‘MOH Is On The Brink Of Collapse’: Government Dentist, Penang

“MOH is on the brink of collapse. We are collapsing inside. And I think they know it, but they don’t care,” says a permanent dental officer working in a Penang klinik pergigian, adding that nothing has moved despite DG Hisham being in office for a decade.

KUALA LUMPUR, Jan 31 – A government dentist from a public dental primary clinic in Penang has complained about demotions for dentists who recently received permanent positions in the service.

The dental officer, who is in a permanent post, revealed that although their salaries remain the same as per when they were previously on contract, annual increments are affected.

Besides lower wages, the dental officer working in the Ministry of Health (MOH) also raised issues with placements, overwork, and burdensome programmes amid understaffing.

The dental officer from a klinik pergigian was among 1,652 government health care workers nationwide, predominantly from MOH, who took a CodeBlue survey earlier this month on workplace frustrations.

In CodeBlue’s poll, 95 per cent believe Malaysia’s public health care system is currently in crisis, 98 per cent are angry at the situation, 73 per cent are thinking of quitting their job, and 52 per cent are willing to go on strike if one is organised.

On workplace issues, 83 per cent perceive that the government isn’t serious in addressing issues in the public health care system, 80 per cent say they’re underpaid, 78 per cent complain of overwork, 74 per cent suffer from burnout, and 61 per cent feel insecure about their career progression. A quarter allege workplace bullying, while 2 per cent claim workplace sexual harassment.

Below is the government dentist’s story in their own words. As civil servants are prohibited from speaking publicly, CodeBlue is providing them anonymity. The transcript of CodeBlue’s interview with the dental officer has been edited lightly for clarity.

Grade Demotion, Lower Salary Increment For Dentists Moving from Contract to Permanent

First off, in terms of the way that we were selected. I think you are aware that there is no clear cut on what was the criteria for selection: Whether you know how much we’ve achieved. So, I feel that that’s, that part is unfair. Even though I got the permanency, I do feel it was not clear. That’s number one.

Number two, if you recall they did mention that they were creating new vacancies. It’s not like you continue your grade. You start back from scratch. For example, for dentistry, the parallel grade for dentistry will be UG41.

So let’s say, if you are in your contract and you are 44, you go back to 41. I just enquired recently from the pegawai tadbir, the administration side, and they said that you would have to go through the two years again to become 44.

To be fair, yes, they’re creating new vacancies, but I don’t see the logic in demoting the grade to 44. Maybe if you can keep the person at maybe 41 and then give them six months or one year to return back to the set post, then it’s okay.

In terms of salary, we have maintained it. But the grade increment for salary has different increment values. So, we do lose out in terms of grade for salary increments.

For example, if I’m 41, and my yearly increment will be about in the RM200 plus range, and when I’m in 44, it’ll be around like another extra RM300 plus. I’m really losing out on RM100. Since now that I’m in 41, I will get a RM200 increment instead of the RM300.

It’s a significant amount, but the workload is the same, more or less.

Placements For Dentists Exclude KL, Selangor, Negeri Sembilan

People under this programme for medical, I understand that you are all made to stay in your current position, right? Current place of work, right? For dental, they go to different places and I mentioned in my previous email that KL, Selangor, and Negeri Sembilan were not offered.

So for medical, you stay put where you are, but for dental, the places that were given excluded KL, Selangor, and Negeri Sembilan. If they are trying to say that is a fair way of selection, I think it’s not fair because they did not include KL, Selangor, and Negeri Sembilan.

The doctors who are native to those three states cannot serve their particular state. And these three states are in extreme need of medical and dental personnel, excluding the states of Sabah and Sarawak.

Dental officer, klinik pergigian, Penang

So I think it’s fair, especially if you have your family, and you can save a lot, right? It’s a lot of expenditure by staying in a place that I’m not native, to which I did not have a choice. Like for example, I got Penang because I had no choice.

If let’s say, there was KL and all three states, and I end up having Penang, I think it was a fair selection. So, in that sense, I would like to inform my juniors or whosoever is going to take up this new permanency post to be aware of all these things because they don’t tell you this until the very last minute during preparations.

They made the post online that they are picking up interviews.

Only Two Weeks To Report For Duty Out-Of-State

So let’s say, I think it was in June? June or July? Let’s put it in July. So around August, you have to start getting all your documentation and you have to straight go for the interview. And let’s say you get permanent, you have barely two weeks to report for duty.

And I understand, there is a privilege or a concept where you can apply to your new state to give you a stay of reporting for duty. They give you an additional two weeks to complete your task and whatnot, but it depends on the state or whoever’s in charge in the state.

If the state allows you to do that, then it’s okay. Penang did not allow me to do that.

So I had two weeks to find a place to stay and to get settled in. The worst thing is this brings into play another factor – I’m Indian, so I was subjected to racism in terms of finding a place to stay.

Dental officer, klinik pergigian, Penang

I’m a doctor. I’m finding for a place to stay in two weeks. None of them wanted to offer me a place to rent — even though I had the money for it.

And it’s also, in general for doctors, it’s quite difficult to find a place to stay. Because if I’m not mistaken, the amount they give you is only RM400 for kos penginapan, they call it.

If you are going to give me quarters, which I did try to apply, number one, they did say the quarters, priority is given to the lower grades.

Because they feel, number one, lower grade, and they feel that we are doctors, and we should be earning enough, which I don’t think is true because they’re paying people peanuts here.

So for example, right now I’m spending on housing – RM1,200 for my rental alone, excluding the electricity and water.

I’ll give you my net salary – it comes to about RM3,800 net salary. So with RM1,000 going to my rental, how much can I give my parents? Sometimes they need money, so I need to give them money.

Dental officer, klinik pergigian, Penang

And then, you’ve got the car because, of course, they’ll tell you — if you’re a doctor [and] you don’t have a car — “How can you not afford one?”.

So there’s a lot of expenditure that they don’t see coming into play because back in the day, RM400 you can survive because doctors were given quarters back in the day. So, I really don’t think it’s a favourable thing to us doctors, pharmacists and dentists as well.

I even pity my medical friends as well. Because number one, it’s not a good idea sometimes if they are just made to stay put in a place that they don’t like.

So when I read the garis panduan, the guidelines, it says for the state of Sabah and Sarawak and if I’m not mistaken, it’s a minimum of two years you have to be working there before you can apply for a transfer. If it’s peninsular, it’ll be three years.

I’ve read that based on the criteria, I think it’s called Lampiran B or C, the criteria is that you have [to have] a medical problem, someone stalking you, or your life is threatened, or a parent who is extremely ill and whatnot.

So, my question is, do I have to wait for me to be married, or for my parent to be severely ill, or for someone to come and stalk me in order to get a transfer?

The guidelines are not realistic.

All you have to do is just send me back to where I’m native from. I know it’s a bit selfish, but if you take care of your doctors, you take care of your staff, your nurses, they can give it 200 per cent.

Inconvenient Systems

We have new systems, which I think is actually a good idea that we’re going towards more technological advancements.

But the problem is the way they are forcing us to balance the patient work as well — the returns and all. I don’t think we can manage, and we are totally understaffed to be honest.

We see patients. On top of that, we have to go to schools and do incremental dental programmes. And after that, we have to take the data from whatever we are doing with our patients or whatever we’ve done in school and insert them into the returns.

Now the thing is, every year it’s either changing or it’s becoming more and more tedious. Also you start asking yourselves, “Who are these returns for actually?”.

So it doesn’t make sense because it has not improved our way of treating patients. It has not improved our way of managing the clinic in any way.

Interviews For Permanent Posts Should Look At Applicant’s Performance and Contributions

The solutions – number one is the selection of people from the interviews. Select people based on their performance, how active they are, whatever khidmat masyarakat they have joined, and what is their contribution to the clinic.

Because for me, they did not see my contributions at all. They just saw the way that I was talking using my soft skills. Yes, I think soft skills are important, but I think whatever a person has earned throughout the three years of their contract that should matter.

You bring in a little folder and then you go, for example, the admin side will kind of arrange the documents for you, but when they’re interviewing you, they don’t ask the questions based on what is in the folder.

For example, “Oh, okay, you are in charge of, let’s say, assets (machineries, furniture etc. that are registered under the clinic and owned by the government). What have you contributed or what do you know about it? Or you know khidmat masyarakat, what have you done?”.

This wasn’t done. What they asked me was, “If we were to send you to a place that you’ve never heard of, like some Kampung Belimbing, would you be okay with it?”. And then introduce yourself and give me three reasons why we should take you.

There was a colleague of mine who was not willing to go far because she said, “I have a family”. She did not get it. She did not make the cut.

Dental officer, klinik pergigian, Penang

You should look at the person’s credentials because then it’s not fair, especially to medical: how much effort they put inside, how many hours they have done on-call.

For my case, I had a good solid amount of paperwork consisting of patients’ good reviews, all proof of active participation and involvement, as well as proof of holding significant positions and responsibilities in the clinic, BUT I was not queried on this.

Instead, it was all about, “Are you willing to go to a remote area?”. Others had questions about their job scope in their respective clinics, but others and I weren’t lucky.

So in summary, some of the ones who got permanency in dental really did deserve it with their hard work, while some would have had the privilege of having a poor record but taken on the basis of verbally agreeing to go wherever they get.

Don’t Use KL, Selangor, and Negeri Sembilan As Transit For Contract Officers

Number two, in terms of placement, there should be a revamp in the placement and transfer system. KL, Selangor, and Negeri Sembilan shouldn’t be used as transit for contract officers.

When I say transit, basically, they’ve opened up a lot of placements in KL, Selangor, and Negeri Sembilan for contract officers. Because when I called and asked if there are any permanent positions in any of these three states, I was told, “Oh, they’ve actually reserved all these spots or NDOPS (new dental officers programme), which is new dental officer for contract officers in dentistry”.

So they said it’s all reserved for the contract officers, and it’s quite a substantial amount because I was a contract officer once, and I did see that there were a lot of selections of clinics, but when it came to my vacancy, there was very minimal.

Basically, we got the dirty end of the stick, even though we are permanent.

Dental officer, klinik pergigian, Penang

KL and the Klang Valley – with its high population density – should focus on retaining permanent officers who want to work long term there and serve the rakyat. Instead, it’s being seen as a transit for keeping officers under short term service.

So, these three states especially need more permanent officers who know that they’re going to stay for long – stability and you get more permanent officers who are able to train the younger ones better. The demographic in these three states are people who are well-learned people, number one.

Number two, they need people who they can trust with their treatment. If you were to go somewhere in a more rural state [or] area, some pak cik will be like, “Oh, cabut gigi ah? Okay, lah.” If I say that to someone in the Klang Valley, he’s gonna be like, “What?”

You need someone who can handle patients, who knows how to handle patients, who is good with portfolios, especially in these three states.

Unmarried People Bottom of The Lot

Number three, in terms of transfer criteria, I think it is ridiculous for unmarried people to be bottom of the lot – in terms of like when you want to apply for transfer, it’s written there that you’ve got a spouse, or you’ve got a child, or you’ve got a medical problem. If you don’t have any of these three criteria, you have to wait for three years.

I think one year is fair. You tell me one year I can accept, but not three years. That’s too much because I’m staying alone here. Do I have to wait for someone to come and kidnap me and stalk me at night?

So that’s why I’m dying here. I want to go back and serve my state. I don’t care. I want to serve my state, serve my people. Because my state is suffering. We are the richest state, Selangor, but we have the lowest amount of medical personnel.

Dental officer, klinik pergigian, Penang

Most of our officers are based in either Sabah, Sarawak, Kelantan, Terengganu, or far up in the north, like me in Penang.

I think these three are the key solutions I hope our new health minister looks into. Actually, it’s not about the health minister. The ones that are important are actually your DG (director-general) and number two is your sec-gen (secretary-general).

Hisham Has Been DG For A Decade, But Nothing Has Moved

Basically, all this while, we’ve been complaining about overwork, underpaid, understaffed. But only when groups like Hartal did a sensational thing or [does] something that affects their image, only did people start to take action.

Everybody has been complaining since 2010 and all. Health director-general Dr Noor Hisham Abdullah was not a recently appointed personnel; he was appointed for quite some time [since 2013], but nothing has moved.

Health ministers can come and go, but the one who’s permanent there is your DG and your secretary-general. They’re the ones who are going to be there permanently, and they’re the ones who are going to call the shots.

Dental officer, klinik pergigian, Penang

If I remember correctly, DG Hisham got an award for Malaysia’s management of Covid – I did not agree with that. I would say it was not his. He is the wrong person. The one who should be getting it is someone on the ground level. Or at least he should have dedicated it to the doctors and staff or something like that.

So the question is, who is going to take care of us? We can’t be expecting Hartal to take care of us all the time because they have family, and they have their jobs at risk too.

So who exactly is going to look out for us? You need your bosses to look out for you.

‘MOH Is On The Brink Of Collapse’

If you ask me, I think the only one who actually made an effort to understand our problem might be [former Health Minister] YB Khairy [Jamaluddin]. I’m not trying to be political; he maybe did only a few things, but he did something — we have to give it to him. At least he managed something. I have to give him, I have to appreciate him for that.

Our current health minister [Dr Zaliha Mustafa], she’s not off to a great start by introducing period poverty as one of MOH’s directives.

Period poverty is important. MOH can help, but technically, it is under the Welfare Department. When you use our funds, our management, our personnel, everything for this programme, you take away the funds and everything for other needs — like hospitals, clinics, everything.

We doctors would love to help with period poverty, but not at this time when MOH is on the brink of collapse. We are collapsing inside. And I think they know it, but they don’t care.

Dental officer, klinik pergigian, Penang

I can’t say much about this current health minister because she is still new, and I don’t know what her stance is, whether she listens, but it doesn’t seem at the moment that she wants to listen – whether it’s for private or government.

I don’t think she’s listening, or she’s listening to the wrong people. Whoever is advising her up there, I think, should resign.

I can’t blame our PM Anwar [Ibrahim] because he would probably have to be very careful about his selection of ministers – who is holding what and who is not holding what. He’s walking on thin ice, actually.

Dr Dzulkefly [Ahmad] may have been a better choice, but would he have actually done anything? Because he did hold that position, but I don’t think he did anything that benefited us or listened to us.

In terms of benefits or programmes for the rakyat, I think all health ministers did their fair share of contributions.

But in terms of who actually turned back and looked at their own staff, who looked at people at the ground level, I don’t think any of them did except for Khairy. He tried his best to actually understand.

Just Handle Work Burden and Fair Pay

The general thing is to listen to the people at ground level. Make their work reasonable.

Number two, pay. Pay your staff what they deserve. I think Hartal, they wrote, “overworked and underpaid”, right? Let’s handle those two. That’s enough.

Number three, do a deep cleansing or a detox or whatever you call it of the management system, especially HR and the admin, MOH and all district offices.

The ground staff are not the problem. The problem starts from the YM (Yang Menjaga) and your SDO (pegawai pergigian pentadbiran/ district officer). And it goes on above. Many YMs and SDOs are hiding behind the fact that they can lord about our doctors and our pharmacists and our dentists.

So if you want to attack them, you have to attack it from the top. Our DG has to just look at us; don’t look the other way.

That’s it.

Just pay us more. Just give us reasonable work and just manage us properly. That’s it. It’s simple, and that’s what makes it very ridiculous that you can’t follow that.

I know we are not asking for the sun and moon. I know you can’t give us a lot of things in a day, but at least try. You need to revamp, especially the subsidised fee that is just too little. You just work on that.

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