OF LITTLE NAPOLEONS… ..THE HEALTH MINISTRY AND… ..THE SULTANAH BAHIYAH HOSPITAL IN ALOR STAR

AHMAD SOBRI

It is appalling that the Malaysian public had to witness yet again another squabble between the Works Minister and Health Minister about the unending controversy of the still uncompleted new Alor Star General Hospital.

Earlier, the Deputy Minister of Health Datuk Dr Abdul Latiff Ahmad apparently accepted blame on behalf of the Health Ministry saying delays were necessary so infrastructural changes could be made to accommodate the latest technological changes in medicine.

Not so, said the Health Minister Chua Soi Lek still insistent that the Works Ministry with its changing contractors were to blame for the mess. Samy Velu, obviously peeved with the finger-pointing, sarcastically accepted blame for the delays,

In Operation Desert Storm, shortly after Iraqi troops rolled into Kuwait in 1990, the United States deployed to Saudi Arabia more than 20,000 medical personnel to provide medical care to coalition forces.

The medical infrastructure for the war included 50 to 500-bedded combat zone fleet hospitals deployed in various parts of the war zone. The scope of treatment available at these facilities mirrored fully-staffed hospitals in the United States. The first 500-bedded Fleet Hospital was built in just 16 days, with the help of Navy Construction Battalion Units complete with operating rooms that can handle general surgical cases, neurosurgery, thoracic surgery, orthopaedic surgery, intensive care units and radiological facilities.

These facilities were further supported by 1000-bedded hospital ships, each of which were equipped with 50 trauma stations that form the casualty receiving area, 12 operating rooms, a 20-bedded recovery room and 80 intensive care beds. The entire medical network comprising 60 hospitals and infrastructure to take in both military and civilian casualties was ready in three months so war against Saddam Hussein could commence.

This level of efficiency appears to elude our health planners and hospital builders in Malaysia. Granted we are in peace time and all these hospitals are Malaysia’s version of “super-hospitals” designed to last us generations, it still doesn’t absolve the persons involved in this muddle for wasting hard-earned tax payer’s money.

The existing 800-bedded Alor Star Hospital was built in 1907. The previous hospital had all the major specialties but in particular was noted for its work in the subspecialty of Urology. In view of Alor Star’s half a million population and indeed Kedah and Perlis 3 million population, more medical facilities were required for the states.

But true to the current penchant of the MOH in wanting to build unwieldy hospitals of dinosauric proportions, clearly outdated in today’s medical world where information technology has ensured that hospitals should be more compact and modular, a new hospital located at Jalan Langgar to be built at a cost of more than RM550 million ringgit started construction in October 2000 and was scheduled to be completed in 2003. So why the 4-year delay?

Health Minister Chua Soi Lek had reportedly commented that JKR is basically to blame as building hospitals are “agak rumit” (can be difficult). It appears the Health Minister is quite unaware that as far as engineering technology is concerned the building industry in Malaysia can surpass world standards if they put their mind to it and are indeed tendering for jobs around the world. The same sadly cannot be said for our Ministry of Health who can’t attract even our own Malaysian doctors to come home.

Architects and engineers design and build what the customer wants. And what the customer wants is detailed out in specifications. And what were the specifications that the MOH gave that these builders had such difficulty delivering? Was it the RM47/sf vinyl seamless flooring instead of the RM2/sf marble flooring? Or was it the Class 100 instead of the Class10,000 Operating Rooms that confused the contractors? Or perhaps the suppliers realized that the space allocated to them for the installation of their supercon MRI was too small too late? Or it could just be the landscape where instead of lilies the contractors planted orchids.

Or… maybe someone realized that there is more money to be made if new specialties like neurosurgery and cardiac surgery were added on? So what if I, the Pengarah, sign off a few extra VOs (Variation Orders) and set the whole project back.

As Pengarah I may be awarded a Datukship for bringing new technology to the state and may be even rewarded by being promoted to being Director-General of Health someday and of course I will win the lasting adulation of my clinical colleagues who will be doing multiple overseas trips to choose new equipment and attend numerous courses and conferences to learn about these new medical marvels all on tax-payers money and sometimes by courtesy of the supplier himself who will of course would have no qualms marking up the equipment cost to accommodate these trips. So what’s a few years and a couple of million extra? Shortage of staff and specialists? That wouldn’t be my problem because by then I would have retired.

Puzzling indeed are media reports commenting that the new hospital would have state of the art cardiac surgical facilities. Because of the rising incidence of heart disease and the very gratifying results of surgical treatment more of these cardiac units were planned for Ipoh, Kuantan, Kota Kinabalu, Malacca and Kuala Trengganu (Though maybe not in this order).

Priority of course will be based on population statistics, incidence of disease, logistics, etc. But surprisingly the next cardiac unit due to open is in ALOR STAR. This appears to be mind boggling, as Alor Star is very close to the nation’s Northern regional center based in Penang when surely places like Kota Kinabalu, Ipoh or Malacca with a larger population base require these units more.

On closer investigation the decision to have it there may be the problem of Pak Lah’s favorite theory of Little Napoleon’s trying to sabotage the government’s efforts to have more equitable health care by hijacking health funds.

Granted everyone wants his or her hometown developed but healthcare cannot usually be rationed this way. Tax payer’s funds must be invested carefully based on need rather then parochialism.

For those in the know, Latiff, is of course, right. For individuals who advocate that the MOH should still be health managers of our health resources in this day and age, the saga and problems of the new Sultanah Bahiyah Hospital in Alor Star, the Sultan Abdul Halim Hospital in Sungai Petani, Sultan Ismail Hospital in Johore, the never-ending upgrading work in the Sultanah Aminah Hospital in Johore and the now crumbling Ampang Hospital should be a revelation of what happens when there is little accountability when projects of first world infrastructure are managed by a third world mentality.

If anything else, it should remind the public how callous officials are when public funds are involved.