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Malaysian Health Care System: Are we really up to the mark?

                   The Malaysian health care system has always been regarded as the best in the world by many quarters in this country. But are we really up to the mark ? In terms of accessibility and affordability, we are probably one of the best health care systems in the world. This is commendable as the people has access to the nearest public health care facility within about 5-10km range (atleast in the peninsular Malaysia), eventhough not the same can be told about East Malaysia. In terms of affordability, we are probably the cheapest public health care provider in the world with the fee ranging from RM 1 to RM 5 inclusive of consultation, investigations and medications. Many foreigners would stare at you with a surprise look when you mention this to them. Unfortunately, affordability and accessibility alone are not going to guarantee a quality health care system.

                    Of course, we can go on boasting to everyone that we have the latest technology with MRI, CT, PET scan, multislice CT, multimillion ringgit hi-tech hospitals etc etc and we can provide all the latest treatment available in the market. All the newest and expensive medications are included into the “Blue Book” within a few months and made available to the public but only by special prescription by specialist/consultants. But are all these really reaching the “rakyat”.

                 Firstly, let’s look at the district/rural health services. Of course we have many health clinics everywhere for the satisfaction of the people. Many more health clinics are being planned under the 9^th Malaysian plan. One question that we must ask ourselves: Are all these clinics equipped with the most important material – the doctors? The answer is a big NO. About a year ago, only about 30-40% of the health clinics in Johor were manned by a doctor. The rest were manned by paramedics mainly medical assistants, nurses and “jururawat masyarakat”. Let’s look at one example.

                   There is a health clinic just 8-10km away from Johor Bahru town (within the Iskandar Development Region, I must say!) which sees about 150-180 outpatients a day but these patients are only able to see a doctor 2 sessions per-week. The doctor is only available at the clinic every Thursday and Friday morning. The rest of the days, the patient would just end up seeing a medical assistant (MA) where as the doctor would be seeing the maternal and child health clinic. Most of these MAs who are being made to be a doctor are junior staffs and unaware of many medical diseases. They still believe that fasting blood glucose of 8 mmol/l is enough and a BP of 160/90 is adequate. The MAs are still giving oral ventolin/salbutamol tablets to asthmatic patients rather than educating the patient for steroid inhalers. These MAs, who are actually doing a great service to the public health care of this country, are only given minimal opportunity to upgrade their knowledge in medical fields. So, let me ask everyone again, are we really giving the best quality of medical care to the “rakyat”? Remember, this clinic is within a big city! What about those clinics which are 50-200km away?

                   These health clinics which are the backbone of the primary health care system in the country are actually giving inferior quality medical services to the community at large. The medications that they are allowed to prescribe are still the same as how it was 20 years ago. They are still restricted from prescribing many drugs especially the List A and sometimes the list B drugs (if there is no doctor available). There are still many antibiotics and antihypertensive medications cannot be prescribed by the health clinic medical officers. The Family Medicine Specialist (FMS) are overloaded with administrative work and “campaigns” which makes them hardly have any time for their clinical duties. These will force many doctors/MAs to refer patients many kilometers away to a hospital where specialist services and better medications are available. These have resulted in many chronic lifestyle diseases such as Diabetes Mellitus, Hypertension and Bronchial Asthma taking the lives of many of our people with its complications. Some of these patients who depend a lot on this health clinics, by the time they land up in a hospital, it is just in time for us to write their burial permit!

                   We suppose to achieve developed country status by 2020, which is only 13 years away! But are we ready in term of our health care? Chronic diseases are on a rise. As such the primary health care is going to play an important role to overcome a national epidemic on complications of diabetes, hypertension etc. Patients with renal failure is definitely going to increase and rather than us talking about how many dialysis centres we are going to open, we should actually look back and ask ourselves why is these happening.

                   The government and Ministry of Health (MOH) should look into these serious issues rather than talking about petty issues like buying Hi-FI technology, building hospitals and health clinics, registering GP clinics when traditional healers are happily selling steroids, antibiotics and medications over the counter and launching campaigns just for the sake of doing one every year. It is really embarrassing to see that after 50 years of independence we still have MAs seeing patients at outpatient clinics. The shortage of doctors or rather, the mal-distribution of doctors is to be blamed for this scenario. Minimal attempts are made to improve the working condition of doctors in the hospitals and health centres when a lower qualified clerk is sitting in a comfortable chair and table with a computer in an air-conditioned room in Putrajaya and hospital offices. These grouses were recently highlighted by many doctors in the newspaper. The MOH is quite confident that there would be a surplus of doctors by 2010 based on the assumption given in my previous article and as such they are not bothered. In reality, I don’t think it is going to happen as there are many doctors who are migrating out of the country, switching their profession and resigning from civil service. Mal-distribution will definitely continue with many cables and strings being pulled.

                   Many multi-million ringgit hospitals are going to be built under the 9^th Malaysian plan despite the MOH struggling to equip our current projects like Hospital Ampang, Hospital Sg Buloh and Hospital Pandan with proper number of medical officers. Rather than spending millions of ringgits building hospitals and health clinics, we should be looking at how this money could be used to upgrade health clinic facilities and used as incentives for doctors at primary health care level. It is very sad to see patients that have been treated for many years by an uninformed MA’s coming to you with complications. What do you say to them? For me, we have failed to treat the patient with the best medical care and we should blame ourselves for that. There need to be a stronger political will to overcome this inferior medical care that our “rakyat” is undergoing at this moment. Would a VIP or VVIP ever send his/her relatives to be treated by a MA?

                   MOH should get their priority right in dealing with our primary health care system. Tertiary hospitals can have all sort of latest technology and subspecialty but they are only treating the complications, but of course, they are always at the spotlight and as such, that is what a politician wants. If we do not improve our primary health care, we are going to get into big trouble when national epidemic of complications begin to flood the tertiary centres. So again, are we up to the mark ……………….?