Letters
By EJB
13.2.08

It appears that there is no end to the spin of Annie Freeda Cruez for the yarn she creates for DG Merican. Today the NST highlighted an article, “Malaysia’s rural health service second to none”. They forgot to add that it was for the year 1965 when you had to worry essentially about cholera, typhoid, malaria and hookworms.

DG Merican, just fresh from conning doctors that the PHFSA (Private Health Care and Facilities Act) is not meant to penalize registered doctors but is there actually to weed out bogus ones, has seen to it that, Basmullah Yusom, a registered practitioner, still languishes in Kajang Prison. He shows no remorse for blatantly lying to doctors and to parliament. He appears not to have a conscience either as he goes on another PR jaunt with Annie Freeda Cruez. Today it appears that he is trying to win brownie points by highlighting to the largely gullible Malaysian public that our rural health service is well run and effective. He is, of course, now in danger of believing his own bull.

Merican’s ebullient statistics include a health clinic every five kilometers and that more than 95 per cent of the rural population have access to a doctor. There are also 2,965 clinics and 151 mobile clinics in rural areas and there is one health clinic or centre for every 20,000 people while there is one community or rural clinic for every 4,000 people.

Impressive statistics until one actually walks into one of these clinics and realizes that there is only a nurse or HA who is going to attend to today’s epidemic of hypertension, diabetes mellitus, heart disease and cancer. Their duties – check your BP, sugar, etc and dish out 30 year old medication for the next 6 months packed in two polystyrene bags with a “Kalau mau jumpa doctor…tunggu tiga bulan ya…”. If the patient returns alive on follow-up, repeat above. Any complications, refer to “Hospital Besar” and join the queue where the rest of Malaysia will also be waiting to see not a specialist..but a medical officer in the specialist clinic, who could have been just transferred from the same district the patient was seen. This is the modus operandi of the Malaysian Healthcare System for the last 50 years.

Forget about obesity or even dengue, HIV, hepatitis or the reemergence of tuberculosis all of which have already claimed thousands of lives. Access to a doctor? Yes, try waiting three months if you are lucky. And incidentally how many of these clinics, especially the mobile ones comply with PHFSA rules. And how is it nurses are doing neonatal care, deliveries including curative, family health, dental, nutrition and dietetics, health education and promotion, home nursing, care of the elderly, rehabilitative services, environmental sanitation, adolescent health and community mental services. Not to mention Medical assistants merrily providing general anesthesia still in Sarawak in the year 2008. Aren’t these against the PHFSA? Oh hang on? Yep, that’ right. One rule for Merican and one rule for Basmullah. Silly me. Nurse kill government patient OK. Basmullah no pay RM1500 for private clinic, go to jail.

Merican even appears to take credit for the healthcare provided for the Orang Asli. The Orang Asli Affairs Hospital in Gombak is run by the Orang Asli Affairs Department. And parliament was informed further in May last year that it is so well-run by the Orang Asli Affairs Department (JHEOA) that the Health Ministry has no intention of taking over the management. Much of the base work and credit for Orang Asli healthcare must surely go J. Malcolm Bolton and subsequent British Officers who improved Orang Asli Healthcare even throughout the Emergency.

There are enough publications in the literature to confirm that healthcare among the Orang Asli has been in terminal decline after independence with the Health Ministry itself having the distinct notoriety for scapegoating the Orang Asli’s themselves whenever disasters such as hepatitis break out among them. As recently as last year, Nicholas and Baer reported that the crude death rate and maternal mortality rate is still twice higher among the Orang Asli then the rest of all West Malaysians. (Healthcare for the Orang Asli: Consequences of Paternalism and Colonialism).

But Merican and Annie, go further. They utter that horrible phrase “telemedicine and teleconsultation”. We have to take it that Amrin Buang, the Auditor General must have clearly failed to delve into this rip-off. Merican must be quite oblivious to the death of Medical Online linked to KUB in July 2003. Tasked to develop telemedicine, Medical Online died a horrible death when it couldn’t pay suppliers because of the insidious learning curve associated with this project by the project managers and the ministry. Its troubles in Ipoh said a lot about jumping the gun. How do you install a multi-million ringgit IT system comprising of expensive hardware and software when there is no electricity supply? Just like hospital having ISO status but roof is leaking?

Worse still no one in the Ministry of Health realized that technology waits for no one. While billions were spent on both hardware and software, all courtesy of the tax-payers money and probably Petronas, none in the ministry actually grasped that if they don’t learn it fast enough, the equipment and software is trash. Being practical appears not to be the Ministry’s stronger points. In its euphoria to achieve first world infrastructure, the MOH just failed to grasp how really appalling our third world mentality is.

Just a little research would have showed that even the National Health Service(NHS) in Britain was sliding into a £20 billion (RM120 billion) IT disaster. British tax-payers till this day have been unforgiving and have threatened to punish Labour for their miscalculation in trying to implement electronic patient clinical records without studying in depth its feasibility. Basic problem – clinicians, whose support was essential in the introduction of IT to clinical care, were unconvinced and the costs / benefits for the NHS were unclear from Day One. Suppliers and ignorant ministry officials in Malaysia must have done such a sales pitch about paperless hospitals that our cabinet must have been left completely transfixed.

Today Malaysia will have to deal with the financial calamity arising from a civil servant at the Ministry which the government chose to believe. Woefully the main officer responsible for this mess is still apparently at the Ministry of Health and she is even expecting a promotion. And apparently the dumb lady even let the suppliers keep the source codes after paying millions for the software. Such are the brains that run the Ministry of Health and squander what must be, meager resources by now.

But this government never learns. Since it is must be mesmerized beyond belief at its ability to fool all of the people all of the time, it has now ended-up believing its own bull. But since, parliament has been dissolved, I fear, Malaysians must brace themselves for greater thought provoking articles by both Merican and Annie Freeda Cruez.