Tuesday, May 17, 2011

Malaysia only spent less than 3% of its GDP on the healthcare (WHO recomends 5%)

Rising pressure of healthcare cost


Increases in medical bills are outpacing the general inflation rate each year. That raises the question whether healthcare is reserved only for those who can afford it
“I got the bill for my surgery. Now I know what those doctors were wearing masks for”
– American bureaucrat, James H. Boren (1925)

WHAT is the value of a human’s health? Sixteenth-century English scholar and vicar at Oxford University Robert Burton put it at such: “Restore a man to his health, and his purse lies open to thee.”
Tan Sri Dr Abdul Khalid Sahan

That denotes that health is priceless, and almost everyone would pay anything to get well. With the doctors’ power to demand, medical services do not come cheap.

And with the continuous rise of investments in research and development as well as the adoption of the latest technologies to deal with the rapid emergence of new and complicated illnesses (and the re-emergence of some deadly ones), healthcare costs are soaring by the day.

So, who can afford to fall sick these days?

Across the world, the increases in doctors’ bills are outpacing the general inflation rate each year. It is estimated that the global medical inflation averages about 10% each year.

In Malaysia, medical inflation is estimated to be around 15% each year. That is to say, a simple appendicitis surgery that cost RM1,800 three years ago will set you back by about RM3,000 today.

The next question then: Is healthcare reserved only for those who can afford it?

Far from it. As former Health Ministry director-general Tan Sri Dr Abdul Khalid Sahan puts it, healthcare has been universally accepted as a basic right of all citizens.
Dr Pawel Suwinski

“Everyone has a right to receive it irrespective of his or her ability to pay,” Khalid explains, adding that the Government is accountable for ensuring that healthcare is made accessible to all citizens.

The existence of public healthcare services in Malaysia is in line with that notion. Although the system is not perfect, its services are provided almost free of charge because they are heavily subsidised by the Government.

And complementing the public healthcare system in Malaysia is the private sector, whose existence is supposed to help improve the delivery standards of the public healthcare sector – in that the “richer” patients would go to the private hospitals, and therefore, help lighten the workload of the public sector, so that the “poorer” patients can have better and faster services at government hospitals.

Private healthcare services are expensive (or as some would complain, ridiculously expensive) mainly because they are profit-driven centres.

Shocking bills
Over the years, there have been growing concerns that private hospitals tend to overcharge their patients. According to Dr Chan Chee Khoon, professor and convenor for health and social policy research cluster at Universiti Sains Malaysia, there are built-in incentives for over-investigation, over-treatment and over-medication in a profit-driven, fee-for-service system.

Therefore, some patients have been slapped with exorbitant charges by private hospitals due to “unnecessary” treatment courses.

Datuk Dr Jacob Thomas

For example, there is the case of Madam LC, in her 60s, who had been diagnosed with breast cancer with metastasis to liver stage IV, and was admitted to a private hospital in Kuala Lumpur in January. Upon discharge the following day, she was slapped with a bill of more than RM7,000. Of this amount, nearly half was for a specific medication called Injection Aclasta, which, according to the patient, retailed at only RM1,400. In addition, LC was also billed for a bilateral mammogram, when she actually did a single one, as she had a left mastectomy more than 10 years ago.

Upon protest, LC was offered a 7% discount, which included a revision of the mammogram charges. She turned down the offer because she felt she was still being overcharged for the medication.

In the middle of last month, she received a telephone call and an SMS from the hospital’s public relations officer, offering a 20% refund. She requested the offer be made in writing but to this day, she has yet to hear from the hospital.

Unfortunately, LC’s experience is not an isolated case. As an industry analyst puts it, whenever the patient is unaware and “can afford it”, such practices tend to occur because private hospitals are driven by profits.

However, a private hospital doctor told StarBizWeek that most of them do not mean to over-diagnose or over-treat patients. He explains that doctors in the private hospitals tend to subject their patients to “better monitoring” as part of what they call defensive medicine, due to the rising risk of litigation.

He adds, “So, gone are the days when the doctor would send the patient home for self-monitoring before admitting him or her for further treatment.”

Nevertheless, thanks to the introduction of medical insurance, certain medical expenses incurred by policyholders can be taken care of. Hence, it is viewed as increasingly important for individuals to have such insurance policies, with sufficient coverage.

This is because we have often heard of how terminally ill patients had to endure the high costs of treatment. Some even had to borrow money. Some had exhausted their insurance coverage and some had given up hope for medication.

Then again, while medical insurance policies have helped to alleviate the financial burden of patients, they have also contributed to the rapid increase of medical costs at private hospitals. This is because insurance policies are another opportunity through which private hospitals can make quick bucks.

Affordability issue

It is estimated that only about 40% of the country’s population, or 10.8 million Malaysians, are medically insured. This leaves about 16.2 million people without health insurance policies. Then again, this may not be a big concern in Malaysia as patients can always turn to the Government.

Over the years, the steep costs at private healthcare centres have caused some patients to go back to public healthcare. And with the global recession, even more are expected to seek public, rather than private, healthcare services.

Dr Pawel Suwinski, Frost & Sullivan Malaysia Sdn Bhd’s senior consultant of healthcare practice for Asia-Pacific, says this may be the trend, given the present economic condition, which has an impact on consumers’ incomes, making private healthcare services increasingly unaffordable to many.

Suwinski points out that people will obviously make their choices based on affordability. And between the options of a cheaper but more troublesome public healthcare and a more convenient but expensive private healthcare, patients are now more likely going to opt for the former.

Association of Private Hospitals of Malaysia (APHM) president Datuk Dr Jacob Thomas concedes that it is possible that patients will turn to the public healthcare system in these troubled times, but he argues that there is only so much that the public hospitals can cope with. As it stands now, these hospitals are already overloaded with patients.

The healthcare gap

Undeniably, there is a huge disparity between public and private healthcare services in Malaysia. First, the public healthcare sector continues to lose its trained medical professionals to the more lucrative and usually urban-based private sector.

Also, it has to cater to the growing number of patients as the bulk of the Malaysian population cannot afford private healthcare.

The massive brain drain and the higher volume of patients have resulted in an overwhelming workload for the public healthcare sytem. At present, the public sector accounts for about 39,000, or 77%, of the total hospital beds in the country, while the private sector accounts for the remainder of about 12,000 beds.

But there are almost 9,000 doctors in the private sector, compared with about 13,500 doctors employed by the Government.

So, the ratio of doctors to hospital beds is still lower for the private sector, which has one doctor to attend to every 1.3 beds, versus the public sector’s one doctor for every three beds.

As a result, patients at government hospitals wait longer to get medical attention and they get less personalised attention from the doctors. Therefore, there tends to be a lack of communication between doctors and patients.

Equally competent
However, industry observers say this does not mean that doctors at public hospitals are any less competent than their counterparts in the private sector.

Frost & Sullivan’s Suwinski says the public healthcare sector, in fact, has more experienced specialists, who are also involved in the teaching process for the medical profession.

APHM’s Thomas concurs, saying that most doctors in the private sector are after all, products of the public sector. Hence, there is not much difference in the competency levels between doctors of both sectors.

He adds that the private healthcare sector has been “fortunate”, as it does not have a large volume of patients, and is therefore able to provide more personalised attention.

According to Suwinski, the perception that public healthcare services are inferior is mainly due to the longer waiting hours at government hospitals and their less attractive facades. “But these have no connection with the quality of care delivered,” he points out.

He thinks the public healthcare sector can overcome the poor perception by upgrading older facilities, acquiring new technologies and equipment, and improving its manpower.

Meanwhile, Thomas points out that the public-private partnership was recently established to help the Government cope with its growing list of patients.

The partnership involves the Government sending some of its patients to the private sector for certain consultation and treatment. The process will not burden the patients as the costs incurred are still borne by the Government.

“It is a win-win situation, whereby the private sector can help ease the load of public hospitals,” Thomas explains.

Beyond borders
A recent study by the National University of Singapore shows that the process of transforming Malaysian healthcare into a global commodity is well under way. This is underpinned by the Government’s effort in institutionalising various incentives such as tax support, accreditation, sales promotion and marketing activities to promote the country as a healthcare hub.

According to Thomas, the private healthcare sector has been tasked to be the driver of medical tourism in Malaysia.

Among the factors working to Malaysia’s advantage, Thomas says, are its cost-competitiveness compared to the regional and international markets, the good infrastructure, and the fact that English is widely spoken here.
In addition, the overall performance of Malaysia’s healthcare system is considered remarkably good by the standards of the World Health Organisation (WHO).

Indicators supporting this are the country’s health-adjusted life expectancy, which is around 63 years (comparable to that of industrialised countries), and the maternal mortality rates, which have fallen by more than ten-fold over the last four decades (from 320 deaths per 100,000 livebirths in 1957 to less than 30 deaths per 100,000 livebirths currently).

According to Suwinski, WHO considers the Malaysian healthcare system to be one of the best and a role model for developing nations.

Frost & Sullivan had earlier estimated that Malaysia’s healthcare industry would grow 8% this year, supported by a 2009 budget allocation of RM13.7bil. Last year, the Government spent about RM13bil on the healthcare industry.

Room for improvement
Malaysia devotes only a small portion of its gross domestic product (GDP) annually to healthcare. Over the years, the Government has consistently spent less than 3% of its GDP on the healthcare sector. The WHO-recommended level is 5%.

But it is almost in line with the trend of neighbouring countries Singapore and Thailand that have been dedicating around 4% of their GDP on health spending. On the other hand, the expenditures on health by the governments of rapidly developing China and India have both exceeded 5% of their GDP since 2002.

In general, developed countries allocate larger portions of their budgets to healthcare. The US, for example, dedicates around 15% of its GDP annually to health spending, while Japan dedicates around 8% and Britain, 7%.

According to an analyst, by consistently spending less than the WHO-recommended amount, a country could turn its healthcare system into a laggard.

Industry observers say the importance of healthcare cannot be underestimated. As Khalid puts it, healthcare goes beyond the individual recipients to the family and society, and investment in health is an indirect investment in the economy of the country.- Star, 14/3/2009, Rising pressure of healthcare cost

Saturday, January 1, 2011

Drumstick Vegetable Health Benefits

Drumstick Vegetable

Drumstick tree called the "Power house of minerals" is the most common tree in India. Its leaves,fruits, flowers, barks and seeds have medicinal values and are used in various manners in all dishes. Invaluable in preventing cardiac diseases; researchers have stated that the nutritional value of the leaves is equivalent to 7 times the Vitamin C in oranges plus 4 times the calcium in milk plus 3 times potassium in bananas plus 2 times the protein in milk plus 4 times the vitamin A in Carrot. We were amazed to read it.

Drumstick Vegetable – What are Drumstick Health Benefits? | Health Benefits Of Drumstick | Nutrition Values Of Drumstick Vegetable
The drumstick is a fairly common vegetable grown all over India and Pakistan. It is valued mainly for the tender pod. It is antibacterial and a wonderful cleanser. The drumstick tree is perennial, erect, slender, medium sized with many arching branches. It is mostly grown as a backyard tree in most of the South Indian homes. It has drumstick like fruits, small white flowers and small and round leaves which are cooked and eaten as vegetable. Nutritionally, drumstick pods and leaves are of great value as sources of acrotene, calcium, phosphorus and vitamin C. The leaves, flowers and fruits of drumstick which are used as vegetable have great nutritional value. The tender fruit is used in samber and most dishes in South Indian homes. The leaves and flowers are used to prepare curry and cake.

Juice of Drum stick when mixed in milk and offered to children greatly helps by strengthening their bones as it is said to be a great source of Calcium. Also drumstick is said to be a great blood purifier. Pregnant women should often eat drumsticks as it helps ease any kind of pre and post delivery complication. Drumstick soup helps ease any kind of chest congestions, coughs and sore throats. Inhaling steam of water in which drumsticks have been boiled helps ease asthma and other lung problem.
The leaves are rich in Vitamins A and C and are considered useful in catarrhal affections. The pods made into a soup are prescribed as a diet in sub-acute cases of enlarged liver and spleen, articular pains, tetanus, debility of nerves, paralysis, pustules, patches and leprosy. A curry made from unripe pods is effective for keeping intestinal worms at bay.
Drumstick is generally included in sambar or kurma. For a different recipe, add it your soup to give it a very oriental taste.

Drumstick leaves can be given to infants and growing children and serve as a good tonic. However it may be difficult for children to eat them naturally, as they are bitter. So the best way to give them to infants would be to extract the juice from these leaves, filter it and mix them with milk before being given to them. However older children can be given the fruit and leaves in the form of curries and other preparations like the South Indian Sambar or mixed and cooked with pulses. They help build healthy and strong bones and also help to purify the blood stream. Pregnant and lactating mothers can benefit a lot from the health benefits of drumstick leaves and fruit. Drumstick leaves is an ideal tonic for pregnant and lactating mothers and provide them with the calcium, iron and vitamins that help to reduce the sluggishness of the uterus and help have a safe and easy delivery.
Seven times more vitamin C than oranges to fight many illnesses including cold and flu. Four times more vitamin A than carrots to protect against eye disease, skin disease, and heart disease. Four times more calcium than milk to build strong bones and teeth. Three times more potassium than bananas essential for the functioning of the brain and nerves.Nearly 2 times the protein in milk and almost equal amounts of proteins as in eggs basic building blocks of all our body cells.The bark contains a gum that is used as a seasoning and a treatment for some stomach ailments.The seed is often used to purify dirty or cloudy drinking water. It is pounded into small fragments, wrapped in some sort or cloth, and then placed into water jars or containers.This pounded seed acts as flocculent, taking impurities out of water solution.

Drumstick Vegetable Health Benefits:
1.Finally drumstick juice greatly adds to the glow on one’s face. Make a mixture of drumstick and limejuice and dab it on your face. You will find your face glowing greatly.
2.Inhaling steam of water in which drumsticks have been boiled helpourcs ease asthma and other lung problem.
3.Drumstick soup helps ease any kind of chest congestions, coughs and sore throats.
4.Pregnant women should often eat drumsticks as it helps ease any kind of pre and post delivery complication.
5.Juice of Drum stick when mixed in milk and offered to children greatly helps by strengthening their bones as it is said to be a great se of Calcium. Also drumstick is said to be a great blood purifier. 

Thursday, October 28, 2010

Of leptospirosis and melioidosis in Malaysia

To prevent leptospirosis and melioidosis, you need to know where they lurk in your surroundings.

IT is easy to assume that leptospirosis and melioidosis are one disease, but with two names. However, that is far from true.

Dr Christopher Lee ... Parents should stop their kids from running around in flood water.

While both diseases are caused by bacteria, the type of bacteria and the source of the diseases are different. Leptospirosis is actually caused by bacteria found in rat urine and melioidosis by bacteria found in soil and water.

One reason for this misunderstanding could be due to fact that both the bacteria that cause the two diseases can occasionally be found in the same environment. This is shown in the recent outbreak in the Lubuk Yu recreational area near Maran, Pahang, where members of a rescue team were exposed to the groups of bacteria that cause leptospirosis (Leptospira sp.) and melioidosis (Burkholderia pseudomallei).

But it is important for us to make a distinction between the two since different treatment and prevention methods are required for both diseases.

We’ve seen this before
Both leptospirosis and melioidosis are not new diseases. Leptospirosis, for instance, is an old disease. The first fatal case of leptospirosis was reported in Malaysia in 1925 by researcher W. Fletcher. However, the incidence of leptospriosis was only five per 100,000 population in 2009, which is low compared to the incidence of dengue (136.89 per 100,000 population), TB (63.95 per 100,000 population) and malaria (24.74 per 100,000 population).

As it is also common in all countries of the tropics, Malaysia is not any worse than other country, says infectious disease physician Dr Christopher Lee. “I’m not saying it to downplay (the issue) but people shouldn’t panic over things like this. You will also get this on and off whenever there are floods,” he adds.
In the Lubuk Yu recreational area near Maran, Pahang, members of a rescue team searching for a missing man were exposed to bacteria that cause leptospirosis (Leptospira sp.) and melioidosis (Burkholderia pseudomallei).

Melioidosis, however, is rarely reported, says Health Ministry Disease Control Division Director Dr Lokman Hakim Sulaiman, when contacted via email. “Among the earliest report was by Puthuchaery SD and colleagues who published a review of 50 cases of septicaemic melioidosis in Tropical Medicine and Hygiene Journal in 1992,” he adds.

Where it’s at
As rats are the main carriers of leptospirosis, the disease goes where the rats go. However, as the bacteria can also infect a wide range of animals, people who work or come into contact with these animals (including birds, mammals and reptiles) like farmers, veterinarians, or military personnel can also be infected.

But if you have heard of the chain email message that says you can get infected if you drink from soda cans that have dried rat urine on them, Dr Lee says there is no proof that this has happened. “The Leptospira can survive for some time, but when it is dessicated, the chances for it to survive is very low. But is it zero? That would depend on how much contaminant there is in the first place,” he says.

That said, cleaning the surface of any container you drink from before you drink from it is always a good idea.
As the Leptospira is carried mainly by rats, leptospirosis goes where the rats go.

He notes that although there is a possibility of getting infected by ingesting contaminated food or water, people usually get infected through skin contact. (See SF3, How you can get infected)

Because of that, floods are typically where leptospirosis outbreaks start. When floods happen, rats drown and die. And when they die, they lost control of their bodily functions and let out urine that contaminate flood waters.

“Every time there is a flood, there is an increase in cases of leptospirosis,” Dr Lee says. That is why he often cringes when he sees children running around in flood waters. “Parents should stop their kids from running around in flood water,” he notes. Other places where people can get infections are rubbish dump sites, outdoor recreational areas and even certain households when there is rat infestation in the house.

Melioidosis, which is endemic in Asia, Southeast Asia and Northern Australia, is not carried by hosts. However, you can get infected when B. pseudomallei enters your body through burns and cuts in the skin, or through contaminated dust or water droplets you breathe in.

“It is very closely linked to rainfall,” says Dr Lee. “When it is the rainy seasen, the melioidosis rates go up. The most common areas are agricultural areas like paddy fields,” he adds. As melioidosis is linked to soil and surface water, it is more often seen in rural areas with agricultural based activities.

Fortunately, both diseases are not known to be spread from person to person.

Note the signs. Treat it early.
While leptospirosis and melioidosis can infect people of any age, gender, race, and health condition, melioidosis usually affects only those who have underlying chronic diseases such as diabetes, heart disease, kidney disease, thalassaemia, and cancer.

The good news is, a majority of people (as far as 90-95%) who get leptospirosis have no symptoms or are mildly symptomatic,” says Dr Lee. The remaining five to 10% might develop symptoms of the disease, but only a few will progress to develop serious complications of the disease, called Weil’s syndrome.

It may take about two to 10 days for initial symptoms to appear. “The most common symptom is usually initial flu-like illness,” says Dr Lee. People who are infected might develop fever for a few days and recover from it before proceeding to the second phase of the disease in the second week, where the fever returns and more severe complications appear.

“The complications are normally things like meningitis, kidney failure and jaundice,” Dr Lee says. However, there are also instances where patients develop bleeding of the lungs. Therefore, symptoms to look out for in leptospirosis include high fever, jaundice (yellowish pigmentation of the skin and eyes), headaches, chills and vomiting.

“The earlier you give antibiotics, the lesser are your chances of getting complications. There is no guarantee, obviously, but the earlier you get treated, the better off you are,” Dr Lee explains.

As for melioidosis, those who are at risk are people with co-morbidities, and diabetes is by far the most common risk factor for developing serious disease. However, like leptospirosis, early administration of antibiotics can prevent further complications in people who are at high risk of developing them.

Symptoms of melioidosis include symptoms of localised infection (ulcers, formation of pus, fever and muscle aches), acute or sudden lung infection (high-grade fever, cough, and chest pain) and acute blood infection (fever, shortness of breath and disorientation). However, when the infection has spread throughout the body, a person can also experience sudden weight loss, headaches and even seizures.

Normal, healthy people who have melioidosis generally have mild symptoms or do not develop these symptoms at all.

Prevention is key
While antibiotics can be used to treat both diseases, taking steps to avoid getting infected in the first place is still a better option.

As there is yet no vaccine that is effective for any of the two diseases, avoiding activities that expose you to the bacteria is the way to go. However, if you could not avoid them, wear protective clothing that prevents you from coming into contact with potentially contaminated water or soil.

You can also consult your doctor to find out about an antibiotic (doxycylcine) you can take one or two weeks before embarking on activities that exposes you to leptospirosis (e.g. jungle adventures and rescue work in flood-stricken areas) but this is currently not an option to prevent melioidosis.

However, if you are already exposed, it helps to be informed of the symptoms associated with both diseases so you could seek medical help promptly when you experience them.- Star, 22/8/2010, Hidden bacteria

Friday, August 20, 2010

Malaysian doctor - population ratio is still far short of WHO minimum standards...

We must be interested in doctor-population ratio, not the doctor-patient ratio. {Note that here we are looking at both doctors in government service and private practice, and we really need to be more concerned about the government doctor - population ratios).

According to the 2008/2009 Economic Report produced by the Minisitry of Finance, in 2007, this was 1:1,145, and the same figures seem to be given by the Health Minister in 2008 and 2009.

KUALA LUMPUR, Oct 19 (Bernama) -- The government aims to achieve a ratio of one doctor to 600 people by 2020, from 1:1,145 currently, Health Minister Datuk Seri Liow Tiong Lai. - Bernama, 19/10/2009, Government targets doctor-population ratio of 1:600 by 2020
He said the the government was still facing a severe shortage of doctors in government, with only 60% or 13,000 positions filled. so far. This meant the doctor to patient ratio was 1:1,145, when the ratio for developed countries was 1 to 600, says Liow - Star, 13/6/2008, Doctors shy away from service at govt hospitals
 Population per doctor is 1:1,145 in 2007 - Malaysian Socio-Economic Indicators (Official Report)
Now, in a recent report, the Deputy Health Minister is telling us something different. Is she talking about doctor - patient ratio, or is she talking about doctor - population ratios? WHO Standard is talking about doctor-population ratios. A perusal of the Ministry of Finance report, shows that the doctor-population ratios for 2003 [1:1,377 ], 2004 [1: 1,402 ] 2005 [1: 1,300] 2006 [1: 214] and for 2007 [1:145]. Datuk Rosnah now tells us that last year (i.e. 2009), it was 1:940, and in 2000 it was very much better, i.e. 1:905.Is she telling us the truth? Is this the doctor-population ratios, or the doctor-patient ratios?

It is also shocking to note that the doctor-population ratios for Sabah [1:2248] and Sarawak[1:1709] seem to be far worse than the national figures. If Rosnah's figures are to be taken as correct, i.e. 1:940, this means that Sabah and Sarawak have been discriminated against. It is important for us to maybe try to get hold of other State figures to see if there is equitable distributions of doctors by the UMNO-led BN government - or is the Klang Valley and/or the Federal Territories being treated better compared to the other States? It is also important to see if the UMNO-led BN government has managed to overcome the shortage of government doctors remembering that the Health Minister in 2008 told us that there was a severe shortage - i.e.  40% of the positions yet to be filled.

The UMNO-led BN government has been pre-occupied with building projects...but less attention have been paid in getting sufficient  government doctors for all persons in Malaysia. Najib, when he became Prime Minister, had his own 1Malaysia Clinic projects - and these were open in many places where there already existed government clinics/polyclinics, when all we needed to do was to extend the services of these clinics(or part of these clinics) to 24 hours. There was no need for the renting of new premises, wasting money for renovations, etc. Money saved could have been better utilized increasing the number of government doctors, medical personnel and equipments. But alas, Najib wanted something for people to remember him by...besides the submarines, Altantuya, etc - and that would be the 1Malaysia Clinics...

PUTRAJAYA: Malaysia continues to face a shortage of doctors, with the ratio falling short of the 1:600 standard set by the World Health Organisation (WHO), Deputy Health Minister Datuk Rosnah Abdul Rashid Shirlin said Friday.

She said the Malaysian ratio last year was 1:940 while in 2000, it was 1:905.

"The Government, particularly the Health Ministry, has drawn up several measures, including making available various incentives to raise the number of doctors and medical graduates in the country.

"Going by the annual increase in the number of medical graduates, we are optimistic of attaining the (WHO) ratio by 2015," she told reporters after the signing of a memorandum of understanding (MoU) at the ministry here.

The MoU was signed by Newcastle University Medicine Malaysia and the ministry to enable the educational institution to use the ministry's facilities for its campus in Johor once it begins operations next year.

Rosnah said a drastic shortage of doctors was experienced in Sabah and Sarawak because many medical personnel were reluctant to be transferred to those states.

"The ministry has taken steps to overcome this shortage, among them allocating more doctors to the two states, especially those serving in government hospitals or clinics.

"Besides, we also have a mandatory rotation system," she said.

Sabah and Sarawak have a doctor-population ratio of 1:2248 and 1:1709, respectively. - Bernama, Star, 23/4/2010, Malaysia hopes to attain WHO doctor-patient ratio by 2015
Given the amount of money expended by Malaysians for the education and training of medical students and personnel, maybe the period that they be bonded to the government, i.e. the period that they serve in government hospitals and clinics should be increased. Those, who do not want to be so bonded could always pay for their own education at private universities. Our priority must be the achieving of the 1 government doctor for every 600 persons. Salary for doctors and medical personnel should also be increased to prevent an outflow of valuable resources and government investments. Other incentives could also be provided, i.e. government housing, pension benefits, further education and specialization opportunities, participation in international medical conferences, etc.

I am sure that latest statistics are so easily available as to the numbers of government/private doctors, nursed, medical personnel. Statistics should also be available for the different states, regions, etc... 

Malaysian government  should really minimize their efforts in promoting medical tourisms. In an internet age, the private medical facilities can do their own promotion/marketing. Why waste government and Ministry of Health resources, time, money and personnel promoting greater business for private medical establishment.

The shortage of doctors & medical personnel, hospitals, specialist hospitals, etc is very real - and, one who even go to the less crowded specialist hospitals (compared to general hospitals, clinics, polyclinics), find that after registration at 8.30am, one only manages to see the doctor, get the medicine and leave at about 2-3pm....and the reason is not that the government employees are lazy and slacking - but is really because of the shortages we face. It is this delays that have driven many to the private clinics/hospitals... Really, Malaysia can do better...so much more better. Our PM, Ministers, etc...should really utilize the government clinics, polyclinics and hospitals as normal patients (with no preferential treatment) for them to understand better....

There was a General Hospital in Mentakab - and then in Temerloh, Pahang a specialist hospital was build. The Mentakab General Hospital was foolishly shut down, and now this places extra burden on the Temerloh Specialist Hospital (which caters for Pahang) because you still have to have wards for mothers delivering babies, accident victims, minor surgery patients. Really poor planning - and we really need the Mentakab General Hospital build up and operational again - and being beside the train station, bus routes, etc - it served a very large population of people. How many similar foul-ups have happened all over Malaysia?

Leptospirosis infections, a rat-borne disease, has been steadily increasing over the last five years.

PETALING JAYA: The number of leptospirosis infections, a rat-borne disease, has been steadily increasing over the last five years.

According to the Health Ministry, there were 263 deaths because of the disease in 2004 compared with 1,418 cases last year.

The ministry’s disease control division director Dr Lokman Hakim Sulaiman said there was increased awareness and reporting of the cases.

“The incidence of leptospirosis is five per 100,000 population in 2009 compared with 136.89 per 100,000 population for dengue,” he said in an e-mail reply to queries from The Star.

Dr Lokman confirmed that the leptospirosis incident in Lubuk Yu near Maran, Pahang in June was an outbreak.

The Lubuk Yu recreational forest near Maran, Pahang, has been closed to the public since July after six people died within a week after being involved in a search operation for a drowned victim.

Of the 83 people involved in the rescue work, eight died after they were infected by leptospirosis and melioidosis bacteria.

Another man, a state Health Department personnel, died when he was infected with leptospirosis after swimming in Lata Bayu, Baling, Kedah, which has remained temporarily closed to picnickers.

Besides Lata Bayu, two other recreational spots – Puncak Jening in Kuala Nerang and Bukit Wang in Jitra – have also been temporarily closed to the public.

On Tuesday, the Perak health department had asked three national service training camps to stop their water activities after samples taken from pools nearby tested positive for the leptospirosis bacteria.

Symptoms of leptospirosis can range from flu-like illness that can progress to meningitis, kidney failure, jaundice, and the bleeding of the lungs.

Symptoms of melioidosis include acute lung infection and blood infection. - Star, 21/8/2010, Number of leptospirosis cases on the rise in the last five years

Monday, May 10, 2010

12 new kidney failures per day in Malaysia - do we have enough dialysis machines?

Do we have enough dialysis centers...

KUALA LUMPUR: Every day, 12 Malaysians suffer from kidney failure and have to be put on dialysis to survive, said Deputy Health Minister, Datuk Rosnah Abd Rashid Shirlin.

She said data from the Malaysian Dialysis & Transplant Registry in 2009 also showed that 10% of the country’s population suffered some form of kidney disease and the number is expected to rise annually.
“The number has increased by nearly 400% in just one decade, from over 5,000 in 1999 to more than 20,000 in 2009.

“The culprit of this rising trend is Malaysians’ unhealthy lifestyle and dietary changes,” said Datuk Rosnah at opening of the 11th International Federation of Kidney Foundations Meeting (IFKF) in Hotel Nikko yesterday.

Among those who attended the event were IFKF president Dr. Miguel Carlos Riella and his vice president Lynn Kulasingam and National Kidney Foundation chairman Datuk Dr Zaki Morad Mohd Zaher.

Dr. Zaki said Malaysians should seriously look at the importance of early detection and treatment.- Star,10/5/2010, 12 kidney failures every day, says Rosnah

Thursday, May 6, 2010

Radioactivity in Bukit Merah Revisited With New Dump Site (NST, 31/7/2005)

Berikut adalah kronologi penetangan Asian Rare Earth (ARE) di Bukit Merah, Ipoh sehingga penutupannya pada 19 Januari, 1994. [Source:- "Chernobyl Malaysia" Kronologi Kejadian Asian Rare Earth di Bukit Merah]

Anda rakyat prihatin. Selamatkan generasi masa depan kita. Bersuaralah dan hentikan pemprosesan ‘rare earth’ di Kuantan sebelum terlambat.


November: Syarikat Asian Rare Earth (ARE) dibentuk untuk mengekstrak itrium ( sejenis unsur nadir bumi) daripada monazit. Pemegang saham utamanya ialah Mitsubishi Chemical Industries Ltd (35%), Beh Minerals (35%), Lembaga Urusan dan Tabung Haji (20%) dan beberapa peniaga bumiputera (10%). Pihak ARE telah mendapatkan pandangan dari Pusat Penyelidikan Atom Tun Dr. Ismail (Puspati), Kementerian Sains, Teknologi dan Alam Sekitar mengenai sisa buangan radioaktif yang dihasilkan melalui pemerosesan monazit. Adalah diputuskan, sisa buangan itu yang menjadi milik kerajaan Negeri Perak akan disimpan kerana berpotensi sebagai sumber tenaga nuklear.


Jun: Penduduk Parit, Perak mendapat tahu kerajaan telah memilih kawasan seluas sembilan ekar, kira-kira 6 km dari penempatan mereka untuk dijadikan tapak penimbunan sisa radioaktif syarikat ARE.

30 Jun: Ekoran bantahan hebat daripada jawatankuasa penduduk serta lain-lain pertubuhan politik dan sosial, kerajaan membatalkan cadangan itu dan kemudian mula mencari tapak baru.

11 Julai: Kilang ARE mula beroperasi di KM 7.2, Jalan Lahat di Bukit Merah.


November: Penduduk Papan (kira-kira 16 km dari Ipoh) mendapat tahu ARE sedang mengorek lubang berhampiran tempat kediaman mereka untuk dijadikan tapak buangan sisa radioaktif. Tapak itu merupakan pilihan kerajaan


24 Mei: Kira-kira 6,700 penduduk Papan dan pekan-pekan yang berhampiran menandatangani satu surat bantahan dan menghantarnya kepada Perdana Menteri, Menteri Besar Perak, Menteri Kesihatan serta Menteri Sains, Teknologi dan Alam Sekitar.

31 Mei: Seramai 200 penduduk Papan membantah tapak pembuangan yang dicadangkan. Mereka menyekat jalan yang menuju ke tapak itu.

5 Jun: Perdana Menteri berkata, kerajaan telah mengambil segala langkah berjaga-jaga untuk memastikan keselamatannya dan menegaskan pembinaan tapak buangan radioaktif di Papan akan diteruskan.

18 Jun: Kira-kira 300 penduduk Papan sekali lagi mengadakan tunjuk perasaan sebagai membantah tapak buangan yang dicadangkan.

28 Jun: Menteri Sain, Teknologi dan Alam Sekitar, Datuk Amar Stephen Yong berkata, tapak buangan Papan adalah selamat kerana dibina mengikut piawaian yang ketat. Beliau mencabar pengkritik supaya membuktikan tapak itu boleh mengancam kesihatan dan alam sekitar. Sementara itu, ARE meneruskan operasinya dengan menimbun sisa torium di sebuah kawasan terbuka dan kolam berhampiran kilang itu.

1 Julai: Kira-kira 3,000 penduduk termasuk wanita dan kanak-kanak mengadakan tunjuk perasaan secara aman sebagai membantah tapak buangan tersebut.

4 Julai: Seramai 2,000 orang penduduk terus mengadakan tunjuk perasaan meskipun Ketua Polis Perak memberi arahan supaya bersurai.

18 Julai: Pembentukan Jawatankuasa Bertindak Bukit Merah, terdiri daripada penduduk Bukit Merah, Lahat, Menglembu dan Taman Badri Shah, sebagai tanda sokongan kepada penduduk Papan. Sahabat Alam Malaysia (SAM) menghantar satu memorandum kepada Perdana Menteri memaklumkan paras radiasi yang tinggi telah dikesan dikawasan kolam terbuka berhampiran kilang ARE di Bukit Merah. Satu bacaan yang dicatat oleh pegawai-pegawai SAM sewaktu berkunjung ke situ ialah 43,800 milirem/tahun. Paras ini melebihi 88 kali paras maksimum yang ditetapkan oleh Suruhanjaya Antarabangsa bagi Perlindungan Radiologi (ICRP) untuk orang ramai.

29 Ogos: Michael O ‘Riordan dari Lembaga Perlindungan Radiologi Kebangsaan British dijemput oleh kerajaan untuk memeriksa tapak buangan toksik di Papan.

19 September: Sekumpulan tiga orang dari Agensi Tenaga Atom Antarabangsa (IAEA) Pertubuhan Bangsa-bangsa Bersatu mengunjugi tapak buangan di Papan atas jemputan kerajaan Malaysia. Mereka mengisytiharkan tapak buangan itu tidak selamat.

5 Oktober: Dr William Cannell, seorang ahli fizik dan penganalisis kesihatan menerima jemputan penduduk Papan untuk melawat tapak buangan tersebut. Hasil pemerhatian beliau mendapati kerja-kerja kejuruteraan yang dijalankan oleh syarikat terbabit sangat buruk.

21 Oktober: Seorang pakar dari Amerika dan bekas ahli jawatankuasa Akademi Sains Kebangsaan Amerika bagi kesan-kesan Biologi Radiasi Mengion (BEIR), Dr Edward Radford, atas jemputan penduduk Papan, membuat tinjauan di tapak buangan sisa itu. Beliau dapati tapak itu tidak sesuai sementara lubang-lubang yang digali mempunyai dinding yang nipis atau sudah merekah.

7 November: Seorang pakar buangan sisa industri dari Jepun, Dr. Jun Ui, menerima jemputan penduduk Papan untuk memeriksa tapak buangan ARE. Beliau juga mendapati tapak itu tidak sesuai dijadikan kawasan penimbunan sisa berbahaya.

28 November: Kabinet membincangkan laporan-laporan yang diserahkan oleh dua badan kawalan. Laporan yang dikemukan oleh Lembaga Perlindungan Radiologi Kebangsaan British (NRPB) berkata, penduduk hanya akan selamat jika faktor-faktor tertentu diberi perhatian oleh kerajaan Perak dan syarikat ARE. Laporan kedua oleh IAEA pula berkata, lubang-lubang yang dibina tidak memenuhi syarat-syarat yang ditetapkan.

9 Disember: Lebih 1,500 penduduk di Papan mengadakan mogok lapar selama sehari sebagai membantah keputusan kerajaan untuk meneruskan rancangan menempatkan tapak buangan sisa di Papan. Penduduk Bukit Merah membawa masuk seorang pakar radiasi dan genetik dari Jepun, Profesor Sadao Ichikawa untuk mengukur paras radiasi di kawasan terbuka dan kolam berhampiran kilang ARE. Beliau dapati paras radiasi di situ terlalu tinggi malah paras tertinggi yang dicatatkan melebihi 800 kali paras yang dibenarkan.

12 Disember: Timbalan Perdana Menteri, Datuk Musa Hitam menunjukkan minat secara peribadi terhadap perkembangan isu Papan ini. Beliau mengunjungi tapak buangan tersebut.


11 Januari: Selepas mesyuarat kabinet yang dipengerusikan oleh Timbalan Perdana Menteri ketika itu, Datuk Musa Hitam, kerajaan mengambil keputusan memindahkan tapak buangan sisa ke Mukim Belanja di Banjaran Kledang yang terletak kira-kira 5 km dari Papan dan 3 km dari Menglembu.

1 Februari: Lapan orang penduduk, bagi pihak diri mereka sendiri dan penduduk Bukit Merah membuat satu permohonan di Mahkamah Tinggi Ipoh menahan ARE daripada mengeluar, menyimpan atau menimbun sisa radioaktif di sekitar kampung tersebut.

Akta Perlesenan Tenaga Atom 1984 dikuatkuasakan. Ia memastikan pengendali bahagian pemasangan nuklear (termasuk kerajaan) bertanggungjawab terhadap ancaman nuklear. Lima ahli Lembaga Perlesenan Tenaga Atom (AELB) dibentuk di bawah Akta itu, dengan perwakilan dari Puspati, Kementerian Kesihatan serta Kementerian Sains, Teknologi dan Alam Sekitar.

14 Oktober: Hakim Anuar Datuk Zainal Abidin di Mahkamah Tinggi Ipoh memberikan kepada penduduk Bukit Merah perintah menahan dan menghentikan ARE daripada mengeluar dan menimbun bahan sisa radioaktif sehingga langkah-langkah keselamatan yang secukupnya diambil. Lebih daripada 1,500 penduduk Bukit Merah hadir di mahkamah untuk mendengar keputusan itu.


22 September: ARE mendakwa ia telah membelanjakan lebih RM2 juta untuk meningkatkan langkah-langkah keselamatan (sepertimana yang dikehendaki oleh perintah mahkamah), diikuti oleh piawaian IAEA. Ia menjemput pakar tenaga atom dari Amerika, Dr E.E. Fowler (Bekas kakitangan IAEA) untuk mengunjungi kilang berkenaan. Menurut beliau, paras radiasi berhampiran kawasan pembuangan yang disediakan oleh ARE memenuhi piawaian ICRP dan beliau dapati kilang itu selamat untuk beroperasi.

5 Oktober: Kira-kira 3,000 penduduk Bukit Merah dan kawasan sekitarnya mengadakan tunjuk perasaan terhadap rancangan ARE untuk menimbun sisa radioaktif di tapak kekalnya di Banjaran Kledang.

28 Oktober: Profesor Sadao Ichikawa dalam kunjungan kali keduanya ke Bukit Merah mendapati paras radiasi di sekitar kilang ARE masih melebihi paras yang dibenarkan. Beliau dilarang masuk ke dalam kilang itu.

16 November: Sekumpulan penyiasat dari AELB memeriksa beberapa buah tapak buangan sisa torium yang dilonggokkan secara haram di Bukit Merah. Mereka dibantu oleh bekas kontraktor ARE, Ng Toong Foo yang pernah membuang sisa di situ. Bacaan di salah sebuah tapak ialah 0.05 – 0.10 milirem/jam (iaitu 438 - 876 milirem/tahun) melebihi paras keselamatan maksimum 0.057 milirem/jam yang ditetapkan oleh ICRP.

26 November: Perwakilan dari tujuh kawasan (Bukit Merah, Lahat, Taman Badri Shah, Menglembu, Papan, Falim dan Guntong) membentuk sebuah jawatankuasa Anti-Radioaktif Perak (PARC).

8 Disember: Menteri di Jabatan Perdana Menteri, Encik Kasitah Gadam berkata hasil pemeriksaan AELB di dua tapak buangan haram Bukit Merah mendapati paras radiasi di situ adalah selamat. Menurutnya, sungguhpun AELB mendapati paras radiasi di situ melebihi paras normal, ini tidak membahayakan kerana tapak-tapak itu sangat sedikit bilangannya.


6 Februari: Tanpa mempedulikan perintah Mahkamah Tinggi Ipoh kepada ARE supaya menghentikan operasi, AELB Malaysia memberikan lesen kepada ARE supaya meneruskan operasinya.

10 April: PARC menjemput 14 pakar asing untuk datang ke Bukit Merah-pengasas-pengasas Institut Antarabangsa bagi Kepentingan Awam di Kanada, Dr Rosalie Bertell; Setiausaha Pusat Keselamatan Industri dan Kepentingan Alam Sekitar di India, V.T. Pathmanaban; dan Presiden Institut Kesihatan dan Tenaga di Amerika Syarikat, Kathleen Tucker merupakan antara mereka yang dilarang memasuki kawasan ARE. Dalam satu forum yang berlangsung di Bukit Merah, pakar-pakar itu membuat kesimpulan bahawa ARE mendedahkan pelbagai ancaman kesihatan yang serius.

12 April: Kira-kira 10,000 orang penduduk berarak di Bukit Merah sebagai membantah operasi yang dijalankan semula oleh ARE.

24 Mei: Kira-kira 300 orang penduduk diperintahkan bersurai oleh anggota Unit Simpanan Persekutuan (FRU) berhampiran ARE. Lebih 20 orang, termasuk tiga wanita mengalami kecederaan dalam dua pertelingkahan pada hari itu. Seramai 60 orang ditahan oleh pihak polis. Semua kecuali enam dibebaskan kemudian selepas disoal-siasat. Keenam-enam pemuda itu dibebaskan seminggu kemudian di mana pihak polis tidak mengenakan sebarang tuduhan. Penduduk menghalang kerja-kerja membina jalan yang menuju ke tapak buangan kekal di Banjaran Kledang yang dicadangkan.

23 Julai: Seorang doktor Kanada, Bernie Lau, diupah oleh PARC untuk meletakkan alat pengesan gas radon di luar kilang ARE. Beliau berjaya mengesan sejumlah gas radon dibebaskan daripada kilang itu.

Terdahulu dari itu, Menteri Sains, Teknologi dan Alam Sekitar Datuk Amar Stephen Yong berkata, kerajaan berpuas hati dengan laporan penilaian kesan alam sekitar bagi tapak buangan kekal yang dicadangkan itu. Penilaian itu dijalankan oleh ARE bersama beberapa orang pegawai Kementerian.

7 September: Perbicaraan saman yang dikemukakan oleh lapan orang penduduk Bukit Merah terhadap ARE bermula di hadapan Hakim Peh Swee Chin di Mahkamah Tinggi Ipoh. Sebagai mengetengahkan nasib mereka, para penyokong PARC berjalan sejauh 8 km dari Bukit Merah ke Ipoh. Polis menyuraikan tunjuk perasaan mereka berhampiran Menglembu. Sembilan orang ditahan tetapi dibebaskan setelah diikat jamin. Kira-kira 1,000 orang hadir di mahkamah sebagai menunjukkan sokongan mereka.

11 September: Para penduduk berarak dari Bukit Merah ke Mahkamah Tinggi Ipoh pada hari terakhir perbicaraan. Jumlah mereka yang hadir dianggarkan 3,000 orang.

18 Spetember: Penduduk Bukit Merah mengemukakan permohonan perbicaraan kerana menghina mahkamah terhadap ARE memandangkan ia melanggar perintah menahan operasi yang diberikan oleh Mahkamah Tinggi Ipoh kepada mereka pada tahun 1985.

27 Oktober: Lebih 100 orang yang ditahan di bawah Akta Keselamatan Dalam Negeri (ISA). Di antaranya termasuklah pengerusi PARC, Hew Yoon Tat; timbalannya, Hiew Yew Lan; (bekas) setiausaha PARC, Lee Koon Bun; ahli jawatankuasa, Phang Kooi Yau dan peguam Pengguna Pulau Pinang (CAP) yang mewakili plaintif Bukit Merah, Meenakshi Raman. Merek dibebaskan selepas dua bulan.

November: ARE mula membina tapak buangan kekal sisa toksik di Banjaran Kledang.


25 Januari: Perbicaraan disambung semula.


13 Februari: Perbicaraan tamat selepas berlansung selama 65 hari dan berlanjutan lebih 32 bulan.


11 Julai: Penduduk Bukit Merah memenangi kes saman terhadap ARE. Mahkamah mengarahkan penutupan kilang ARE dalam tempoh 14 hari. Pihak ARE pula mengumumkan ia akan membuat rayuan di Mahkamah Agung.

23 Julai: ARE mengemukan rayuan di Mahkamah Agung berhubung perintah Mahkamah Tinggi Ipoh supaya operasinya dihentikan. Pengerusi PARC Hew Yoon Tat dan salah seorang plaintif dalam saman terhadap ARE, Lau Fong Fatt menemui kakitangan atasan Mitsubishi Chemical di Jepun. Mereka diberitahu ARE mengemukan rayuan tanpa kebenaran syarikat itu.

24 Julai: Berikutan permohonan ex-parte oleh ARE, Hakim Besar Mahkamah Agung menahan (sehingga perintah selanjutnya) perintah Mahkamah Tinggi Ipoh kepada ARE supaya menghentikan operasinya.

3 Ogos: Lebih 2,000 orang dari Bukit Merah hadir di Mahkamah Agung untuk mendengar rayuan ARE terhadap perintah Mahkamah Tinggi Ipoh yang menggantung operasinya. Bagaimanapun, hakim-hakim Mahkamah Agung Menangguhkan perbicaraan kepada 5 Ogos kerana ‘tekanan oleh mereka yang berpiket di luar mahkamah.’

5 Ogos: Mahkamah Agung membenarkan permohonan ARE untuk menolak perintah Mahkamah Tinggi yang meminta ARE menghentikan operasinya berikutan rayuan syarikat berkenaan. Menurut hakim-hakim itu, penutupan tersebut akan menyulitkan kilang dan 183 pekerjanya.


15 Mac: Perbicaraan rayuan yang dikemukan oleh ARE di Mahkamah Agung ditangguhkan pada 7 Jun.

7 Jun: Perbicaraan mendengar rayuan ARE sekali lagi ditangguhkan ke satu tarikh yang akan diberitahu kelak.


19 Januari: Pengumuman syarikat ARE untuk menghentikan operasi.

Against Radioactive Waste

aku takde gambar nye.... sape2 yang boleh share?