical school, MMC had no choice but to introduce the minimum requirement based on SPM results in addition to pre-university results (only A level, STPM and few other courses can supersede)!! We are probably one of the very few countries in the world, which do not use a standardised pre-university qualifications as a sole requirement. I would rather prefer if MMC makes a few well-known Pre-U courses as the minimum requirement, such as STPM, A-Level, IB, Australian Matriculation etc etc. As far as I am concerned, Foundation studies SHOULD NOT be used as an entry qualifications into medical course. Not only it is NOT standardized but prepared and marked by the university itself!! Whatever said, you need certain level of intelligence to do medicine. You may not need to be a A-star student but at least the top 5-10% of the cohort.  Medicine is not for any tom, dick and harry. That having been said, you also need genuine interest and passion to function as a good doctor.

Since the minimum requirement was introduced in 2011, all students accepted into local private medical schools have to submit their results to MMC for verification. The universities will do this. However, despite this I have heard and seen many students being accepted into medical schools locally without the minimum requirement.  The students are accepted and subsequently asked to appeal to MMC. When Crimea Medical University was derecognized in 2005, the NOC was introduced. The government noticed that there are students who have very poor SPM/STPMresults, from Arts stream and even those who fail SPM, were doing medicine in Crimea.  Unfortunately, there are still many students out there who are doing medicine WITHOUT NOC. This is simply because, they were told that as long as they have a recognized degree, it is not a problem.

Sad to say, the situation will change soon. Last year’s MMC’s guideline clearly says that those who do medicine in an unrecognized university without minimum requirement, will NOT be permitted to sit for the MQE exams. This basically means that you can forget about practicing medicine all together in this country. You can try to get a job in another country where your degree might be recognized.

When the job market gets saturated, the government will become choosy as any other profession in civil service. Preference will be given to government-sponsored students and local public university graduates. This will be followed, by the rest. With limited number of post available, what criteria will SPA use to offer employment? This is where your NOC will come into force. Very likely that those who do not have NOC or the Minimum entry criteria will be the last choice to be offered a job. You may end up jobless as there will be almost 6-7,000 graduates/per-year by 2017.

Obviously, there is no law to do this but getting a post in civil service is a privilege and not a must. The only problem in medicine is the fact that if you do not do housemanship, you will not be able to practise as a doctor in this country. Thus, MOH is working on a few formulas to decide on who will get a job in MOH in the future. With the civil service being controlled by almost 90% from a single race, the people as well as the politicians will make transparency and biasness as an issue. So, we need to come up with fair and transparent criteria.

Over the last few months, many suggestions are being discussed at MOH level. The first suggestion is to give housemanship post on contract basis, after which you need to sit for an exit exam. The exit exam as well as your superior’s assessment will be used to decide who will get a MO post. Basically, you need to reapply into government service after Housemanship. What happens to those who fail? Obviously, you may not be able to work as a doctor or may need to redo housemanship.

The latest suggestion, which is seriously being considered, is the common entry/licensing exam or MMLE. Many countries as well as many other professions do this. Even our nursing board has exams similar to this.  The lawyers have CLP but they can still work as legal adviser without CLP. For me, this will be the best option. MMLE should include all graduates including the local public and private universities. It should be standardized and centralized by MMC unlike the current MQE exams. Only those who pass will be able to get a job. This will definitely remove the mediocre ones as long as it is fair and transparent.  Unfortunately, this was suggested by our ex ex DG (Tan Sri Dato Dr Ismail Merican) but was shot down by cabinet due to political reasons!! In Malaysia, education is always politicized!

So, for those students who do not have the minimum criteria, please do some other course. This is my advise to you. Firstly, unless you do well in a well established, standardized Pre-U course, you do not qualify to do medicine. Secondly, with the soon to be surplus of doctors, your chances to get a job in Malaysia will be slim. Finally, do not waste your parent’s money. Put that money to good use. I would also like to advise parents that they should not force their child to do medicine and please do not ask your child with mediocre results to do medicine. You are committing  a crime to the society. I have seen enough mistakes being done by the current generation of doctors, life threatening mistakes that I have hardly seen before. It clearly shows the deteriorating quality of doctors in our community. We do not want to see students with SPM results like below to do medicine. In “real and genuine” medical schools, they will not even survive the first year. I am not saying that all good grade students will become good doctors but you need certain level of intelligence to do medicine coupled with passion and genuine interest.

FYI, the SPM result below is a Russian graduate who applied for Master’s program. A friend of mine who were interviewing them sent it to me!! She got a shock of her life when she saw the result!! Obviously, this student would not have got a NOC based on the current criteria. Obviously, she may not get a Master’s seat, as the competition is getting tougher.

Our ignorant society needs a wake up call……………………

Read Full Post »

For a physician in Malaysia, Dengue is considered as a bread and butter disease. Since Dengue was first discovered in Malaysia in early 1900, it had claimed many lives. Unfortunately, to date, there is NO cure for this disease.

The current Dengue epidemic/outbreak, which started almost 11 months ago, somewhere in April 2013, is one of the longest and most disastrous episodes I have ever seen during my 17 years of service. I have never seen such a long epidemic before and it looks like there is no end coming.  Unfortunately, our public who screams when they hear about 3-4 H1N1 cases or Hand Foot Mouth syndrome seems not to be bothered about Dengue. They take it very lightly as though it is a non-fatal disease. For the year 2013, Dengue had claimed almost 94 lives. The number has reached 17 deaths in just 37 days of this year! Remember, majority of these patients are young and healthy individuals. JB hospital is having 1 death every week since November 2013!!

Where are we going wrong? It is a preventable disease and a holistic approach is needed. Our public health officers seem to be overloaded with this epidemic, so much so, they do not even come and interview any dengue cases in the wards anymore. Personally, I feel it is of no value. As long as they are aware the number of patients and where they are from, actions should be taken. Unfortunately, I feel that we are losing the battle. We are still deploying the same strategy since the last 50 years or so, which clearly has failed to control the disease this time around! The actions taken also seem to be rather slow due to shortage of manpower and lack of budget. What is the point of notifying within 24hrs when no action is taken within 48 hours?

Opening “Klinik Kesihatans” up to 10pm is not going to solve any problems either. Our Health Minister announced before the Chinese New Year that KKs would be opened till 10pm in Dengue Hotspot areas to reduce the congestion at Government Hospital emergency departments (ER). I think the more important issue is to educate the public that emergency department is for emergencies and not for cold cases. In 2003, MOH introduced outpatient clinics in Emergency Department with a rate of RM 40/hour. It was open to all doctors in the hospital. It failed. Subsequently, with the same reason of reducing ER patient load, most major KKs were asked to open till 9.30pm with a locum rate of RM 80/hour since 2008. Again, did this reduce the ER department patient load? The answer is NO. What we need is “public-private” integration, which will make our GPs as part of the primary health care system supported by a National Health Financing Scheme. This is what 1Care “suppose” to do but due to the current political situation, it has been postponed once again.

Now, with the excuse of Dengue, all KKs in hotspot areas are being asked to open till 10pm. Likely, even after this epidemic settles (hopefully), the opening hours of these clinics will remain, with the excuse of “ receiving good response from the public” as the 1Malaysia clinics supposedly did. The GPs nearby these clinics will definitely be affected. Eventually, MOs in KKs will be asked to work shift duties in order for KKM not to pay the “overtime allowance” of RM 80/hour. A pilot project of shift duty was conducted in KK PD last year. With close to 15 MOs in major KKs, it is not impossible to introduce shift duty. It will come, whether you like it or not. The only problem will be safety issues especially for female doctors and lack of support staffs despite having enough doctors.

What are we lacking in the preventive measures for Dengue?  Firstly, we are still going after the Aedes mosquito after the incidence has already occurred (chasing from the back). Fogging and house inspection are only done almost 2-3 weeks after a case is reported in a particular area. By this time, the mosquito would have bitten hundreds more and would have laid hundreds of eggs all over the place. Should we think about detecting Aedes mosquito breeding area before it even starts to infect people with the Dengue Virus? During the 2003 outbreak, the then Johor state Pengarah Dr Prethapa Senan came up with a good idea.  He decided to place a half cut mineral water bottle(small), on a wooden stick, pricked to the ground every few kilometers in a hotspot area. The health inspector will periodically check these bottles and immediate fogging and cleaning of the affected area with residence help is done, if an Aedes mosquito larva is detected. I found it rather interesting and  although it involves a lot of work, it did bring down the number of dengue cases and the epidemic was over in just 6 months. Another issue that I always wonder is to what happened to discussions between MOH and researchers and academics from our universities?? I am sure many academics are involved in Dengue research and their expertise may be useful in controlling the disease.

As far as I am concerned, this Dengue outbreak should be considered as a National Disaster and a proper disaster plan should be developed for an all out war against Dengue. BUT I don’t see it happening from our political masters who are more interested in making “jokes” everyday in public. I don’t see any massive adverts to “scare” the people in the mainstream news, papers as well as alternative medias. This disaster should send chills through the spines of every resident so that the people will get frightened and do the needful to help the authorities. The Ministry should work hand in hand with the residence rather than working on their own. There is no point having mortality meeting after a death has occurred and only after that, inspections are done at the deceased house and surroundings to “prevent” another death!! Whatever said, Dengue is a public health issue and not a clinical issue.

There is NO cure for Dengue. IT is your own body’s immune system that kills you. That’s why the complications occur after the fever settles as your immune system starts to produce antibodies. It is also the reason why a secondary infection is more fatal than the primary infection. Many patients have the idea that early admission to hospital can cure their Dengue but frankly, the body cures itself. The only thing that doctors do is to keep you well hydrated and treat the complications, hoping that your body will over come it’s own immune system’s assault. Thus, there are also many Dengue cases that can be managed on an outpatient basis. The most important thing is that the patients need to be monitored by an experienced doctor. From my experience, when complications occur, many will die no matter what we as doctors do! You survive purely by luck!

Whether anyone realize it or not, this outbreak is a huge public health burden and draining huge amount of money. The insurance companies are bleeding billions of ringgits due to huge amount of admission to private hospitals. Many of these admissions may not be necessary but the fact remains that a patient can only use his medical card if he/she gets admitted. Thus, there are many unnecessary admission to private hospitals simply because the insurance companies do not cover outpatient treatment. I would suggest that insurance companies should make some adjustment during this outbreak to cover outpatient treatments of Dengue. This will definitely save a lot of cost for them.

It is rather sad to see young patients dying from a tiny virus and a mosquito. Many at times, we just watch this patient’s die right in front of our eyes as we stand helpless! May this epidemic come to an end soon………………

National dengue alert

Read Full Post »