I cannot help noting the muddled, directionless thinking in our ministry of health which has now somewhat become reflective of the country's ills. The director- general of health, sometime ago, in trying to discredit the standards of the Crimea State Medical University, Ukraine espoused how important 'evidence-based medicine' was in justifying CSMU's derecognition.
Shortly following that, the health minister and the DG both went about trying to implement the Private Healthcare Facilities and Services Act 1998 an Act that was outdated, not thoroughly discussed with the medical fraternity and passed through parliament in haste under questionable circumstances.
Health Minister Chua Soi Lek incredibly, on Dec 12, 2006, announced that China had agreed to help Malaysia set up integrated hospitals that will incorporate Western, traditional and complementary medicine. For what rhyme or reason would you want to do this now when the current focus is clearly on evidence-based medicine with the new Act ostensibly geared to make certain quackery doesn't take place? If this not a contradiction, what is?
And even before ambiguities of the Act have been ironed out, the DG and Chua sensationally decide to seal six clinics after reportedly elaborate undercover work by officers of the ministry's possibly underworked Medical Practices division. I thought we were done with burning and guillotining 'healers' in the medieval ages. Aren't there greater priorities in healthcare in this country? Or are these theatrics designed to deflect recent criticism of the ministry's poor services and bungling including its poor ambulance services, its inability to cope with dengue cases and the new Alor Star hospital debacle.
Among the clinics sealed were ones that were run by medical assistants, nurses (all in likelihood trained by the ministry themselves) and midwifes who have 'delivered hundreds of babies'. It would have been interesting to find out the waiting time for patients, the mortality and morbidity rates and patient satisfaction at these 'illegal clinics' whose only fault appears to be that they have run foul of the law for running these establishments without doctors or rather feigned the duties of doctors.
The ministry appears to be forgetting that almost all their community clinics are run by 'jururawat desa' (community nurses) who indeed deliver hundreds of babies at their community clinics and homes. Staff nurses and medical assistants run almost all the ministry's health centres treating cough and cold, hypertension, diabetes, prescribing medication right till even doing minor surgery including circumcisions. Medical Assistants (MA) till this day provide anesthesia for patients in many divisions in Sarawak. Forget about the Act. How do you now explain to the general public that it is okay for them to be seen by an MA or nurse at a government health or community centre. Is it okay for the MA to anesthetise and indeed carry out a post-mortem? Is it also okay for the midwife to deliver babies and vaccinate children? Is it also alright for MAs to intubate and ventilate patients? Is circumcision done by an MA safe? Is a fracture reduced and plastered by a medical assistant in Sampoerna district hospital acceptable? One rule for the private sector and another for the government?
The confrontational approach which has become the hallmark of our current minister and DG is now appearing to be the rule rather then the exception of this government's healthcare policies. By these actions we have to assume that the Barisan Nasional government approves of these confrontational policies. GPs now will probably have to brace themselves for not modifying their doors or equipping themselves with emergency equipment that they may not use.
Doctors' organisations who will undoubtedly pay a heavy price for their continued 'elegant silence'. Flimsy resistance by the MMA and its lack of warning to members to unite led to the implementation of the Private Healthcare Facilities and Services Act 1998 and a similar stance will put paid to the National Healthcare Financing Scheme where it seems a consulting firm and CEO have already been appointed. As in the PHFSA, the ministry is again hiding behind the OSA for the NHFS' details. We have learnt nothing from the vulturisation of the ministry's meager budget in the early 90s leaving patient care compromised due to lack of competitive tendering, cronyism and sweetheart contracts.
As you approach the Malaysian Medical Council building at Cenderasari, KL you cannot escape the adjacent giant signboard that reads 'Unit Perubatan Traditional dan Komplimentari' (Traditional and Complementary Medicine Unit) right next to the MMC. We may have lost the edge to keep this noble profession of ours above the fray simply because we have failed to stand-up and be counted. Medical ethics laid down and emphasised by the founders of our profession like AA Sandosham who championed clinical medicine are today definite history. Malaysian doctors are today just ordinary citizens and we should not fault the public or courts for siding with Whitaker instead of Bolam. Noble we are, no more.
