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The Health | january-february , 2021
| Cover Story |
3
. SHORTAGE OF DOCTORS
Despite having increasing numbers of local and foreign graduated medical professionals annually , Malaysia is facing a shortage of doctors , particularly in specialist fields .
Since the introduction of the contract system in Dec 2016 , doctors have echoed their dissatisfaction . It would leave many jobless after completing their two-year compulsory service and halts their path towards specialisation .
The Covid-19 pandemic has also amplified the need for expansion in healthcare services , yet the Budget 2021 has failed to address the manpower shortage in public healthcare facilities .
While the Malaysian government ’ s decision in November 2020 to promote contract medical officers from Grade UD41 to Grade UD43 to earn the same emoluments as their permanent counterparts is very much welcomed , it does not address the long-term needs .
The Malaysian Medical Association ( MMA ) has continuously advocated and requested the government for an increase in permanent positions .
MMA President Prof Datuk Dr M Subramaniam said : “ While we speak about the doctors to patient ratio , clearly this ratio has been insufficient in this pandemic . Simultaneously , the distribution of doctors remains questionable as we have seen severe shortages in certain stages .
“ While the Ministry of Health ( MoH ) has been urged to provide doctors to these areas , we also see a need for the Public Services Department ( JPA ) to increase these positions .”
He also suggested narrowing the gap between government and private doctors by making the service more attractive .
“ This would substantially reduce the ‘ leakage ’ of senior talents primarily due to frustration . The gap is at least 2-3 times now .”
“ We have also requested from MoH to reduce the timescale for promotion to UD56 . Previously , a doctor was promoted from UD54 to Grid Khas C . However , later UD56 was introduced , and now there is a further wait of 5-6 years to reach a JUSA post .”
The MMA has also urged the government to be transparent in selecting permanent positions and promotions at all levels .
Pointing out the pandemic has caused extreme fatigue among frontline doctors , Dr Subramaniam stated MoH provided psychological support for both frontliners and backliners through the Mental Health Psychological Support team state .
“ Among the efforts started by the MMA include Helpdoc which was launched four years ago to help doctors to not only cope with stress but also address issues faced by doctors at work ,” he shared .
“ While we welcome all these initiatives , we believe that all frontliners should also qualify for hazard leave during this period . This is especially when they are not only working tirelessly but also sacrificing time and being away from their families .”
4
. MENTAL HEALTH
Mental health cases are on the rise , especially during this pandemic with the implementation of movement
restrictions and social distancing orders .
A study by the Institute for Public Health among Covid-19 hospitalised stable patients in 2020 revealed that depression was three times higher ( 7.5 per cent vs 2.3 per cent ) while suicidal ideation was twice higher ( 4.0 per cent vs 2.1 per cent ) among these Covid-19 patients as compared to the prevalence among the general population in Malaysia as reported by the National Health and Morbidity Survey ( NHMS ) 2019
The MOH ’ s Psychosocial Helpline received more than 35,000 phone calls from March to October 2020 on problems related to emotional stress , anxiety , and depression .
Statistics from The Befrienders Kuala Lumpur show more contacts received from those in distress and feeling suicidal in July , August and September compared to April , May and June .
Accessibility to a mental health diagnosis , treatment and support services is vital , even more so during this pandemic . However , the allocation for psychiatry and mental health services was reduced by RM31.4 million from RM344.8 million for Budget 2020 to RM313.4 million for Budget 2021 , which Dr Rajbans Singh , President of the Malaysian Wellness Society , feels will make things worse .
Along with mental health , the overall wellness of one ’ s health is also a concern going into 2021 . To increase the country ’ s wellness level during the pandemic , Dr Rajbans said Wellness Education and the media could help .
He added : “ The seven things the Blue Zones do is something we all can follow .”
Blue Zones are the world regions where people live healthier and longer than others . Five ‘ Blue Zones ’ have been posited , namely Okinawa ( Japan ), Sardinia ( Italy ), Nicoya ( Costa Rica ), Icaria ( Greece ) and Loma Linda in California .
5
. PREVENTIVE HEALTHCARE
The 2019 National Health and
Morbidity Survey ( NHMS ) findings showed little to no improvements in the prevalence and risk factors of noncommunicable diseases ( NCDs ) amongst Malaysians .
Chronic diseases such as cardiovascular disease , diabetes and chronic respiratory disease are imminent for Malaysians in the long run if preventative and corrective measure are not put into place going into 2021 .
The Covid-19 pandemic has severely disrupted all healthcare service and treatments , and brought about hesitancy among patients to visit healthcare facilities , fearing the virus transmission .
Dr Noor Ani Ahmad , Director of Institute of Public Health ( IPH ) from the National Institutes of Health ( NIH ) said : “ Prevention is better than cure . It is better and easier to prevent the disease from occurring rather than to treat after they get sick .”
Preventive healthcare is essential . The repercussion of late detection can
sometimes result in disease complications , disabilities and even death . Hence , prevention is very much imperative in all health conditions .
“ The Malaysian population should be empowered to take care of its own health by adopting a healthy lifestyle , including regular health screening and early treatment to prevent complications .”
“ We ’ re aiming not only to increase life expectancy but also to ensure good quality of life without disability towards healthy and active ageing .”
Referring to the NHMS findings , she said : “ These figures demonstrate the lack of awareness among Malaysians in taking care of their own health .”
“ A similar scenario is also seen with some Covid-19 patients when they presented to health facilities at a late stage resulting in longer hospitalisation and even death .”
The Ministry of Health ( MoH ), she said , advocated “ all sectors are health sectors ” which emphasised that health was everyone ’ s responsibility and not just the MoH .
Creating a supportive environment for a healthy lifestyle and disseminating health information , especially the importance of early detection and treatment , should be the ideal strategy .
“ The Covid-19 pandemic taught us the most effective protection against it is for us to take care of our own health and avoid high-risk situations . These new norms should be our contemporary culture .
“ While we ’ re protecting ourselves against Covid-19 , we should also protect ourselves from other diseases by adopting routine health screening to detect noncommunicable diseases such as diabetes and hypertension , and to screen against cancer .”
She also noted the awareness of the importance of health screening should be targeted at the younger generation by engaging them through social media platforms .
“ We can also identify role models such as national athletes as change agents who can influence this group to adopt a healthy lifestyle and encourage regular health screening . The element of early healthseeking behaviour can also be added into popular TV series or telenovela .
“ With comprehensive and holistic intervention strategies , it is hoped we can see better health-seeking behaviour among Malaysians in the next NHMS .”
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. ALTERNATIVE THERAPY
Alternative therapy , which includes traditional and complementary medicine ( T & CM ), has been used by many worldwide for many centuries to maintain the health and quality of life .
In 2007 , the Ministry of Health ( MoH ) established a T & CM division to promote modern and herbal medicine .
The division classified alternative medicine into traditional Malay medicine , traditional Chinese medicine , traditional Indian medicine , homoeopathy , complementary medicine and Islamic medical practice .
In 2018 , the MoH also launched the T & CM Blueprint 2018-2027 to guide a systematic and sustainable approach in developing the T & CM industry . Now , with renewed focused on preventive medicine , an alternative therapy is expected to grow significantly .
Malaysian Association of Advancement of Functional & Interdisciplinary Medicine ( MAAFIM ) President Dr Vijaendran Subramaniam said : “ From the general observation of members of MAAFIM , I would