Don’t neglect Sabah, please

by Another Doctor

I refer to the Malaysiakini article Kota Marudu needs more than wireless Internet.

I read Dr Hams letter and cannot help but agree with many of his observations. I worked in Sabah for over seven years as a house officer and medical officer.

After my housemanship, I was sent to Ranau to serve in the district hospital. What Dr Hams described in Kota Marudu is not something isolated to that district alone in Sabah. It is an often repeated story in the whole of Sabah.

My first introduction to the poverty in Sabah came during my first months there, when a sweet 70- year-old lady from Kota Marudu was sent to the Queen Elizabeth Hospital with deep jaundice. She lived alone in a small village off Kota Marudu and noticed the jaundice about a month before.

She had no money for the taxi fare and so waited a month to sell off her chickens to have enough money to pay RM50 for the transport to Kota Marudu Hospital. She had to walk two miles to get to the road to get to the taxi.

Having been born, bred and educated in Peninsular Malaysia, I was shocked. When she arrived, she was septic and had a gallstone lodged in her common bile duct. The stone was duly removed but she was found to have a heart problem that required a pacemaker.

We arranged for her to get a permanent pacemaker but she refused. When I pressed her for her reason, she told me that she couldn’t afford to buy batteries for the pacemaker, having sold off her chickens. Once I explained to her that the batteries would last for years and we would provide them, she agreed to the pacemaker.

Ranau town itself has roads and is on the main highway between Sandakan and Kota Kinabalu. It developed primarily as a result of the Mamut Copper Mines in the district. However, highway in this context means a two lane road with frequent landslides and potholes, with a two-hour drive to Kota Kinabalu.

Outside Ranau, transportation becomes a problem as tarred roads disappear to become gravel or crudely marked logging trails.

Anyone who has worked in Sabah would have the same stories to tell, of extreme poverty and poor transportation. During my 2 years in Ranau, I’ve heard and seen it all, patients with cerebral malaria, a condition unheard of in Peninsular Malaysia, coming in after 48 hours to the hospital from places like Kaingaran and Karagasan, with relatives having to push the ‘pirate taxi’ through the mud, spending RM50 on fare during the monsoon season, the equivalent of 2 months income, this too when petrol was only around RM1.20 a litre in Ranau. Patients having to delay treatment for life threatening conditions because a bridge washed away along the trail (I won’t even call it a road) to Tambunan.

Emergency surgery such as caesarean sections, appendectomies and even ectopic pregnancies had to be performed in our little district hospitals by Medical Officers with little more than 4 months housemanship experience. Medical emergencies such as myocardial infarctions, which in Peninsular Malaysia would be managed in a Coronary Care Unit setting, had to be managed in the district hospital level.

I’m grateful however, that my staff in that hospital were the best I’ve ever had the pleasure of working with and were dedicated enough to want to make a difference in their patients’ lives. But poor transportation does not only affect the access to healthcare. Having no roads to be able to transport their agricultural produce for sale means that these people are stuck in a never ending cycle of poverty. At most, some of them get RM20 to RM50 by selling their produce to middlemen to be sold at the monthly tamu or market at prices that are perhaps only 10 percent of the value of the goods.

These innocent people are also preyed upon by traveling cloth merchants, mostly foreigners, who offer them ‘easy payment schemes’ to buy cloth for clothes, and when they cannot pay for the cloth and the interest accumulates, they end up having to marry their daughters to these men, who often have wives back home in Pakistan.

One of the cases I could never forget was of the family who came to Ranau Hospital just as I was leaving, a family who had failed crops, were hungry and unable to get food. The father collected some toad eggs and fed them to the whole family in a desperate attempt to stave off hunger. When they arrived at our little emergency room, one of the children were dead and two passed away within 10 minutes of arrival in our casualty unit due to poisoning.

Education is a problem in parts of Sabah outside major towns like Kota Kinabalu at the moment. Many children would be lucky to be able to get to a school or even afford to get to one. Most of my patients outside Ranau were lucky to even have a primary school education and a vast number of women marry in their teens.

I’ve had 14 year olds delivering babies in Ranau, most of them have never ever stepped foot in a school. The education level is so poor that many women feed their children condensed milk thinking that it’s better than breast milk.But at the heart of it all, these mothers want the best for their children but are not empowered with the knowledge to help them.

Major towns in Sabah have electricity courtesy of the Sabah Electricity Board, but smaller villages have either diesel generators or rely on candles or lamps when night falls. How can children study in these conditions?

Like many doctors in the districts, I had to learn Dusun to communicate better with these patients who could speak little else. Forty five years after the formation of Malaysia, the promise of a better life for these poor Dusun, Murut and Rungus patients in the districts of Sabah is a pipe dream at best.

How can our politicians claim to have brought development to the state and have neglected these poor people, many of whom still wear the cheap t-shirts and caps given free by political parties from many elections ago. How can I claim to be proud of Putrajaya with it’s beautiful bridges and lamp posts and the Petronas twin Towers when our fellow Malaysians in Sabah are so neglected?

The cycle of poverty and illiteracy one sees in the districts in Sabah brings despair to the heart. Eradication of poverty must tackle the real issues of education and transport and not just handouts to poor people.

By all means, declare Sept 16th a public holiday, but remember it in it’s real context, where we made a promise to our brethren in Sabah and Sarawak to treat them as equals in Malaysia, and give them the development they’ve been long denied.