Saturday, February 16, 2008

Our Pathetic Healthcare (Malaysiakini Article 2007)

Once upon a long time ago, I vowed as a naïve medical student to serve fellow Malaysians with my utmost sincerity. Despite much disappointment with the mediocrity of our local university, I was determined to repay the rakyat for the subsidy they have provided me with. It has finally dawned on me that it is practically impossible to provide optimum healthcare in a pathetic healthcare system like Malaysia’s.

Indeed, ours is a system that is flawed at its very roots, and top.

An Obsession of Vanity
The shortcomings of Malaysia’s healthcare are anything but oblivious to the Ministry of Health.

Instead of putting in concrete efforts to overcome simple problems with simple solutions, the MOH has instead chosen to busy itself with efforts of vanity and exhibitionism. Penning a rosy Piagam Pelanggan and a lofty “misi dan visi” for every single sub-department will not translate into better services. Putting our healthcare personnel through time-wasting, brain-washing Kursus Induksi, Biro Tatanegara (BTN) and Penilaian Tahap Kecemerlangan (PTK) programs will not produce more skillful and knowledgeable staff. Holding weekly perhimpunan pagi hospital and singing patriotic-sounding songs will not miraculously make anyone serve their fellow Malaysians with greater commitment and efficiency. Forcing our doctors to don bacterial-laden white coats and equally lethal neck ties is the perfect example of style without substance. Seeking and attaining MS ISO accreditation is far from reflective of the quality of services our patients are receiving. These fanciful so-called recognitions have instead added unnecessary red tape and rigidity to a clumsy, obese system already burdened and bloated with excessive bureaucracy and paperwork.

The MOH’s misplaced obsession with ISO recognition and protocol is holding everybody back – doctors, nurses, lab technicians, radiographers and everyone else trying to fulfill their duties in a system that frustrates.

While healthcare in much of the rest of the modern world is cruising ahead, Malaysia’s is so very wedged in the medieval ages, with no signs of any prospective improvements under a greedy government more concerned about serving the interests of its cronies in the money-loaded field of medicine.

Arrested in Medieval Ages

The typical government hospital has no computer networking system to store and track patients’ records and investigation results and. When a patient is readmitted, there is no inkling what was done in the previous admission. Crucial investigation results are rarely returned to the respective patients’ notes. Almost everything is traced by phone in an age when people across the globe are downloading music, movies and any form of data at the click of a mouse. Doctors and nurses are kept crazily busy tracing investigations taken weeks and months ago, instead of seeing and attending to patients like they were trained for. Elsewhere in the medical laboratory, lab technicians are answering relentless phone calls from their clinical colleagues stationed throughout the hospital instead of performing chemical tests and analyzing specimens like they were trained for. Sending specimens and collecting results are all done by foot, resulting in senseless delays in a field that requires a constant sense of exigency.

At a time and age where information transfer has never been much easier, our doctors, nurses and hospital attendants are still scurrying about like messenger pigeons chasing after scraps of paper that could be anywhere in a hospital of 600 beds.

Consequently, a simple two-minute test like a full blood count can be delayed up to hours. Receiving its results can take an eternity. Not uncommonly, some important investigations can never be successfully traced which in bulk, translates to wasted millions as tests are repeated merely because the first ones were nowhere to be found. All that is needed to address this crippling deficiency is a cheap, simple networking system any computer-savvy secondary school kid is capable of setting up.

Time is golden they say, and this is particularly true in cancer, where the difference between a week and a month may mean the difference between survival, morbidity and death. The histopathology services in our government system squirm along at a sluggish pace. It is totally not uncommon for one to wait months for a tissue diagnosis of a suspected malignancy, by the time which the cancer would probably have metastasized. Occasionally and not surprisingly, diagnostic reports disappear altogether, leaving the patient without a final diagnosis.

Frustrated with this gaping weakness of our healthcare system, most doctors choose instead to convince patients to perform their tests in private laboratories and hospitals - at a costly sum, needless to say. The patients’ loss is the cronies’ gain, as friends of BN in healthcare businesses stroll gleefully on their way to the bank.

Medical wards or refugees camps?

Fifty years of merdeka and liberation from colonialists yet our medical wards are still very much like overrun, pre-war, post-disaster,refugee camps. Sixty patients with a spectrum of ailments are packed like solid popiah into a single ward no larger than a badminton court.

The immunocompromised HIV patient lies beside the old man with active tuberculosis who, coughing towards the immunosuppressed cancer patient on chemotherapy just opposite his bed. There is hardly any observation of barrier nursing or isolation. It is far from surprising that our ill patients are succumbing to multiple infections.

There is zero room for privacy in the typical general ward. Screens are scarce and often impossible in an overcrowded ward. Clinical procedures are performed in full view of other patients and relatives, putting the patient through untold embarrassment and loss of confidentiality. Unless the Health Minister desires to undergo a digital rectal examination with a strong, curious audience of 60, there is no reason why our mothers and fathers should be put through such ordeals.

The general appearance of our wards is a shame. Rusty beds with broken wheels, faulty drip stands held in place by cheap plaster, blinking fluorescent lamps, and noisy mini-wall fans are the norm of the day and make good for a scene in Dark Water. Our febrile elderly patients become dehydrated, and literally fry in the seething heat that epitomizes the current state of our hospitals. Septic patients with high fever, chills and rigors waste away in crammy, stuffy, noisy general wards, while the crooks they elected as representatives recuperate from a simple ankle sprain in spacious, air-conditioned single bedded rooms, oblivious to the sufferings of the simple-minded folk who put them in power in the very first place.

As BN-putras plunder the nation even as one is reading this article, ill and sick Malaysians are wasting away in shoddy wards so deficient in so many aspects. ECG machines so crucial in diagnosing acute cardiac events are sometimes shared between two wards of 80 patients. In times of emergencies, doctors and nurses run helter skelter hunting for elusive ECGs, pulse oximetries, ventilatory bags, oxygen tanks, arterial blood gas machines and heck, even blood pressure sets. Not uncommonly, life-saving intubation sets are incomplete or faulty and cardiac monitors are so ancient that the readings cannot possibly be taken seriously.

Our patients wait months to undergo CT scans, ultrasounds and MRIs. Ineveitably, some patients meet their Maker way before their appointment date. In one large state in East Malaysia, there are merely two CT scans to serve 2 million people, one of which is low-grade and substandard. With the rise in vascular diseases, most government hospitals still do not offer CT angiography. In an oil-rich nation, is this beyond our means?

In our existing miserable state, doctors, nurses and attendants do not even have working counters of their own and are instead wrestling for limited space to do the ridiculous paperwork bestowed upon them, in stark contrast to the posh, cooling office that the Minister sits in.

Pitiable Corrective Measures

Some hospitals, in a vain attempt to deal with the overcrowded wards, transfer “stable” patients to so-called extension wards which are commonly separated from the main hospital. Not infrequently, these supposedly stable patients deteriorate and require urgent intervention – elusive help which would not arrive as there is usually no resident doctor on-call in these peripheral units located far away from the main hospital building. Many needless deaths occur due to delayed help in these “recovery units” and “extension wards”.

Our clinics are not any better, if not worse. With the massive wealth of Tanah Melayu, it is beyond belief that most of our wards and clinics are not equipped with a computer and printer. Referral letters are hand-written, resulting in unquantifiable confusion, communication errors and disastrous consequences. Specimen tubes have to be labeled manually instead of cheap and convenient printed stickers. Up to five patients undergo consultations simultaneously in a room no bigger than Proton Perdana.

Malaysia boleh?

Emergencies Bereft of Urgency

Government ambulance services are reasonably renowned by now – for the wrong reasons. While the public may decry the unnecessary deaths of Mohd Yusry and Yusnita Abas due to alleged ambulance delay, much more nonsense does not reach public knowledge. Poorly equipped to begin with, most of our ambulances serve as nothing more than a modified human transporter, with no inbuilt oxygenation, no ready supply of emergency drugs, no intubation sets, no communication services save for the driver’s handphone. Patients’ running out of oxygen supply during an ambulance ride is a daily occurence. Essentially, our ambulances serve only to transport an ill patient from one place to another in the shortest time possible. Whatever happens in along the way is solely left to God, and beyond the control of any medical personnel, who has few tools to work with.

The sad state of our ambulance services is seen beyond emergencies. In many rural districts, ambulances serve as perhaps the only form of transport for poor patients to travel to a general hospital. Our ambulances fail miserably even in this undemanding task. Recovering patients end up stranded for weeks awaiting ambulances from the district hospitals to send them home to their anxious families. Ward beds are occupied unnecessarily. Some patients waited so long that by the time an ambulance is actually available, they developed severe hospital-acquired infections due to an unnecessarily prolonged stay in the ward.

Here in Malaysia, the field of emergency medicine is one that lacks a sense of urgency. Uncannily however, such lackadaisical attitude is cleverly hidden during buy-elections - by-elections, I mean.

Unsupportive Support Services

Our sad state stretches far beyond the clinical scenario. Our hospital support services are equally, if not more pathetic. Faulty elevators lie in ruins, unrepaired for months, causing delay in almost everything and to everyone. The elderly lady with severe osteoarthritis is forced to walk up seven flights of stairs to visit her ailing husband. Is this humane? Far from it. Urgent phone calls lose their very adjective as doctors wait ten minutes for calls to be answered and a further ten minutes as operators flip through prehistoric, dog-eared antique phone books instead of an ultra-convenient computerized directory. What could have been achieved in minutes and seconds take hours and days instead. Replacing a burnt bulb takes a mere four minutes but getting the personnel to actually do so may take up to four months. So much for privatization of hospital support services.

What is needed, What is not

Improvements to our healthcare do not require fanciful slogans so characteristic of the Badawi administration. We do not need more time-wasting, money-consuming kursus or more standard operating procedures (S.O.P) that make everything so rigid and methodical. As it is, everything is already moving at snail pace. With that statement, I am of course guilty of insulting the snail.

We need wisdom and sincerity if we are to improve our healthcare. Both unfortunately, are not synonymous with the Barisan Nasional regime.


Anonymous said...

you shouldn't complain so much about the outdated, "medieval" wards in Malaysia.come to Russia and you'd see that it really IS pre-world war I. but i suppose the grass is always greener on the other side eh

Anonymous said...

i wonder if you must be working in some hospital that is really ulu. went to kelantan to do my elective and the wards had computers that could print results. the staff nurse's room also has one. the doctor's room has one. the rooms are small but it wasn't that bad. 2 med students, 1 doctor and patient and patient's relative could fit. it could be a lot worse.

I'm in australia now but seriously some of the hospitals even worse den malaysia's. Very old and gloomy. And with the amount of resources they have(tax is about 40%), you would think it could me much better. so don't think of malaysia is so bad. every health system has its own set of issues.