When British Prime Minister Boris Johnson was down with Covid-19 in April last year, he was advised by his personal physician to be admitted to hospital, which he promptly complied with.
At one stage, when his health was threatened, he was reportedly admitted to the ICU for intensive care and closer observation. Not that there were no other more reputable private hospitals, but the National Health Service’s St Thomas Hospital, where Johnson was admitted is one of the best hospitals for a commoner, what more a sitting British prime minister.
In Asian countries such as Japan, South Korea, Indonesia, Thailand, and Singapore, the top hospitals are the university hospitals and public hospitals, and not necessarily privately run.
These examples should be adequate and convincing enough to argue for the case of having the best health care facilities in public institutions in our country.
Public health care facilities for the people should be the the equivalent of facilities available and accessible for those higher up on the social ladder.
As we are emerging from the Covid-19 pandemic, Malaysia is waking up to many new promising developments. The health minister has been elected the Vice President of the World Health Assembly, and the Malaysian Health Travel Council is ready to attract international health tourists again, hoping to grab a healthy chunk of the lucrative health tourism market.
And it has also been announced that the Institute for Medical Research (IMR) will lead a national task force to champion vaccine production for local needs and beyond.
While we greet these announcements with hope, we should be prepared for the possibility that they may not move beyond the initial self-gratification, if we link the state of the top public health facilities in other countries and compare them with what we have here.
We should ask the following questions in relation to these recent developments.
- Where do our VIPs, political and administrative leaders go to for their medical or surgical treatments? If it is in Malaysia, were they mostly treated in expensive private hospitals, or were they treated by senior doctors in university hospitals or Ministry of Health (MOH) hospitals?
- Where are the best and most experienced oncologists, cardiologists, nephrologists, neurologists, hepatologists, hematologists, and gastroenterologists, and are they in public hospitals? Where can we find the best gynaecologists, neurosurgeons, cardiothoracic surgeons, spinal surgeons, hand and micro-surgeons, and plastic surgeons? What about paediatric oncologists, paediatric urologists, paediatric cardiologists, and paediatric plastic surgeons? Since they are the best clinicians, are they also the best clinical teachers to teach and train future doctors and specialists to meet the ever increasing needs of the health care needs of the country?
- For more complex clinical services, including organ transplants, where can patients in need go to get their liver, kidney, bone marrow, heart and lung transplants? What about combined heart-lung transplants? What about islet cell or pancreas transplants? Are there any hospital that do all this in Malaysia? After all, one cannot expect an ailing patient with end stage heart failure or lung failure to survive overseas travel in search of an organ donor.
How recent was the last procedure performed and how many have been performed over the last 12 months? If the specialists had not done enough, did the administrators, policymakers, or fund providers bother to find out why, and rectify any faults seriously and promptly? What are the numbers of procedures done, compared to other countries?
If we take the case of Hospital Selayang as an example, some possible answers to the issues raised may be found, if we have the will to reflect, investigate, and find a solution.
When it comes to the national organ transplant programme, which needs a full team of trained clinicians, anaesthetists, radiologists, immunologists, laboratory scientists, specialist nurses, and donor and recipient coordinators to develop and operate, it will be a challenge to attract personnel, but it is much more challenging to encourage professionals to build their careers in the programme.
Despite ratifying the World Health Organization (WHO) guiding principles on cell, tissue and organ transplants, and adopting the resolution at the World Health Assembly, some Members of Parliament and State Assemblypersons have found it easier, if not necessarily cheaper, to have their kidneys transplants done overseas.
On the capacity of the IMR to spearhead the national vaccine production plan, we should question their state of readiness and the support it receives to meet requirements such as adequately trained staff members, laboratory reagents, scientific equipment, and research funding.
Dengue is endemic and has taken the lives of many Malaysians well before the Covid-19 pandemic. What happened to the IMR field trial involving genetically modified mosquitos, launched by the then deputy director-general of health in December 2010 , when 6,000 sterile male mosquitoes were reportedly released in the jungles near Bentong, Pahang?
On the use of genetically modified Wolbachia mosquitos, has anyone checked the funding and progress of the programme? Apart from funding and technical support from the University of Glasgow, the University of Melbourne, the British Wellcome Trust, and the Institute for Behavioural Research, how will the contract field and lab scientists support their families, given that their paltry RM2,000 income is well below the national poverty line?
When we did our first national survey on chronic kidney disease in 2012, the research budget for the urine test kits for albuminuria was sourced from the Postgraduate Renal Society of Malaysia (an NGO with members made up of nephrology clinicians in the MOH).
Given the perennial staff and budgetary constraints, we should ask if the IMR is capable of performing simultaneous HLA cross-matches and tissue typing if we have four available kidneys from two concurrent deceased organ donors (two kidneys from each deceased donor), to be matched with eight potential kidney recipients, should such a procedure be required after working hours, or on weekends or public holidays?
After the first solid organ transplant performed in 1975, we are still struggling with 70 to 100 kidney transplants a year for the 2,000 to 3,000 suitable new patients, out of 7,000 to 8,000 new end stage kidney disease patients annually, as reported by the National Renal Registry.
And when transplants continue to be performed successfully in public hospitals in Singapore, Thailand, South Korea, Vietnam, Hong Kong, Europe, and North America, the only MOH liver transplant centre at Hospital Selayang and the main kidney transplant centre at Hospital Kuala Lumpur (HKL) have stopped performing transplants from the third quarter of last year.
HKL recently solved the lack of operating room and ICU beds (reserved for Covid-19 patients) by arranging patients to undergo live-donor transplants in two private hospitals, paid for with a grant provided by the MOH.
This took place when there are two existing public transplant facilities, namely the National Transplant Resource Centre (NTRC) that coordinates and facilitates deceased organ donors and organ retrieval in various hospitals in Malaysia, and the National Kidney Transplant Centre (NKTC) at the Institute of Urology and Nephrology, Hospital Kuala Lumpur.
Not a single transplant has been performed for more than a year in these two facilities, and unless we rectify the deficiencies and provide the necessary support for them to restart their transplant programmes and redouble their outputs.
Why are VIPs and their relatives continuing to fly overseas for medical treatments and procedures? Why should VIP orthopedic patients travel overseas for just neck or back pain treatment?
Why can’t we have the best health care facilities and services in public hospitals, for you, for me, for the Prime Minister, for the royals, for everyone?
Dr Ghazali Ahmad is a consultant nephrologist who previously worked in several Ministry of Health hospitals and has performed collaborative clinical and epidemiological research. He is the current president of the Asian Society of Transplantation and the past president of the Malaysian Society of Nephrology, Malaysian Society of Transplantation and Postgraduate Renal Society Malaysia.
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