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

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

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

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

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.

1979

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.

1982

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.

1983

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

1984

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.

1985

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.

1986

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.

1987

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.


1988

25 Januari: Perbicaraan disambung semula.


1990

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


1992

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.


1993

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.


1994

19 Januari: Pengumuman syarikat ARE untuk menghentikan operasi.


Sumber Against Radioactive Waste

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

Healthcare of the rakyat should not be compromised for monetary benefits

The Consumer's Association of Penang (CAP) views with deep concern the government's proposal to implement its full-paying patient (FPP) scheme via commercial private wings (CPWs), which in its pilot project at the Hospital Selayang has failed to benefit both doctors and patients. Such a scheme is fundamentally flawed and will only serve to deprive the low income and poor rakyat of their right to specialist care as is their basic human right as citizens.

By right, there should be a very clear separation between the public and private sector when it comes to healthcare. This is because the government is responsible for regulating the private healthcare sector and carrying out enforcement duties. 

In fact, private healthcare is, in principle, is supposed to complement public healthcare and not assume the role of the public healthcare sector as the principle guardian of the rakyat's health. This abrogation of duty by the government towards the rakyat is now being manifested by its various exercises in corporatisation and the outright albeit gradual and systematic privatisation.

As far back as 2004, CAP had objected to this proposed scheme. Now the government seems insistent on reintroducing this unjust programme despite the public outcry. If the proposal is implemented, it will mean that public hospitals will have a private wing purely for commercial purposes; the idea being to increase remuneration for government doctors and other medical staff. 

At the outset, the idea seems novel and attractive to those working in the public sector. However, there are serious implications for consumers especially the poorer ones. There is also the possibility of discrimination which might pit one set of professionals against the other.

A look at our private health sector and how it operates profitably should be able to give us an insight into the repercussions of a move to encourage privatisation in parts of the public healthcare sector.

For example, the general practitioner operates in a way that he profits from his consultation charges and for the procedures that he does outside of the routine ones like urine tests, blood tests, etc. He also makes money from dispensing medications, where prices are marked up.

The private hospital makes its money from a whole list of services that it provides. The list is exhaustive and includes the charges for the following: medicines, board and lodging, procedures (surgical), nursing, use of equipment and also administrative costs – all of which can be exorbitant and beyond the means of many. The above is likely to be duplicated if public hospitals set up private wings. 

As it is, some public hospital settings in the country already have a public-private mix. The Universit Malaya Medical Centre (UH) is one such setting while the other is the Institut Jantung Negara (IJN). What have been the consequences of such changes?

So far, they can be said to be discouraging, to say the least. The costs of medicines, procedures, and laboratory charges at UH have shot up many times. The IJN is probably the costliest place for heart surgery. Also, the waiting time for heart patients who are unable to afford surgery could be up to two years or more.

There are other implications if the ill-planned scheme goes through. Among them are:

Manpower shortage - there has been a perennial shortage of medical manpower in the country. In the year 2000, there were 6,429 medical vacancies in the public sector. In 2004, there were at least 3,000 critical vacancies. In 2008, the doctor to patient ratio in the country was 1 to 1,105 patients.

As a result of this shortage, medical officers are very much overworked in the public sector. For instance, a medical officer in the Outpatient Department in the major government hospitals could see up to 150 patients a day or more (the ideal number recommended by the health ministry is a maximum of 50).

How is this shortage to be addressed with the commencement of CPWs? If there is an overall manpower shortage, why is there a need to deploy staff to the CPW and while facing ever increasing number of patients?

Inadequate infrastructure - there is a shortage of better-class wards even in the general hospitals so how do we accommodate the influx of CPW patients into the general hospitals? This could lead to depriving the poorer patient and the converting of beds for the use in the privatised wings.

In addition, there are already some big hospitals with insufficient medical equipment, for example, MRI machines. The patients who come in will have to be sent to another hospital to obtain these services, thus inconveniencing these patients.

Discrimination - upgrading of some hospitals to CPW status and not others will create discrimination in terms of remuneration for staff and this might cause an exodus of staff to greener pastures.

The lure of the ringgit can also be a temptation for corrupt practices - there could be corrupt doctors who would see patients in the CPW and admit them to the public side for procedures. He could then pocket fees illegally by offering a concession to the patient. This practice is rampant in places like India and Egypt where there is a public-private mix.

Equity and accessibility - to remain competitive, charges over the years will escalate. The net benefit for the poor will be less access and a further erosion of equity.

Sustainability - CPWs found not to be profitable might face a predicament unlike private hospitals. The latter can be closed down if seen to be unprofitable, but can the same thing be done for CPWs?

If the aim is to increase remunerations for medical staff, then there are some means whereby additional income for the government could be generated. Among these are:

Part payment by patients at government hospitals - Third-class patients should continue to be charged nominal rates for specialist and in-patient treatment. These charges can be raised slightly, where appropriate, to bring in more revenue. Those who cannot afford to pay full rates should be given discounts or, in the poorest cases, free treatment. Patients in the second-class and those in first-class should pay a greater percentage of the costs of treatment.

Increase the charges for outpatient treatment - the current charge of RM1 for outpatient treatment at government facilities could be raised. Based on the 1998 total outpatient attendances at government health facilities, raising the outpatient rate to RM5 could bring in at least another RM100 million which could go towards financing the healthcare system further. The figure would be much higher with the present day number of patients.

Extend Socso's services to include medical care in general - in other words, its services should not be restricted to only treatment for industrial accidents and occupational diseases. The annual 'profits' of Socso (which actually represents a significant subsidy to the state by workers) could thus be transferred to the Health Ministry through hospital payments.

Since Socso covers all employees earning below RM2,000 per month, the poor and lower-income wage-earners would be able to draw on their contributions to finance their medical bills in government clinics and hospitals, thus easing the financial strain on the Health Ministry.

If the existing Socso contributions are still insufficient, the rates for Socso contributions could be raised marginally. An increase of only RM1 a month by employees plus another RM1 by employers would yield a substantial overall increase in the government's healthcare spending capacity.

At the same time, the manpower shortage should be addressed. As a short-term solution, a fixed number of foreign doctors should be encouraged to take up permanent employment here. This measure could be halted once there is enough local staff to cater for our medical needs, especially in the rural areas.

CAP reiterates its objection to the government's proposal to create private wings in public hospitals for the purpose of increasing doctors' remuneration or for any other reason. The primary role of public hospitals is to ensure equitable and accessible healthcare especially for the middle and lower-income groups and the poor. There will be a conflict of interest if the already- overburdened public healthcare resources are further diluted to cater for private wings.

The initiation of a two-queue system within public sector hospitals will be disadvantageous to the very population they are aiming to serve, ie, the patients who need the service most. There is great potential for abuse of the system as was shown in previous attempts in the late 1960s.

If the intention of these private wings is to help retain public specialists, this has yet to be proven as there will inevitably be a tendency for specialists to use the private wing as a 'testing ground' before they leave completely for the private sector.

Introducing private practice in government hospitals is decidedly unacceptable as it will drastically change the face of the present healthcare system to the acute disadvantage of the rakyat. CAP calls on the health ministry to scrap the proposal for introducing the FPP scheme. 

The healthcare of the rakyat should not be compromised for monetary benefits.

The writer is president, Consumers Association of Penang - Malaysiakini, 9/3/2010, Private wings will cripple public healthcare

Star : Diabetes and blindness

KUALA LUMPUR: One in four patients with severe diabetic-related retina damage end up blind because they come in too late.

The national Diabetic Eye Registry principal investigator Dr Nor Fariza Ngah said that out of 13,973 patients with diabetic retinopathy, 3,311 suffered severe retinal damage and of them, 774 could no longer get their blindness reversed.

The statistics were derived from 36,952 diabetic patients screened for diabetic retinopathy from January 2007 to December 2009.

Dr Nor Fariza told The Star that the symptoms were often missed because it was asymptomatic, with some seeing floaters or having blurred vision.

For this reason, she said all diabetic patients must get their eyes examined at least once a year.

Retinal damage occurs when the thin layer of the retina is detached from the eye-wall and patients could suffer bleeding in the eye-ball as well. Blockage in the eyes’ blood vessels results in new blood vessels growing into the eye cavity to compensate the blockage and pull the retina away from the back wall of the eye.

It also occurs when protein leaks from the vessel into the surrounding retina and causes swelling.

Universiti Malaya Medical Centre retinal surgeon Dr Angela Loo said some patients ended up blind despite a well-done surgery because they came in too late.

“Often, they expect us to perform miracles, but even if we managed to do a good job re-attaching the retina, their sight cannot be restored.”

Dr Loo, who trained in Britain for seven years and practised in Hong Kong for four, said severe retina damage numbers were low in both countries.

She said the lack of awareness and complacency among Malaysians, were the main reasons for many diabetes cases being undiagnosed and poorly controlled, adding that some patients also did not return for follow-up laser treatment and their condition deteriorated.

She said teamwork was needed in detecting the symptoms, adding that the high-risk groups included those with diabetes for a long time, poorly controlled blood sugar and blood pressure, presence of other diabetic complications such as kidney impairment and foot ulcer/gangrene, high blood cholesterol, smoking habit, anaemia and diabetes in pregnancy. - Star, 10/3/2010, Diabetes and blindness

Healthcare is a government responsibility...

Health is a major concern for Malaysia, especially when the current Barisan Nasional government seemed more inclined towards privatization of healthcare. The new Prime Minister, Najib Razak, when he was the Deputy Prime Minister also was involved in an attempt to sell off the National Heart Institute (now 100% government owned) to some private company. This move was stalled.

Malaysian government pre-occupation  is for the having of medical facilities with advanced facilities and capabilities in Malaysia - but not for the access of healthcare to all for free (or nominal fees).

Save for public servants (and public service pensioners), every other person would have to make some sort of payment for medical care in Malaysia's government facilities. The payment is minimal - but to some, it may be beyond their means. 

There is a different rate for foreigners, which is 50 times more for even a simple registrations. While Malaysians pay RM1 for registration, foreigners pay RM50. [In the new 1Malaysia Clinics, apparently the fee that foreigners pay is more reasonable - RM15]. The problem is that foreigner must have proper documentation before treatment is generally provided. Malaysia has possibly about 5 million undocumented migrants - and theoretically they would not have access to healthcare in Malaysia.

Over the years, I have also become aware of a lot of diseases that Malaysians suffer from, and in this blog, I do hope to be able to gather more information relevant to patients, their families and malybe even doctors.

What are the relevant supports available in Malaysia? Is there a patient/family society? Are there magazines/publications on these topics? Who are the specialist in this field? ....

This Blog with also attempt to change government policy, and will be fighting for universal good healthcare for all for FREE. It is the obligation of the government to take care of the health and healthcare needs of the people in Malaysia.