Medical Practitioners Allowed To Provide Basic Information On Services

KUALA LUMPUR, June 28 (Bernama) -- Medical practitioners and health institutions are now allowed to provide basic information on their services and facilities.

Health Minister Datuk Dr Chua Soi Lek announced Tuesday that they could now provide basic information according to disciplines, names, places of practice and credentials but without mentioning experiences or using superlatives.

The information, together with photographs of the practitioners or institutions, could be conveyed through websites, yellow pages and the newspapers, he told reporters after opening the Association of Private Hospitals Malaysia (APHM) Healthcare Conference at Seri Kembangan, near here.

"However, we still require such information to be submitted for vetting and approval by the Malaysian Medical Advertisement Board," he said.

The decision, which takes immediate effect, was made after consultations with the board, the Malaysian Medical Council, medical associations and medical academics, to promote health tourism in the country, he added.

Currently, medical practitioners and health institutions are forbidden to make any statements that would draw attention to themselves or their practices.

Dr Chua said that with the guidelines loosened up, the medical practitioners and health institutions still had to seek approval from the Malaysian Medical Advertisement Board before being allowed to provide basic information on their services.

Anyone found providing the information without prior approval from the board could risk their practices being suspended for several years, he said.

Dr Chua also explained that patients were allowed to access their medical reports, which are summarised reports their medical records if they wanted to seek treatment at a private hospital after being treated at the government hospital, or vice versa.

However, copies of the medical records could only be released for medico-legal cases.

Patients could forward their complaints to the ministry if they were unable to get their medical reports from the hospitals or clinics, he said.

Dr Chua also said that he expected the review by a consultant from the World Health Organisation (WHO) on the patient safety strategies prepared by the Patient Safety Council Malaysia to be finalised by next month.

-- BERNAMA

The best advertisement a doctor can have are some good words from a well treated and satisfied patient. Nothing beats word-of-mouth.

Missing Baby Found

The STAR reports that the baby abducted from the nursery of Sungei Petani hospital recently has been found. Polis is said to have rescued the four-day-old missing baby of Noryati Abu Bakar at a house at about 4 am this morning. The baby is said to be safe and has been warded for observations.
A nurse working in Sungai Petani hospital who is said to have taken the baby has been arrested. The nurse is said to have lost her own baby recently. Syabas to the polis for solving the case within a relatively short period of time.

New Software Speeds Up Results For Breast Cancer Tests

New Software Speeds Up Results For Breast Cancer Tests



PENANG, June 22 (Bernama) -- It used to take between one and two weeks but a new computer software produced by experts of Universiti Sains Malaysia now enables the result of a breast cancer test to be known in only seconds.

Called "Neuralmammo Diagnostic for Breast Cancer Based On Neural Work", the software promises to reduce not only the waiting time for test results but also the number of medical specialists required to conduct tests.

All it takes is some information on the patient and a sample of cells to obtain this information.

The software was invented by a group of researchers from the Centre for the Study of Electrical and Electronic Engineering and the Centre for Medical Science Study of Universiti Sains Malaysia (USM).

It won the gold medal at the Invention Industrial Design Technology 22005 (ITECH) exhibition in Kuala Lumpur last May.

Head of the research team Dr Nor Ashidi Mat Isa said the invention could reduce the number of pathologists required to conduct breast cancer tests.

"With this software, medical assistants can carry out the test," he told a media conference Wednesday.

Dr Nor Ashidi said the research started two years ago and cost RM20,000 and the new software could provide information on the disease from its early to critical stage accurately.

So far the new method had been used to test 330 patients at the Kubang Kerian Hospital in Kelantan, he said.

"99.3 per cent of the results were found to be accurate and we plan to extend its use to the Penang Hospital," he added.

-- BERNAMA

Avoiding soya 'may aid fertility'

Avoiding soya 'may aid fertility'
By Michelle Roberts
BBC News health reporter in Copenhagen

Women should avoid eating too much soya if they are trying for a baby, a UK fertility expert believes.

A study in humans has shown a compound in soya called genistein sabotages the sperm as it swims towards the egg.

Professor Lynn Fraser, from King's College London, said even tiny doses in the female tract could burn sperm out.

She told a European fertility conference that avoiding soya around women's most fertile days of the month might aid conception.

Long swim

Genistein is present in all soya-containing products such as soya milk and many vegetarian foods, as well as some pre-packed meals and pizzas.

It is also present in vegetables such as peas and beans, but the researchers say it is not yet clear if levels if the compound in these foods are significant.

Professor Fraser tested what happened to human sperm exposed to the compound in a dish in the lab.

The compound kick-started a reaction in a large proportion of the sperm that gives them the ability to fertilise an egg.

In real life, this does not usually happen until the sperm have been inside the female for some hours and are close to completing their long swim towards the egg.

Therefore, if women have genistein in and around the womb this could hamper conception by making sperm peak too soon, believes Professor Fraser.

This could mean they would not be able to fertilise the egg, she told the annual meeting of the European Society for Human Reproduction and Embryology.

Low concentrations

In mice she found it took higher doses of genistein to cause the reaction, but in humans very small doses were enough.

"We were really surprised. Human sperm proved to be even more responsive than mouse sperm to genistein, responding to very low concentrations - well within the amounts that have been measured in people's blood."

She said it was not yet known how much soya might be a safe amount to avoid this effect.

"It's not a question of completely stopping eating products containing soya.

"But it might be best for a woman to avoid them for a few days around the time she is ovulating."

'Early days'

Professor Fraser's previous work in mice showed that compounds similar to genistein - one found in hop-based products like beer - affect sperm in the same way.

These compounds are all weak oestrogens, but Professor Fraser does not believe that their action on sperm is the same as the female sex hormone.

Instead, genistein seems to trigger the production of a signalling molecule in sperm called cyclic AMP.

Dr Allan Pacey, Senior Lecturer in Andrology at Sheffield University and Secretary of the British Fertility Society said: "It's early days, but clearly if what happens in the laboratory also occurs in the woman's fallopian tube as the sperm make their way to the egg, then there would be the potential for fertilisation to fail."

A spokeswoman from the Vegetarian Society said: "For anyone struggling to become pregnant, avoiding soya products for a few days a month is worth a try if there is even a slim chance that it will help increase fertility.

"Obviously many vegetarians and vegans use soya in their diet, however as there are lots of vegetarian and vegan alternatives to dairy, milk and meat on the market, it shouldn't pose a problem."

Story from BBC NEWS:

Malaysia's Infant Mortality Rate Drops Dramatically

KUALA LUMPUR, June 21 (Bernama) -- Malaysia has done well in reducing the infant related mortality rates over the past several decades, Health Minister Datuk Dr Chua Soi Lek said.

He said Malaysia's infant mortality rate had dropped from the ratio of 40.8 per 1000 livebirths in 1970 to 13.0 in 1990 and 6.2 by 2002.

"Our under five (years old) mortality rate has also fallen by a similar magnitude over the corresponding period, from 57 to 17 per 1000 livebirths between 1970 and 1990, and to nine in 2000," he said in his speech at the High Level Forum on the Health Millennium Development Goals (MDG) at Mita Conference Hall in Tokyo, Tuesday. His speech was faxed to Bernama here.

The two-day forum started Tuesday and was hosted by Japan in cooperation with the Asian Development Bank and the World Health Organisation. The participants are Health, Finance and Development ministers from Asia Pacific region.

Dr Chua said although Malaysia was facing shortage of doctors and nurses, maternal and child health (MCH) was not compromised.

In fact, a lot of headway was made by training allied health profesionals, such as community nurses, medical assistants and dental nurses and providing basic health care to those in the rural areas.

"We have also provided training to the traditional birth attendants. As a result, the proportion of births attended to by skilled health personnel had increased from 20 per cent in 1970 to 96.1 per cent in 1990 and 99.2 per cent by 2000," he added.

Dr Chua said Malaysia also achieved 99 per cent in "safe deliveries" for the babies due to the specific MCH programme where all the antenatal mothers were tagged according to their levels of risk and those at greater risk were given greater attention.

"We audit every maternal death. Infant growth is monitored by growth charts. There is also nutritional surveillance of children and rehabilitation for those who are mal-nourished," he said.

He also said that to further bring down the infant mortality rate, training was also provided to the staff on neonatal resuscitation.

-- BERNAMA

The MOH certainly has some great low figures to present. Imagine our Infant Mortality Rate must be less than 6 per 1000 livebirths now! The WHO figures for Malaysia are 18 per 1000 livebirths (1990), 11 (1995), 8 (2000) and 7 (2003)!

The Derecognition Controversy

Looks like the withdrawal of recognition of the CSMU medical degree is turning controversial and drawing flak especially from MIC. The MIC president appears to be exasperated. There are said to be some 470 Indian Malaysian medical student in CSMU! Samy is alleged to have accused the MMC of wanting to pevent Indian students from studying medicine.
Not providing CSMU with a grace period to rectify any shortcomings in its medical course is certainly controversial. Lets hope good sense will prevail as so many of our students are involved.
The Opposition leader is going to move an urgent motion in Parliament tomorrow calling for the suspension of MMC's withdrawal of recognition of Ukraine’s CSMU medical degree. His motion reads as follows ::

“That under SO 18 the House gives leave to the Ketua Pembangkang and MP for Ipoh Timor YB Lim Kit Siang to move a motion of urgent definite public importance, viz the Malaysian Medical Council’s derecognition of Ukraine’s Crimea State Medical University (CSMU) medical degree.

“CSMU has become the single biggest university, whether in Malaysia or in the world, with the highest concentration of Malaysian students pursuing medical studies, with some 1,100 Malaysian students i.e. about 300 Malays, 240 Chinese, 470 Indians and 25 others, with students sponsored by government and other agencies, such as Angkatan Tentera Malaysia, MARA, Yayasan Selangor, Yayasan Terengganu, MIED, KOJADI and various banks.

“MMC cannot be faulted in refusing to compromise with patient safety or wanting to ensure that Malaysian students in medical courses, whether locally or abroad, are trained to become quality doctors when they graduate and not be shortchanged, but the MMC must act with fairness, transparency and flexibility, or it has only itself to blame if it is accused of ulterior motives like the serious allegation by the MIC President Datuk Seri Samy Vellu that the MMC just wanted to stop Indians from becoming doctors.

“Unless the CSMU medical standards are irredeemably low, in which case it should never have been given recognition in 2001 in the first place, it is only fair and right that CSMU should be given a grace period to comply with whatever shortcomings found by the MMC, and not for derecognition to be announced so arbitrarily, summarily and absolutely.

“MMC should immediately suspend its decision on derecognition of the CSMU medical degrees, make public the shortcomings of the CSMU medical programme and give the CSMU a grace period to comply with them before a final decision on derecognition is made.”

Yours sincerely,

(Lim Kit Siang)

Ketua Pembangkang
MP for Ipoh Timor

NewBorn Missing from Hospital

Father Pleads For Return Of His Newborn Baby Boy



SUNGAI PETANI, June 20 (Bernama) -- "Please return my baby. I really want my son back. Please don't do anything to him, his health condition is not okay yet," appealed the father of a six-hour baby boy who was missing from the ward at the Sungai Petani Hospital, Sunday.

Mohamad Nordin Idris, 34, said the incident had made him and his family very upset, especially after he was elated to be blessed with a son on Father's Day, Sunday.

"My wife delivered the baby at 8.32am. The nurse informed me that my son has to be transferred to Ward A4 due to breathing problems," he said when met at his house in Taman Sri Tanjung in Sungai Layar here Monday.

Nordin, who has two other sons -- Mohamad Norsyazwan, 10, and Mohamad Norsyamer, 5, -- said the 3.6kg infant was hooked to a respiratory system when he sent the registration document to Ward A4 where seven other babies were treated.

After that, he returned to the ward to meet his wife, Noryati Abu Bakar, 31, before returning home to take napkins and came back to see his son at 11am.

"When I sent the napkins, I saw my son was no longer in the respiratory system and was being fed milk. Then I called for azan but did not touch him," he said.

He said the last time he saw his son was at 1.30pm before going home and received a call from the hospital at 2.45pm asking to come to the hospital immediately.

Mohamad Nordin, who works in a biscuit warehouse here, said he was told by the hospital management that his baby was missing at about 2.20pm from the ward and was asked to be patient.

"How can I be patient, my wife and I are very disappointed over the incident due to the hospital's negligence. This is not the case of losing a cat but missing a baby.

"From what I know, only the baby's parents will be allowed to enter the ward and the ward's door will be locked when the visiting hours ends.

"But, from the three times that I entered the ward, the nurse on duty never asked who am I and the door was not locked. This is the carelessness which really affected me and my wife," he said, adding that the incident should not happen to anybody else. He said he lodged a police report at the Kuala Muda police station even though the hospital Director Dr Harif Fadzillah Che Hashim had made a similar report.

"The hospital's director said I need not have to lodge any report since the hospital has made a report but I don't care, I still lodged a report. I was also asked by the hospital management not to publicise the incident," he said.

He said he would discuss with his family on the next course of action, including suing the hospital.

"What's more important to me now is to calm down my wife, he said.

Noryati, looking dejected and depressed, hoped her son would be found as soon as possible.

She urged the authorities to step up efforts to find her son.

"I appeal to the person who has taken my son to take good care of him and return him to us," she said in between sobs.

Noryati, who was discharged from the hospital at 11am Monday, said she had not even seen her son's face but only knew that her baby was a boy when he was shown to her after she delivered the third child.

Meanwhile, attempts to meet hospital director Dr Harif Fadzillah for comments drew a blank.

-- BERNAMA

Kelantan A Problematic State To Health Ministry - Dr Chua

GUA MUSANG, June 19 (Bernama) -- Kelantan gives the Health Ministry the most problems as a result of the state government's failure in providing satisfactory health services to its people.

Health Minister, Datuk Dr Chua Soi Lek said his ministry had to provide special allocations of almost RM100,000 yearly to implement specific programmes like clean water availability and food supplementation, including provision of vitamins for undernourished children in the state.

"The unsatisfactory state of health of the people in Kelantan, with its many infectious diseases because of poor water quality and unhygienic food, is a big challenge to the ministry.

"All this is known to the state government, but they have still failed to provide clean water supply or raise the socio-economic standard of the people, especially the rural poor," he told reporters after visiting the construction site of a new health clinic for Gua Musang here Sunday.

He said the ministry had to shoulder the risk of potential disease outbreak although it was mainly due to the weakness of the state government.

Besides this, he said the PAS government, under the leadership of Datuk Nik Abdul Aziz Nik Mat, had also failed in terms of enforcement, resulting in infectious diseases like cholera, typhoid, malaria and dysentery continuing to be a problem in Kelantan unlike other states which hardly faced such cases.

He said about 30 per cent of Kelantanese children below the age of five were malnourished compared to the 20 per cent average at the national level.

"We hope the state government supports our efforts to help the poor as other states don't have such programmes. It is also proof Kelantan has never been mistreated by the federal government," he said.

On other developments, Chua said the federal government had approved an allocation of RM70 million for expansion of the Gua Musang Hospital.

"It is for the building of three wards, including a maternity ward, operating theatre, laboratory, blood bank, nurses hostel, a pharmacy, X-Ray facilities and upgrading of existing equipment," he said.

-- BERNAMA

Another gomen MINIster hitting out at the only state with a opposition party in the gomen. Health is basically looked after by the Fedral gomen and whatever proramme carried out in the state is directed and initiated at the federal level. Even if a programme has to be carried out owing to local needs, the officers involved are federal officers. But there are stituations and activities where the state may help out to improve the health of its people. Water presently remains a state concern and so those cleanliness of the surroundings and sanitation.
Why is the MINIster complaining about the special allocations of almost RM100,000 yearly to implement specific programmes like clean water availability and food supplementation, including provision of vitamins for undernourished children in the state. This annual amount is a pittance considering the money spent on other things. And to say that this proves that the federal gomen has never been mistreated Kelantan is obvious an understatement. It is obvious whether there has been any mistreatment.
What is welcomed is the news that the Gua Musang Hospital will be due for upgrading. This will definitely be for the good of the population living in that area. This upgrading has been promised for many years and has been brought out for airing at each of the election campaigns.

MMC Withdraws Recognition Of Ukrainan Medical Undergraduate Programmes

PUTRAJAYA, June 16 (Bernama) -- The Malaysian Medical Council (MMC) has withdrawn recognition of the medical undergraduate programme offered by Ukraine's Crimea State Medical University (CSMU) to any students registered and admitted into academic year one after Dec 31, 2005.

MMC president Datuk Dr Mohd Ismail Merican said MMC also decided at its June 14 meeting not to recognise similar programmes offered by 10 other universities in Ukraine.

The MMC was concerned about the quality of medical training or education in Ukraine in producing safe and competent doctors to meet Malaysia's needs, he told a media conference Thursday.

The decision would not affect the current 1,119 medical undergraduates enrolled in various academic years in CSMU as the de-recognition would only apply to those admitted and registered after Dec 31, 2005, said Dr Mohd Ismail who is Director-General of Health.

Those pursuing the pre-medical foundation course would be eligible only if they were admitted and registered into the first academic year before Dec 31 this year.

"In other words, any CSMU undergraduates admitted and registered for academic year one and onwards before Dec 31, 2005 are eligible to register with the MMC upon their graduation.

"Those who register after Dec 31 must sit and pass the Medical Qualifying Examination stipulated under the Medical Act 1971 to be eligible for registration (with the MMC)," he said.

The CSMU was the first institution to be granted recognition by the MMC effective Aug 7, 2001. As of last month, 1,366 students are studying in CSMU -- 1,119 in various academic years and 247 others taking the pre-medical course.

Dr Mohd Ismail said that following numerous complaints, the authorities visited CSMU in October 2003 to verify them as well as the other 10 Ukrainian universities for the purpose of granting recognition.

They found some of the Malaysian students admitted into the medical undergraduate course were school drop-outs with very poor secondary school results.

The students were allowed to pursue the programme after passing the pre-medical foundation courses conducted by the Ukrainian universities.

"Their secondary school qualifications were never taken into consideration. Even arts stream secondary school drop-outs were allowed to pursue such courses," Dr Mohd Ismail said.

He said a study conducted on CSMU graduates working in the Health Ministry, and the feedback gleaned from their supervisors, revealed that the graduates' usage of English medical jargons was limited as they were more fluent and familiar with technical jargons in Ukrainian or Russian.

"Their jargons, being alien to our medical fraternity, may jeopardise the safety of our patients and well-being," he said.

The ability of the Ukrainian universities to provide teaching in English was doubtful as the number of English-speaking lecturers and facilities were insufficient to meet the demand from the sudden increase in the number of Malaysian students.

Dr Mohd Ismail said during the authorities' first visit in 2001, there were only 53 Malaysian students in CSMU, and the number jumped to 900 in 2003.

"The drastic increase in the number of student intake may inevitably compromise the quality of medical education," he said, attributing the spike to purely business considerations.

-- BERNAMA

It looks like our short association with the medical schools of the Ukraine has come to an end. The MMC recognised Ukrainian medical degrees efective Aug 7, 2001. This opened up a means for many who could not get into the medical schools locally to go to the Ukraine. Presently there are said to be more than 1000 Malaysians pursuing medical studies there. The first recognised batch of Malaysian Ukrainian trained doctors have already graduated, this batch is said to consists of about 35. The MMC has announced that students who enrolled for their medical studies after 31st Dec 2005 will not be recognised. And those who are presently in pre-medical classes better ensure that they are in the first year before 31st Dec.
There have been complaints earlier on that these medical schools were not very particular regarding who they admit, now our Health DG has revealed that even arts students and others with a science background in schools. The DG is absolutely right in ensuring that such students should not receive iimmediate recognition upon their graduation.
The CSMU is asking why it has not been told why recognition of its medical degrees has been witdrawn and why it has not been given a grace period to rectify any shortcomings. Lets await answers from the DG.

Malaysia HIV measures under fire

Malaysia HIV measures under fire
By Jonathan Kent
BBC News, Kuala Lumpur


Malaysia's Health Minister Chua Soi Lek has asked religious leaders to drop their opposition to moves to contain the spread of HIV.

Mr Chua was reacting to a World Health Organization warning that the country was on the verge of an HIV epidemic.

Senior Muslim clerics have criticised plans to distribute free condoms, saying it would encourage promiscuity.

The WHO sounded the alarm after studying health ministry data on HIV infection in Malaysia.

The WHO said the virus was in danger of spreading out of control, especially among intravenous drug users.

More than three quarters of the 65,000 cases of HIV infection reported in Malaysia since 1996 have been attributed to the sharing of needles.

But the proportion of cases thought to be due to sexual transmission has also more than doubled in the same period.

Mr Chua has advocated a pragmatic approach, giving out free needles and condoms to reduce the spread of HIV.

It is a brave stand in a country whose many religious groups are united primarily by their conservatism.

Mr Chua will try to win his opponents round when he meets ulamas - Muslim religious teachers - next week.

The senior Muslim cleric in the state of Perak has already decried the plan to hand out free condoms, saying it would lead to more illicit sex.

Political leaders in two other states have said drug addicts, or those who are HIV positive, should only be given condoms if they are married.

Story from BBC NEWS:

An HIV epidemic is knocking on Malaysia’s door

An HIV epidemic is knocking on Malaysia’s door.

This startling conclusion was reached by the World Health Organisation (WHO) after its officials studied statistics and spoke to Ministry of Health personnel.

It disclosed that some 15,000 children have been orphaned by AIDS in Malaysia. Dr Hans Tieru, the WHO representative, said that the development of the HIV situation here was being monitored closely by the world organisation.

"It was only after studies were carried out that a finding was made that Malaysia was at the initial stage of an HIV epidemic," he said. This was reported in the UNAIDS/WHO Report on the Global HIV/AIDS Epidemic 2004.

Nearly 65,000 people have been diagnosed with HIV since 1996. Of this number, 9,444 have developed full- blown AIDS and 7,195 have died.

But the authorities and non-governmental organisations believe the official figures are only a conservative estimate.

Drug use lies behind the bulk of the HIV/AIDS cases in Malaysia. There are 130,000 intravenous drug users, many of whom share needles, raising the risk of infection.

Health Minister Datuk Dr Chua Soi Lek said he was troubled by the WHO finding. "This is a challenge for all Malaysians. We have to find a way to stop the spread of HIV," he said.

The situation called for radical approaches, including free distribution of condoms and clean needles to stop the spread of infection among drug users, he said.

But Dr Chua also sounded a note of caution. Though most HIV-positive Malaysians were drug addicts, a growing number of people were being infected through sexual contact.

---NST


The controversial plan to issue condoms and needles to halt the spread of HIV among drug users looks set to take off.


All Health Minister Datuk Dr Chua Soi Lek has to do is convince influential religious leaders next week that the alternative to the scheme is unthinkable.

"Together with the minister in charge of religious affairs, I will meet the ulamas. We will tell them that what we are doing is to prevent the spread of the disease to a worrying stage," he said.

Dr Chua said under the plan slated to start in October, 130,000 intravenous drug users would be given clean needles. More than 70 per cent of this group who are sexually active will be given condoms.

This harm reduction regime will save 90,000 Malaysians from being infected with HIV/AIDS.

"This will save the Government RM500 million a year in terms of treatment with drugs alone," he said.

Many religious groups have shot down the idea, saying that giving condoms will only encourage sexual promiscuity.

Dr Chua said that condoms would only be given to a targeted group of people — drug users, and will be under close supervision by trained professionals.

The latest figures show that 64,439 people were infected with HIV. If nothing is done to curb the spread of the disease, the number of HIV cases will escalate to 300,000 by 2015.

---NST

Free Condoms And Needles For Addicts Not A Waste- Chua

KUALA LUMPUR, June 13 (Bernama) -- The cost of providing free condoms and syringes to drug addicts is expected to cost RM145 million annually but will help avoid 90,000 new HIV infections, Health Minister Datuk Dr Chua Soi Lek said Monday.

He said the government was seriously thinking of introducing the measure (free provision of needles and condoms to drug addicts) as the cost of treating HIV patients had exceeded RM500 million yearly.

"That is the cost of medication only and does not include other costs," he told reporters after opening the Millennium Development Goals Seminar organised by his ministry and the World Health Organisation (WHO) here.

Dr Chua said almost 40 per cent of drug addicts who were HIV positive also contracted other illnesses like tuberculosis and pneumonia which further added to the cost of treatment.

"In short, providing the needles and condoms is not a waste of the people's money ... in terms of savings, it is triple the amount," he said.

Earlier this month, Dr Chua announced that the government was seriously considering providing syringes and condoms for free to drug addicts to stem the spread of HIV.

However, the proposal received various reactions, with ulamas and religious organisations fearing the move would lead to indiscriminate sex while non-governmental organisations lauded the move.

Dr Chua added that he and Minister in the Prime Minister's Department, Datuk Dr Abdullah Mohamed Zin would meet with ulama groups soon to clarify the issue.

-- BERNAMA

The Illiterate Surgeon

The Illiterate Surgeon
From the New York Times
By NICHOLAS D. KRISTOF

ADDIS ABABA, Ethiopia

Just about the worst thing that can happen to a teenage girl in this world is to develop an obstetric fistula that leaves her trickling bodily wastes, stinking and shunned by everyone around her. That happened four decades ago to Mamitu Gashe.

But the most amazing thing about Ms. Mamitu is not what she endured but what she has become.

Ms. Mamitu's story begins when she was an illiterate 15-year-old in a remote Ethiopian village unreachable by road and with no doctor nearby. She married a local man, became pregnant and after three days of labor, she lapsed into unconsciousness and the baby was stillborn.

"After I woke up, the bed was wet" with urine, she remembers. "I thought I would get better after two or three days, but I didn't."

That's typically how an obstetric fistula arises: a teenage girl, often malnourished and with an immature pelvis, tries to deliver her first baby. The fetus gets stuck, and after several days of labor it is stillborn - but some of the mother's internal tissues have been damaged in that time, and so to her horror she finds herself constantly trickling urine or sometimes feces from her vagina.

Soon she stinks. Her husband normally abandons her, the constant trickle of urine leaves her with terrible sores on her legs, and if she survives at all she is told to build a hut away from the rest of the village and to stay away from the village well. Some girls die of infections or suicide, but many linger for decades as pariahs and hermits - their lives effectively over at the age of about 15.

Fistulas were common in America in the 19th century. But improved medical care means that they are now almost unknown in the West, while the United Nations has estimated that at least two million girls and women live with fistulas in the developing world, mostly in Africa.

This should be an international scandal, because a $300 operation can normally repair the injury. A major effort to improve maternal health in the developing world should be a no-brainer, for it could prevent most fistulas and reduce deaths in childbirth by half within a decade, saving 300,000 lives a year.

But maternal health is woefully neglected, and those suffering fistulas are completely voiceless - young, female, poor, rural and ostracized. They are the 21st century's lepers.

Ms. Mamitu was exceptionally lucky in that she was brought to a hospital here in Addis Ababa that offered free surgery by a saintly husband and wife pair of gynecologists from Australia, Reginald and Catherine Hamlin. Reg is now dead, while Catherine is the Mother Teresa of our time and is long overdue for a Nobel Peace Prize.

After that operation, 42 years ago, Ms. Mamitu was given a job making beds in the hospital. Then she began helping out during surgeries, and after a couple of years of watching she was asked by Dr. Reg Hamlin to cut some stitches. Eventually, Ms. Mamitu was routinely performing the entire fistula repair herself.

Over the decades, Ms. Mamitu has gradually become one of the world's most experienced fistula surgeons. Gynecologists from around the world go to the Addis Ababa Fistula Hospital to train in fistula repair, and typically their teacher is Ms. Mamitu.

Not bad for an illiterate Ethiopian peasant who as a child never went to a day of school.

A few years ago, Ms. Mamitu tired of being an illiterate master surgeon, and so she began night school. She's now in the third grade.

The Fistula Hospital where Ms. Mamitu works is nicknamed "puddle city" - because patients stroll around dripping urine - but it abounds with joy and hope.

President Bush has increased aid to the developing world generally and to Africa in particular, but a few days ago he rejected Tony Blair's appeal for a further dramatic increase in assistance for Africa. The real stakes in that rejection will be measured in lives like Ms. Mamitu's. I hope that Mr. Bush will reconsider - for the sake of people like those girls with fistula living in huts alone on the edges of hundreds of thousands of villages.

Ms. Mamitu shows us what a tragedy it would be to write them off. A couple of Australians once gave Ms. Mamitu a break, and so today Ms. Mamitu is not a victim at all, but an inspiration.

And, I hope, an inspiration to us to be more generous.

E-mail: nicholas@nytimes.com

More Medical Seats at IPTAs

Medical Faculties At Varsities Able To Handle Bigger Intake Of Students

KUALA LUMPUR, June 11 (Bernama) -- The government has increased the teaching capacity at the medical faculties of all the public universities to cater to a bigger intake of students, Higher Education Minister Datuk Dr Shafie Mohd Salleh said.

He said this was to prevent a recurrence of last year's problem where 128 Sijil Pelajaran Malaysia top scorers failed to get places to study medicine locally.

Dr Shafie said basic facilities such as teaching equipment had been improved or upgraded and more lecturers had been recruited since last year.

"So far, so good. I am quite sure that what happened last year will not happen again," he told reporters after launching the Career and Education Fair 2005 here.

Last year, after a public outcry, the government awarded the top scorers Public Service Department scholarships to study medicine overseas.

Dr Shafie also said that the announcement of this year's university intake would be made before the end of the month as the new 2005/2006 session begins in July.

In another development, Shafie said he had approved the unpaid leave of University Malaya economist Assoc Prof Dr Terence Gomez who had tendered his resignation after the university did not approve his two-year secondment to take up a research post in the United Nations.

"I only saw the application yesterday and I approved it," he said when asked by reporters to comment on the matter.

Shafie said he had also rejected Gomez's resignation, which means the economist could return to the university after completing his two-year secondment in Geneva.

-- BERNAMA

Unbelieveable as it is, our MINIster of Higher Education only saw Dr Gomez's application for unpaid leave yesterday. He is probably a non-Malaysiakini reader, a non-blog reader and is deaf to what Opposition Leader, Lim Kit Siang as to say. If he intends to join "The celebration with Dr Terence Gomez", i would gladly sponsor him. The appproval may have come at the 11th hour but there is cause for celebration in GostanLand.
Did the UM VC not revealed Dr Gomez's forced resignation to him? Did they not discuss the issue prior to the VC accepting the resignation? If both the answers are 'No' then he should fire the VC.

A Nation Of Healthy People

Govt Acts To Create A Nation Of Healthy People

PORT DICKSON, June 11 (Bernama) -- The government is turning words into deeds in its desire to create a nation of healthy people.

Today it announced a plan to establish a community health promotion centre in every state under the Ninth Malaysia Plan (2006-2010).

The announcement was made by Prime Minister Datuk Seri Abdullah Ahmad Badawi in his speech at the launch of the national-level healthy lifestyle campaign here. The text of Abdullah's speech was read out by Negeri Sembilan Menteri Besar Datuk Seri Mohamad Hassan.

Abdullah said these community health promotion centres would provide health packages that would enhance the people's knowledge and skills in four areas: healthy eating, engaging in physical activity, cultivating a healthy mind, and refraining from smoking.

A pilot project has been established at the Seberang Jaya Community Health Clinic in Penang, he said.

"The establishment of these centres is to realise the government's desire for the people of Malaysia to be healthy and well," said Abdullah.

He said the primary challenge the government faced in building a society that practised a healthy lifestyle at all times was changing the behavioural pattern of the society.

The prime minister said it was not easy to alter the behavioural pattern of society, adding that it could not be achieved overnight.

"We need much time to ensure that society not only changes its behavioural pattern but also maintains the new practice continuously," he said.

He said the government did not wish to have a situation where the people engaged in physical exercise and consumed healthy food for some time and then went back to their old ways.

The prime minister said that understanding the difficulty in changing a society's behavioural pattern, the government was encouraging promotion of a healthy lifestyle by establishing the relevant infrastructure and services.

Abdullah said the government, through the Health Ministry, always gave serious attention to the provision of excellent health facilities for the people.

Up to 2003, he said, the Health Ministry had established 117 hospitals, 864 health clinics, 1,847 rural clinics and 95 maternal and child health clinics in the country.

Abdullah also said that the situation of non-infectious ailments, particularly cardiovascular disease, that the nation faced now was most serious and worrying.

"Therefore, the government through the Health Ministry always strived to enhance health education and promotion among the people," he said.

Abdullah said one cause of cardiovascular disease, diabetes and obesity was the lack of physical activity.

The prime minister said the government's desire to create a nation of healthy people would not be achieved without the commitment of every individual and organisation in the society.

"Every member of society must play his or her respective role in helping the Health Ministry to realise its vision of building a healthy and active Malaysian society," he said.

Health Minister Datuk Dr Chua Soi Lek was also present at the launch of the three-day campaign.

-- BERNAMA

NO to Open Debate on Free Needles and Condoms

Health Minister Declines Open Debate On Free Condoms For Addicts

CAMERON HIGHLANDS, June 10 (Bernama) -- Health Minister Datuk Dr Chua Soi Lek said Friday he did not wish to engage in an open debate, including through the media, on his ministry's proposal to distribute free needles and condoms to self-confessed drug addicts to check the spread of HIV/Aids.

"I will not respond to any opinion on the matter because at this stage we are still compiling information on the matter," he said.

Speaking at a press conference after visiting the Cameron Highlands Hospital project in Tanah Rata here, he said he would explain the issue at a press briefing after "all sides had expressed their opinion".

The ministry proposed to distribute free needles, condoms and methadone to a group of drug addicts under a pilot programme as a means of checking the spread of HIV/Aids.

Several state governments, including Perak, Terengganu dan Selangor, had opposed the proposal and Perak Menteri Besar Datuk Seri Tajol Rosli Ghazali had suggested that the issue be discussed at a special meeting of the Council of Muftis.

"The proposal is part of our responsibility to improve the health of the people ... we do not want to be known as a developing nation with a high incidence of HIV," Dr Chua said.

Meanwhile, he said the government's decision to stop building large hospitals under the Ninth Malaysia Plan and to upgrade existing ones was because the existing 125 hospitals were sufficient and that some of the hospitals were not fully utilised.

He said only one or two places still needed a large hospital while at other places smaller hospitals would be built, or existing hospitals would be upgraded.

He added that small hospitals would be equipped with equipment such as X-rays, maternity wards, children's wards and pharmacies.

According to him, the government would from now adopt the tender system for projects under his ministry to reduce costs. Some hospitals cost more than five star hotels to build, and when the cost was calculated per bed, each bed cost RM1.1 million, he said.

On the Cameron Highlands Hospital, he said it would be completed in March next year.

-- BERNAMA

Government Hospitals May Not Accept Patients From Private Hospitals

Government Hospitals May Not Accept Patients From Private Hospitals

TEMERLOH, June 9 (Bernama) -- The Health Ministry may cease the practice of government hospitals accepting patients from private hospitals for post-surgery treatment.

Minister Datuk Dr Chua Soi Lek said the co-operation between government and private hospitals, established on mutual understanding and on humanitarian grounds, had long existed.

He added that it was unfair to put the blame on government hospitals if patients from private hospitals who were brought there died.

Dr Chua was referring to a complaint by family members of a rubber tapper who died at the Sungai Petani Hospital Wednesday.

They claimed that P. Rajamah died due to the hospital's delay in admitting her.

A report in a newspaper Thursday said that Rajamah was supposed to undergo an operation to reduce a swelling in the brain at a private hospital but was sent to a government hospital because the Intensive Care Unit at the private hospital was full.

Speaking to reporters after a working visit to the Temerloh Hospital today, Dr Chua said it had become a trend for private hospitals to send their patients to government hospitals on the excuse that they did not have ICU facilities or the patients could not meet the high cost.

"After getting the payment (for the surgery), patients are sent to government hospitals and, when the patients die, we (government hospitals) are blamed," he added.

Dr Chua said he did not want the government hospitals to be blamed for the death of patients from private hospitals.

"We are being accused of not attending to the patients, making them wait too long .... We have to review this and, perhaps, will cease the co-operation with private hospitals like in the case of accepting their patients for post-surgery treatment," he told reporters after a working visit to the Temerloh Hospital, here Thursday.

Earlier, in his speech, Dr Chua said the government had no plans to build new hospitals under the Ninth Malaysia Plan.

However, he said, several hospitals would be upgraded to ensure quality service for the people. He said the ministry would increase the number of health clinics, adding that there were 4,000 clinics nationwide.

-- BERNAMA

The job of the MOH is to see that there is a win-win utilisation of both the public and private medical services in order that the patients benefit. Just like gomen hospitals and health facilities, private medical clinics and hospitals come in all shapes and sizes with varying equipments, staff, expertise and facilities. Often gomen health clinics and smaller hospitals are not properly nor fully equipped to handle all kinds of patients and often patients have to be transferred for them to receive optimal medical management or followup intensive treatment after initial stabilisation. Often this is faced by the smaller private hospitals and clinics. To deny patients further treatment in gomen hospitals just because they have been initially treated in private hospitals is to deny them proper treatment. What the MOH should do is to come up with a protocol for proper and safe transfers of such patients when the private hospitals do not have the expertise or equipments or facilities to properly manage the patients. Private medical practitioners should also liase with their counterparts in gomen hospitals to ensure that when the need arises, there is proper and safe transfers of these patients between facilities. Communication breakdowns and mis-communications should be reduced to the minimum.
Just because of the recent case of Rajamah the established co-operation between gomen and private hospitals based on mutual understanding and on humanitarian grounds should not be cast aside. The MOH should instead fully investigate this case and apportioned blame correctly. In the case of Rajamah, interventions by none other than MIC president Datuk Seri S. Samy Vellu and state executive councillor Datuk V. Saravanan were said to be needed before Rajamah could get admited to the ICU of Sungai Petani Hospital.

Of Free Needles & Condoms

June 02, 2005 15:23 PM

Govt Mulls Needle Exchange, Free Condoms To Addicts - Dr Chua

KUALA LUMPUR, June 2 (Bernama) -- The Health Ministry is seriously considering providing needles and condoms to drug addicts to reduce the spread of HIV, the AIDS-causing virus, Minister Datuk Dr Chua Soi Lek said Thursday.

As an initial step, he said, the ministry would embark on a six-month pilot project to supply free needles and condoms to 1,200 injecting drug users (IDUs) besides methadone, a drug substitute.

Under the Harm Reduction Programme, the needles and condoms would be supplied through 10 selected government and 10 private clinics nationwide in October after the medical staff have been given proper training.

"We've to consider the needle exchange approach. We are providing them the needles so that they will not share needles. In many countries, the results are good in reducing HIV infection rate," he told reporters.

Dr Chua said 61,486 HIV infections, including 8,955 AIDS cases, were reported as of September last year, with 7,083 deaths.

He said 75 per cent of the HIV infections or 46,292 cases were IDUs.

Dr Chua said his ministry's effort was merely a "clinical and medical initiative" as the existing programmes have failed to reduce the infection rate.

"Morally, we're neutral. Actually, in medical reality, without condoms, HIV will spread," he said, expressing the hope that the public would give their feedback and support for the programme to be implemented.

He said the Cabinet Sub-Committee on Drug Addicts Treatment and Rehabilitation headed by him had considered all available data, including a study conducted in 26 drug rehabilitation centres in 1998.

The study on 6,326 inmates showed that 65 per cent of them were IDUs, with 77 per cent of them injecting drugs more than three times a day and shared needles with more than five people, he said.

He said the study also showed 77.6 per cent of the IDUs were sexually active, with only 18.7 per cent of them using condoms during sex.

He said the same study revealed the risk of contracting HIV among IDUs was six times higher than among non-IDUs.

"The risk of being infected with HIV among those sharing needles is seven times higher than those not sharing needles," he said.

It has been projected that by the year 2015, HIV carriers would escalate to 300,000 and drug addicts to about one million.

Dr Chua said the committee also considered other studies such as the global review of needle and syringe exchange programmes implemented between 1993 and 1998 in 29 cities worldwide.

He said they showed HIV prevalence among IDUs dwindled by an average of 58 per cent a year while the number of IDUs did not increase.

By contrast, he said, in 52 cities where no such programmes existed, HIV infections increased by six per cent annually.

He also cited the study in Belarus which showed such programmes had prevented over 2,000 HIV cases. Similar successes were also reported in Australia under the same programme.

Dr Chua said the government was aware of the public sensitivities on the move to provide free needles and condoms to addicts but the Health Ministry's stand was clear -- to discourage free sex.

"We only want the high-risk groups to use condoms. When a person is diagnosed to be HIV-positive, we do not encourage him or her to be every where.

"Using condoms is only one of the safeguards to prevent others from contracting HIV," he said.

In this regard, Dr Chua urged political parties and non-governmental organisations not to exploit the plan for their own agenda.

"Don't exploit the plan for political mileage. It has nothing to do with politics but for the interests of HIV sufferers and to protect Malaysia's image.

"We do not want Malaysia to be known as a developed nation but with the highest number of HIV carriers in Asia," he added.

-- BERNAMA

Free Needles And Condoms Less Expensive, Says Dr Chan
The Sarawak Perspective

KUCHING, June 7 (Bernama) -- It would be less expensive for the government to supply free needles and condoms rather then spending tax payers money trying to cure the HIV carriers and drug addicts.

Sarawak Deputy Chief Minister Tan Sri Dr George Chan said the Health Ministry's proposal might sound absurd, but as far as the medical side was concern, that would be a better measure to curb the problem of drug addicts and the spreading of HIV virus in the community.

"It would be much more expensive if you try to cure them... this people are not productive anymore, so this is a small price (for tax payers) to pay," he said.

Dr Chan was asked to comment on Health Minister Datuk Dr Chua Soi Lek's statement that the ministry would embark on a six-month pilot project to supply free needles and condoms to 1,200 injecting drug users (IDU's) beside providing them with methadone, a drug substitute.

"The moral side I would not want to comment...but as far as medical side is concern, that is a better thing to do rather than letting them to use needles and pass them around, which will then increase the chance of people being infected," he said, relating to his personal opinion as a medical doctor.

On the state government's stand of the issue, Dr Chan said so far the Cabinet had not discussed the matter.

Dr Chan's opinion was echoed by the president of the Federation of Kuching and Samarahan Division Chinese Association Dr Chou Chii Ming, but felt that there should be strict control as to who should get the free needles and condoms.

"Providing free needles and condoms will not be sufficient as we do not know who around us are drug addicts of HIV carriers. So, those people who get these things must register themselves," he said.

The ministry's proposal was also lauded by a community leader, Kapitan Lim Sin Khee, who believed that prevention was better than cure.

"It is good because we have to prevent the AIDS-causing virus from spreading. More importantly, drug addicts have to appreciate what the government is doing.

"As the number of drug addicts and HIV carriers is increasing, it is imperative that the government take stringent measures to stop the spread of the virus," he said.

-- BERNAMA

Perak Backs Free Condoms Plan But Only For Married Addicts
The Perak Perspective

IPOH, June 8 (Bernama) -- The Perak government will support the Health Ministry's plan to give free condoms to drug addicts to check the spread of HIV/AIDS if the distribution is restricted to married addicts.

Menteri Besar Datuk Seri Tajol Rosli Ghazali said the state would have a problem with the plan if condoms were given to unmarried addicts as well.

"It is okay if you want to give condoms to husbands but if you give it to bachelors, it is not appropriate since Islam prohibits sex between unmarried couples," he told reporters after the State Exco meeting.

He was asked to comment on a statement by Perak mufti Datuk Seri Harussani Zakaria Tuesday that opposed the ministry's plan to distribute free condoms and syringes to addicts.

Tajol Rosli said the state government supported the distribution of free condoms to married couples because it encouraged the use of condoms by Muslim couples with HIV/AIDS.

Perak required Muslims intending to get married to be tested for HIV/AIDS and those found positive would be given counselling and advice to use condoms if they wanted to continue with their marriage, he said.

He called on the Health Ministry to review the plan and hold discussions with religious leaders and non-governmental organisations to find the best way of implementing it.

On the plan to give free syringes to drug addicts, Tajol Rosli said the Perak government would not object to the plan but the ministry must first study its effectiveness.

He also called on the Council of Mufti to hold a meeting to discuss the issue and arrive at a common stance because the states now had varying views about it.

-- BERNAMA

It looks like finally the MOH is accepting that the gomen initiatives to deal with drug addiction and the spread of HIV are not producing results. Finally the MOH is seriously considering providing addicts with methadone and introducing free condoms and needles to addicts under the Harm Reduction Programme of combating drug addiction and HIV spread. These initiatives have produced good results in countries using them. Mindful of political, social and religious sensitivities, the MOH has rightly pointed out that the latest move must be seen as a "clinical and medical initiative".
Sarawak seems to have taken to the proposal positively but the Perak MB despite saying that the state gomen would support the MOH latest move, he wanted the condoms given only to married addicts. The reason for this is that "Islam prohibits sex between unmarried couples". The MB appears to be behaving like the proverbial ostrich, does he seriously think that the prohibition is seriously being observe by all single persons or that singles do not become drug addicts or have HIV. What is his view on unmarried non-muslim addicts? The effectiveness of the Harm Reduction Programme has already been shown in many studies and in countries using it for theri drug programmes, does he seriously want the MOH to carry out further studies and reinvent the wheel? It must also be noted that the Perak mufti Datuk Seri Harussani Zakaria also opposes the MOH's plan to distribute free condoms and needles to addicts.
It looks like Dr Chua might not get his pilot run running soon. The moral polis are surfacing once again.
Meanwhile, our rather indecisive PM, when asked about the MOH initiative, said the gomen is still considering the move and had yet to decide on the suggestion. He is saying all despite knowing that HIV/AIDS has reached a critical and dangerous stage. He said he had also asked the Health Minister to hold meetings with religious leaders to give an explanation on the dangers of the disease. Maybe he should be with Datuk Chua when the latter is explaining things to the religious leaders in order to provide moral and religious supports.

Dr M relative’s drug label monopoly an outrage

From a Malaysiakini letter writer :: Totally Put Off

Jun 7, 05 1:43pm

I was appalled to read the recent expose on the latest example of crony capitalism in Malaysia involving the award of an monopoly concession to label all medicines and drugs before they can be sold in Malaysia.

There was no open, competitive bidding for this concession, no terms of reference, nothing. The company that received the concession, Mediharta Sdn Bhd, is partly-owned by Dr Mahathir Mohamad's sister in law, Saleha Mohamed Ali.

The rationale for the concession? These hologram drug labels will allegedly prevent counterfeit medicines from reaching our shores. But the Western pharmaceutical companies that produce these medicines and who should be cheering such a move are actually criticising it because:

a. the incidence of fake medicine is small in Malaysia and limited to traditional herbal medicines, which is not their concern;

b. the holograms are easily copied anyway and

c. it adds an extra layer of costs with no benefits to the consumer

This issue is not the same as the pirated software (CDs, VCD and DVDs) problem in Malaysia which is much more rampant and where the West supports any steps by the government to curb piracy.

This is more akin to allowing a company to charge 10 cents/ for every litre of diesel or petrol sold at every petrol pump in Malaysia in return for doing nothing . Except in the labelling issue, it is even more punitive.

It punishes every Malaysian each time they fall sick particularly the elderly and the chronically- ill. It adds an extra cost layer to our increasingly costly healthcare system with no added benefit.

Unlike our ‘beloved’ tolled roads for which there are alternative routes, medicines have no substitute. Drugs are patented and cannot be copied easily, if at all. Even generic drugs (cheaper versions of original drugs whose patents have lapsed) will have to be labelled. No exceptions. Even syringes now have to be labelled.

Despite protests from the pharmaceutical industry, the US and EU, the Malaysians government has pushed through the hologram label proposal which scheduled to be implemented this month.

So much for developing a first class mentality to match our first class infrastructure, Pak Lah. We haven't progressed from the good old feudal days when the ‘ketua kampung’ would bestow special privileges upon his coterie of cronies.

Will this be the last straw that breaks the camel's back? Will the rakyat finally say ‘enough is enough’ and finally put their collective foot down?

Ensuring healthcare delivery system works

The NST Sunday Interview

THE SUNDAY INTERVIEW: Ensuring healthcare delivery system works
By Annie Freeda Cruez


Datuk Dr Ismail Merican, the Director-General of Health, has been making his rounds, meeting the doctors, nurses and administrators of public hospitals around the country. Putting faces to names is just the first step of his mission to make public hospitals the first, rather than last, cho ice for Malaysians, he tells ANNIE FREEDA CRUEZ

Q: We heard you have been on rounds to check what is happening in hospitals?

A: I care just not for doctors but all levels of healthcare providers in the ministry. That is why I am going round the country meeting everyone ranging from state and hospital directors to specialists, doctors, nurses, attendants, medical assistants and allied health personnel.

Why? Because I want to send the message that each one of them is important in the whole structure of the healthcare system.

I find the time to do that. Some of them had never seen the face of their director-general before. Now they have, and I'm listening to what they say. They may have particular problems and may also give good suggestions to improve the service. The important thing is to make sure they know we care.

We may not be able to offer better remuneration, but at least we can improve the working environment and career structure and provide more opportunities for them to update themselves technically.

If they want to pursue further training overseas to improve themselves, I will be the first to support them. I have gone to the Penang, Seremban and Malacca hospitals and I hope to cover all the States this year. I want to make sure I know the people I am dealing with. Some of them are names I see on documents. Now I want to meet and put a face to the names.

Q: How are you planning to bring changes?

A: I (want to) remind doctors of their role. What they can do and what they cannot do, that is what I mean by good medical practice.

I would like doctors to go back to the original concept of being doctors. I want ministry doctors to be the best they can.

Now, we are giving them more opportunities for training, providing a good working environment and better on-call allowances. In essence, we take care of our healthcare providers, so they in turn should take care of the profession and their patients and clients.

Q: You are known as the no-nonsense Director- General...

A: I have a strong sense of urgency. When instructions are given, I expect those who have been entrusted with the task to carry it out quickly and not delegate it to someone who will take a couple of weeks or months to get it done.

I place a lot of emphasis on trust and responsibility. If, for some reason, the instruction is not carried out, they must come back to me with an explanation.

When I give it to them personally, I mean business, and it also means that it is urgent and needs to be done quickly, within a week or two.

Similarly, patients must be given due attention, care, importance and a sense of dignity. It is unprofessional to make people wait and wait for decisions to be made simply because no one wants to make a decision and keep on passing the buck.

Some decisions we have made to improve the healthcare system include the implementation of the fast-track lane, reducing patients' waiting time, making sure doctors wear their white coat and name tags, rotation of doctors to various disciplines, and branding the Ministry of Health.

I assess the staff at all times. People walk into my room and I assess them as to how much they know and how much they don't know. I want to make sure they know more than me and if I know more than them in their area of expertise, I get apprehensive with the officers concerned.

The state and hospital directors must inform us of anything unusual that happens in the State or hospitals so that we can take fast remedial action. Nothing is worse than getting the news from the newspapers.

Q: What about doctors' complaints?

A: Doctors are unhappy about the working environment and slow promotions. This is my priority and hopefully in the next few months, we will be able to get more good news from the authorities regarding this.

Doctors also welcome greater opportunities to specialise and improve their knowledge and skills.

Q: What other improvements do you have in mind?

A: If they can improve the healthcare delivery system, have a sense of belonging, have a sense of urgency and are imbued with the ministry's corporate culture, I will be more than happy.

Q: At what stage is the National Health Plan?

A: It is going according to plan. Under the Ninth Malaysia Plan we are gearing towards upgrading of healthcare facilities as well as improving human capital.

I don't want to depend too much on foreign expertise. We need to start the training right now. We need to identify people, send them overseas so that they can come back and train others. Building human capital is very important.

Right now there is an imbalance regarding the type of specialist services offered in this country. We want to address this problem.

We need to identify the people and train them so that after four to five years, we will have a good group of competent and highly skilled specialists and sub-specialists to cater to the needs of our country.

Q: What about national healthcare financing?

A: I think enough has been said. The concepts and principles are very clear. The principle is, those who can afford must pay and those who cannot afford — the elderly, handicapped and the poor — will be taken care of by the Government. The concept is very simple.

We would like the public to get the same quality and scope of care or even better care from an integrated healthcare system.

Q: What about the target group?

A: It is being worked out. The Government and the ministry is very caring. We are not so heartless as to leave people in the lurch, as claimed by some NGOs or associations which keep on churning out statements and rhetoric as if they are the only ones who care about the people.

Please give us some credit. We have been toiling all these years to serve the people with high quality healthcare. Surely we are not about to abdicate our responsibility and leave sections of the population uncovered.

We always maintain that whatever we introduce is going to be better than what we have now. We are very caring and we will know what to do when the time comes.

Q: What plans (are there) to handle emerging are there and re-emerging diseases?

A: We have formed two committees. One is the National Pandemic Preparedness Plan, a special committee which will look into how we respond to a pandemic. It was set up in early May. I already had the first meeting to lay down the ground rules.

We must simulate an outbreak and see how far we are prepared. I intend to do this soon and enlist the co-operation of all stakeholders including the public and private sectors, the NGOs and the community.

We already have the SOP (standard operating procedures) and the guidelines about having these are not good enough. We need to simulate and test the system and see how prepared everyone is.

The second committee is the National Laboratory Biosafety committee which is important as well as it will make sure that all the labs in the country have the required standards to cater for the diagnosis of emerging diseases and identification of the aetiological agent.

We have in place a good surveillance system and early warning systems to detect unusual syndromes or atypical clinical presentations and take the necessary measures to contain and control as well as alert the community.

Big O: Redundant reflex?

The Darwinian logic behind the female orgasm has long remained elusive. Women can have sexual intercourse and even become pregnant, doing their part for the perpetuation of the species, without experiencing orgasm. So what is its purpose?

Over the last four decades, scientists have come up with a variety of theories, arguing, for example, that orgasm encourages women to have sex and reproduce or that it leads women to favour stronger and healthier men, maximising offspring's chances of survival.

But in a new book, Dr Elisabeth A Lloyd, a philosopher of science and professor of biology at Indiana University, takes on 20 leading theories and finds them wanting. The female orgasm, she argues in the book, The Case of the Female Orgasm: Bias in the Science of Evolution, has no evolutionary function at all. Rather, Dr Lloyd says the most convincing theory is one put forward in 1979 by Dr Donald Symons, an anthropologist.

That theory holds that female orgasms are simply artifacts - a byproduct of the parallel development of male and female embryos in the first eight or nine weeks of life.

In that early period, the nerve and tissue pathways are laid down for various reflexes, including the orgasm, Dr Lloyd said. As development progresses, male hormones saturate the embryo, and sexuality is defined.

In boys, the penis develops, along with the potential to have orgasms and ejaculate, while "females get the nerve pathways for orgasm by initially having the same body plan." Nipples in men are similarly vestigial, Dr Lloyd pointed out. The female orgasm, she said, "is for fun".

NYT News Service

Operation On Twins A Success, Says Doctor

ALOR STAR, June 1 (Bernama) -- A team of local medical experts successfully operated on a pair of twins to repair their deformed spines although the operation on one of them was stopped due to complications.

The operation on the 25 year-old twins, Norbarkhih and Norbarkhiyah Mohd Yusoff, which took 17 hours since yesterday until about 2am Wednesday, made history in the country's medical record.

Immediately after leaving the operating theatre at 1.50am, the Alor Star Hospital consultant orthopaedic and spine surgeon, Dr Zamyn Zuki, who led the team, went to meet the twins' father, Mohd Yusoff Shari, shook his hand and told him that the operation was a success.

Tears of happiness welled in Mohd Yusoff's eyes and his wife, Sharifah Esah Syed Osman, after hearing the news. Both thanked the medical team for giving hope of a normal life to their daughters.

The twins' parents dashed towards Norbarkhiyah, who was still in a semi-conscious state, and held her hands as she was wheeled out from the operating theatre.

Speaking to reporters, Dr Zamyn said the operation was considered a success although the surgery on Norbarkhih had to be stopped about 6pm yesterday because of excessive bleeding.

"In the situation facing Norbarkhih, we (team) decoded to stop the operation because of the high risks involved, including endangering her life, if we were to continue with the operation.

"But she can continue with the operation in a few weeks," he added.

Dr Zamyn said the operation on Norbarkhiyah went smoothly and took a longer time than expected, which was between 10 and 11 hours, because of the curve on her spine which was higher than estimated.

"The surgery (on Norbarkhiyah) was smooth and she had shown good response like moving her feet after the operation," he added.

Besides Dr Zamyn, others in the team were Universiti Malaya orthopaedic specialist Dr Omar Isa, Alor Star Hospital orthopaedic specialists Dr John Ooi and Dr Jasminder Singh, Sungai Petani Hospital orthopaedic specialists Dr Ajay Kumar Sharma, Taiping Hospital orthopaedic specialist Mr Chooi Wai Kit, two anaesthetists and 24 support staff.

Dr Zamyn said the twins were in stable condition and were placed in the Intensive Care Unit for observation.

He said the operation made a history because it was the first involving identical twins with the same problems of scoliosis (deformed spines) and the surgery on them were conducted at the same time.

"We will not have an occasion like this again - twins, same problems and their operation held simultaneously," he added.

As for Mohd Yusoff, 67, neither words nor expression could describe his feelings and appreciation to the medical team for the successful operation.

Mohd Yusof said he was restless throughout the operation and had feared the worst, especially after seeing Norbarkhih, being wheeled out of the operating room much earlier than expected.

He said he would ask Norbarkhih to continue with the operation to correct her spine some other time.

-- BERNAMA

In BolehLand where records are very important, another success has been claimed. History has been made :: The first time, identical twins with scoliosis has been operated on simultaneously in the same hospital in the same state and in the same country. As an aside note, the chief surgeon has declared the simultaneous operations a success although the surgery on Norbarkhih had to be stopped about 6pm yesterday because of excessive bleeding. He said also that she will be operated on again later. Here's wishing the two sisters an early and full recovery.