08
The Health | june-july, 2020
| Hot Topic |
Surgeons to the fore
in fighting Covid-19
Harnessing the leadership of Malaysian
surgeons is key to our success
By Prof Dato Dr Hanafiah
Harunarashid (Director, HCTM) left and
Dr Husyairi Harunarashid (Clinical
Epidemiologist, HCTM)
Previous epidemics or
outbreaks in Malaysia, like
dengue, tuberculosis or HIV/
AIDS, could be handled “only”
by physicians, infectious
diseases specialists or public
health experts, due to their
smaller scale. However, the
immense scale of the global Covid-19
pandemic meant that Malaysia required
a response from our entire health system,
government as a whole and entire society.
Malaysia pulls together
Malaysia’s first cases of Covid-19 came on
Jan 25 with a few foreign patients. This later
exploded after a religious mass gathering
in March, leading to one of the largest
contact tracing exercises ever conducted
in Malaysia. With the help of the police and
with a cooperative community, we could
manage the unfortunate spread of Covid-19
from one mass gathering, although it went
to five generations of transmissions.
Due to an unexpected political
transition, Malaysia went without a Health
Minister for 14 days in Feb-Mar 2020.
During that time, the battle-hardened
Ministry of Health (MoH) technocracy
essentially ran the show. The new Prime
Minister declared a nationwide Movement
Control Order (MCO) starting March 18,
Malaysia’s first movement restrictions
since 1969 when racial riots occurred.
More draconian measures called
Enhanced MCOs were imposed to further
restrict movements in hot-spot areas of
high transmission rates. Taken together,
this was effectively the largest securityenforced
curfews during peace times.
Similar to other countries, such restrictions
were necessary but carried an economic,
social, psychological and political cost.
As we write, the MCO is still in force.
To date, the government has issued three
economic stimulus packages to protect
the poor, the vulnerable, the unemployed
or the under-employed and the small and
medium enterprises (SMEs) that form the
bulk of Malaysia’s economy. These stimulus
packages prove that this pandemic isn’t
only medical or health, it’s economic, social
and political.
Perhaps the most important thing
to note from the Malaysian Covid-19
experience is that despite a political
transition, the public health services
remained intact and continued fighting
Covid-19 at a national level. This supports
the principle of a professional technocracy
in the Health Ministry being the “stable
foundation” that survives any political
transition or uncertainty.
Harnessing the natural
leadership of surgeons
Right now, an endocrine surgeon is leading
the Malaysian national effort against
Covid-19, rather than the more commonly
expected infectious diseases specialist or
public health physician. As the Director-
General of Health, Datuk Dr Noor Hisham
Abdullah, an Endocrine and Breast surgeon,
leads the entire health apparatus of the
Malaysian government as the senior-most
technical civil servant.
Although not a communications expert,
epidemiologist or pulmonologist, his
factual, calm and predictable demeanour
during the daily Press conferences is
reassuring to Malaysians. Described as “the
quintessential civil servant”, he played his
part in managing the challenge of Malaysia
going through an unexpected political
transition.
It’s not only the Director-General of
Health that is a trained surgeon, but also
directors of several large hospitals and
academic medical centres. At least five
academic medical centres in Malaysia are
helmed by trained surgeons (a vascular
surgeon, an orthopaedic surgeon, a
neurosurgeon, a plastic surgeon and an
eye surgeon. Indeed, the leadership of
surgeons is needed during these trying
times. Surgeons head both the Ministries
of Health (MoH) and a majority of higher
education hospitals.
“Surgeons are born leaders. We are
taught to make difficult decisions,” says
Professor Dr Tunku Kamarul Zaman,
Director of UMMC and a Consultant
Orthopaedic Surgeon.
Surgeons are not trained
epidemiologists or administrators but
fighting this pandemic recalls familiar
surgical concepts. Decisions are made
under pressure and with scarce resources.
Strict infection control saves lives on the
operating table and in the health system.