Malaysia - Meeting nation's healthcare needs

MEDICAL tourism in Malaysia is forecast to grow. More and more foreigners are flocking here to seek a variety of treatments across the cost spectrum. By all accounts, the country is an attractive destination for medical tourists.

The availability of competent medical personnel and high quality facilities will continue to give Malaysia the edge over competitors.  Indeed, the country generated RM588.6 million in healthcare travel revenue from January to September last year, according to the National Transformation Programme (NTP) annual report.

The biggest market was Indonesia, making up 62 per cent of the healthcare revenue, followed by the Middle East (7. 4 per cent), India (three per cent), China (2.6 per cent), Japan (2.6 per cent), Australia and New Zealand (2.5 per cent) and the United Kingdom (2.5 per cent).

It makes sense for Malaysia to seize the opportunity to brand and position itself as a provider of affordable, quality healthcare. 

Still, the enthusiasm for bringing in cash from afar must be tempered with realism. And, the reality is many Malaysians, especially those in the rural areas, lack access to quality healthcare.

As Federation of Private Medical Practitioners’ Associations Malaysia president Dr Steven Chow suggests, the government must “allocate more budget for healthcare and stamp out leakages to ensure that the money is well spent”.

There is nothing wrong with hospitals treating patients from other countries. If it enables them to earn extra money, what’s the harm? But, Malaysians should not be deprived of treatment, and this is the crux of the issue. We must give priority to healthcare for citizens over medical tourism.

The government has done a great job developing the healthcare system since 1957. According to the Health Ministry, the incidence of those becoming poor because of healthcare spending is low, and comparable to mid-level Organisation for Economic Cooperation and Development countries such as Hungary, Sweden and Denmark.

This is because of the highly-subsidised public healthcare system, which does not even recover the actual cost care delivery from users. The ministry recovers less than three per cent of actual expenditure through various fees collected for patient care and other fees such as rental of staff quarters and hostels, and licensing fees.

Yet, within this highly-subsidised public facility structure there are those who do not or cannot pay their fees. Those who cannot pay are referred to medical social officers for assessment of fee waiver and assistance from the health fund.

There are also Malaysians who do not settle their bills, regardless of their socio-economic circumstances.

But, the bulk of defaulters are foreigners, many of whom could have entered the country specifically to access the public healthcare system.

These limitations notwithstanding, the ministry must brace itself for the challenges of an expanding ageing population, high prevalence of non-communicable diseases, increasing and expensive medical technology as well as unexpected environmental and communicable threats to health — all the more reason for ensuring the well-being of all Malaysians and not solely for profit-making.

nst.com

Malaysia - Too young to marry

CHILD marriages will do more harm than good to children, according to several paediatricians interviewed by MetroPerak.

Malaysian Paediatric Association President Dr N. Thiyagar said, as far as paediatricians are concerned, girls below the age of 18 are regarded as children.

He said there are a lot of health issues involved physically, psychologically and mentally, for girls who get married young, and subsequently become pregnant.

Dr Thiyagar, who is also the Malaysian Association for Adolescent Health vice-president, said when a young teenager, or a child gets pregnant, there is a higher risk of complication in pregnancy.

He said young mothers are often not physically, and mentally capable of bearing children.

According to Dr Thiyagar, World Health Organisation statistics show that girls who give birth before the age of 15 are five times more likely to die in childbirth than girls who are in their 20s.

“Besides this, the babies of young mothers also might have major complications, such as pre-mature delivery.

“Another concern is the social impact of the young mothers who are forced to stop schooling,” he said when contacted recently.

He was asked to comment on PAS MP Nik Mazian Nik Mohamad’s suggestion in Parliament recently that child marriages should be allowed as children below the age of 16 already have sexual urges.

Nik Mazian had said if they are prevented from marrying (young), youngster will engage in pre-marital sex.

Dr Thiyagar, who specialises in adolescent medicine, said a total of 13,800 pregnancies involving children and teenagers aged between 10 and 19 were reported in Malaysia last year alone.

He said the figures provided by the Health Ministry were revealed during the 12th National Symposium for Adolescent Health held in Johor, earlier this month.

He said, according to the data, a total of 9,800 of the girls were married, while the rest were unmarried girls who became pregnant.

The data also showed that 72% of the pregnant mothers opted out of school.

Dr Thiyagar said under civil law, having sex with someone below 16 constitutes statutory rape.

In Malaysia, the legal minimum marriage age is 18 for non-Muslims and 16 for Muslims.

He said, although major religions do not promote child marriages, under certain circumstances some child marriages are allowed.

Dr Thiyagar said in Malaysia, usually child marriages occur as parents may consent to it to avoid the shame associated with premarital sex or pregnancies out of wedlock.

But he feels that parents must be made aware of the problems that may occur from letting their daughters below the age of 18 get married.

“They are not prepared to carry out their duties as a wife or a mother, as they are denied the appropriate childhood and adolescence, and this causes suffering in psychological well-being and empowerment.

“They are too young to make decisions, and along the way they are exploited because major decisions are usually made by their husbands, and other family members,” he added.

He said therefore the Malaysian Paediatric Association emphasises teaching girls how to be safe, respecting their bodies, and how to get the opposite sex to respect them as a person.

“It is also important for sexual reproductive health lessons to be taught in schools as a subject by itself.

“There is also a need for the family institution to be strengthened so that young people are able to talk with family members about sex, which often the topic is a taboo.

“It is better for them to get the best knowledge from their family members instead of getting incorrect information through the media, Internet or friends,” he added.

Dr Thiyagar said religious education is also very important.

Consultant Paediatrician and Paediatric Neurologist Dr Alex Khoo Peng Chuan said no paediatrician would support child marriage as it is against the rights of the child.

Dr Khoo said children are still dependent on others as they are unable to look after themselves physically, economically or academically.

He said, medically it is not safe for a child to look after themself, or a family, and to have sexual intercourse at a young age brings about mental and physical consequences.

“The implications of child marriages essentially means an end of childhood, as the girls stop being somebody’s daughter, and automatically becomes a wife.

“Her personal development, and independence is curtailed, and they are also at a greater risk of experiencing complications in pregnancy, and child birth.

“Child marriages also deprive young girls from having higher education which would enable them to do better in life,” he added.

Dr Khoo said allowing young girls to get married provides a form of protection to those who prey on vulnerable girls.

He said, because of social disadvantages, lack of education, and poor parental support, some girls may be forced into marriage.

“The age difference becomes one of the concerns as a lot of the husbands may actually have paedophilic tendencies,” he added.

He said child marriages reinforce gender inequality, and poverty, as married girls often leave school, which can have an impact on the socio-economic development of the country

“We need to promote empowerment for the development of all children into healthy adults,” Dr Khoo said, adding that worldwide statistics show that 700 million women were married before their 18th birthday.

This, he said, was 10% of the world population.

The United Nations Children’s Fund has estimated an additional 1.2 billion girls will be a child bride by the year 2050.

Some child brides he said are only eight or nine years old, and that 90% of adolescent pregnancies take place within marriage.

thestar

Malaysia - Health DG advises snake bite victims to seek immediate treatment at nearest emergency dept

PETALING JAYA: The Health Ministry has urged all snake bite victims to seek help at the nearest emergency department or healthcare centre even though Malaysia has more non-poisonous snakes than poisonous ones.

"The doctors working in the emergency department will decide to administer antivenom according to the severity of the effect of the poison: the speed of its spread or its systemic manifestations or effect to the limb," said the ministry's director general Datuk Dr Noor Hisham Abdullah in a blog post.

He said that there had been a surge in the reporting of snake bites as a result of the unusually hot weather conditions the country is facing now.

Nor Hisham added that identification of the species of snake is crucial for doctors to administer specific anti-venoms.

"On most occasions, we are unable to identify the actual snake species that has bitten a victim as it usually slithers away. Actual snake identification allows the emergency doctors to administer specific anti-venom for the species," he said, adding that it is dangerous to capture snakes and it should be avoided.

He said that potentially dangerous snakes in Malaysia are the Malaysian Pit Viper, the monocle cobra, the Shore Pit Viper, Waglers pit viper, banded krait, Malayan krait, the coral banded snake and the King Cobra.

Noor Hisham said symptoms in snake bite victims includes - pain, headaches, vomiting, blurring of vision, and paralysis of the eyelids or the breathing muscles, loss of consciousness, bruising, severe swelling, bleeding and muscle tissue breakdown.

He said a multidisciplinary and inter-ministerial team of experts formed by the ministry is currently working to produce the MOH Clinical Practice Guidelines (CPG) for Snake Bite which will likely be out later this year.

Noor Hisham also said that victims and bystanders should call 999 immediately in case of a snake bite.

Timothy Achariam

thesundaily

Malaysia - Measles vaccination for children of foreigners?

Health ministry considering this measure to control spread of the disease among local population.

KOTA BARU: The Health Ministry will study the possibility of providing vaccination for measles to children of foreigners living in the country to control the spread of disease among the local populace.

Deputy Director-General (Medical) Dr S Jeyaindran said the ministry was actively monitoring the growth of the disease in the country after the anti-vaccine movement was affected by certain parties who rejected injections for fear that it contained DNA of pigs.

“Up till now, there are many illegal immigrants and children in the country who have not been vaccinated.

“We fear that this problem will spiral into a ‘reservoir’ that opens the risk of the disease being spread to the public.

“As such, we want to review the need to vaccinate them for the well-being of the country.

“If they are allowed to deliver children here without vaccination, it will gradually contribute to a pandemic,” he said.

He was speaking to reporters after officiating the Second Kelantan Allied Health Conference 2016 that was also attended by state Health Director Dr Ahmad Razin Ahmad Mahir and director of Allied Health Sciences Division Tan Yoke Hwa here today.

Dr Jeyaindran said they were only able to raise awareness to certain groups of parents on the importance of vaccination for measles to avoid the risk of them contracting other diseases as they grow up.

Bernama

freemalaysiatoday

Malaysia - Rice and rice products may expose infants to arsenic

Rice grains can take up arsenic from their environment, and US rice has some of the highest arsenic concentrations in the world.

Infant rice cereal and rice snacks contain some arsenic, and babies who eat these products have higher levels of arsenic in their urine, a study shows.

It’s not clear yet whether the arsenic will affect their health down the line.

“We knew rice cereal was a typical first food for babies – but we knew very little about how common it is to feed infants rice cereal in the US, or about the timing of introduction of rice cereal,” said lead author Margaret Karagas, of the Geisel School of Medicine at Dartmouth College in Hanover, New Hampshire.

Rice grains can take up arsenic from their environment, and US rice has some of the highest arsenic concentrations in the world, she said.

“Arsenic is a known carcinogen that can influence risk of cardiovascular, immune and other diseases,” Karagas told Reuters Health by email. “There’s a growing body of evidence that even relatively low levels of exposure may have adverse health impacts on young children including on growth, immunity and neurodevelopment.”

She and her team are still investigating whether the infants in this study had any health effects due to arsenic exposure, she said.

The researchers studied 759 infants born to mothers age 18 to 45. Parents reported their infant’s intake of rice products like rice cakes or puffs or dried breakfast cereals containing rice, or brands of cereal bars sweetened with brown rice syrup, in interviews when the baby was four, eight and 12 months of age. The researchers also collected infant urine samples to test for arsenic levels.

About 80 percent of the children were introduced to rice cereal before age one, and a third were eating rice snacks by their first birthday.

Among kids who did not eat fish or seafood, urinary arsenic concentrations were higher for those who ate infant rice cereal or snacks than for those who did not, according to results in JAMA Pediatrics.

The researchers also tested for arsenic levels in some of the more commonly reported rice snacks.

“We were surprised by the percentage of infants who ate rice snacks and that one of these products contained levels above the current EU standard of 100 parts per billion,” Karagas said. “This was a strawberry flavored puffed rice snack, which contained 40 percent inorganic arsenic, with the first two ingredients listed as brown and white rice flour.”

Inorganic arsenic exposure has been linked to cancer as well as other health problems such as neurological, cardiovascular, respiratory and metabolic diseases, said Dr. Antonio J. Signes-Pastor, of the Institute for Global Food Security at Queen’s University Belfast in Northern Ireland.

“This is of particular concern for young children, who are more sensitive to adverse health effects of inorganic arsenic and consume higher amount of inorganic arsenic from food compared to adults per kilogram of body weight,” said Signes-Pastor, who was not part of the new study.

It is important, he said in an email, “to reduce exposure by establishing maximum limits of inorganic arsenic in rice and rice-based products.”

The US Food and Drug Administration had proposed a limit for inorganic arsenic in infant rice cereal of 100 parts per billion, which would mimic the current limit in the European Union, Karagas said.

Reuters

freemalaysiatoday

Malaysia - Malaysia Registers 25,000 Cases of Dengue Fever in Three Months

Kuala Lumpur, Malaysia, Apr 25 (Prensa Latina) Malaysia has registered nationally almost 25,000 cases of dengue fever, the Malaysian Public Health Vice Minister, Hilmi Yahaya has confirmed

Hilmi Yahaya stated that from January until April 24th, 42,683 cases have been reported, a rise of almost 5,000 in comparison with the same quarter last year.

Ninety-four people have died in the same period, which is a reduction on the 120 victims who succumbed to the disease in same quarter in 2015.

According to official data, during January and February this year, the authorities inspected almost 1,000 areas, imposed 3,260 fines and took 353 cases to court.

Yahaya thanked other ministries and governmental agencies for their help in the national operation, which started on April 11th, against the Aedes Aefypti mosquito - the transmitter of the disease.

Analysts have said that the country's initiatives against dengue fever are ineffective, despite being regional pioneers in research on the transmitting agent.

In 2011, Malaysia sterilized 6,000 male mosquitoes and released them to mate with females with the aim of reducing the mosquito population.

The experiment was the first of its type in Asia and although the population of mosquitoes has been reduced, this has not led to a drastic reduction in the incidence of dengue fever.

According to the World Health Organization, in 2015, the hospitals in Malaysia treated 111,000 suspects dengue fever cases, an increase of 16 percent in comparison to 2014.

The WHO also reports that in 2015, 390 million cases of dengue in at least 128 countries were reported.

Dengue fever is transmitted by the bite of the female of the Aedes Aegypti that nests in stagnated waters.

The symptoms are fever, headache, and pains in the joints and muscles.

sgl/Ym/tac/to/ymn

plenglish

Malaysia - Pollution and its effect on productivity

EARTH Day helps create awareness about how environmental issues affect us. One of the biggest challenges we face is the health effects brought by airborne pollution.

Every year, the region’s air is choked by haze. The haze created by forest fires in Indonesia last year was one of the worst on record. It was severe enough to extend to Malaysia.

The air quality crossed into the hazardous range on the Air Pollutant Index at the height of the haze in Malaysia. The education minister had to close schools in the city and three states due to health concerns.

The health effects of air pollution are apparent but less known is the psychological effect it has on our behaviour, and consequently, our performance in the workplace.

My colleagues and I studied how air pollution might affect our workplace behaviour through a behavioural theory known as ego depletion — the idea that an individual’s self-control draws upon a limited pool of mental resources, one that can be used up and needs opportunities to restore.

Not only does air pollution negatively affect levels of oxygen and glucose in the blood, both of which affect self-control, it can also drain our self-control resources psychologically, causing insomnia, anxiety or depression.

Our research examined how pollution affects two kinds of behaviour: organisational citizenship behaviour and counterproductive workplace behaviour.

The first behaviour relates to employee actions that contribute to the functioning of the firm, but are optional and not part of their job. These might include individuals’ willingness to be helpful to others, to engage with their team beyond their job scope, or to take action that protects or improves the firm’s image. Some might label it as going above and beyond the call of duty.

The second counterproductive behaviour is the flipside of this and includes negative employee actions. These might include working on personal matters during work hours, as well as rudeness, hostility or even bullying of colleagues.

A common term for this might be deviance at the workplace. In our research, participants were asked to record daily diary entries rating their perception of pollution levels, their level of mental resource depletion as well as organisational citizenship and counterproductive workplace behaviour.

We found a clear link between high air pollution and decreased levels of organisational citizenship behaviour.

Likewise, increased pollution also saw a corresponding and marked increase in counterproductive workplace behaviour.

Air pollution leads to a decrease in self-control resource, which in turn leads to increased counterproductive and decreased organisational citizenship behaviour.

Specifically, the data gathered showed that the severity of air pollution accounted for around 10 per cent of an individual’s daily self-control resource depletion.

In other words, by reducing our pool of mental self-control resources, the impact of air pollution makes us less engaged at work and more deviant. Moreover, in line with the ego depletion theory, it is apparent that the direct physiological impact of air pollution and the individual’s own perception of its severity act to deplete resources affecting self-control.

Of course, how this manifests itself can vary considerably. A worker may experience little or no health effects from pollution while another in the same office may suffer badly.

Likewise, one individual’s perception of what constitutes “severe” pollution may be different from another.

An essential factor in determining an individual’s ability to manage the effects of drained self-control resources is the support they receive, or feel they receive, from those around them.

For example, demonstrations of active support from the firm can replenish an employee’s mental resource pool.

We found that the negative effects of air pollution on employees’ behaviour were mitigated when organisational support was high, that is when employees perceived that their supervisor or firm was concerned about their wellbeing.

In our research, we came across firms tackling the immediate effects of pollution, such as installing more effective air filters in their offices. Similarly, supportive firms might provide additional work breaks or the option to work from home on high pollution days, or they may provide easier and better access to healthcare.

While this favours an argument that firms should support employees exposed to severe air pollution, all of this comes with a cost to the firm.

By conducting studies like ours, we can better understand the true social and economic implications of pollution and, in turn, add weight to the finan- cial argument for stronger and more effective policies to tackle pollution at source.

Sam Yam Kai Chi

Sam Yam Kai Chi, Assistant professor of management and organisation, National University of Singapore’s Business School

nst.com