P E R S A T U A N P E R U B A T A N M A L A Y S I A MALAYSIAN MEDICAL ASSOCIATION

Transcription

1 April 2016 Berita MMA Vol. 46 No. 4 (For Members Only) PP 1285/02/2013 (031328) P E R S A T U A N P E R U B A T A N M A L A Y S I A MALAYSIAN MEDICAL ASSOCIATION

2

3 Contents MMA EXECUTIVE COMMITTEE President Dr Ashok Zachariah Philip Immediate Past President Dr H. Krishna Kumar President Elect Dr John Chew Chee Ming Honorary General Secretary Dr Ravindran R. Naidu Honorary General Treasurer Dr Gunasagaran Ramanathan Honorary Deputy Secretaries Dr Ganabaskaran Nadason Dr Rajan John SCHOMOS Chairman Mr Vasu Pillai Letchumanan PPS Chairman Dr Muruga Raj Rajathurai Editorial Board Editor Dato Pahlawan Dr R. Mohanadas Ex-Officio Dr Ravindran R. Naidu Editorial Board Members Assoc Prof Dr Jayakumar Gurusamy Dr Gayathri K. Kumarasuriar Dr Juliet Mathew Prof Dr M. Nachiappan Publication Assistant Ms Malar ExCo 4 Editorial 6 President s Message 8 From the Desk of the Hon. General Secretary Lead Article 10 Workplace Stress: A Collective Challenge SCHOMOS 14 MMA Tri-Event: An Overview PPSMMA 16 MMA Tri-Event: Towards Excellence Series SMMAMS 18 MMA Tri-Event: ABC of Housemanship 20 Let s Discuss Housemanship 56th MMA AGM 23 Manifesto of Candidates General 34 CAP-italizing Prevention 36 Women Empowerment Seminar 38 Health & Healthcare Disparities 40 T&CM in Today s Healthcare 41 Humour MMA in the Press 42 MOHE Must Resolve Trainee Doctors Issues, Says MMA 46 Mark Your Diary The views, opinions and commentaries expressed in the Berita MMA (MMA News) do not necessarily reflect those of the Editorial Board, MMA Council, MMA President nor VersaComm, unless expressly stated. No part of this publication may be reproduced without the permission of the Malaysian Medical Association. Facts contained herewith are believed to be true as of the date that it is published. All content, materials, and intellectual property rights are owned and provided for by Malaysian Medical Association and its members. VersaComm makes no guarantees or representations whatsoever regarding the information contained herewith including the truth of content, accuracy, safety, or the absence of infringement of rights of other parties. In no circumstances shall VersaComm be held liable for the contents, materials, advertisements contained in this publication. VersaComm has no influence over the contents of Berita MMA and all opinions, statements and representations made do not in any manner reflect that of VersaComm or its employees. Published by Malaysian Medical Association 4th Floor, MMA House, 124, Jalan Pahang, Kuala Lumpur Tel: ; Fax: , info@mma.org.my / publications@mma.org.my Facebook: Website: Copyright Reserved ISSN PP 1285/02/2013 (031328) MITA (P) 123/1/91 Consultant 12-A, Jalan PJS 8/4, Mentari Plaza, Bandar Sunway, Petaling Jaya, Selangor Darul Ehsan. Tel: ; Fax: versahealth@versa-group.com Printer Atlas Cetak (M) Sdn Bhd No. 2, Persiaran Industri, Bandar Sri Damansara Kuala Lumpur. Tel: Berita MMA expresses its appreciation and thanks to the International Labour Organization for permission to use the World Safety and Health Day Poster. This Berita MMA is a publication only for the members of the Malaysian Medical Association. The Malaysian Medical Association does not warrant, represent or endorse the accuracy, reliability or completeness of the contents of Berita MMA (including but not limited to the advertisements published therein). Under no circumstances shall the Malaysian Medical Association be liable for any loss, damage, liability or expense incurred or suffered in respect of the advertisements and/or from the use of the contents in the Berita MMA. Reliance upon any such advice, opinions, statements, advertisements or other information shall be at the readers own risk and the advertisers are responsible for ensuring the material submitted for inclusion in Berita MMA complies with all legal requirements. The advice, opinions, statements and other information does not necessarily reflect those of the Malaysian Medical Association. Nothing in this disclaimer will exclude or limit any warranty implied by law that it would be unlawful to exclude or limit.

4 4 exco editorial Stop the Bashing! Dato Pahlawan Dr R. Mohanadas Editor ~~~ Are we not embarrassing and demoralising the majority of our younger colleagues who are still passionate about the profession? ~~~ It was intended to be a relaxed Sunday, 20 March 2016, I had yet to see the day s newspapers or the online news, I received a message from a senior Accountant friend, and it read: Your profession is confused, after years of being on anti-cholesterol drugs, you say it does not prevent heart attacks, and today, you doubt the quality of your own doctors, I have lost confidence. Subsequently I realised, it was the headlines of a leading newspaper that Sunday: Unfit to be Doctors, and in the three pages that followed, with headings like, Not cut out to be Doctors and Faking it for Medicine that invited such a damaging remark from a friend. Imagine the impression created on the general public then. Yes, this has not been a particularly kind month for the medical profession. We all know there are issues pertaining to selection of students in some medical schools overseas, the varying quality of medical education, large numbers of new doctors graduating, longer waiting period for housemen appointments, difficulties encountered in housemen training and the like. But does the medical profession deserve such bashing, such disparaging remarks, are we not shooting ourselves at our own feet? Do we realise the damage we are causing to the general public who depend so dearly on our healthcare system for their well-being? Do we realise the negative impact to our own younger doctors and housemen, the majority of them who work tirelessly and conscientiously to support our healthcare system? Are we not embarrassing and demoralising the majority of our younger colleagues who are still passionate about the profession? We have to think again, loads of negative publicity is neither helping us nor the next generation of doctors. Again, these are not issues that appeared overnight. It has been there for some years, repeatedly highlighted in small doses by the profession and all other stakeholders. It has to be fixed, indeed all issues are being discussed at various levels, and hopefully all these challenges will be addressed sooner than later. Minimum entry qualifications for Medicine, Dentistry and Pharmacy in this country is specified. All Institutions are required to abide by these, and if they do not, they risk the closure of the programme and/or the institution. The SPM criteria of a minimum of credit B4 is being reviewed. Indeed, in my own observation, candidates who apply to private Medical Schools with the minimum B4 credits are very few. Most would have had a few distinctions. Nevertheless, distinctions in all science subjects are on the cards, and could be implemented soon as minimum criteria. Several private Medical Schools conduct formal interviews and a few conduct an English Language Proficiency Test. But again, you can never be right on assessing the aptitude of a candidate. It is difficult in one interview. On the varying quality of new graduates, it is to be expected, and it is not new. This would depend mainly on the strengths of the Institutions they have graduated from. However, the 24 months period of housemanship, which is intended to be a period of supervised training, should be able to address this. Then, will a Pre-Registration Examination help? It would to some extent, but who are the graduates who need to appear for such exams and who need not, is a bone of contention. Some have compared this to the Certificate in Legal Practice Examinations, its conditions and its pass rates. We have had too much of unnecessary publicity on the inadequate competencies and skills of some Housemen. This is really an issue for the employer, the Ministry of Health with the great expertise they have and network of hospitals for training. The Ministry and the Malaysian Medical Council have made the ground rules clear, the requirements to designate a hospital, public or private, as a Housemen Training Centre. If the private sector wishes to participate, then, abide by the guidelines. There are challenges in the current environment, but not insurmountable, just that those in the corridors of power need to speed up their decisions. However, this negative publicity generated by the profession and media is not helping anyone. We are only undermining the trust and faith of the general population in our profession. One of the objectives of the Malaysian Medical Association, formulated as early as 1959, is: To participate in the conduct of medical education, as may be appropriate. Our records show the direct involvement of the MMA and its leadership then in the setting up of the Faculty of Medicine at the University of Malaya, and later representing to the Government the need for the second and third Medical Faculties in the country. We should continue to provide input, more directly to the relevant authorities from time to time, at the same time trying to steer away from the negative image that could be created. MMA Branches could contribute at the grass roots by conducting forums for school counsellors and directly engaging with senior secondary school students on criteria of admissions to medical schools, the danger of pursuing studies in institutions that admit students with below average results, career prospects in medical sciences, and the demands and expectations in medical education. We would need that type of service and guidance, at the same time, dispelling the notion that academic excellence equals medicine! For now, let s preserve the sanctity of our noble profession.

5 BEST IN CLASS VITAL SIGNS The New Welch Allyn Connex Spot Monitor The only vital signs monitor to turn to for accurate vital signs measurement, advanced patient safety feasures and seamless connectivity to your EMR. Accurate readings across your patient population Help ensure accurate hypertension diagnosis with unique SureBP technology with blood pressure averaging. Research shows that more than half of patients could be misdiagnosed in a hypertensive category using the single reading method. Provide SpO2 accuracy in challenging conditions including motion, thick fingers or dark skin tone, and low perfusion. Improve data acuracy, efficiency, and mobility Eliminate data entry errors in the patient chart with wireless transfer of vital signs Freedom from wires and cables provides the flexibility to easily work in limited spaces Increase staff efficiency by eliminating typing into patient records Configurable design Select from multiple options to get exactly the monitor you need. Protect your investment with service programmes Partners in Care advanced service programmes include Extended Warranty and Comprehensive Partnership programmes Screenshot Discover our attractive Package Price at or call us for a demonstration Welch Allyn Malaysia Sdn Bhd ( P) I GF 101-2, Ground Floor Tower 2 I Wisma AmFIRST Jln SS7/15 (Jln Stadium) I Kelana Jaya I Petaling Jaya, Selangor DE I Malaysia Tel: I Fax: I

6 6 exco president s message Treat Money As A Tool Dr Ashok Zachariah Philip president@mma.org.my ashokphilip17@gmail.com President Most people know the saying about money being the root of all evil. The actual quotation, from the King James Version, is For the love of money is the root of all evil. I am not sure how many agree with that statement. For me, money is a useful marker of value. It makes it easier for us to get what we value and to dispose of what we have. Imagine conducting our complex modern lifestyles by barter trade! And yet, our attitude to this essential lubricant of life and commerce is strangely ambivalent. We all need it, but we are somehow ashamed of this need. In the case of doctors, we don t even have to be selfloathing. Society will kindly loathe us if we happen to insist on receiving fair recompense for our labours. I am writing on this because of meetings the MMA has been having with Managed Care Organisations (MCOs), Third Party Administrators (TPAs) and the Competition Commission of Malaysia (MyCC). A constant thread through these discussions has been the idea that market forces should determine how much a doctor charges. Market forces, according to theory, should adjust prices according to supply and demand. However, this does depend on the market having access to information. In the case of medical care and health, I think we can all agree that the problem is not a lack of information but a profound lack of comprehension. Almost every doctor these days has felt that sinking feeling caused by the patient who drags papers out of his pocket or bag and says I ve been reading online about my symptoms. There is no lack of information out there, but it is almost impossible for the layman to process. Even when guided by their doctor, many people find it difficult to make the informed decisions that in theory are the hallmark of optimal medical care. I think even doctors find it difficult to make clear and rational decisions about their own health, especially outside their own fields of specialisation, because of the inevitable emotional component to being a patient. How much more difficult it must be for a layman. Given that there is such a lack of comprehension of the available information, it would be almost impossible for there to be the sort of rational, self-interested demand that can help set prices in a free market. For instance, I can quite easily determine if I need another mobile phone, and make a fairly informed determination of the features I want, and then choose the phone I want. That helps set the ~~~ If the minimum consultation provides the doctor with a fair return on his time and effort, he will consider objectively the management the patient needs ~~~ price that manufacturers can charge, though of course things like the cool factor can also affect pricing. However, in the field of medicine there are so many courses of treatment or action that reasonable practitioners might recommend for the same set of symptoms in the same patient. The patient, unable to really understand all the information given to him, might in fear choose the most expensive and radical treatment under the impression that expensive is synonymous with good. On the other hand the more penurious or miserly might choose the cheapest alternative which might in the long term end up more expensive, because it might be ineffective. There is another strand to this, of course the question of supply. As many General Practitioners (GPs) will testify, opening a new practice now is expensive, and there are many clinics vying for a piece of the pie. When a young doctor, deep in debt after renovating and equipping his clinic, sits and waits for too few patients, won t the promise of being on the panel of a big company or MCO be too tempting to ignore? Can we blame him if, in his eagerness to be signed on, he offers a ridiculously low consultation fee? After all, he reasons, a few ringgit is better than nothing. The more experienced GPs will see the fallacy here. You have to spend time and employ staff to see the patients not to mention all the other overheads of private practice. If you charge too low, the consultation fees will not cover these costs. You will actually lose money seeing the patients from these panel companies and MCOs. Unfortunately, by the time our young GP finds this out, he is contractually bound to see the patients. The only way out that some see is to prescribe more drugs than needed or to mark the drug prices up (or both). Though one can understand why this is done, it is still unethical and such behavior cannot be condoned. The best way out of this for both patient and doctor, I think, is for a minimum consultation fee to be imposed. The Competition Commission believes a minimum fee is anti-competitive, but in an environment where consumers are not competent to make an informed decision a minimum fee will protect them from being given unnecessary drugs and treatments. If the minimum consultation provides the doctor with a fair return on his time and effort, he will consider objectively the management the patient needs. On the other hand, if market forces and powerful companies force him to undercut himself, ultimately it will be the patient who suffers. In the long term, trust in the profession will be undermined and at present, let us not forget, doctors are among the most trusted professionals in the country. In this respect, I believe the medical profession stands with the legal profession. The Bar Council has minimum fees for many services, and believes that allowing undercutting would serve their clients badly. Perhaps we should work together to make the point to the authorities that it is not a good idea to try to regulate without comprehending. I only wish that we could do this more often before a law is passed!

7

8 8 exco hgs From the Desk of the Hon. General Secretary Dr Ravindran R. Naidu Hon. General Secretary 12 February 2016 Meeting with Dr Ahmad Razid, Director Medical Practice Division with Dr Federa and Dr Hashinderjeet, En Azahar, Representative from Urusetia, Dr Maha, Secretary of Association of Private Hospitals of Malaysia (APHM), Datin Fadhillah from Malaysian Medical Council (MMC), and Dr Shan from Federation of Private Practitioners. MMA was represented by Dr Muruga Raj, Chairman PPS, Dr Arasu, Secretary PPS, and Dr Ravindran R. Naidu, Hon. General Secretary. This meeting was called with a view to regulate all Third Party Administrators (TPAs) and Managed Care Organisations (MCOs). Issues discussed were: 1. Preparation of contracts or agreements This should be based on good medical practice and good business practice. We have requested that all contracts or agreements be standardised so that it will be easy for the doctors. 2. The contents should be balanced so that it is fair to both parties as currently it is beneficial to TPAs and MCOs only. 3. To review consultation fees which should comply with the 13th Schedule of the Private Healthcare Facilities and Services Act The consultation fee is also to be fixed based on the diagnosis. It was suggested a fair consultation fee be charged based on the diagnosis and time spent on the patient. 4. The price of drugs to be standardised. 5. Delay in remuneration to the doctors. The TPA Representative mentioned that the delay in payment is usually due to mistakes in the submission of claims. However, it was clarified that if the companies delay payments, then advise our doctors not to sign a contract with these companies. 6. Preparation of a MCO Bill. The MMA requested the Medical Practices Division of the Ministry of Health (MoH) to formulate the MCO Bill which is the only way to control them. The MMA brought to the attention that a reply has been received from Bank Negara that they have no regulatory requirements and control over TPAs or MCOs. 15 February 2016 Public Lecture Series by YABhg Tun Dr Siti Hasmah in conjunction with the launching of the Tun Dr Siti Hasmah Lecture Series on Public Health organised by Perdana University. This was followed by launching of the book Battling Adversity by YABhg Tun Dr Siti Hasmah. This book was authored by Associate Professor Dato Dr Andrew Mohanraj.

9 18 February 2016 Meeting with En Mazmalek Bin Mohamad Commissioner Personal Data Protection Malaysia under the Ministry of Communications and Multimedia Malaysia 1. The Minister of Communications and Multimedia Malaysia has rejected the Minister of Health s request to exempt doctors from registering with the Personal Data Protection Act (PDPA). 2. The Commissioner informed that their only concern is DATA. The Medical Act does not state how to store, manage, monitor, and delete the DATA. 3. Whereas the PDPA clearly addresses all the above issues. 4. The Commissioner requested that MMA and APHM work together to formulate the guidelines for the Code of Practice for medical compliance under the PDPA. C urrently the MMC has requested that they will formulate the Code of Practice. But the Commissioner stressed that according to law, they being a regulatory body, cannot formulate the Code of Practice. 5. The Commissioner requested MMA to advise the members to register as they will be sending their enforcement officers soon to make sure clinics comply. 6. The penalty for not registering is a maximum of RM500, and the maximum compound will be 50% which is RM250, All doctors need to display their registration certificate in their clinics 8. MMA highlighted that they have no objections to register. However asking to pay is not acceptable as most of the General Practitioners are not doing well. The Commissioner has given an assurance that he will look into this matter. 18 February 2016 Meeting with The Malaysia Competition Commission (MyCC). This was attended by Tan Sri Norma, Chairman, Dato Abu Samah, CEO, Encik Iskandar Ismail, Director Enforcement Division, and Ms Ayuda Sari ismail, Director Strategic Planning & International Affairs Division. It was confirmed that the fee schedule under the Private Healthcare Facilities and Services Act is not against the Competition Commission Act Any fee quoted in any regulations is not contravening the Competition Commission Act It has been clarified that price fixing is not allowed under the Competition Commission Act A range in the fees is allowed. Docquity A Private and Secure, Doctors-Only Professional Network for MMA MMA has partnered with Docquity, a mobile networking and collaboration channel, to set up a doctors-only professional network for members of MMA. With this partnership, MMA members can use this mobile channel to collaborate with trusted peers across geographies in real time. The ability to exchange and learn from medical experiences in real time over a secure doctors-only network is valuable and can potentially save lives. MMA is partnering with Docquity to create and establish such a doctors-only exclusive network for all MMA members. Groups can be formed within the Council and National Working Committee. The Docquity application allows private and secure discussions with individual doctors or group discussions with multiple doctors. The App is private in a way that it is only for doctors and one needs to be invited to join. The app is secure because Docquity has stringent security features to protect the discussions that occur. You can share images, reports, X-rays or give and receive second opinions on patient conditions during your private conversations with other trusted members. This is our community, our network and initiative to help connect all our members onto a single network and create a precedent in collaborative care. The Docquity ( Mobile Application can be downloaded from the Apple App Store and Google Play Store.

10 10 lead article Workplace Stress: A Collective Challenge Dr Jefferelli Shamsul Bahrin jeff.bahrin@basf.com Regional Head Occupational Medicine and Health Protection BASF Asia Pacific Member MMA Selangor Every year since 2003, on the 28th April the International Labour Organization (ILO) celebrates the World Day for Safety and Health at Work. The purpose is to promote the prevention of occupational accidents and diseases globally. It is an awarenessraising campaign intended to focus international attention on emerging trends in the field of occupational safety and health and on the magnitude of work-related injuries, diseases and fatalities worldwide. The theme for this year is Workplace Stress: A Collective Challenge. Workplace stress can be relevant to medical doctors from various perspectives such as treating doctor, occupational health physician, employee, supervisor, or employer. A treating doctor may see patients who have bodily symptoms of stress. An occupational health physician may diagnose stress in an organisation and propose intervention programmes. Doctors are often employees themselves and subject to stressors affecting their organisation. Some also supervise junior health professionals and have an important role in early detection and referral of stress cases among their subordinates. Many doctors have their own practice and hence determine the work environment which affects themselves and their staff. Doctors themselves can be the source of stress! National Institute for Occupational Safety and Health (NIOSH) defines job stress as the harmful physical and emotional responses that occur when the requirements of the job do not match the capabilities, resources, or needs of the worker. A physically strong worker is less likely to develop job stress when performing physically demanding work compared to a physically weak person. A manager with adequate time, budget and staff is less likely to develop job stress compared to a manager with inadequate resources. An author who prefers solitary work is less likely to develop job stress when performing individual work compared to group work. Getting the right match is important in preventing stress in the workplace. Relationship between stress and health Job stressors Individual factors Acute reactions Illness word load control management styles career security interpersonal relations physical conditions (noise, etc.) personality traits stage of career development family situation financial status social support coping Non-work factors Buffer factors psychological anxiety irritability physiological blood pressure muscle tonus behavioral concentration sleep problems coronary heart disease infectious diseases back pain alcoholism tobacco use from: Hurrel and Murphy, 1992 The relationship between workplace stress and health is complex. Stressors at the workplace can be categorised into work-load, control, management styles, career security, interpersonal relations and physical conditions. There can be more than one category of stressor at the workplace. Individual factors such as personality traits and stage of career development, non-work factors such as family situation and financial status and buffer factors such as social support and coping influence

11 Ministry of Health Malaysia Module on Stress Intervention at the Workplace the reaction towards these stressors. Hence to effectively manage stress at the workplace not only job stressors need to be considered but also individual factors, non-work factors and buffer factors. Acute reactions toward stress include increased anxiety and irritability, increased blood pressure and muscle tone, reduced concentration and sleep disturbance. This can lead to illnesses such as coronary heart disease, susceptibility to infectious diseases, back pain, alcoholism and tobacco use (Hurrel et. al. 1992). It is important that employees, supervisors and doctors understand this relationship. Stress should be considered as a potential cause of: sleep disturbance by an employee, irritability in an employee by a supervisor and back pain in an employee by a doctor. Awareness of such relationship allows the employee to seek further support. It will enable the supervisor to initiate a discussion with the employee and if necessary refer the employee for counselling. The doctor will also remember to take appropriate history before proceeding with further investigations. Stress in the Malaysian workforce is common. It ranges from 20% to 34% among teachers (Hadi et al. 2009) (Masilamani et. al. 2012), 22% among dental officers (Rusli et. al. 2006), 37% among nurses (Harmy et. al. 2003), 39% among the police personnel (Masilamani et. al., 2013), 47% among factory workers (Fazil Z., 2004) and 68% among managers and executives (Swee et. al. 2007). The prevalence of stress among doctors is high: house officers 65.2%, medical officers 41.9% and specialists 30.7% (Ruhaini et. al 2006). This is not surprising especially among house officers and is supported by the findings of a study on Stress and Emotional Burnout among House Officers in Yemen. House officers there felt underpaid, experienced work overload, faced time pressure, feared making mistakes, struggled to make decisions, lacked resources and support, had poor relationship with supervisors, felt insecure in their jobs, and work demands affected their personal life (Sami et. al, 2001). While the work conditions in Yemen may not be identical to Malaysia, the house officers experience here would probably be quite similar. Professor of Occupational Health, Dr K.G. Rampal predicts that the prevalence of stress among doctors in Malaysia will increase (2013). This is due to many doctors entering the workforce, fears of inadequate training and skills and predicted reduced income levels and job insecurity. He further recommended the introduction of stress management programmes and teaching coping or survival skills to junior doctors. A positive step in this direction was the publication of an Intervention Module for Stress at the Workplace which covered stress risk assessment, how to manage stress, healthy lifestyle and monitor stress by the Occupational Health Unit of the Ministry of Health Malaysia in Today, Hospital Kuala Lumpur employees have access to their counselling unit to discuss workplace stress. The house officers and medical officers have established peer support groups which are managed by a psychiatrist and occupational health physician. Employees with stress related and mental health conditions who are returning to work are provided support. These are some clear examples of improvements in managing stress in the workplace. However, more can be done to manage stress at the workplace in Malaysia. A national workplace stress study on all workers would identify who among our worker population are at risk of stress and what are the causal factors. The study population would need to include foreign workers, who now form a significant portion of our workforce, face the most stressful work conditions and have the least social support. It would also be interesting to assess the results of the implementation of the Department of Occupational Safety and Health Malaysia Guidelines on Managing Stress and Violence in the Workplace (2001). The findings of this study would enable us to develop intervention programmes that focus on the worker population at risk of stress and effectively address the causes. We should consider enlarging the reach of stress intervention

12 12 lead article measures currently only accessible to certain work populations. For example could the counselling services and return to work support offered at Hospital Kuala Lumpur also be offered at Ministry of Health hospitals and health clinics and be extended to all workers? Could the stress management in the workplace module developed by Ministry of Health be used by other Government organisations? How about adopting stress management measures originating or being practised overseas? Many global companies such as BASF encourages their entities throughout the world to establish an employee assistance or stress management programmes which cover education on stress management, stress hotlines and face-to-face counselling. Formal work-life balance programmes are also available and this demonstrates their commitment towards balancing the social needs of their employees and the business needs of the organisation. Elements of a work-life balance programme would include allowing flexible work hours, work from home and career breaks. Appointment of an occupational health doctor who regularly interacts with employees and management is common and their work scope would include management of stress. Since tackling organisational stressors can be difficult, some companies have decided to focus their efforts on enhancing individual coping ability through resilience training. To enhance resources and reach to employees they have also nominated and trained peer counsellors. Employers in Japan have recently been required to conduct Stress Assessments for their employees. The British Medical Association offers round the clock confidential nationwide counselling for doctors and medical students. In some countries stress-related conditions are compensable. Tackling stress at the workplace would involve multiple stakeholders. The Department of Occupational Safety and Health, Ministry of Human Resources and Ministry of Health would need to take the lead in any initiative to enhance the current provisions. Universities and the National Institute of Occupational Safety of Health Malaysia could support the research and programme development. BASF s Recommendations for managing work-related stress brochure. Occupational safety and health organisations including the Society of Occupational and Environmental Medicine of the Malaysian Medical Association and the Academy of Occupational and Environment Medicine Malaysia could provide expert input. Other stakeholders would include the Social Security Organization whose objectives include prevention of occupational injuries and disease among contributors, employer and employee organisations such as Malaysian Employers Federation and Malaysian Trade Union Council who would want to protect the interest of their members. Should we not collectively accept the challenge to improve stress management at the workplace? If we include this as one of the strategies in the Occupational Safety and Health Master Plan for Malaysia, I am optimistic that we will progress even further. After all, we already have a proven track record of improving stress management in the workplace and strong collaboration between the key stakeholders.

13

14 14 schomos MMA Tri-Event: An Overview Dr Khiritharan ith Mannie Rajah Honorary Deputy Secretary National SCHOMOS SCHOMOS and PPS, together with the contribution from SMMAMS successfully organised the Towards Excellence Series on 20 of February This series consisted of the Women Empowerment Seminar, ABC of Housemanship Seminar and GP Seminar and Scientific Meeting, which were held simultaneously across three halls at the Sheraton Imperial Hotel, Kuala Lumpur. ABC of Housemanship This seminar was organised by SCHOMOS and SMMAMS, and was inaugurated by Dato Dr Haji Azman Bin Abu Bakar (Director, Medical Development Division, Ministry of Health). The main objective of this seminar was to expose our future doctors to the working culture in our hospitals. This event was attended by more than 160 medical graduates and final year medical students. Some came all the way from Sabah and Sarawak. Senior consultants from different departments with vast experience in houseman training were present to guide our future doctors on how to cope with the stress of housemanship. Among the issues that were highlighted were the potential problems that junior doctors could face, as well as what was expected of them when they are posted in each department. The participants were also exposed to the art of effective communication and were given the opportunity for some hands-on experience with common procedures. There was a session where medical officers and housemen shared their experiences with the participants. A senior officer from the Malaysian Medical Council (MMC) was also on hand to give a talk on how to go about applying for housemanship. His topic also included points on what doctors are entitled to. Seeing that the feedback for the event was very encouraging. SCHOMOS is planning to make this seminar a yearly event. Women Empowerment Seminar SCHOMOS successfully organised a seminar for doctors and the public, to empower women to step up as leaders and promote gender equality. About 100 participants attended this seminar, from the northern states to the south. Among the distinguished speakers who were present to share their experiences were YBhg Tan Sri Rafidah Aziz (Non-Executive Independent Chairperson of AirAsia X Berhad), Prof Dr Kyung Ah Park (President of Medical Women s International Association MWIA), Dr Mary Dato Dr Haji Azman Bin Abu Bakar (Director, Medical Development Division, Ministry of Health) Suma Cardosa (Past President MMA) and Dr Gayathri K. Kumarasuriar (Clinical Psychiatrist and Hypnotherapist, Hospital Sultan Abdul Halim, S.P.). The main aim of the talks was to bring about a positive change in the lives of the participants. The participants were rather glued to their seats listening to all the talks delivered by the charming speakers. The seminar ended with a forum which gave participants a chance to have a lively discussion with the speakers. Dr Pamela Lee chaired and coordinated the event well. Conference of Minds On the same day, a conference of minds was organised by SCHOMOS. Many Past Chairman and Chairperson of SCHOMOS who had contributed many working papers in Majlis Bersama Kebangsaan (MBK) were invited. Dr Krishna Kumar (Immediate Past President MMA), Dr Harwinder Singh and Dr Rosalind met with the SCHOMOS ExCo and shared their experience in successfully presenting MBK papers. They also contributed ideas for future papers. This meeting was chaired by the current SCHOMOS Chairman, Mr Vasu Pillai. SCHOMOS would like to record our gratitude to them for their valuable time and input.

15 From left to right: Mr Vasu Pillai (SCHOMOS Chairman) presenting a token of appreciation to Dato Dr Haji Azman Bin Abu Bakar (Director, Medical Development Division, Ministry of Health) with Puventhiran Pannirselvam (SMMAMS Chairman) and Dr Arvindran Alaga (SCHOMOS Vice Chairman) looking on. among doctors, this Tri-Event managed to enlighten the participants to the happenings around doctors and the public. SCHOMOS would like to thank PPS, SMMAMS, MMA Secretariat, all the speakers, and the participants for taking their time off during the weekend to join the seminars, making it a success. A special thanks to Prof Dr Kyung Ah Park for coming all the way from South Korea. Meeting with Auditor General YBhg Tan Sri Haji Ambrin Bin Buang and the External Auditors for Kementerian Kesihatan Malaysia On another note, SCHOMOS had had a conducive meeting with the Auditor General to clarify certain issues. Auditor s name is being misused by many, in rejecting doctor s claims in hospitals and Klinik Kesihatan. The finance staff in charge should notify the doctor if there are any queries or rejection of their claims. However, these are not done most of the time. YBhg Tan Sri Rafidah Aziz (Non-Executive Independent Chairman of AirAsia X Berhad) Conclusion of The Towards Excellence Series The Towards Excellence Series feedback was promising, with further calls from participants for future events like this to be organised. Apart from fostering goodwill We are entitled to our claims as long as it is genuine and all procedures were followed, based on existing circulars and guidelines. Technical mistakes on claims need to be highlighted to the respective doctors. We hope that these issues will be ironed out as we are looking forward to further correspondence with the Auditor General. We have also requested the Auditor General to look into the variations in handling claims from centre to centre, as we feel that it should be standardised. SCHOMOS would like to thank Tan Sri Haji Ambrin Bin Buang and his team for engaging with MMA and answering all our queries.

16 16 ppsmma MMA Tri-Event: Towards Excellence Series Dr Thirunavukarasu Rajoo Honorary Secretary National PPS T he Inaugural Towards Excellence Series seminar, organised by PPS and SCHOMOS on 20 February 2016 at Sheraton Imperial, Kuala Lumpur was indeed a success. The event covered issues involving Government Doctors, to be precise, exposing medical students and equipping housemen to housemanship training, women empowerment and not forgetting pressing long-standing issues faced by General Practitioners on Managed Care Organisations (MCOs) or Third Party Administrators (TPAs) and also the Pharmacy Bill. There were Lembaga Hasil Dalam Negeri speakers, to address issues on taxation. The Organising Committee which was Co-chaired by Dr Muruga Raj and Mr Vasu Pillai, met just one time throughout the planning of the event. Most of the meetings were conducted via WhatsApp and s. Its high time many of MMA s meetings are conducted using various technologies available. This will definitely reduce the operational cost, as it is too costly to mobilise all our leaders from different parts of Malaysia to just attend a one to three-hour meeting. Not forgetting our precious time that we spend in our vocation and family cannot be measured with the compensation received. This will also allow more members outside Greater KL to participate in activities. We arranged for an Event Management Team to manage the entire seminar which went on uneventfully and many participants from the 480 odd attendees were pleased with the flow of the event without any hiccups. All the stakeholders who participated including the exhibitors were pleased with the outcome of the event. This is very important in keeping the event at or below cost. Based on the successful outcome of these few seminars organised by the event management team, it is obvious that we should leave the organising to the professionals whilst we, the medical professionals, focus on the issues surrounding the medical profession. The Society of MMA Medical Students (SMMAMS) was also included in the Committee, in order to help them gain exposure and also understand current issues faced by the medical fraternity. We believe a succession plan is very vital in the sustainability of any organisation. This should be cultivated and more junior members should be empowered and entrusted to carry out important projects. This will give them the confidence to do better as future leaders in MMA. It is very important to continuously have dialogues with MCO/TPA representatives at the same time, getting the policymakers involved so as to keep the momentum going till we achieve what we are fighting for. Dr Ahmad Razid, the Director of Medical Practice Division and also Dr Harshinder Singh who is in charge of MCOs/TPAs at the Ministry of Health (MoH), were present to give a detailed presentation on MCO and its guidelines. They acknowledged that the long term solution is the Managed Care Bill which is currently being drafted with MMA as one of the participants together with Malaysian Medical Council (MMC), Association of Private Hospitals of Malaysia (APHM), Academy of Family Physicians of Malaysia (AFPM), Federation of Private Medical Practitioners Association Malaysia (FPMPAM), Medical Practitioners Coalition Association of Malaysia (MPCAM), and Pertubuhan Doktor- Doktor Islam Malaysia (PERDIM). As the bill is being drafted, AMALAN has acknowledged and is willing to be the arbitrator to the conclusion of the series of stakeholder engagements that is ongoing between MMA and the MCOs/TPAs. The minutes of the Dr Muruga Raj, addressing the 150 odd General Practitioners Dr Ahmad Razid, taking questions from attendees on issues regarding MCO/TPA meeting will be published in the next issue of Berita MMA. The Pharmacy Bill which may change the landscape of GP practice was also addressed by Tuan Hj Ghazali from the Pharmaceutical Service Division of MoH. He was kind enough to record all our concerns with regards to the Pharmacy Bill. It was also informed that the outcome of the Rand Undang-Undang Farmasi (RUUF) Stakeholders Meeting at Port Dickson in December 2015, will be briefed to the Health Minister on 8 March We have also stated that the Medical profession should be regulated by doctors themselves via MMC as the Pharmacists are being regulated by their own. MMA is keeping close tabs on the evolution of the Pharmacy Bill. Lastly, we can only resolve issues by being united. Please bear in mind resolving long term issues is a marathon and not a sprint and requires lots of patience and endurance.

17

18 18 smmams MMA Tri-Event: ABC of Housemanship Thum Chern Choong Honorary Assistant Secretary SMMAMS The Committee of SMMAMS following a discussion with Dato Dr Azman Abu Bakar, Director, Medical Development Division of the Ministry of Health, Malaysia Housemanship is a daunting prospect, especially when you are a medical student looking at the gap which you have to make a huge leap over. Deemed stressful, tough, and depressive, many medical students experience difficulties when they make the transition into housemen. It was then a stroke of genius of the Malaysian Medical Association for they held the ABC of Housemanship seminar on 20 February 2016, to dispel myths and prepare medical students for the next stage of the journey: Housemanship. Being in the infancy of my medical career, it is a privileged opportunity for me to be able to listen to the opinions and perspectives of them who have been there and done that. A word of congratulations has to be attributed to the Organisers for its impressive line-up of speakers, whose excellent deliveries enlightened the audience who were in the dark of what was in store in the future, and the topic selection itself, which was both relevant and essential not only to house officers, but also to the medical fraternity as a whole. Tan Li Yin (left) and Thum Chern Choong at the ABC of Housemanship seminar ~~~ As healthcare professionals, it is imperative we utilise correct communication skills to deliver bad news clearly, honestly, and sensitively ~~~ As healthcare professionals, it is imperative we utilise correct communication skills to deliver bad news clearly, honestly, and sensitively in order for patients to both understand and feel supported. One such framework deemed helpful in practise to deliver bad news is the SPIKES model. It would be interesting to know how many medical schools prepare their students to deliver bad news using the model, and how effective it translates into clinical practice when said students become housemen. Specialists from various departments converged to speak about life in their respective fortes, and the qualities of housemen which they prize dearly. The theme was consistent across the board; they who are humble, hardworking, and respectful are sought after. In short: Attitude determines one s aptitude. This seminar opened my eyes to opportunities and challenges before me. While it is a tough journey with a steep learning curve ahead, I shall not be afraid, for I will not walk alone; every member of the profession is here to assist me on this journey we all travel together. Because, if you love your job, you do not have to work one more day of your life.

19

20 20 smmams Let s Discuss Housemanship Puventhiran Pannir Selvam puren_thiran@yahoo.com Chairman SMMAMS Greetings to all medical students. As you all know, a Housemanship crisis issue has recently been sparked up and has become quite a significant topic of discussion among people in and out of the medical field. Being students of this field, I am sure this issue is at the back of our minds and thinking about the fact of whether or not we will all be offered jobs in the future can be quite worrying. I am in your shoes as well but now, the question is, why are we beating ourselves up about this matter? Are we going to quit our courses due to this crisis? Or are medical schools shutting down? Or is it that those who have aspired to become doctors are being forced to switch their courses out of the medical field? The answer is NO. Everything is going to remain just as it is now. At the end of the day, what matters most is that we all stay focused on what we aim to do and together as Medicos, we will face all the humps and bumps that come along our journey. The fact is, we have no say in how the system works. The system will remain the same and all we can do is to adapt and make the best out of it. But now, there is another question. Why is there an overflow of housemen in the country in the first place? Is it because of the excessive medical graduates in Malaysia? Or is it due to the lack of training hospitals? Or is it due to the increasing extension rates of housemen that is taking up the placement of new medical graduates? In a recent statement by Datuk Dr Noor Hisham, the Malaysian Director General of Health, he said that 30% of housemen undergo extension of housemanship due to various reasons resulting in the occupancy of placement of new house officers in the Government Hospitals. Hence, the waiting period for medical graduates is increasing as there are lack of placements in the training hospitals. He also mentioned that one of the reasons for the increasing extension rate is due to incompetency of the house officers. Based on a survey which was conducted by SMMAMS, the statistics show that the average waiting period for medical graduates who graduated in the year 2015 is six to eight months. If this problem is not looked into and ~~~ 30% of housemen undergo extension of housemanship due to various reasons resulting in the occupancy of placement of new house officers in the Government Hospitals ~~~ solved soon, then the time of waiting for the upcoming batches of medical graduates might experience a steep increase. I hope the authorities from the Ministry of Health (MoH) will start investigating retrospectively on the core reason of the increase in extension rates among house officers. Being a final year medical student myself, I am aware of the challenges we go through and I know that it is not easy to complete our medical degree and finally obtain our DR title. So when we are done, of course all of us would be more interested in serving the community rather than doing odd jobs for months. There are even instances where some lose interest in the medical field after working in other fields for such a long time. People say that no matter what, one should never forget the knowledge acquired. However in reality, waiting for months without medical exposure has the power to rust and wear off half of our existing knowledge. This can be a significant factor resulting in poor performances during the Housemanship course. In our recent conversation with Dato Dr Azman, the Director of the Medical Development Division in Ministry of Health; he told us that the Ministry is really looking into this matter right now as this issue is mushrooming and becoming chronic. It is honestly really good to hear such news. We hope for change for the betterment of future doctors. Taking all these points into consideration, we, the members of SMMAMS will be meeting the authorities of MoH soon to discuss this ongoing issue on the status of Housemanship in Malaysia. We hope that MoH will take good measures to improve the existing situation.

21

22

23 56th mma agm manifestos 23

24 24 56th mma agm manifestos Candidates: President-Elect 1. Dr Ravindran R. Naidu 2. Datuk Dr Kuljit Singh Dear Colleagues, Dr Ravindran R. Naidu MMA Perak On 27 May 2016 at the MMA AGM in Miri, Sarawak, you will be asked to vote for the next President-Elect of MMA. I am seeking your support and your vote. This election for President-Elect is about choosing a leader who has proven that he can produce results on behalf of the entire profession. My dear colleagues, I have been a longstanding member of MMA and you have had the confidence to see me serve on your behalf in the Malaysian Medical Association in several Committees and several positions including Chairman of the PPS, as the Honorary Deputy Secretary, Honorary General Treasurer, and currently as the Honorary General Secretary of the MMA. In this time I have been effective in ensuring our interests are protected and enhanced over the years. We require this same strong voice and advocacy in leadership of our association. Real leadership is not about titles, positions or rising through organisational charts. Real leadership is about inspiring other leaders to support our goals. What is the relevance of The Malaysian Medical Association to me and to all of us? Many inside and outside the Association have said that the MMA is irrelevant and has done nothing and therefore many splinter groups have blossomed over the years. But in actual fact, MMA has been and is still doing what it is supposed to do for its members. The problem is there is no publicity of what MMA has done and achieved. It is this question of self-doubt and this question of relevance which I am prepared to answer over the next two years if given a chance to lead this esteemed organisation. We have to revolutionise this conservative image of the MMA with a positive cycle of change and to achieve this change we have to do it conscientiously and consistently. Some of these changes have to be immediate or short term while most will have to be gradual, long term and take time. It is through an astute application of my time and energy that I hope to achieve this. We need to reverse negative trends regarding the image of Healthcare Professionals and repair internal differences and external relationships with fellow professionals including the Ministry of Health. I am committed to promoting change in a number of key areas of development affecting our profession: 1. While focussing on how MMA can better interact, communicate and connect with other medical organisations is critical, my duties and leadership in the MMA have alerted me to the growing needs, pressures and daily challenges faced by our own professionals. 2. To work and engage with the Ministry of Health. Engagement with the Ministry of Health is an ongoing process and should not be discontinued. 3. The General Practitioners in this country are facing challenges which need to be addressed by the MMA. 4. To suggest reforms for Medical Education in Malaysia. 5. To engage with the relevant authorities on National Healthcare Transformation and restructuring. 6. Finding ways to better respond to the needs and problems of our younger doctors. 7. MMA membership must be flexible, affordable, relevant and accessible. However, whatever I do must be based on the needs of members, and I pledge to continue to engage with members in person and via our growing internet and social media presence to ascertain their fears, concerns and ideas.

25 56th mma agm manifestos 25 Candidates: President-Elect Dear Colleagues, Datuk Dr Kuljit Singh MMA Wilayah gmail.com My service in MMA close to 20 years will not be complete if I do not offer myself as President-Elect After sitting as Branch Chairman of Wilayah years ago and active participation in two branches (Kedah inclusive), I had also served the central MMA in various capacities as SCHOMOS National Chairman, Deputy General Secretary for years together and finally as Honorary General Secretary Besides leading post in the ExCo, I have also served as Editor BERITA MMA: Five years and Internal Auditor for two years. Despite of having a break from the ExCo between , I held the post of Honorary General Secretary of Malaysia Medical Association Foundation. My experience and exposure in the association is tremendous thus I am very passionate to do more. After being one of the editors of the 55 years MMA History book at a relatively middle age (mid-forties) I have understood the deeper workings of this association and I am prepared to serve both the younger and senior group of doctors to manage different level of problems and issues. My mission in MMA as President would be to enhance networking with the private stakeholders and Government ministries and agencies in order to achieve a better system of healthcare for the patients and a practical one for the treating physicians and general practitioners. The difficulties to survive as a doctor will be addressed in a consultative way as I had done successfully in the last many years in MMA. My strengths are that I would be able to engage different level of hierarchies in most establishments in order to fulfill the aim of the association. With my closeness and networking with the authorities and members, I can ensure you that most of our issues will have a good closing and this will then be the right impetus for more new members to join us in the future as we need to show a good value proposition. Believe me I am committed to do that! Please vote for me in Miri at the National AGM. Thank you.

26 26 56th mma agm manifestos Candidates: Honorary General Secretary 1. Dr Koh Kar Chai 2. Dr Thana Sehgaran Shanmugam Dear Colleagues, I believe that the Malaysian Medical Association is still relevant in this day and age. I believe that the members of this august body have the faith that the Malaysian Medical Association will uphold the dignity of the medical profession. I believe that the Malaysian Medical Association will strive to ensure that the ethical practice of medicine in this country is allowed without hindrance to ensure quality and safe healthcare delivery to our patients. Dr Koh Kar Chai MMA Wilayah drcaseysurf@gmail.com For all these to happen, the Malaysian Medical Association will need office bearers of good standing who are able to understand the processes within and without the association to ensure that its objectives are met. The position of the Honorary General Secretary is of utmost importance as it supports the President in ensuring the smooth management of the association. It takes on the secretarial and administrative duties of this august body. I believe that I am the person who is able to take on the role of the Honorary General Secretary as I understand its responsibilities well and because I am able to tap on to my past experience of holding various offices within MMA, both at branch level as well as central level in the Executive Committee and Council. Notwithstanding is the knowledge acquired from holding positions in the various MMA committees, bodies in the Ministry of Health as well as external organisations. Humbly counting on the support of each and every one of you. Positions held in the Malaysian Medical Association Wilayah Branch: Committee Member, MMA Wilayah Treasurer, MMA Wilayah Chairman, MMA Wilayah CPD Chairman, MMA Wilayah MMA Central: Member, Committee on International Relations Chairman, AIDS/STIs Committee Member, Accident Prevention Committee Member, BERITA Editorial Board Member, CPR Committee, Honorary Secretary, Private Practitioners Section Chairman, Private Practitioners Section, Member, Health & Human Rights Committee Member, Fees Schedule Committee Chairman, SOCSO Committee Member, National Health Policy Committee Honorary Deputy Secretary Vice Chairman, Private Practitioners Section Member, House Management Committee Member, Staff Welfare Committee Assistant Secretary, Private Practitioners Section Chairman, TPA Subcommittee, Private Practitioners Section Other positions held Council Member, Malaysian AIDS Council Appointed Member, Drug Control Authority, National Pharmaceutical Control Bureau, Ministry of Health, Malaysia Appointed Alternate Member, Drug Control Authority, National Pharmaceutical Control Bureau, Ministry of Health, Malaysia Appointed Alternate Board Member (Vice President), Malaysian Society for Quality in Health (MSQH) Appointed representative, Jawatankuasa Jagaan Yang DiUrus, Kementerian Kesihatan Malaysia SIRIM Appointed Representative, Industry Standard committee on Medical Devices (ISCR) Appointed Representative,Technical Committee on Plastic Products Appointed Representative, Technical Committee on Quality Management & Corresponding General Aspects for Medical Devices (TC1) Appointed Representative, Technical Committee on Disposable Single Use Devices (TC2) PhAMA Ethics Appeal Committee Appointed Representative, Council of the Confederation of Scientific and Technological Associations in Malaysia (COSTAM) Appointed Member, Malaysian Adverse Drug Reactions Advisory Committee(MADRAC), MOH, Appointed Member, Traditional & Complementary Medicine Committee, MoH, Appointed Alternate Member, Jawatankuasa Teknikal Komponen Quality Use of Drugs (JKPDUNAS) Appointed Member, Jawatankuasa Teknikal Komponen Quality Use of Medicines Elected ExCo Member of Council, Federation of Scientific and Technological Associations in Malaysia (COSTAM)

27 56th mma agm manifestos 27 Candidates: Honorary General Secretary Dear Colleagues, Dr Thana Sehgaran Shanmugam MMA Wilayah I had obtained a Medical Degree in 1991 and a SEAMEO- TROPMED- CTZ scholarship in 1996 to pursue a postgraduate degree in MSc Public Health (Epidemiology) at College of Public Health College, Manila, Philippines University. I was gazetted as a Public Health Specialist 13 years ago in July I had been recognised for my Public Health Work in the field of epidemiology and disease control during an outbreak of JE, Nipah, SARS and Avian Flu in Perak State. At Jengka Hospital, Pahang and Teluk Intan Hospital, Perak. I was instrumental for the implementation of MQSH, Accreditation and ISO 19001: 2004 certification. My clinical skill, knowledge and practises in primary and secondary healthcare had helped in rural healthcare delivery in Sarawak. I was assigned duties in almost all the hospitals in Sarawak. Currently, I am posted in the Institute for Medical Research and is the driving force for publication, bulletin authorship and an award-winning postal presentation. I have been actively involved in the Malaysian Medical Association for the last ten years in MMA Wilayah as a Committee Member, SCHOMOS, Honorary Secretary, Vice Chairman and next Chairman of MMA Wilayah. I am currently the Council Member, MMA Public Health Society Chairman and Honorary Secretary for MMA VoC at MMA National. I am also a Council Member of Selangor Indian Sports Council and Malaysian Indian Football Association outside MMA s circle. I have served the Ministry of Health for last 24 years with an excellent record in five states including East Malaysia & East Coastal States. I had proved myself in various capabilities as State Epidemiologist, Hospital Director, Administer, Public Health Physician and Researcher. I am now ready to serve the position of Honorary General Secretary in Malaysian Medical Association to translate my vast working experience into implantations and best practises in Malaysian Medical Association with a vision to deliver the best healthcare system and ensure Malaysian Medical Association is a recognisable entity within Ministry of Health and Internationally.

28 28 56th mma agm manifestos Candidates: Honorary Deputy Secretary 1. Dr Ravi Venkatachalam 2. Dr Thomas Kamarudin Kana 3. Dr Saraswathi Bina Rai SK Nagalingam 4. Dr Edwin Leo Suppiah 5. Dr Datesh a/l Daneshwar Dear Colleagues, Many Happy Greetings. I offer myself for the post of Honorary Deputy Secretary at the 56th AGM in Miri, Sarawak. I had graduated from Stanley Medical College, Chennai in I started off my Housemanship at the end of 1990 in HSA, JB and continued my MO posting in Kuching, Sarawak and subsequently joined the armed forces for a short service commission for two years and then back into Government Hospital posting in Seremban before leaving to private practice. Since 1996, I have been and am still in private practice in A&E settings till now. Dr Ravi Venkatachalam MMA Wilayah ravimahes@gmail.com I have been a Life Member in MMA for the last 20 years and had actively started in MMA Wilayah as a Committee Member from 2011 and since then held the post of Wilayah PPS Chairman and currently during our AGM last weekend 20 March 2016 got elected as Treasurer of the branch and will assume position coming June I am also serving under the subcommittees of Constitution and Review Committee and Action on Smoking and Health Committee. During my tenure in MMA Wilayah, We have jointly conducted various medical camps, sports activities and last year we had our Primary Care Symposium in October 2015 and our PPS subcommittee of six members actively took part in organising it and it turned out to be a great success. Currently, our nation is being faced by three major problems namely, Communicable Diseases, top of the list is Dengue, Secondly, NCD which is a cluster of diseases like T2DM, Dyslipidemia, HPT, Obesity and etc. Thirdly, the imbalance between production of Doctors and placement in Government Hospitals. Anyways these problems are already known and I give full support to the ExCo in whatever means to solve these issues. The other main issue is the decreasing membership in the organisation from time to time. I am already working on some proposals from other areas to benefit our members and also to enhance member benefit programmes if they were to join MMA. I am looking at wellness practice programmes for GP s to increase their livelihood and also property investment models that will benefit the members in the long run. Given an opportunity to be elected as one of the Honorary Deputy Secretaries, I pledge my full support and cooperation to be a good team player and work as a team with the new ExCo that will be elected in coming AGM in Miri. See you all at Miri AGM Warm Regards and Thanks.

29 56th mma agm manifestos 29 Candidates: Honorary Deputy Secretary Dear Colleagues, As Chairman of the Organising Committee of the 56th National MMA AGM, I would like to welcome you to our beautiful oil city, Miri. I was born in Sibu, Sarawak in I got my Medical Doctor degree from UKM in After graduation, I did my Housemanship in Ipoh 1994/95. After serving MoH until 2001, I joined the Faculty of Medicine and Health Sciences, Universiti Malaysia Sarawak as a Lecturer in the Department of Family Medicine. My current post is Deputy Dean (Undergraduate and Student Development). Dr Thomas Kamarudin Kana MMA Sarawak drhjkamarudin@gmail.com I joined the MMA as a Life Member in 2002 when I was doing my postgraduate in Family Medicine in HUSM, Kubang Kerian, Kelantan. I was also then elected as a Committee Member for MMA Kelantan. Back to Sarawak in 2004, I became a Committee Member of MMA Sarawak. Serving MMA Sarawak for ten years from Committee Member, Treasurer, Secretary, Vice Chairman, to Chairman. Since 2012/13, I was serving in MMA Council as a Representative from MMA Sarawak. I was also active in the Academy Of Family Physician Malaysia as the Sarawak Section Head since 2010 and a Council Member. We managed to successfully conduct WONCA Asia Pacific Region 2014 in Kuching, Sarawak with 1,000 delegates. I have served as an appointed Malaysian Medical Council member from 2012 until 2014, gaining experience about medical ethics, Medical Acts and Regulations, accreditation of medical programmes, registration of doctors and issues related to the medical profession. From 2014 until now, I served as a member of the Accreditation Committee of Malaysian Medical Council. The President of MMA with his vision, needs a strong and effective team to ensure that MMA will regain respect and its credible reputation among members and other agencies. I believe that I am able to give full support to the President, ExCo and Council members, to ensure that the running of MMA must be following the constitution. With my vast experience, I can help to ensure that MMA s record keeping would be well organised and updated. Member recruitment among young doctors and Life Membership for senior members will be my priority. Lapsed Members should be reduced to zero by giving incentive, regular reminders and facilitation in the renewal process. With pending issues faced by MMA such as Dispensing Separation, MCO/ TPA, TPPA, new Medical Act and internal administrative issues, MMA needs a united, strong and capable ExCo to represent all doctors in Malaysia. With your support and assistance, I now seek to be elected to the post of Honorary Deputy Secretary in the upcoming election.

30 30 56th mma agm manifestos Candidates: Honorary Deputy Secretary Dear Colleagues, I joined MMA in 1984 and have been an active member of the Penang Branch from 1995 to date.over the years I have held various posts at the State Branch including Chairperson and have served in the Council for many terms. I have also served in various Committees of the MMA. Dr Saraswathi Bina Rai SK Nagalingam MMA Penang binarai@yahoo.com I am a Public Health person - trained and bred as such. As much as it is tempting to extol and display here my background and my achievements on papers presented, publications and all the numerous and varied organisations I am involved in and have contributed to; all that is not of relevance nor is it going to make a difference here. Suffice to know that I am a Government employee for the past 30 odd years. Integrity is of the utmost importance to me, in addition to punctuality. I speak my mind and will always do the right thing. In applying for the post of the Honorary Deputy Secretary here, I do not expect to move mountains but rest assured I will do whatever it takes to get a job done as long as it is morally and legally right. I am at a stage in life where recognition and pats on the back for a job well done does not make a difference to me. Personal satisfaction means more and there is nothing I would like more than to see this Organisation that I am a part of move to great heights, with all the members having the same vision. Our doctors face so many challenges and problems from outside, so we need to be strong from within; we need a team that can gel and work together without the drama. I stand out on two aspects: the sole female candidate and the candidate with the longest name...ever! But let this not be the reason for you to elect me. I wish to be elected on merit and on your confidence that I am a capable candidate and will be an asset to the ExCo. I have the greatest respect for both Dr John Chew and Dr Ashok Philip they are the reason I have applied for this post. I very much look forward to working with them as one of the Honorary Deputy Secretaries this year. However I can only do that if I have your mandate and your vote.

31 56th mma agm manifestos 31 Candidates: Honorary Deputy Secretary Dear Colleagues, My name is Dr Edwin Leo Suppiah. I have been an active Member of the MMA Selangor Branch since I am one of the five candidates contesting for the post of the MMA Honorary Deputy Secretary. Dr Edwin Leo Suppiah MMA Selangor edwinleodr@gmail.com I obtained my MBBS from Madras University, and did my MBA in Hospital Management in UKM and my Postgraduate Diploma in Occupational Medicine also from UKM. I served in the Malaysian Armed Forces for two years and subsequently in a private Hospital for 18 years. Since 2004 I have been practicing as a solo General Practitioner in Selangor. I have served as the MMA Selangor Branch Vice Chairman for two years and then as the Chairman for another two terms in the 90s and again in 2012 and I also served as the Branch Treasurer and the Secretary and PPSMMA Branch Chairman during different years. As Selangor is eligible for two Council seats for the Chairman and Vice Chairman subsequently as a result I have served in the Council for a total of eight years. I have also served in the House Management Committee. Selangor State has the largest number of members and the Branch has been very active over the years. After my experience in the Selangor Branch from 1990, holding all the different posts over the years and serving in the Council for a total of eight years, I would now like to offer my humble services as one of the Honorary Deputy Secretaries in the Council. I have been a General Practitioner for 12 years and I fully understand most of the problems facing General Practitioners specifically and doctors in general. I will bring up such issues to the ExCo and Council for their necessary action. I practice and live in Selangor, so it will be very convenient for me to attend meetings when necessary. I am not promising any dramatic changes, but I will follow the constitution, which states that the Honorary Deputy Secretary will assist the Honorary General Secretary and deputise for him and shall be responsiblefor any other duties delegated to me by the Council, ExCo or the Honorary General Secretary. I will carry out all duties delegated to me to the best of my capability, using the experience gained over the years in the Branch and the Council. My fellow colleagues and friends, I am sure you will in your wisdom make the right choice. I wish all the other candidates also good luck. Positive Thinking is not only about Expecting the Best to happen but it is also Accepting whatever happens is for the Best Thank You.

32 32 56th mma agm manifestos Candidates: Honorary Deputy Secretary Dear Colleagues, This association has been very close to my heart ever since I started my medical career. I truly believe in its relevance and believe strongly that it remains the most important body independently representing doctors in Malaysia. It has had its fair share of trials and tribulations over the past few years but I am sure, with the proper team of administrators, we will be able to restore the glory of the MMA. Dr Datesh a/l Daneshwar MMA Wilayah drddk@yahoo.com My believe is that this association is for its members. It s not primarily a charitable association, a humanitarian association, a regulatory body per se. It s an association that solely should look after the welfare of its members who are of course all doctors. A doctor s welfare extends beyond his own gratification at a personal level. Being a noble profession, I know doctors who find satisfaction in serving the community, doing humanitarian work, coming up with better regulations to make our profession ever so noble and this is what MMA will facilitate. To make their ambitions come true by providing them the platform to speak, the muscle of funding, the voice of thousands so that we may make the deaf hear once again. That is my motive, of aspiring, to have the opportunity to steer MMA towards that goal in my capacity in the ExCo. I have previously served at the state level in Kedah for many years and recently was the National SCHOMOS Chairman As you all may remember it was that year that my Committee brought you the deals from car companies, AirAsia etc. We were determined to increase our membership strength and thus some perks were required to bring in new members and to benefit the existing ones. You must understand that with numbers we have strength. With that we will ALWAYS remain relevant. I hope that one day, soon enough, every doctor in Malaysia will be a member of the MMA. I look forward to your support if you too aspire to see MMA the way I envision it. I am happy you serve.

33 Royal College of Surgeons in Ireland Intercollegiate Basic Surgical Skills Course - Penang 2016 Month Date Venue June 15 th 17 th Penang Medical College September 7 th 9 th Penang Medical College December 7 th 9 th Penang Medical College Intercollegiate Basic Surgical Skills Course THREE DAY TECHNICAL TEACHING COURSE Aimed at: Surgical trainees who are starting Basic Training in their first year. Course Objectives: To train participants in basic techniques for all types of surgery Course Content: Closing Date: The emphasis of the course is on:- One month (exactly) before course date commencement. o basic knot tying techniques o suturing techniques o percutaneous biopsies o gastrointestinal/vascular anastomosis Fee: o repair of nerve and tendons EURO for Malaysians Nationals (Government Service) o introduction to safe laparoscopy EURO for all others o endoscopic procedures Bank Draft to: The Royal College of Surgeons in Ireland How to apply: Please note that there are only sixteen places available on each course. These are awarded on a first come, first served basis on receipt of completed application and fee. Please keep this Surgical Training Office advised of any changes to your contact details. To enrol, please return completed application form ( available at and fee to:- Prof. N. Premnath Director of Surgical Training Royal College of Surgeons in Ireland Penang Medical College 4, Jalan Sepoy Lines 10450, Penang Malaysia prem@pmc.edu.my

34 34 general CAP-italizing Prevention Did you know that respiratory diseases are listed as the number 2 cause of hospitalisation and death in Malaysia? Recent data shows that respiratory diseases are recorded at a 12.41% hospitalization rate and 21.70% death rate respectively. 1 Respiratory diseases are a serious health problem among Malaysians as we are often exposed to all types of viruses and bacteria in our warm tropical weather. This is definitely a concern as one of the most pressing diseases in the respiratory category is Community Acquired Pneumonia (CAP). Prof Dato Dr Hj Abdul Razak Muttalif drarm@hotmail.com Senior Consultant Chest Physician Institute of Respiratory Medicine Hospital Kuala Lumpur Life Member MMA Wilayah ~~~ Pneumonia is an inflammatory condition which primarily affects the oxygen-absorbing areas of the lung, or more simply: it s a lung infection ~~~ But first let us start with Pneumonia what is Pneumonia? Pneumonia is an inflammatory condition which primarily affects the oxygenabsorbing areas of the lung, or more simply: it s a lung infection. It is usually caused by a viral or bacterial infection, or less commonly known microorganisms 2. Pneumonia can cause respiratory failure by triggering a combination of infection and inflammatory response the lungs quickly gets filled with fluid and become stiff. This stiffness, combined with severe difficulties in extracting oxygen may require long periods of mechanical ventilation for survival. Streptococcus pneumoniae is the most common bacterial cause of communityacquired pneumonia also known as Pneumococcal CAP. Pneumococcal CAP is one of the leading causes of death and hospitalization worldwide. 3 Pneumococcal CAP can be classified as non-invasive, when bacteria cause infection in the lungs but are not detected in the blood concurrently, or invasive, when bacteria also enter the bloodstream (bacteraemia pneumonia) or another normally sterile site in the body. While non-invasive forms of CAP are typically more common, the invasive types of disease are generally more severe. Community Acquired Pneumonia (CAP) is different than hospital-acquired pneumonia where the disease is contracted by patients who live in a healthcare system in a long-term capacity or have recently visited a hospital. A literal understanding of CAP would be that you acquire pneumonia through your everyday life in the community mixing with people, being in crowded situations and socializing sounds pretty much like an average Malaysian s life! Asia currently is and is projected to continue being, home to a dominant share of the world s population. According to a United Nations report, the proportion of elderly citizens (aged 60 and above) in the region is expected to increase from 9.9% in 2010 to 23.6% in In many developing countries, the number of adults aged 65 years and below is expected to grow by more than 250%, with some of the countries including Philippines, Malaysia, India and Bangladesh. 5 These statistics provide an overview of the alarming rates of the disease in adults and are an indication for the urgent need to address the prevalence of pneumonia in adults.

35 ~~~ Community-acquired pneumonia is a vaccine-preventable disease and vaccines have come a long way from its conceptualization from two centuries ago ~~~ There are many factors that cause a person to be easily affected with pneumonia but it is especially dangerous when they have a weak immune system. Pre-existing health complications such as Chronic Obstructive Pulmonary Disease (a lung disease that makes it hard to breathe), asthma, renal or liver disease, cancer and diabetes can make them more prone to developing pneumonia. 6 Additional external factors such as smoking, increased alcohol intake and living conditions such as long-term care residency also have a hand in reducing the functionality of their immune systems, making them more susceptible to the risk of infection and more prone to complications and mortality. CAP and 75% fewer cases of vaccine type Invasive Pneumococcal Disease (IPD). This shows that vaccination for CAP will indeed reduce the burden of the disease significantly among adults. It is important that we need to be aware of the serious consequences of CAP that can be easily contracted when you pick up your grandchildren from kindergarten, go to a crowded fair or market or even when you travel to tourist destinations. As CAPiTA demonstrates, immunization should definitely be a priority as it is the most effective way to be protected against CAP as well as other life-threatening infectious diseases. The benefits of vaccination outweigh the costs associated with its development and administration. It also is a good economic option as it potentially prevents death and hospitalization as well as reduces the cost of treatment, care and rehabilitation, which is why immunization is important in preventing CAP as well as various other life-threatening diseases. *This article has been published with the kind permission of Pfizer Malaysia. The elderly account for the majority of communityacquired pneumonia infections owing to their lower immune capabilities which naturally weaken with age. This includes even healthy, active older adults! 7,8,9,10,11 For example, Hajj and Umrah are ideal conditions for community-acquired pneumonia. Research has shown that pneumonia is the largest cause of hospitalisation of Hajj pilgrims during the Hajj season with more than 19.7% percent hospitalization rate. 11 The Hajj attracts millions of people from different parts of the world who congregate in a limited area for an amount of time, leading to the widespread of infectious diseases and epidemics. As pneumonia spreads from person to person through respiratory droplets from sneezing or coughing, Hajj provides the ideal environment for the spreading of the disease. Good news however is that community-acquired pneumonia is a vaccine-preventable disease and vaccines have come a long way from its conceptualization from two centuries ago. A recent study called CAPiTA (Community-Acquired Pneumonia Immunization Trial in Adults) investigated the efficacy of vaccination for immunity in a form of group, or herd immunity, among adults aged 65 years and older. This was the first trial on pneumococcal conjugated vaccine in adults which highlights the efficiency of conjugated pneumococcal vaccine in adults. The CAPiTA findings reinforce the crucial role that immunization plays an important role in reducing the incidence and burden of vaccine-type pneumococcal CAP and IPD among the elderly. As reported in the study, there were 45.6% percent fewer first episodes of vaccine-type CAP among vaccinated subjects than in subjects who received placebo. It was also found that the vaccinated group experienced 45% fewer first episodes of non-bacteremic and non-invasive 1. Adapted from 2014 Health Facts by Ministry of Health Malaysia. Available at Accessed on 9 November McLuckie, A., ed. (2009). Respiratory disease and its management. New York: Springer. p Cunha, BA. Medscape. Community-acquired pneumonia. Updated September 13, Available at article/ overview. Accessed April United Nations. World population prospects: the 2008 revision. Highlights. United Nations; Selected tables. unpd/wpp2008/pdf/wpp2008 Selected Tables 1.pdf. 5. Kinsella K, He W. US Census Bureau, International Population Reports, P95/09-1, An Aging World 2008, US Government Printing Office: Washington DC; Adapted from Pneumonia: Causes, Symptoms and Treatments. Available at: Accessed on 16 December Weinberger B, Herndler-Brandstetter D, Schwanninger A, et al. Biology of immune responses to vaccines in elderly persons. Clin Infect Dis. 2008;46: Peto L, Nadjm B, Horby P, et al. The bacterial aetiology of adult community-acquired pneumonia in Asia: a systematic review. Trans R Soc Trop Med Hyg. 2014;108(6): Rozenbaum MH, Pechlivanoglou P, van der Werf TS, et al. The role of Streptococcus pneumoniae in community-acquired pneumonia among adults in Europe: a meta-analysis. Eur J Clin Microbiol Infect Dis. 2013;32(3): Said MA, Johnson HL, Nonyane BA, Deloria-Knoll M, O Brien KL. Estimating the burden of pneumococcal pneumonia among adults: a systematic review and meta-analysis of diagnostic techniques. PLoS One. 2013;8(4):e doi: /journal.pone Adapted from Vaccination during Hajj, Umrah, Pfizer launches awareness campaign on Pneumonia. Available at: business-a-economy/189/ /. Accessed on 3 October 2012.

36 36 general Women Empowerment Seminar Dr Juliet Mathew Editorial Board Member ~~~ As the world is becoming more and more gender neutral, women should widen their thinking perspective instead of further isolating themselves ~~~ The Empowering Ladies (Left to right) Dr Delini Devi Ramadras, Dr Gayathri K. Kumarasuriar, Dr Kyung Ah Park, Dr Mary Cordosa and Dr Lee Yew Fong The Women Empowerment Seminar organised for the first time by MMA, was held at the Sheraton Imperial Hotel, Kuala Lumpur on 20 February The seminar served the participants through three eloquent and inspiring women speakers in the morning; they employed various thought provoking methods and informative ways to proliferate the message of gender equality across the hall. Prof Dr Kyung Ah Park, Professor of Anatomy at Yonsei University College of Medicine in Seoul, Korea and President of the Medical Women s International Association (MWIA) was the first speaker for the day. She started the morning on a powerful note Women Empowerment Is Not Men Hating! She presented her topic on Work-Balance Life and described ways of managing time while still preserving the sanity of self. Her stress management methods were grouped under the five balls of managing life The Work Ball, The Home and Family Ball, The Relationship Ball, The Friends Ball and The Self Care Ball. These addressed the many roles women play in the society. She also particularly stressed the importance of not succumbing to the Superwoman Syndrome. Dr Mary Cordosa, Consultant Anaesthesiologist and Pain Specialist, also the first female President of MMA, continued the morning with her talk titled, Celebrating the Achievements and Looking to the Future. She raised a very important question, one that should evoke enough awareness to strive for improvement in all individuals Are we the ones stopping ourselves?. She further elaborated on the positive changes that have taken place so far in history in the fight towards gender equality. She provided much data on this and cited

37 explains, to acknowledge that men have their issues as well, hence, we need to be fair to them too as we crusade for our rights. Stereotyped roles exist for both genders, she concludes strongly. The highlight of the day s event for me was the dynamic presentation that afternoon by the Guest of Honour, Tan Sri Rafidah Aziz, former Minister of International Trade and Industry. Her show of confidence and professionalism itself spelt empowerment in bold letters, as she tackled on the subject of Leadership Male Champions for Change. She delivered her message loud and clear as she stressed to the audience Forget about women empowerment, talk about self-empowerment! Women, she exclaimed with a chuckle, were empowered way before men were born. The globalising world, she added, has generally given us easy access to gaining knowledge, and has delivered higher competencies within various industries, especially, the healthcare industry. However, it has also evoked many types of new challenges. YBhg Tan Sri Rafidah Aziz with MMA President, Dr Ashok Philip and the Organising Committee the various organisations involved in being responsible for the major milestones that have been achieved in the workforce thus far, through various platforms such as the Convention on the Elimination of all Forms of Discrimination against Women (CEDAW), Platforms for Action and the Millennium Development Goals (MDG). Dr Gayathri K. Kumarasuriar, Psychiatrist and Clinical Hypnotherapist, ended the morning session with her presentation titled, Gender Equality for Women Benefits Men Too. She mesmerised the crowd with her many amusing anecdotes, and her simple storytelling manner through which she managed to arrest the floor s attention to a standstill point. The participants were initially breaking into giggles that soon became a crescendo of laughter a much-needed delight in the midst of all the seriousness that morning with regards to the subject at hand. She highlighted the fact that mutual respect is simply necessary. There is a need, she Hence, gender discrimination or marginalisation of any groups for that matter, according to her, would only worsen the process of growth and success. She further advised that, as the world is becoming more and more gender neutral, women should widen their thinking perspective instead of further isolating themselves under any feminine, gender equal or meritocracy groups. The real issue is not the gender, she admonished. There must be a will to change and grow. Everyone must strive to be champions to be better! Look beyond your little circle and make sure no rules constraint you from moving forward! I attended this seminar with an open mind, and at one point, doubted my scepticism in questioning the real necessity for women to form any more groups to tackle the empowerment issue do we not have enough groups already? My thoughts were rightfully justified by the end of the day. The take-home message for me was this empowerment from within is, as I have always believed it to be, the core need to rule one s life. An inspiring day, indeed.

38 38 general Health and Healthcare Disparities Dr Xavier Vincent Pereira 1 Consultant Psychiatrist Taylor s University School of Medicine Live Member MMA and Dr Sharuna Verghis 2 ~~~ Malaysia is frequently cited as an example of having the lowest burden of out-ofpocket payments for healthcare in Asia ~~~ 1 Associate Professor (Psychiatry), Taylor s University School of Medicine, and Chair of the Health and Human Rights Committee, Malaysian Medical Association 2 Co-founder and Director of Health Equity Initiatives, Kuala Lumpur, and member of the organizing committee of the National Symposium on the Right to Health. The Health and Human Rights Committee of the Malaysian Medical Association will organise a National Symposium on the Right to Health on 23 April 2016 in Kuala Lumpur. The symposium will provide an opportunity to examine and deliberate on the Malaysian experience of entitlements and freedoms and equality and nondiscrimination that afford the possibilities to enjoy the highest attainable standard of health within a right to health approach. It will also broaden the understanding of whether the current strategy and praxis of Universal Health Coverage (UHC) warrants a conceptual expansion from a right to health perspective to achieve its avowed goals. Malaysia s healthcare system has received international recognition with primary healthcare services being at the helm of health services in the country. The development of health infrastructure; increase in the quantity, quality, and geographical distribution of skilled human resources; strengthening of referral mechanisms; and expanded access to multi-disciplinary and integrated care at the primary healthcare level has contributed to progress in health outcomes such as reduction in maternal mortality and morbidity rates and under-five mortality (1). Additionally, life expectancy at birth is about 75 years (2). These health outcomes are significant indicators of development, and the state of health and human rights in any country. Nevertheless, Malaysia faces substantial challenges in preserving these health gains as it experiences several transitions. Demographic and epidemiological transitions have contributed to an ageing population and a dual burden of disease. The major causes of death are shifting from communicable to non-communicable diseases while many communicable diseases are witnessing an emergence and reemergence (3). At the same time, the health system has been gradually transitioning into a dichotomous two-tiered system of public and private healthcare, with the private sector catering largely to urban areas and affluent patients and providing primary and secondary care, while the public sector s primary care services are largely utilised by poor and rural populations (3). On the economic front, although income inequality has been decreasing in absolute terms (4), it is still higher relative to many developed countries(5). Simultaneously, there has been an increase in the income gap between the richest and poorest states in the country (6) and within some ethnic groups (7). The emerging paradox is amplified in the health and healthcare experiences of the socially vulnerable. Three of several possible examples are cited here. For example, compared to the national average, the Orang Asli experience higher crude death rates, higher burden of maternal and infant morbidity and mortality and of infectious and non-communicable diseases, relatively lower immunisation coverage, relatively lower percentages of safe deliveries, and high rates of poverty (8, 9).

39 According to the Ministry of Health (MoH), Malaysia, the Malaysian population is reported to be protected against catastrophic health expenditures through policies of universal coverage (10). Malaysia is frequently cited as an example of having the lowest burden of out-of-pocket payments for healthcare in Asia (11) and of catastrophic medical expenditure risk (12). This corresponds to the underlying principle of the Malaysian healthcare system that accessibility to healthcare should not be determined by the ability to pay (13). Despite this, the World Health Survey Report Malaysia 2003 (as cited in the 10th Malaysia Plan) (10), reports that the lowest two deciles (poorest) incurred higher out of pocket payments than the other eight deciles in terms of proportion to income and about 4.0% of households were exposed to catastrophic spending. This means that those who are already economically and socially vulnerable could suffer devastating impoverishment as a result of utilising healthcare. Alongside these developments, accessing public healthcare has become increasingly challenging for non-citizens like migrant workers. Although evidence shows that migrant workers are integral to the productivity of the country (14), contribute substantially in taxes, and are required to contribute toward mandatory health insurance, they encounter numerous policy barriers in accessing healthcare. They pay high and un-subsidised user fees in public hospitals and are deported when they test positive for treatable infectious diseases. Their ineligibility for more than five days of prescription medicine in public hospitals limits access to care for chronic illnesses. Immigration counters in some hospitals have been known to arrest undocumented migrants, including women who have just delivered. Established principles of healthcare financing are then challenged and concepts of UHC are interrogated. How universal is universal health coverage? Does UHC only include citizens? How does the current practice of UHC link to its historical origins of social protection which included migrant workers who contributed to the economies and societies they resided in? The anomaly is in the paradox of the location of health and healthcare disparities among the more socially vulnerable. It underscores the lesson that the elimination of discrimination and neglect which is core to a right to health approach and the removal of financial barriers that impede access to healthcare under UHC are not substitute options. They are complementary and concomitant. As Malaysia s healthcare system struggles with increasing costs related to an ageing population and dual burden of disease, low levels of Government spending on healthcare relative to other countries, and paucities and incoherencies in the distribution of healthcare workers, right to health norms of equality, nondiscrimination, participation, and transparency could support the realisation of imperatives of solidarity, equitable risk pooling, and equitable access related to UHC. References 1. Ekman B, Pathmanathan I, Liljestrand J. Integrating health interventions for women, newborn babies, and children: a framework for action. The Lancet. 2008;372(9642): Department of Statistics Malaysia. Press release. Abridged life tables Malaysia, : Government of Malaysia; 2015 [2016 March 9]. Available from: pdfprev&id=cwxzrwcvmtzrwfp4ustqqmp3mg9qzz Jaafar S, Noh KM, Muttalib KA, Othman NH, Healy J, editors. Malaysia health system review. Manila: World Health Organization; Economic Planning Unit. Household income and poverty. Jadual 6: Pekali Gini mengikut kumpulan etnik, strata dan negeri, Malaysia, : EPU, Prime Minister s Department, Government of Malaysia; [2016 Feb 17]. Available from: 5. World Bank. Malaysia. Overview [2016 Feb 17]. Available from: Mahavera S. Income gap between rich and poor states went up in 2 years, says think tank: Malaysian Insider; 2015 June 24 [2016 Feb 17]. Available from: 7. Lee HA. Is Msia s spectacular drop in income inequality for real? : Free Malaysia Today; 2015 Oct 16 [2016 Feb 17]. Available from: Nicholas C. Orang Asli: rights, problems, solutions. Kuala Lumpur: National Human Rights Comission of Malaysia (SUHAKAM), UNDP. Study and review of the socio-economic status of aboriginal peoples (Orang Asli) in Peninsular Malaysia for the formulation of a National Development Plan for the Orang Asli: UNDP Malaysia; [2016 March 9]. Available from: home/operations/projects/poverty_reduction/75636_orangasli.html. 10. Ministry of Health Malaysia. Country health plan. 10th Malaysia Plan care for 1 Malaysia. Putra Jaya: MoH. 11. van Doorslaer E, O Donnell O, Rannan-Eliya RP, Somanathan A, Adhikari SR, Garg CC, et al. Effect of payments for health care on poverty estimates in 11 countries in Asia: an analysis of household survey data. The Lancet. 2006;368(9544): Flores G, O Donnell O. Catastrophic medical expenditure risk. Tinbergen Institute Discussion Paper / July 13 [cited 2016 Feb 25]. Available from: or org/ /ssrn Yu CP, Whynes DK, Sach TH. Equity in health care financing: The case of Malaysia. International Journal for Equity in Health. 2008;7(15):doi: / World Bank. Immigration in Malaysia: Assessment of its economic effects, and a review of the policy and system report completed in collaboration with ILMIA Ministry of Human Resources of Malaysia. Human Development, Social Protection and Labor Unit, East Asia and Pacific Region, World Bank, The Health and Human Rights Committee of the Malaysian Medical Association will be organising a symposium on The Right to Health on 23 April 2016 at Sunway Putra. The Minister of Health will be the Guest of Honour at the symposium.

40 40 general T&CM in Today s Healthcare Dr Gayathri K. Kumarasuriar gsuriar@yahoo.com.sg T&CM and Editorial Board Committee Member Life Member MMA, Kedah The World Health Organization (WHO) defines traditional medicine as the sum total of the knowledge, skills, and practices based on the theories, beliefs, and experiences indigenous to different cultures, whether explicable or not, used in the maintenance of health as well as in the prevention, diagnosis, improvement or treatment of physical and mental illness. Complementary medicine or alternative medicine are used interchangeably with traditional medicine in some countries. They refer to a broad set of healthcare practices that are not part of that country s own tradition and are not integrated into the dominant healthcare system. The very phrase Traditional and Complementary Medicine (T&CM) raises many an eyebrow amongst us, the allopathic practitioners for it conjures images of shamans and street vendors promoting medical advice and products of questionable quality. The practice of traditional medicine in our country is not just a skill that is handed from generation to generation. It is very much a way of life and is part of our culture. The strong faith the public have in our traditional healers is often more than they have for modern practitioners of medicine like us. Many a times it is upon the advice of the traditional and complementary practitioners that patients eventually come to us for consultation. The complexities of new diseases and their lack of response to the western medications and side-effects suffered by patients when on these medications are causing more and more people to turn towards T&CM. Sadly, taking advantage of these factors, there are many quacks and bogus healers who rampantly advertise their services and products to hoodwink the vulnerable public in the name of traditional and complementary medicine. It appears that all one needs to do is put up a poster, with no official approval, hang it by a tree or paste it on the pillars of a teh tarik stall. We have all seen colourful arrays of posters advertising various interesting and sometimes mystical promises of mind-boggling cures. The Ministry of Health (MoH) established the T&CM division in 2004 with the aim of integrating traditional and complementary medicine into the modern medical system. This was done to regulate, achieve a balance and monitor the safety in the integrated usage of both Western and T&CM medicine. Under the T&CM banner we have the Malay, Indian and Chinese Traditional Medicines, Homeopathy, Islamic Medical practice and Complementary Medicine. Despite the classification of these services, their demarcation is still vague in our country and it seems that almost anyone can be a T&CM health provider. Regulation is needed.the MoH has passed the T&CM Act in 2013 (Act 756). It is now in the process of waiting to be gazetted by the Parliament. In the meanwhile, damage is being done. Awareness has to be created. On that note, come this 7 May 2016, the Traditional & Complementary Medicine (T&CM) Committee of MMA will be conducting the 4th Evidence Based Seminar. The theme this time is, Advances in Traditional and Complementary Medicine in Asia at the Grand Seasons Hotel. This seminar is packed with renowned speakers, both local and from overseas. They will deliver updates on integrated medicine and the challenges faced, latest evidence based research and various attractive topics which will surely hold the interest of even the skeptics amongst us. There is only one way to find out! Be there and hear it for yourself, first hand. You may browse MMA s webpage for more information or to register online.

41 general 41 Humour OLD IS GOLD! Robert, 85, married Jenny, a lovely 25-year-old. Since her new husband is so old, Jenny decides that after their wedding she and Robert should have separate bedrooms, because she is concerned that her new but aged husband may over-exert himself if they spend the entire night together. On their wedding night, Jenny prepares herself for bed, and the expected knock on the door. Sure enough, the knock comes, the door opens and there is Robert, her 85-year-old groom, ready for action. They unite as one, all goes well, and Robert takes leave of his bride, and she prepares to go to sleep. After a few minutes, Jenny hears another knock on her bedroom door. It is Robert, again and he is ready for more action. Somewhat surprised, Jenny consents for more coupling. When the newlyweds are done, Robert kisses his bride, bids her a fond good night and leaves. She is set to go to sleep again, but then, you guessed it-there is another knock on the door! Robert is back again, rapping on the door and he is as fresh as a 25-year-old, ready for more action. Once more they enjoy each other. This time, as Robert gets set to leave again, his young bride, now truly exhausted, says to him, I am thoroughly impressed that at your age you can perform so well and so often. I have been with guys less than a third of your age who were only good once. You are truly a great lover, Robert. Robert, somewhat embarrassed, turns to Jenny and says: You mean I was here already? The moral of the story: Don t be afraid of getting old, Alzheimer s has its advantages! MARITAL BLISS Compiled by, Dato Wira Dr LR Chandran and his team of jokellectuals, Alor Setar A newly married couple was walking through a garden when suddenly a dog runs towards them. They both knew that it will bite them, so the husband quickly lifts his wife and decides to let the dog bite him instead, rather than his sweetheart. The dog, however, stopped before them, barked for a while and then ran away. The husband gently puts his wife down, expecting a hug and a few kind words in return for his heroic gesture. He was shocked beyond words when his wife shouted instead, I have seen people throwing stones and sticks at dogs..this is the first time I am seeing someone trying to throw his wife at a dog! Moral of the story: A wife is wife. No one else can misunderstand a husband better than his wife! LIFE TRANSACTIONS A man and his wife were in court to have a divorce. The problem in contention was who will gain custody of their child, the man or the wife. The wife jumped up and said, My Lord, I am the rightful owner of the child, I brought her into this world, with pain and labour alone. The judge then turned to the man, and gave him the chance to defend himself. The man said slowly, My lord, mine is a question: when you insert your ATM card into the ATM machine and the money comes out, does the money belong to you or the machine? Court took a long recess after that as much time was needed to control the outraged wife!

42 42 mma in the press features xx The Sun Daily - 1 March 2016 MOHE Must Resolve Trainee Doctors Issue, s ays MMA PETALING JAYA: The long term solution to the issue of too many housemen doctors lies with the Higher Education Ministry (MOHE), says Malaysian Medical Association (MMA). Its President Dr Ashok Zachariah Philip says that there are too many medical programmes in the country producing a large number of trainee doctors. MMA has informed the Health Ministry that there are too many medical programmes in the country. We feel there should be more stringent screening of students before they join medical courses, and more stringent procedures for accrediting the courses. However, there is considerable reluctance by the ministry to address the problems, said Ashok when contacted. The Health Ministry is looking to extend the five-year moratorium imposed by the government in 2011 on new medical programmes in the country due to the influx of trainee doctors in the country. Instead of producing new doctors, existing medical colleges are encouraged to emphasise on quality, Health Ministry s director-general Datuk Dr Noor Hisham Abdullah told thesun on Monday. Ashok said there are about 10,000 posts in hospitals for housemen which would be equivalent to 5,000 a year, as housemanship is for two years. The number of new doctors seems to have stabilised at this number, about 5,000 a year. Thus, in theory, every new doctor should be able to get a post as a houseman. Under current laws, the government is obliged to provide housemen training to every Malaysian with a recognised medical qualification, he added. However, he said that problems arise as many housemen take longer than the stipulated two years to complete their housemanship, either because they are extended or because of prolonged sick leave. A small number also disappear without giving notice, but their posts remain filled until they can be terminated. This causes a delay in accommodating all the new doctors. When there are vacancies, only then can we call for interviews. The duration of the waiting period can vary. If you are lucky, perhaps two to three months. If not so lucky, maybe six to eight months. However, they will all get jobs eventually, said Ashok.

43

44

45

46 46 mark your diary YEAR 2016 APRIL FUTURE OF MEDICAL EDUCATION AND HOUSE OFFICER TRAINING SEMINAR Theme : Moving Towards Professionalism Dates : 16 April 2016 Venue : Grand Seasons Hotel, Kuala Lumpur Time : 8.00 am 5.00 pm Contact : Ms Moon Tel : Fax : Emai : medic_edu@mma.org.my 8TH MMA SABAH PRIMARY CARE CONFERENCE Date : April 2016 Venue : Grand Ballroom, Pacific Sutera, Kota Kinabalu, Sabah Contact : Ms Elsie ( ); Ms Florita ( ) Fax : mmasbh8gpc@gmail.com Facebook : SOLUTION FOCUSED SYMPOSIUM Date : April 2016 Venue : International Medical University, Bukit Jalil, Kuala Lumpur, Malaysia Contact : Ms Liong Siao Lin / Ms Janet Foo Tel : / 7072 Fax : icl@imu.edu.my/ Website : NATIONAL SYMPOSIUM ON THE RIGHT TO HEALTH Date : 23 April 2016 (Saturday) Time : 8.00 am 5.00 pm Venue : Sunway Putra Hotel, Kuala Lumpur Contact : Ms Jalina Tel : Fax : / assistance@mma.org.my 12TH MALAYSIAN HOSPICE CONGRESS Date : April 2016 Venue : SWAN Convention Centre, Sunway Medical Centre, Bandar Sunway, Selangor Organiser : Malaysian Hospice Council Contact : Dr Michael Yoong Tel : Fax No : mhccongress2016@gmail.com Website : XIII MALAYSIAN CONFERENCE AND EXHIBITION AND VI INTERNATIONAL CONGRESS AND EXHIBITION OF ANTI-AGING, AESTHETIC AND REGENERATIVE MEDICINE Date : 29 April 1 May 2016 Venue : Sheraton Imperial Kuala Lumpur Secretariat : SAAARMM Secretariat Address : 142, Jalan Ipoh, 3rd Floor, UMNO Selangor Building Kuala Lumpur Tel : / Fax : / dr_harnam@hotmail.com Web site : MAY ADVANCED LEVEL OBSTETRICS AND GYNECOLOGY ULTRASOUND COURSE Theme : Scanning to save lives Date : 6 8 May 2016 Venue : Kompleks Rawatan Harian, Hospital Raja Permaisuri Bainun Ipoh Contact : Dr Japaraj H/P : Fax : japaraj@hotmail.com 4TH EVIDENCE BASED SEMINAR ON TRADITIONAL & COMPLEMENTARY MEDICINE Theme : Advances in Traditional and Complementary Medicine In Asia Date : 7 May 2016 Venue : Grand Seasons Hotel, Kuala Lumpur Contact : Ms Muthu / Ms Yulliz Tel : (Ext: 200 or 218) Fax : / publichealth@mma.org.my / admin2015@mma.org.my Website : INTERNATIONAL GERIATRIC ORTHOPAEDIC UPDATE FOR PRIMARY CARE PHYSICIAN AND GENERAL PRACTITIONERS 2016 Date : 7 May 2016 Venue : Sunway Putra Hotel, Kuala Lumpur Time : 2.00 pm 6.30 pm Contact : Ms Muthu Tel : (Ext: 200) Fax : / publichealth@mma.org.my Website : 56TH MMA NATIONAL ANNUAL GENERAL MEETING 2016 Date : May 2016 Venue : Meritz Hotel Miri, Sarawak Contact : Ms Melanie Kho Tel : (Office Hour) H/P : (Office Hour) Fax : (Office Hour) agmmiri@gmail.com JULY MALAYSIAN THORACIC SOCIETY CONGRESS 2016 Date : Conference workshops on 28 July 2016 : Conference July 2016 Venue : Hotel Equatorial, Bukit Jambul, Penang Secretariat : Academy of Medicine secretariat@mts.org.my Tel : Enquiries : Malaysian Thoracic Society m.thoracicsociety@gmail.com Tel : Fax : Website : AUGUST THE MMA PAHANG BRANCH 6TH ANNUAL SCIENTIFIC MEETING & REGIONAL MEDICAL UPDATES 2016 Date : August 2016 (Saturday - Sunday) Time : 8:00 am 5:00 pm Venue : The Vistana Kuantan, Pahang. Contact : En Mohd Ariff Hazami Elliazir Enquiries : mmapahang@gmail.com Facebook : SEPTEMBER 41ST ANNUAL DERMATOLOGY CONFERENCE Theme : New Horizons in Immunology and Dermatology Date : 5 18 September 2016 Venue : Pullman Kuching Hotel, Kuching, Malaysia Enquiries : Mr Eric Chan Tel : pdmreg@gmail.com Website :

47

48