Before 2022 ends, Malaysia would have another government (or a similar one, who knows).
Here are some thoughts, hopes, and a wish list from a government doctor who has served in Sabah for nearly a decade.
We need to go back to the basics of health care – infrastructure and access. Many Malaysians in rural Sabah (and Sarawak and Peninsular Malaysia) still need to cross rivers, ride boats, and make their way through unpaved gravel roads to reach a facility, only to find out there is no X-ray machine there.
There is a lack of hospitals (district and tertiary) in Sabah, causing patients to have to travel long distances (some up to 100+km) just to see a specialist.
The Pan Borneo Highway is (slowly) being completed, and it is hoped that by GE16, ambulances do not have to play the “dodge-the-pothole” game as they ferry patients and respond to calls.
Handphone access and coverage is often weak and sometimes undetectable in certain tertiary hospitals in Sabah, what more in district hospitals where coverage and internet connection is important, especially for referrals?
Medical equipment, from autoclave machines and operating theatre instruments to lab supplies such as reagents, test tubes, culture bottles, and others need looking into. Aged and broken equipment should be repaired or replaced; the system supplying essential items to hospitals should be improved to enable clinicians to carry out their duties without worry.
There have been some improvements: the first ever MRI machine reached Sandakan hospital in December 2021.
Prior to that, all patients needing an MRI would have to travel to Kota Kinabalu. This would take either six to seven hours by land or a 45-minute flight across a distance of 300 to 400km.
A senior Sarawak public health government doctor has this to say: “Old, dilapidated health care facilities are still running and treating patients on a daily basis. There is a need to not only repair these facilities, but outright replace it anew”.
Are we still going to be treated in rotten or mouldy wooden clinics with no electrical supply and clean water supply come 2030?
Enough of temporary measures which do not address the root cause. Futureproofing is needed in terms of staffing, specialty coverage, emergency services, and so much more.
We hope the newly elected government takes the basics seriously. There is really no point having the newest technology, best expertise, and fanciest programmes if patients cannot access them; or to have these in major cities while rural health care suffers.
The contract system in employing health care workers, especially doctors, has cost us a lot. Many bright talents have already left for other countries, which offer a more secure future.
It is heartbreaking to see young doctors, full of potential, leaving their home country to seek a better life. My only hope is that they will, one day, return to Malaysia.
Through the efforts of many parties, including caretaker health minister Khairy Jamaluddin, marked improvement has been seen, one of which is the admission of contract doctors into the postgraduate training programme.
Long overdue benefits like hazard leave and flight warrants have finally been implemented, but one wonders why it was denied in the first place.
However, there is much work to be done, including the formation of a promotional ladder and salary scheme for contract doctors to match the career progressions of permanent doctors.
The recent exercise to award permanent positions to contract doctors left everyone confused. What was the criteria? Why did so many high achievers (at work, academic performance and extracurricular activities) not get permanent positions?
There were no reasons given. Again, this drove many to quit and leave government service.
We hope that the newly elected government will continue to improve the contract system and will not delay the handling of the issues mentioned above. We cannot afford to lose more young doctors. Stop the brain drain before it is too late!
Malaysia needs more government specialists and subspecialists, especially in East Malaysia. Certain subspecialties are handled by ONE single person covering the entire state, e.g. vascular surgery, geriatrics and cardiology in Sabah. Some areas have none at all!
The retention of specialists and subspecialists in the government sector will continue to remain an issue (e.g. JUSA positions), unless incentives are taken seriously.
Promotional criteria, again, is a mystery; it has been years since the last exercise. State health directors need to be more proactive (and not dismissive) in allowing government specialists to utilise the flexi-hour working system that was created to retain them in the service.
The salary scheme and allowances for subspecialists needs to be revamped. It takes subspecialists a total of 12 years (or more) of studying, with some bringing entire families across Malaysia and overseas (some with inadequate allowances), only to return to Malaysia with no extra salary compared to a general specialist.
How do we expect them to remain in government service? There is much talk of expanding services and improving expertise to better serve the community, but we have not been proactive in retaining our government specialists.
We hope the newly elected government will take specialist retention and incentives seriously to ensure that all Malaysians have access to specialist level health care in government centres.
Holding Up The Health White Paper
There are many more issues, and what I have mentioned above is just the tip of the iceberg.
I hope the Health White Paper will be implemented by successive governments, for the sake of health care in Malaysia.
May the newly elected government not neglect its implementation, and render it a white elephant instead.
Dr Timothy Cheng is an orthopaedic surgeon at Duchess of Kent Sandakan Hospital in Sabah.
- This is the personal opinion of the writer or publication and does not necessarily represent the views of CodeBlue.