by LKT

I refer to your letter “University Myanmar Sabah” where the author lists various problems with the administration, staffing and ultimately blames the Dean, albeit prematurely, for the shortcomings of this Medical Faculty.

As long as there is a need for doctors and a concomitant maintenance in the rise of standards or medical technology exists, the evolution or expansion of medical schools here in Malaysia must be encouraged contrary to the opinions of some of your readers that a number of of these facilities ought to be shut down.

Development of local-based medical universities is critical if we are going to keep costs down and maintain standards instead of sending our bright but financially underprivileged children to such institutions based in Indonesia and Russia which did not have the benefit of a British educational input which has helped this country on previous occasions to have word class standards in medical care.

In 1962, when Thumboo John Danaraj was appointed the Foundation Dean to the Faculty of Medicine, University of Malaya in Kuala Lumpur, he proposed that the Medical Faculty should have its own hospital.

Up to the 1950’s, the Faculty of Medicine, National University of Singapore, which was known previously as King Edward VII College of Medicine had been the only medical school in Malaya and Singapore. The output of doctors at that time was small: 60 per year forcing many Malaysians to go overseas to seek undergraduate medical education.

Construction of the faculty building began in July 1963 right through March 1967 when the first wards were opened culminating finally in the completion of the Paediatric, Maternity and Rehabilitation Units which became functional in March 1968.

On 5th August 1968, the University Hospital was officially opened by the Agong. University Malaya had a world class Faculty and Hospital. But what of the lecturers?

T.J. Danaraj had no qualms bringing in the best lecturers he could afford and most of these lecturers originated from the Indian subcontinent, some of whom are still with the University. The country had not enough doctors let alone lecturers and in the initial years the University Hospital had to depend on a large expatriate population to help establish this school.

Although the working capital for this Malaysian medical icon came from both the Ministry of Education and Health, trouble was already brewing at the Ministry of Health, known those days and even sometimes today as the “Medical Mafia” which wanted to have the final say in all things medical in this country. They refused initially to recognise housemanship at the UH as part of the 4-year compulsory service until there were widespread protests by UH doctors.

But things were much worse at UKM with almost daily skirmishes between the MOH and UKM lecturers, nurses and students at clinics, wards, operating theaters and even corridors as to whose hospital or turf it was at the General Hospital Kuala Lumpur until the then Dean, Khalid Kadir, had to literally beg Anwar Ibrahim for money to set up the current HUKM.

Similarly when the MOH put up their new hospital at Kubang Krian, wanting to move their old hospital which frequently had to face floods, there was a stand-off between USM and the MOH, both of whom wanted the hospital. Tengku Razaleigh had to step in at that time and gave preference to USM renaming the hospital to HUSM.

Primary and secondary specialties, facilities and equipment at the UH, HUKM and HUSM are certainly better then any MOH hospital because they are independent and have that extra edge having better educational and research facilities.

Universities having to face this nightmare apart from University Sabah Malaysia are UITM which till this day “shares” a hospital with Selayang but its lecturers are not given clinical or operating rights in that hospital.

Hospital Serdang is built on UPM land but is run by the MOH and almost everything the Dean decides is overturned by MOH’s Hospital Director. UNIMAS which is supposed to share Hospital Umum Sarawak is literally treated like a leper when it comes to utilization of the hospitals facilities.

UIA shares the Kuantan GH with the MOH but is constantly scuppered when it attempts to upgrade services. IMU gets along at Seremban GH only because its President is a previous DG of Health. But all the other private medical colleges like Manipal in Malacca, Perak College of Medicine at Ipoh and AIIMST at Sungai Petani run “medical schools”.

How this is possible is beyond comprehension. A student only becomes a good doctor if he/she sees many cases and reads around the subject. Lecturers who are virtually stopped from seeing patients because of this turf war, no matter how good they are, can only do so much. A surgical lecturer cannot show a student what a hernia repair entails and how the patient is followed up if they are not involved. Medical education is an apprenticeship. It always has been and will always will be.

Teaching of our students, our own children, should be every doctor’s responsibility and joy, for they are our future. But this horrendous personal interests coupled with animosity and a rivalry without basis by the MOH is wreaking havoc for medical education in this country.

It was proposed to the Higher Education Minister, Mustapha, last year that general hospitals be turned over to medical schools and money be further invested into these hospitals to upgrade services and research. But the MOH talked him out of it.

We may be nearing our 50th year of independence but if you had the opportunity to work in Sabah, you would have discovered that diseases such as malaria and tuberculosis are not yet eradicated, let alone dengue.

Many state governments want to upgrade health services in their own states very badly for health is one way you can show people directly that you care which is why they clamor for a medical school. But not everyone understands the reasons why development of these schools are sometimes stunted unlike Indonesia and India where medical colleges rapidly mushroom all the time.

Having a medical school is certainly a great impetus to advance healthcare. Having expatriates is not the problem. It is the third world mentality of our civil service at the MOH that is dragging this country’s healthcare down the tubes.

Chua Soi Lek and Ismail Merican may lament the questionable quality of some of our doctors but they are greatly responsible for the current state of affairs. The government, in particular, the Higher Education Ministry must step in and must take alternate advice instead of being subservient or cowed into believing that the MOH are the authority.

Education must take precedence if we are serious about providing proper healthcare to Malaysians and this can only happen if this “ship with two captains” syndrome is eradicated.

Failure to do so would further condemn our nascent medical schools to closure, forcing our prospective medical undergraduates, as during the period of the singular King Edward VII College of Medicine in Singapore, to go to Indonesia, Ukraine, Russia and countries which didn’t have the benefit of our once premier health care standards.

T.J. Danaraj was visionary, even in the 50’s when he foresaw that in the Malaysian setting, a medical faculty must have its own hospital.