Three years ago, my grandfather was admitted to a public hospital. What followed was two weeks of frustration.
It took seemingly forever for us to receive the medical report, and the medical personnel appeared to be in a perpetual state of stress and anxiety.
Most shockingly, many other patients looked as though they were in the same situation as us, desperately waiting for treatment that their loved ones may not receive in time.
Fortunately, we transferred my grandfather to a private hospital where he was treated promptly.
The incident left a sour taste in my mouth, not out of spite, I was more so curious as to why Malaysian public health care could not handle such an emergency. In fact, complaints of “There are not enough doctors” in public health care facilities are a dime a dozen.
To address the shortage issue, I aim to diagnose the three root causes, supplemented by a second opinion through interviews with three health care workers, namely a medical officer, a nurse, and a contract medical assistant from a public health clinic in Selangor.
Maldistributed And Mismanaged
Dr Mior Mohd Yusof Adnan from the Association of Malaysian Islamic Doctors said that Malaysia has more than enough resources to nurture future health care workers, but the real challenge lies in workforce planning and placement.
In 2022, Free Malaysia Today quoted the then-president of Malaysia Medical Association (MMA), Dr Koh Kar Chai, as saying that the shortage was more apparent in rural areas such as Sarawak and Sabah, as many health care workers refused to work there.
A year later, CodeBlue reported that the Klang Valley faced a shortage due to the relocation of health care workers to Sarawak and Sabah. In the same article, it was reported that a medical officer at Hospital Kuala Lumpur stressed that the relocation did not make sense as the Klang Valley caters to a much larger population.
Medical officer M agreed that some health care workers are unwilling to relocate to Sabah and Sarawak because they prefer staying with family members. He pointed out that the Klang Valley is also facing a shortage of health care workers.
“Despite hospitals like Hospital Klang being so large in scale, I couldn’t understand why they are constantly facing a shortage,” he said.
Nurse S said that relocation can be quite burdensome for health care workers. “A lot of times the reasoning does not make sense,” she bemoaned. “The government will ask us to relocate so that we get out of our comfort zone. There is no such thing as a comfort zone because unlike the top management, no matter where our job as nurses remains focused on taking care of patients.”
“It can be extremely taxing, especially for a mother like me,” she grieved. “Having to relocate, finding new places, and settling in with children can be quite daunting for many health care workers. It is not that I am against relocation, I just wish to provide convenience for my family members.”
Contract medical assistant A said that although he is willing to relocate as needed, it does not change the fact that it can be quite stressful. “For contract health care workers, the government will relocate us to wherever they deemed our service as most needed,” he said.
“If you have been working at a place for three or four years, and you even built a family there. Of course it would be stressful having to relocate,” he added. “Nevertheless, contract or not, we are trained to follow these orders. The stress will never go away.”
From my perspective, health care workers are the ones at the mercy of the government, and the public are the ones suffering from the repercussions of “There are not enough doctors”.
There are so many uncertainties surrounding the distribution of health care workers, it left me questioning if we are seeing an illusion of shortage due to poor workplace planning or an actual shortage.
They Give Their All, But Receive Underwhelming Support And Benefits In Return
In my opinion, the best example of ill treatment against health care workers is the contract system introduced in 2016 to combat the glut of medical graduates. Now, it has become an excuse by the Public Services Department (PSD) for their improper human resource management.
CodeBlue has quoted an anonymous medical officer as saying, “No one wants to serve as a contract doctor after you’ve studied hard for five years to get the degree.”
As a matter of fact, over 3,000 contract doctors have quit in the last three years.
The contract system applies to positions, such as but not limited to, medical assistant officers, medical laboratory technologists, assistant environmental health officers, and X-ray operators, all of which suffer from a sense of lack of job security.
Contract health care workers essentially share the same responsibilities as their permanent counterparts but receive much lower salaries and lower sets of benefits.
In terms of benefits, there is not much for contract workers. They may opt to leave the government system and join the private sector to get more benefits like higher salaries.
The situation is exacerbated by the fact that there is no clear timeframe for a contract worker to be promoted to a permanent promotion. “I heard from my friends and family that their contracts keep getting extended without a clear picture as to when they will be promoted,” according to M.
A is also currently in a similar situation. “For medical assistants, there are a lot of permanent positions being offered in the private sector. Even if the benefits offered by the government and private were the same, the workload will still be very much different.
“The biggest factor is that one would be put under contract with the government system, while the other would have a peace of mind being in a permanent position.” he said.
“Many of my friends have quit the government system,” he lamented. “As someone who has been under the contract system for five years now, I can definitely understand why.
“Just that for now, I am staying. Nonetheless, can you imagine if you had been studying hard for the past few years only to get put under a contract? It is hard for you to not feel let down. In this case, you might rather join the private sector.”
According to him, there are also many differences in benefits between contract and permanent worker. For example, a permanent medical assistant may receive subsidies or paid leave when they choose to further their studies, while a contract worker would need to fork out their own money.
“My friend who was also a contract worker broke his leg in an accident,” he shared. “He was forced to rehabilitate for 30 days. But the thing is, contract workers only enjoy 15 days of paid leave per year.
“It resulted in him having to pay back his 15 days of salary to the government. It is unfair. He has since quit and joined the private sector.”
Poor Mental Health Among Health Care Workers
In 2023, CodeBlue revealed through a survey that 1,205 out of 1,652 health care workers said they are thinking of quitting the public health service, citing reasons such as being overworked and underpaid, burnout, and uncertainties about future career progression.
In the same year, CodeBlue conducted another survey on mental health issues among health care workers and quoted the then-president of MMA, Dr Azizan Abdul Aziz, as saying that although the survey did not represent the entirety of health care workers, even a single worker admitting to mental health struggles is a cause for concern.
Moreover, the mental stress suffered by health care workers have led to workplace bullying and harassment. At worst, we have seen news of health care workers committing suicide due to mental health issues.
In my opinion, although the health care industry in general is known to be a high-stress sector, the combination of maldistribution and lacklustre benefits have made it even harder for health care workers to cope.
S shared her personal thoughts on mental health issues by describing the relationships between junior and senior nurses, “When I was a junior nurse at a hospital, I was lucky enough to have met a mentor who was kind and helpful.
“Of course there are still mentors who are more egotistical. During my earlier years and even now, I believe that bullying exists, especially among medical officers.
“Again, I consider myself lucky. My mentor taught me that I should return the favour by one day becoming a senior who is tolerant and open-minded,” she said.
“Hence, I would say that the most important thing is for every health care worker to work together like a family. There is no need for ostentatiousness, we are ultimately servicing the public.”
As for A, he believes that health care workers are suffering from mental health issues due to heavy workloads.
“As a contract worker, we mostly share the same working hours as our permanent seniors. However, some seniors may leave the workplace unannounced, leaving us attending to patients on our own. In my eyes, this can and should be counted as a form of bullying, even if it is indirect,” he said.
“From what I have observed so far, housemen are actually the ones suffering the most,” he added. “They are always overworked to the point where they are beyond stressed and tired.
“Many housemen would not see the chance for promotion as they would be so stressed out to the point where they quit before that. Their workload can be extremely traumatising.”
“In my opinion, the unjustifiably long waiting period between graduation and placement also plays a factor in mental health issues suffered by new health care workers.
“Let’s say a graduate would have to wait two years before getting a placement, they would have become unfamiliar with what they had learned in school by then.
“Of course, they would then be unfairly reprimanded by their seniors even though it is not their fault that they had to wait such a long time to get a placement,” he said.
“A health care worker with pent-up stress may quit or in a worst-case scenario, commit suicide.”.
What Does the Future Hold for Malaysian Public Health Care?
As I was reading through the news and interviewing these three health care workers, I felt a little sense of despair.
It seems that public health care is in dire need of a total reformation. Fortunately, under the current administration, the government is currently working on fixing what I view as the biggest blunder, namely the contract system.
Leaving that aside, the respective interviews with M, S, and A struck a chord with me; their answers left me with more optimism than any policy could.
M, even as a permanent medical officer, has been adamant in showing support for health care workers who may be suffering from the contract system.
“It is better if the government could do away with the contract system,” he said. “I think they should place graduates in permanent positions. This way, they would not quit public health care. This is the most direct way for us to solve the shortage issue.”
S remains optimistic in urging health care workers to stand together amidst these tough times, all for the sake of the public who need them. “I sincerely hope that there will be more actions taken to tackle the shortage issue.
“In the nursing field, there are a lot of hierarchical rules that are being passed down from one generation to the next. Similar to how I hope that nurses could one day do away with these rules, I wish the government could make long-term plans to combat the maldistribution, low benefits or any other causes of the shortage issue,” she said.
A left the deepest impression on me. During my interview with him, he never stopped doodling on a piece of paper as if something was troubling his mind; and his tone of voice was considerably more dejected than M and S. In spite of that, he was willing to confide his personal experiences as a contract medical assistant.
I am ashamed to admit that at first, I was questioning if he was really satisfied with his job. However, as our conversation progressed, I was convinced that he is someone who has dedicated himself to health care. I was touched.
I see him as an inspirational health care worker — someone who not only will put his best foot forward in any situation, but also motivate people in his surroundings to do the same.
His aspiration speaks for his character better than I could ever:
“Even if I am only a contract medical assistant now, I hope to become an educator one day. I know that it is difficult given my position. Nevertheless, I hope to educate future generations of workers. It may not be a grand ambition, but that is what I want to do,” he said.
As for myself, my initial motive for writing this article was to reiterate what is already known about the issue of the shortage of health care workers. Unexpectedly, I gained more than what I could ask for through the interviews with M, S, and A.
Through them, I learned the sacrifices made by health care workers — be it relocating from their family or working through unfavourable contracts. These are hurdles that I may never experience in my life. Yet, their words have painted a vivid picture in my mind.
My biggest hope for the future of public health care is for the government to start taking concrete action — increase the budget, implement new and permanent employment strategies, and provide mental health support for health care workers.
At this crucial time, I choose to believe that any action is better than no action.
I wish that my words here can console all health care workers who are crumbling under the crisis. We have taken you guys for granted for too long.
I also hope that one day when we become grandparents, walking into a public hospital will guarantee us “seeing a doctor”.
Law Zhen Bond is a third-year student in the Bachelor of Communication in Media Studies programme at Tunku Abdul Rahman University of Management and Technology.
- This is the personal opinion of the writer or publication and does not necessarily represent the views of CodeBlue.
