‘The Doctors Are Not Okay’: Ipoh Timor MP

Howard Lee calls for a needs analysis audit to determine the actual need and demand in public hospitals, as well as more investment into staff and equipment, saying the contract system leads to doctor brain drain.

KUALA LUMPUR, Dec 23 – Ipoh Timor MP Howard Lee Chuan How admits that government doctors are facing hardships with limited resources, amid the overcrowding of emergency departments like in Raja Permaisuri Bainun Hospital (HRPB).

The government backbencher MP from the DAP advocated for a nationwide needs analysis audit across government hospitals – not just the general hospital in Ipoh, Perak – to uncover the “objective reality” of emergency departments and to assist in determining budgetary allocations to upgrade the “software” and “hardware” of hospitals.

Lee called for funding to be invested into both facilities and human resources in public hospitals, after talking to doctors from HRPB, a Ministry of Health (MOH) facility, whom he said are “not okay”.

“So there needs to be, fundamentally, more money invested in hardware. When I say hardware, I’m not talking about bricks and mortar only; I’m also talking about equipment because, as you (CodeBlue) have reported, the doctors that I have spoken to are not okay,” Lee told CodeBlue in an interview in Parliament last Tuesday.

“When our frontliners are not put in a position whereby they have the tools to do their job, then jeopardy is on their name as well as on the operational integrity of MOH. 

“So I don’t think anyone would deny that the doctors are not okay. They’re not. I mean, let’s not try to deny that. And I don’t think anyone is denying that, but what’s the solution?

“The solution is investment.”

He also pointed out that even when public hospitals do have the right equipment, there is a lack of staff and expertise to operate it. 

“Operating theatres that have literally the most advanced equipment, but you don’t have the expertise to run it. You don’t have the OT nurses, you don’t have the specialists, or enough specialists, or a specialist who wants to take on. Basically, you’ve got a mismatch.”

CodeBlue reported last week on the severe congestion in HRPB’s emergency department (ED), where seriously ill patients, including ventilated cases, are stranded for up to six days due to insufficient critical care beds and staff. 

CodeBlue’s 5,000-word report also stated that two HRPB patients died in general medical wards after they were stranded in the ED for more than four days, including one case that a doctor deemed to be a preventable death.

Lee said he understands that HRPB is currently carrying out a needs analysis audit. A needs analysis audit is an analysis which defines the deficiencies or problems in a system and also identifies the causes and solutions to such problems. It can be thought of as the process of identifying gaps between what should be happening and what is happening, and accounting for the causes of these gaps. 

“I have sources who have informed me of a needs analysis audit being carried out, though I am not sure if it is an ongoing one or one as a result of the recent reports pertaining to HRPB’s plight,” Lee told CodeBlue. 

“Either way, it’s one that I welcome and I feel is something that ought to be applied nationwide and not just at HRPB.”

Audits in the health care field are a process used by health care professionals to assess, evaluate, and improve care of patients in a systematic way. Such audits measure the current practice against a defined (desired) standard. This is part of clinical governance aimed at safeguarding high quality clinical care for patients. 

“We need the real picture of what’s happening in the emergency departments of hospitals,” Lee said.

“What’s really happening in terms of bed occupancy in all the wards, and actually, we want to see the different wards, at what level of occupancy there is, whether or not there are enough doctors, whether there’s enough junior house officers, senior medical officers, registrars, and consultants in the service to meet the demand that is there.

“And what does the demand mean? Is the demand of people who feel like they’re turned away included in the statistics? All these really need to be discussed.”

In addition to discovering actual need and demand in public hospitals, the needs analysis would also be useful when it comes to staffing issues. 

Contract System Leads To Doctor Brain Drain From Malaysia

Ipoh Timor MP Howard Lee Chuan How speaks to CodeBlue in an interview in Ipoh on November 14, 2022. Picture by Saw Siow Feng.

According to Lee, the government needs to rethink whether it wants to maintain its hard stance of not offering doctors permanent positions in the public service.

“Basically, you’ve got a mismatch. When you have the equipment, you don’t have the expertise. Or when you have the people, the equipment and the hardware is not there. Or you have the patient, but either one of these things are not complete. So there needs to be a long, hard look at, I would say, a long, hard needs analysis,” he said.

“In policy, I would sequence a needs analysis right at the top. Right now, I’m sure that someone is probably doing that already and of course, again, and I repeat, I’m not a minister, I’m not an executive. I’m not in MOH in any capacity. 

“But I would say that if you’re asking me what needs to be done immediately, it’s a needs analysis, or audit, or whatever you wanna call it. And then from that, really look at, you know, address the contract doctors’ issue.

“I know it’s not black and white, but when you have this situation where you’ve got equipment, but there’s not enough staff to run it, is it wise for us to take this kind of strong position that [there’s] no increase in contract doctors, no permanent doctors?

“Do we have the luxury to say that? We don’t. Do we want to lose talent to the private sector? Do we want to risk the integrity of our public health service going down the dumps, not only lose it to private locally, but lose it to private elsewhere — out of the country?”

Infectious disease expert Prof Dr Adeeba Kamarulzaman from Universiti Malaya said yesterday that at least 30 top medical graduates from her university leave for Singapore every year, with some even now going to the United Kingdom.

“We will continue to have this problem forever, until we are serious about addressing the health care workers’ issues in Malaysia — doctors, nurses and allied health professionals,” Dr Adeeba tweeted, in commenting on a CodeBlue report on complaints from an emergency doctor about unrealistic expectations for the overcrowded ED.

“For a start we can perhaps look at urgently plugging the brain drain of fresh medical graduates and MOs (medical officers) because of a lack of posts and clear training pathways.”

Lee also said he would like to be in the position to allocate no less than RM50,000 from his constituency development funds to HRPB, a tertiary hospital, to tackle some issues, such as equipment shortages. 

“I must stress that HRPB actually serves Ipoh Timor, Ipoh Barat, Tambun, Gopeng, Batu Gajah, and pretty much the entire state actually,” said the Ipoh Timor MP from Perak. 

“So I think it is incumbent upon all MPs to do something, but I’m going to put my money where my mouth is. I’m going to allocate if and when – we don’t know what the allocations are for next year yet…whether or not there’ll be a continuation, a reduction, or an increase in parliamentary constituency development allocations.

“But I would like to be in the position fiscally — through my constituent development allocations — to allocate no less than RM50,000 to assist in some of those equipment shortages, et cetera, et cetera.”

CodeBlue’s report on the overcrowded ED in HRPB had highlighted dilapidated and damaged beds without bed railings that are necessary to prevent senior citizens from a fall, which sometimes causes a delay in admission of elderly patients. A vital signs monitor was also broken in the Yellow Zone (Semi-Critical Zone).

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