PETALING JAYA, April 19 — The National Cancer Society Malaysia (NCSM) has repurposed pandemic lessons and programmes into an arsenal of initiatives and health care literature for the fight against cancer.
NCSM managing director Dr Murallitharan Munisamy said the cancer group used techniques from its Covid vaccination campaign – interestingly, with beauticians, hairdressers, and barbers – for its awareness and education programmes on cancer.
“I think one of the big lessons we learned from Covid is this idea that in order to communicate, we need to reach down to different people at different levels, in different languages, in different contexts,” Dr Murallitharan told the Oncology Summit 2023 organised by the Galen Centre for Health and Social Policy here last March 9.
“We ran at that time together with lots of other organisations, this partnership thing, Infovax – this huge vaccination campaign in which materials were put out in [languages like] Mandarin and Tamil. Specific people that we trained went out to small communities, gathered people in [groups of] twenties and thirties, and spoke to them to convince them to vaccinate.
“We basically translated all those learnings into this programme, which is called Beauty. Underpinning it is, of course, this idea that we are reaching across to beauticians and barbers to actually get them to start educating people. But at the back end of it is also that we are building this huge library of communication materials, which is in Malay, Mandarin, and Tamil.”
The Infovax programme which Dr Murallitharan refers to is a community education and awareness series created by the Malaysian Medical Association Public Health Society to assuage public worries and doubts about getting vaccinated.
The programme disseminated Covid vaccine information in a multitude of languages through its online portal and held online Facebook sessions to engage and educate the public on Covid-19 vaccination.
Beauty (Bringing Education and Understanding to You) and Health, the programme which transforms the lessons learned from the Infovax programme, is an NCSM programme that takes the cancer dialogue into the community via hairdressers and barbers.
Drawing inspiration from a programme in China, Beauty aims to raise awareness about cancer screening and health by involving barber shops and beauty salons in Malaysia as health communication platforms for cancer screening for both males and females. The project will create community-based networks that will be equipped with digital technologies.
“Very concrete risk reduction strategies and activities are actually not the business of physicians or clinicians or within the space of the Ministry of Health (MOH). It needs to be in youth and sports. It needs to be in schools. It needs to be in communities,” said Dr Murallitharan, a recipient of the Global Best Cancer CEO award from the Union for International Cancer Control.
“These are things that are absolutely no business within the Ministry of Health. And it’s all our business actually because our kids are the ones who are dying. In terms of screening, no one’s paying for screening. Insurance doesn’t pay for screening.”
Whilst NCSM busies itself with the dissemination of information and community outreach, Breast Cancer Welfare Association Malaysia (BCWA) president Kim Lim focused on lessons in connectivity.
The breast cancer survivor, drawing attention to the degree of correspondence between non-governmental organisations (NGOs), found higher levels of communication between organisations during the pandemic than post-pandemic.
According to her, the higher correspondence levels during the pandemic can be directly tied to the amount of time people had. As many worked from home, they had more time to focus on all the contacts they had at their disposal.
For Lim, this great degree of connectivity is a departure from the solitary independence that formed a large part of NGO culture; and the shift from singularity to teamwork enabled them to efficiently utilise their staff, build stronger relationships with other NGOs, and aid more people.
“I guess for all of us during the pandemic period we pivot. We can’t go to the hospital; we can’t do outreach; we have to crack our heads. So, everyone went digital. We started out counselling session on digital platforms. It works even until now. We try to do it in hybrid platform, but if we want to do more digitalisation or move towards outreach, everything needs funding,” Lim told the oncology summit.
“As an NGO, we are not government funded. Everything is public funded, and we have a small team to mobilise, so it is not easy to do much. Even when we come back to data, we have data, but we have to manually key in. There’s no central data. Even for all NGOs to come together to share data, there’s no transparency on that.
“So for the pandemic period, when we pivoted to online, when it works, there are more people that we can actually reach to, whether on social media, whether on Zoom, whether on phone, WhatsApp – we can reach more people. And this is one of the learnings that we start to realise that instead of doing more physical, but when the public has the means to go online, we can reach them.”
While NGOs have found ways to overcome pandemic problems and repurposed solutions for cancer, the MOH is still struggling with conducting outreach and addressing cancer due to staff shortages.
Dr Feisul Idzwan Mustapha, previously from the MOH’s disease control division, informed the summit that the staff who run public health clinics are the same staff who are sent to run outreach programmes.
“We can do outreach, and it comes at great cost to us because we’re using the same health care staff who are supposed to be in the clinic, but we need to do the outreach, and we appreciate those NGOs who help us when we do outreach activities.
“This is one of the challenges even before Covid. Definitely, when it comes to Covid, the health screening was totally disrupted,” said Dr Feisul.
Exacerbating the problems faced by the MOH and NGOs is the public.
Defining it as a “demand” problem, Dr Feisul stated that people — inherently — are reluctant to get screened, despite it being free, convenient, and an important part of protecting personal health.
“We often talk about the supply side, but less on the demand side. I know it has been touched. Talking about health literacy or help seeking behaviour or screening behaviour, this is what I call the demand side.
“So, while you can have your National Cancer Institute (IKN) less than five kilometres away from you, and the services are provided for free, it doesn’t mean that patients go to it.”
Illustrating his point, Dr Feisul recounted how his aunt, who lived less than 2km away from IKN, did not tell anyone, nor seek any form of treatment till her cancer was growing.
Additionally, Dr Feisul, who is currently a deputy director of public health at the Perak state health department, described another incident where an elderly man refused to get himself screened while waiting for his wife – who had gone to get herself screened.
“One of my colleagues was just relating to me, even when we do outreach in the low-cost housing, people do not want to come down. So, this is where we need help,” said Dr Feisul, an expert in non-communicable diseases (NCDs).
“And more interestingly, this is [a] perfect example, there was some cancer screening outreach programme being done and [an] elderly couple: the husband rode the motorcycle and dropped the wife at the outreach. The nurse went out [and asked], ‘Pak Cik, we’ve got health screening available. Do you want to check your blood pressure, blood sugar, cholesterol?’
“He said, ‘No, thank you.’ And he’s just outside, and he’s free, and he’s waiting for his wife anyway. It’s not like he is going anywhere. I don’t have any answer, but this is real. This is what’s happening, and this is the challenge.”
The incidents are perfect examples of – what Dr Feisul classifies as – high-risk individuals. According to him, people who get themselves screened are low-risk individuals as they have a vested interest in their health, whereas high-risk individuals are people who are unconcerned, or appear to be unconcerned about their health, and who do not get themselves screened.
The National Health and Morbidity Survey 2019 found that only 49 per cent of its adult respondents got screened in the past 12 months, with the prevalence being higher amongst older groups (77.3 per cent).
It was determined that though many are aware of health screening or periodic medical checkups, the uptake in Malaysia is very low, and the elderly utilise the available health screening programmes more compared to younger eligible age groups.
