MMA September 09(L)

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Transcript of MMA September 09(L)

Page 1: MMA September 09(L)
Page 2: MMA September 09(L)

The Gift Of Life

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Page 3: MMA September 09(L)

Contents SEPTEMBER 2009 www.mma.org.my

MMA EXECUTIVE COMMITTEE MEMBERS: 2009-2010

DR DAVID K. L. QUEKPresident 2009-2011

DATO’ DR KHOO KAH LINImmediate Past-President

DR MARY SUMA CARDOSAPresident-Elect

DATO’ DR N.K.S. THARMASEELANHonorary General Secretary

DR HOOI LAI NGOHHonorary General Treasurer

DR KULJIT SINGHHonorary Deputy Secretary

DATO’ DR SARJEET SINGH SIDHUHonorary Deputy Secretary

DATO’ DR MOHAN SINGH PANNUMember

DR HARVINDER SINGHMember

Published by: Malaysian Medical Association4th Floor, MMA House, 124 Jalan Pahang 53000 Kuala Lumpur.Tel: 03–4042 0617, 4041 8972/1375 Fax: 03–4041 8187, 4041 9929Email: [email protected] / [email protected]

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EDITORMessage from the

EDITORIAL BOARD

EEddiittoorr::Dr Kuljit Singh

EExx--OOffffiicciioo::Dato’ Dr N.K.S. Tharmaseelan

AAddmmiinniissttrraattiivvee OOffffiicceerr ((PPuubblliiccaattiioonnss))::Matilda Cruz

EEddiittoorriiaall BBooaarrdd MMeemmbbeerrss::Datuk Dr N. ArumugamDr Mary Suma CardosaDr Chen Wei SengDr Saraswathi Bina RaiDr Andrew, Tan Khian KhoonDr Harvinder SinghDr Krishna Kumar DDIISSCCLLAAIIMMEERR::

The views, opinions and commentaries expressed in the BERITA MMA (MMA News) do not necessarily reflect those of the Editorial Board, MMA Council or

MMA President, unless expressly stated.

4 President’s PageThe First 100 days…

8 Secretary's PageFrom the Desk of the Secretary

10 PPS ColumnQuality in General Practice

12 From the Desk of: Tan Sri Dato’ Seri Dr Mohd Ismail MericanBetter Prospects for Doctors Working in the Ministry of Health

14 SCHOMOSSCHOMOS Meets Director-General of Health

16 InsuranceUpdate on Hospitalisation Plans for MMA Members

17 Press StatementAustralian Park Named After Malaysian Doctor

18 Book ReviewClinical Atlas of Nasal Endoscopy

19 Letter to Editor1st MMA/MAAH Urban Outreach - Programme at SMK Sri Sentosa KL

20 Mark Your Diary

21 Classified Advertisements

24 ReportIntroductory Plantation Health Seminar

26 CME Update- Limbal Stem Cell as Potential Therapy to Blinding Corneal Conditions- Colour Blindness

30 Branch News- MMA Wilayah Activities- Briefing to the Private Sector on Influenza A (H1N1) in Penang - MMA Perlis Pain Workshop- MMA Perlis Dinner 2009

34 SP’s Korner

Medical Tourism: Are we ready for it?Medical tourism is described as a practice of traveling acrossinternational borders to obtain healthcare. This happens when citizens ofother countries find quality healthcare cheaper in another country.Singapore and Thailand have been in this business for a few years andMalaysia seems to be slowly catching up on its own bit in promotingmedical tourism. We are more conducive to attract a bigger medicaltourist crowd but are we doing enough and do we have the correct focus?One of the main concern is the brain drain from public hospitals to privatehospitals. Doctors are fully aware that medical tourism flourishes well inprivate hospitals especially when payment is in cash without any hasslefrom the local MCOs. Limited private practice in government hospitals,which was initially aimed for foreign patients, seems to have failedmiserably.

Medical tourism promotes foreign exchange income and elevates ourstandards, as we have to compete to be the best. One of the seriousconstrain is lack of medical manpower particularly doctors and nurses.Though we may have the highest number of medical schools per capitain the world [23 medical faculties for a population of 27 million], we arestill running low in numbers of doctors in public hospitals. We also knowthat the bubble will soon burst as the medical graduates are soon goingto graduate and will fill up all the empty post right up to the interiors ofEast Malaysia. Maybe then we can promote medical tourism withenough doctors for our rakyat and medical tourists.

Our worries will not end with increase foreign patients [medical tourists]in the next few years as we also may face challenges from foreign doctorshaving their practices in Malaysia after the AFTA comes into effect. It willbe rough turf for local doctors to keep up with this competition.Malaysian doctors will be allowed to work within our region but how manyof us will do so? I foresee tougher times in the future for doctors andmaybe the medical profession will not be a favorite choice anymore withinthe next decade. Some serious proactive steps should be initiated now.

Regulatory RequirementsDo we need more agencies, societies or associations to regulate doctorsand their practices? Are we not frustrated enough with By-laws andActs? We do not need any more governing instruments on our practicesin the name of quality. It is often ridiculous to register in so many differentregisters, government agencies and societies, which portray qualitycontrol. The medical practice itself has its difficulty in managing MCOs,insurances and ‘consulting’ pharmacies. It is not at all acceptable fordoctors to face additional burden of complying with quality controlsocieties. We should stand strong to reject any more regulatinginstruments into our practice. Doctors are noble enough to self-regulateand practice within the domain of medical ethics and best patient care.

My best wishes to all like always, and let us work out a better future fordoctors. �

DDrr KKuulljjiitt SSiinngghhEditor

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• MALAYSIAN MEDICAL ASSOCIATION • SEPTEMBER 2009

President’s Page

There are still quite a lot ofmisgivings and negativeimpressions about doctors inprivate practice, the healthcaresystem and the MMA in general—that we are too concerned with ourown parochial interests, some ofwhich I have tried hard to dispel byresponding more with theauthorities that be. But all thisrequires greater interaction andpositive dialogue on a personallevel with more consistentengagement and commitment.

2. What are your issues/plans for the MMA in the near andlonger term?Many of the issues that have arisen during the first 100 days of mypresidency are not all new. However, these have been raised andare now under discussion, with the view to some degree ofresolution or action. Among the most pressing issues include thefollowing: a) RReevvaammpp aanndd rreejjuuvveennaattee oouurr MMMMAA SSeeccrreettaarriiaatt and motivating

our staff to be more productive and professional; b) EEnnccoouurraaggee oouurr mmeemmbbeerrss ttoo rreeccooggnniissee tthheeiirr oowwnn iimmppoorrttaanntt

iinnddiivviidduuaall rroollee as well as collectively, and instill increasedparticipation in the affairs of the medical profession, to remindphysicians about their calling, their vocation, their kindlier morecaring nature, as well as to remember to be our patients’greatest advocate;

c) EEnnccoouurraaggee oouurr MMMMAA lleeaaddeerrsshhiipp ((EExxccoo aanndd CCoouunncciillmmeemmbbeerrss)) ttoo ttaakkee uupp mmoorree rreessppoonnssiibbiilliittiieess, more in-depthinterests, develop and acquire training and leadership skills, sothat together we can better plan for more concerted policies anda more meaningful, more participatory and influential role for ouraugust association, vis-à-vis healthcare and professional issuesin our country;

d) EEnnggaaggee wwiitthh tthhee MMaallaayyssiiaann PPhhaarrmmaacceeuuttiiccaall SSoocciieettyy,,pharmacists in general and their leadership to move towardsgreater professionalism, cooperation and collaboration;

e) WWoorrkk wwiitthh ootthheerr pphhyyssiicciiaann ggrroouuppss towards greater unity ofpurpose and direction, e.g. FPMPAM, Academy of FamilyPhysicians of Malaysia (AFPM), Academy of Medicine, MOH;

f) RReevviissiitt tthhee ddiirreeccttiioonn aanndd ppoolliicciieess ooff tthhee MMMMAA’’ss nnaattiioonnaallhheeaalltthh ppoolliiccyy ccoommmmiitttteeee, including re-establishing an updatedblueprint for ‘Health for All’ Malaysians, including equity andaccess issues;

g) RRee--eennggaaggee aanndd ccrriittiiccaallllyy rreevviieeww tthhee iissssuuee ooff ssiinnggllee--ppaayyeerrNNaattiioonnaall HHeeaalltthh IInnssuurraannccee SScchheemmee for our Malaysianhealthcare system revamp, the continuing role of our privatesector, its possible integration or greater assimilation with thepublic sector, reconsider other financing options, e.g.DRGs/case-mix, catastrophic coverage/safety net, etc.;

h) LLeeaadd ddiissccuussssiioonnss oonn tthhee iinnaapppprroopprriiaatteenneessss ooff uunnppooppuullaarraanndd uunnnneecceessssaarryy rreegguullaattiioonnss on the private medicalpractitioner, especially with regards the possible extension ofMMSSQQHH aaccccrreeddiittaattiioonn of private clinics, repeal of agreed-tounpopular arbitrary regulations of the Private HealthcareFacilities and Services Act 2006, working with the AFPM tofurther strengthen primary care services and standards;

i) RReeccooggnniissee tthhee iimmmmiinneennccee ooff nneeww AAFFTTAA aanndd MMRRAA ppoolliicciieesswhen they come into play in 2010, and how they impact uponour profession and our members, engage with the authorities(MITI, MARTRADE, BIM, EPU) to mitigate the possibleprofessional implications on some sectors of our healthcareproviders;

1. How has it been, the first 100 days in office?As I have commented earlier some 2 months ago, the office ofPresident of the MMA has been quite demanding and taxing, yet itis a very challenging learning process.

Clearly, not many doctors understand the burdens of office and themandated responsibilities of the President of the MMA. I certainlydid not expect such an onerous if ponderous task.

One could of course, just take this in one’s stride, and carry on asper usual, accepting the position as President of the MMA as justanother feather in one’s cap of personal achievement or ambition.But this, I believe would seriously undermine the status andunderstated strength of purpose of the MMA.

Anyone who aspires to be an MMA leader must be aware of theresponsibilities and tasks ahead. He or she must necessarily wishto do more, to represent the profession more robustly and withfullest attention to details of the multifarious issues, which pertainto the medical profession and healthcare scenario in the countryand beyond.

Not surprisingly, much is expected of the President as thepresumed spokesperson and the recognised opinion leader of whatmust be the most respected association in our society, especiallywhen the MMA is seen to represent the interests of the largestnumber of our doctors.

I think many among the public are aware that we still represent therational voice on healthcare issues in the country, and would likevery much to listen to our viewpoints, although increasingly withmore and more skepticism and mounting mistrust.

Certainly many officials in the MOH and the Health Minister himselfregards us highly as an important sounding board on all aspects ofhealth, which impinge on our Malaysian healthcare scene. I waspleasantly surprised that a recent Malaysian public survey foundthat doctors are widely regarded as having the second moststressed profession! A few years back, some 72% of the publicpolled also found us to be the most trusted among all otherprofessions! This gives us hope that we can still offer meaningfuland beneficial services to our rakyat, despite mounting grumblingsof physician carelessness and callousness.

Journalists, news editors and health officials expect the MMA tohave an opinion on myriad issues no matter how esoteric or fatuousthey might be (e.g. what do I think of so-and-so’s inane commentthat “masturbation may predispose to the H1N1 flu”?!!). Curiouslythey all appear to believe that the President should readily have allthese information, ideas and opinions at his or her fingertips! ThePresident must be able to respond nearly immediately and clearly—often with an impossibly unrealistic black-and-white certainty.

He must also be the know-all with regards any health issue, nomatter how remotely connected! Perhaps this underscores therespect and the expectation that the MMA is the de facto bodywhere our opinions matter and ought to be sought… We areflattered, but at the same time bemused at the hystericalapproaches of some of these media people, anything to stoke theinterests of the readers!

It is with this in mind that I have felt compelled to try and activelyengage with as many organisations and authorities as possible, i.e.any influential body that requires our input and ideas. How muchwe have managed to impart in terms of influence or suggestions,remain to be seen. But it is clear that if we had not been there, thenour doctors’ interests might not have been represented at all.

cont’d...pg 5

Dr David K.L. QuekPresident 2009 - 2011

The First 100 days…

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President’s Page (cont’d)

4. Do you think that MMA should be THE provider for CME /CPD, or like the specialist register this should be given to theAcademy of Medicine or MMC?There is no doubt that the MMA remains the best organisation toadminister and coordinate the CPD mechanism for doctors in thecountry. Our approach has been simple and well documented, andhas served to ensure that doctors can keep track of their continuingprofessional development efforts, when they register for suchactivities. Of course we can further strengthen this mechanism toinclude web-based learning and documentation and therefore moreaccurate logging in of CPD points.

At this juncture, the MMA believes that the Academy and/or theMMC do not have the logistical, secretarial or manpower support toadminister this duty. However, the MMA also hopes that we can beoffered greater incentive to continue this function, which we arenow performing without any due recognition or financial support.

While the specialist register is now within the purview of theAcademy of Medicine, its implementation is now incomplete anddelayed because of its requirement for registration fees, which weunderstand is time limited. If the administration of CPD function isto move anywhere, it should not further burden the practicingphysician. The fact that GPs and family physicians are makingefforts for continuing education and professional developmentshould be sufficient to ensure that the MMA continue to supporttheir endeavours, ultimately for our patients’ benefits.

5. Should it be compulsory for all doctors to have a certainnumber of CPD/CME points over a certain period to continueobtaining their APC?With the implementation of the revised Medical Act some time in2010 (?), we expect that the practicing license will be linked to proofof CPD for physicians, the final quantum has yet to be finalised, butis in the order of some 50 to 60 CPD/CME points over 2 years. Thiswill mandate that doctors take greater responsibility to updatethemselves on a regular basis.

It is estimated that thus far only some 10 to 20% of our doctorsattend any sort of CPD programmes, and then only sporadically atthat! This expected rise in registration and collection for CPDprogrammes/points will stretch our administrative function andcapacity, and thus we hope to be able to perform this withadequate and fair support from the MOH or the MMC. Otherwisethis exercise may hit stumbling blocks of gridlock and missedopportunities. Ensuring that more than 25,000 doctors get theirCPD registered points will be a definite challenge, but I believe weare up to it. We are in the midst of streamlining registrationtechniques such as the use of ID card readers and automatic datacapture/entry, but cost constraints are real issues.

6. When or should Malaysian doctors give up their role indispensing medications?The short answer to this, is ‘NO’, not yet anyway. In my view, I thinkwe are still far from yielding our rights to dispensing medicines andtherefore separate prescription from dispensing. I urge the Ministerof Health to seriously avoid making any arbitrary and hurried actionwith regards this contentious issue. This viewpoint persists despiteour continuing dialogue with the MPS and their continuing lobbyingfor such a move.

Perhaps the most important reason against such a move is the factthat our citizens have yet to learn the difference between what itmeans to be a doctor and what the pharmacist’s role is. For toolong, our rakyat have come to assume that consulting with a doctorfor a health ailment meant being accompanied by some givenmedicines for the healing process—no medicines, no charge, manystill feel and expect.

That the patient-doctor consultation process is a professionalexercise is rarely accepted as a means of fair remuneration for thedoctor, although increasingly more and more are acceptingspecialist visits as such. Thus, the recognition of appropriate fees

j) AAddddrreessss llooccaall ccoonnddiittiioonnss ooff hheeaalltthhccaarree, particularly theconcern of too mmaannyy mmeeddiiccaall ggrraadduuaatteess in the immediatefuture where training, supervision and experience may becompromised. More than 2,000 new doctors now enter the jobmarket annually, and with the new scheme of 2-years ofhousemanship, followed by another 2 years of compulsoryservice (recently just revised downwards by the MMC andMOH), these may be shortchanging our future doctors and theirprofessional skills and competency. There have been concernsthat our training positions may be inadequate for this largerinflux of recent years.

k) PPuubblliicc sseeccttoorr pprrooffeessssiioonnaall iissssuueess ttoo bbee ssttrreennggtthheenneedd. At thesame time SCHOMOS will continue to fight for better and betterworking conditions, fair and appropriate remuneration andcareer prospects for our doctors in public service.

l) TToooo mmaannyy MMeeddiiccaall SScchhoooollss. In the light of the above scenario,MMA joins other bodies concerned as to the possible glut andredundancy of future medical graduates. Too many are nowbeing produced or are returning. Medical schools and collegeslocally should be scrutinized so that the ‘mass production’ ofmore graduates does not undermine the standards and theneeds of the country.

MMA subscribes to the view that there should be a moratoriumon new medical schools and that existing medical schoolsshould not be allowed to exceed their capacity to churn outmore graduates than have been agreed upon, without adequateminimum standards of necessary skilled teacher-student ratio,the availability of medical student clinical clerkship opportunitiesin our overcrowded training hospitals, and the ‘needs’ basis forthe country.

m) MMeeddiiccoo--lleeggaall cchhaalllleennggeess. This will continue to escalate asmore and more of our patients are increasingly empowered,become more knowledge-savvy, as well as expect a lot more.Medical errors and mishaps are now tolerated poorly and thenoften are met with more medico-legal challenges andcomplaints. With the rising costs in medical care, there is also atendency to expect greater clinical results, failing which disputeson charges are rising, with mounting threats of litigation andthreats of professional complaints to MMC and the mass media.

n) EEnnggaaggiinngg wwiitthh ootthheerr hheeaalltthh aanndd mmeeddiiccaall pprrooffeessssiioonnaall bbooddiieessoonn tthhee iinntteerrnnaattiioonnaall lleevveell (WMA, CMAAO, MASEAN, IPPNW)to spearhead consistent policies of common concerns, e.g.global warming-climate change initiatives, human rights inconflict or state-controlled nations, custodial torture and deaths,nuclear disarmament, ‘orphan’ communicable diseases control,global poverty eradication (Millennium Development Goals),healthcare equity and access for all, etc.

3. What is MMA's role in outbreaks like the A/H1N1 influenzapandemic?The MMA has under my lead chosen a cooperative and engagedapproach with regards this recent outbreak. We have taken thelead to disseminate patient education and defuse public panic aswell as to support the MOH’s directives and plans to cope with thisnovel pandemic.

We have also voiced our concerns as to the limited and frustratingrole of private sector doctors during the earlier phase of thispandemic, the lack of consistent downstream transmission oftimely information, inadequacy of algorithms of clinical approachesand therapies, confusing access to referral, medicines andappropriate testing, etc. Happily, most of these have now beenironed out and are much better understood and practiced.

We have also managed to successfully convene an urgentPandemic Flu Conference with the full cooperation from the MOH,which was well received and actively attended by over 700participants. We will continue to help voice our input andsuggestions to further improve the approach towards this stillunraveling pandemic, so that our public can be best served, andour doctors better protected and empowered.

cont’d...pg 6

cont’d...from pg 4

• MALAYSIAN MEDICAL ASSOCIATION • SEPTEMBER 2009

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• MALAYSIAN MEDICAL ASSOCIATION • SEPTEMBER 2009

President’s Page (cont’d)

physically. We need to increase our membership numbers to swellour ranks of meaningful representation—30% is simply too small anumber as of now! We need our doctors to speak up and comeforward on issues that affect our professionalism and our livelihood,or that may adversely affect our patients.

Reaching out to members is proving to be quite difficult andperhaps not timely or quickly enough. The monthly Berita MMAappears wanting in its reach. Dissemination of information andnews does not appear to be fast enough for our members. Somuch so that some members have voiced frustrations and strongviews that the MMA leadership has not been seen to have done oracted promptly enough concerning some urgent professional orpractice issues.

Doctors must learn to use the Internet more proactively and accessinformation and MMA’s standpoints on various issues, morequickly. We continue to experience some hiccups with our MMAwebsite. We are trying to improve and upgrade this so that thishttp://mma.org.my will be a much better, more speedy andcontemporary site for our official news and views.

In the interim, I have offered my personal health blog(http://myhealth-matters.blogspot.com/) as a more constantlyupdated news and views website, which focuses on mainlyprofessional and practice issues. I am also available for email([email protected], or [email protected]) inquiries, contactsand commentaries, which may help reach out to more of ourconcerned members out there.

Finally, members must understand that the mainstream media(MSM) do not and have not always responded to all our pressreleases. The MSM very rarely feel the need to publish any of ourmany communications, and only those, which they feel arenewsworthy for the day or week. This means that most of our pressreleases go unpublished despite our best efforts—most of thepublishing remains the prerogative of the editors and the reporters,as frustrating as this may be to us, when we seem not to get ourmessage across to the public and the doctors at large.

However, there is a silver lining: most of the alternative internetmedia such as Malaysiakini, Malaysian Insider, Malaysian Mirror,Malaysian Medical Resources, Nutgraph have been receptive to ourpress releases although some editing takes place. So please learnto access these alternative media streams for more timely updatesand opinions from our MMA, and myself as the president.

9. Are there any controversies that are unpleasant to discuss inthe open, but which should be shared with all members?Issues of involvement/engagement with the MOH: the MOH’sgeneral and still persistent view and perception that private sectordoctors and institutions are only interested in making money, aretoo uncaring, too blasé as to public health issues such ascommunicable diseases, e.g. dengue fever and the recent A(H1N1)flu, and that our standards of care are below their expectations!The MMA must lead in dispelling such misperceptions, and worktowards greater cooperation and commonality of purpose.

National issues which impact on health and human rights must beaddressed and be openly brought out into national consciousness:national health financing issues, integration of public-private sectorplans, pharmacist-doctor separation of duties, planned Qualityassurance programs such as MSQH for all private clinics,AFTA/MRA trade opening of the healthcare sector issues;inadequate debate on the required number of medical schools,doctors for our healthcare system and its potential glut andpotential declining standards, etc.

We must take the lead to expose injustices, perceived wrongdoingsand social inequities so that we can enhance civil society as awhole, as part of a more enlightened professional movement. Thereis much to do, but these are challenges, which I am convinced thatthe MMA can make important contributions, and perhaps leave alittle impact of good and social justice in our wake. �

for professional consultation must be made aware of andinculcated into the public mindset.

Furthermore, pharmacists too are professionals, and are not merelydispensers of drugs and medicines, nor convenient suppliers ofhealth and beauty products! They too have professional duties,which command more than the simplistic view that their tasks aresimply to dish out cheaper discountable medicines and free drugadvice!

We need to continue to educate our patients and our rakyat thatboth doctors and pharmacists are professionals who areexpensively and extensively trained for specific tasks at helpingpatients obtain the best healthcare advice and experience. Untilsuch time, patients and our rakyat cannot abdicate their personalduty and opt for the simplest way out.

Purchasing medicines without prescription or reviews at doctorvisits, is dangerous and self-defeating in the long term, and mayeven be catastrophic. The public must recognised that mostscheduled medications should be used correctly and must besupervised and monitored by their doctors; this step cannot bedispensed with, just for saving a few dollars!

Our continuing professionalism demands that we expose suchwrongful illegitimate activities, so that together both doctors andpharmacists can further enhance their roles up a few notches. Weneed to re-educate our rakyat that doctors and pharmacists are notjust medication dispensers! Cost and convenience considerationswhile important should be better managed and understood by all.

7. What is the MMA’s stand on private hospitals, insurancecompanies and MCOs taking a percentage of professional fees foradministration? Isn’t this a form of kick back or fee splitting? Whatabout specifying and volume contracting for lower fees as well? We are in principle opposed to any form of discounted businessarrangements, which encourage promises of greater volume ofpatient referral to certain medical establishments. This inducementcan be construed as fee splitting and may constrain patient choiceunfairly based on pure economic incentives rather than professionalreasons. We recognise that some private hospitals are veryaggressively marketing their services with such incentives in mindbut which only undermines the professionalism and morale of theirdoctors.

The MMC has already responded to queries by the MOH AmalanDivision, by stating categorically that volume discounts and bulkpurchasing of professional services (doctors fees) is tantamount tokickback and fee splitting, and thus, should not be allowed andmay breach professional conduct. However, other non-professional services such as laboratory tests, room charges andpharmaceutical charges may be subject to market forces.

8. What are some other obstacles you face or anticipateencountering?Having not having enough time, personal resources and energy totackle all these issues. I worry about continuity of purpose andinvolvement from our future leaders and membership. Too manydoctors are simply not interested enough, and expect a fewdedicated volunteers to take up the cudgels of responsibility andaction to get involved.

This is not to imply that as leaders (for a relatively short span oftime, 1 to 2 years), we can all make earth-shaking impacts whichlast—but we have certainly to try leave some imprints which defineour better nature and perhaps would have left some legacy oftrickle-down, step-by-step advances in our lives and that of ourhealthcare system and our profession.

Events may actually overtake us if we do not represent ourselvesmore vigorously and with full support from our doctors—we needgreater participation and more support both ideologically and

cont’d...from pg 5

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8 Secretary's Page

• MALAYSIAN MEDICAL ASSOCIATION • SEPTEMBER 2009

The MMA is an organisation involved with the

mammoth task of looking after the welfare of

doctors. In doing so we need to look after

several aspects related to the medical profession. It

would be virtually impossible for the office –bearers

themselves to look after the affairs of the MMA. MMA

has thus, formed several Committees – 3 main and 28

other Committees with 34 other representatives to

several NGOs and MOH Committees. To function

effectively, the Committees within MMA meet about

100 times a year. The total number of meetings with

MOH itself amounts to almost 200 with a similar

number of meetings with NGOs.

MMA calls for volunteers annually to serve in these

Committees. They are usually limited to a five year

term provided they attend meetings regularly. This

would give a larger number of members a chance to

serve the MMA. Normally before the AGMs a circular

is sent out to this effect, seeking members to volunteer

to serve in these Committees. The PPSMMA and

SCHOMOS Committees are elected at the AGM.

Members must appreciate the immense work done by

MMA to promote the welfare and look after the rights

and concerns of doctors (even non-members).

Doctors are urged to become members of the MMA

and be more involved in the affairs of the MMA, after all

it is the only national association for doctors. �

Main Committees 3

Other Committees 28

Total Number of Committees 31

Number of Meetings per year 78

Representatives to MOH 9

Representatives to NGOs 25

Dato’ Dr N.K.S. TharmaseelanHonorary General Secretary

NNoottee:: TThheerree mmaayy aallssoo bbee aaddddiittiioonnaall eemmeerrggeennccyy mmeeeettiinnggss

Total Number of MOH Meetings 167Number of NGOs/Other Meetings 210MMA Exco Meetings 6MMA Council Meetings 6HGS-Staff Meetings 6Managers/HGS Meetings 52

FFiigg.. 11:: NNuummbbeerr ooff MMeeeettiinnggss PPeerr YYeeaarr

Total number of members (excluding students) 8046Total number of student members 2633

NNoo PPeerrcceennttaaggeeLife Members 26 1Ordinary Members 225 7Renewals 2454 78Lapsed & Rejoined 201 6Students 250 8

From the Desk of the Secretary....

FFiigg.. 22:: MMMMAA MMeemmbbeerrsshhiipp SSttaattiissttiiccss FFrroomm 11 JJaann -- 3311 JJuullyy 22000099

FFiigg.. 33:: TToottaall NNuummbbeerr ooff MMMMAA MMeemmbbeerrss

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PPS Column10

• MALAYSIAN MEDICAL ASSOCIATION • SEPTEMBER 2009

Donebedian, an American writer on medical quality talks aboutquality in healthcare as examinable using the concepts ofstructure, process and outcome.

StructureThis refers to the systems you have in place to deal with aspectsof running the practice. If you bulk bill all your patients or are acash only practice, you can get by very easily with a manualaccounting system. If you have multiple surgeries, issueaccounts to all your patients and have several categories of feelevel, your accounting needs may be better handled by acomputerized accounting system. The structure of your practicewill determine how you may best deal with patient accounts.

ProcessProcess refers to how the structures you have in place function.Let us assume you are bulk billing all your patient contacts.Process issues would include items such as:• Do you get vouchers signed for all your patients?• Are the vouchers correctly filled in?

OutcomeOutcome refers to what happens after an event occurs. Infinancial terms this is the amount of money you take home fromthe practice. In other areas of practice performance, outcomesmay be more difficult to measure readily.

(Source : www.racgp.org.au/runningapractice/evaluation)

Seven Steps to Patient Safety in General Practice

SStteepp 11 :: BBuuiilldd aa SSaaffeettyy CCuullttuurree• Carry out an audit to assess your team’s safety culture.• Highlight successes and achievements in improving safety,

and be open and honest when things go wrong.• Apply the same level of rigour to all aspects of safety,

including incident reporting and investigation, complaints,health and safety, staff protection and clinical qualityassurance.

• A strong safety culture requires – leadership, teamwork,accountability, understanding, communication, awareness ofworkload pressures and safety systems.

SStteepp 22 :: LLeeaadd aanndd SSuuppppoorrtt yyoouurr PPrraaccttiiccee TTeeaamm• Talk about the importance of patient safety and demonstrate

you are trying to improve it by including an annual patientsafety summary in your practice report or your PracticeQuality Report.

• Include patient safety in in-house staff training, including theuse of improvement methods, and ask for it to be part ofcontinuing education outside of the practice.

• Promote safety in team meetings by discussing safety issuesand making it a standing agenda item.

SStteepp 33 :: IInntteeggrraattee yyoouurr RRiisskk MMaannaaggeemmeenntt AAccttiivviittyy• Regularly review patient records (e.g. using case note review

tools) so that areas of common harm such as delayed ormissed diagnoses/treatment can be identified.

Definition of Quality

The Institute of Medicine defines quality as:

“…….the degree to which health services forindividuals and the population increase thelikelihood of desired health outcomes and areconsistent with current professional knowledge.”

Donabedian argues that ‘every healthcare practitioners and everyhealthcare institution has two major objectives: (1) to providecare of the highest possible quality, and (2) to provide care at thelowest possible cost. He identifies three components:• SSttrruuccttuurreess:: material resources, facilities, equipment and the

range of services at the practice level.• PPrroocceesssseess:: what is done in giving and receiving care.• OOuuttccoommeess:: the effects of care on the health status of the

patient and the community.

The ‘Health For All’ policy outlined a quality framework foradvancement of health promotion internationally. Colloquiallyknown as the Ottawa Charter, the framework identifies a series ofprinciples and strategies. The principles are:• The prerequisites for health such as peace, shelter, education,

food, income, stable ecosystem, sustainable resources, socialjustice and equity.

• Advocacy within political, economic, social, cultural,environmental, behavioural and biological systems.

• Enable equity in health care for all; and• Coordinated action by all concerned to promote health.

The strategies are:• Building healthy public policy;• Creating supportive environments;• Strengthening community action;• Developing personal skills; and• Reorienting health services.

The six dimensions of quality:1. Safe – avoiding injuries to patients from the care that is

intended to help them.2. Effective – providing services based on scientific knowledge

to all who could benefit and retaining from providing servicesto those not likely to benefit (avoiding under use and overuse,respectively).

3. Patient-centred – providing care that is respectful of andresponsive to individual patient preferences, needs and valuesand ensuring that patient values guide all clinical decisions.

4. Timely – reducing waits and sometimes harmful delays forboth those who receive and those who give care.

5. Efficient – avoiding waste, including waste of equipment,supplies, ideas and energy.

6. Equitable – providing care that does not vary in qualitybecause of personal characteristics such as gender, ethnicity,geographic location or socioeconomic status.

(Source: A Quality Framework for Australian General Practice,Background Paper July 2005, The Royal Australian College of GeneralPractitioners)

QUALITY IN GENERAL PRACTICE

cont’d...pg 11

by Dato’ Dr Mohan SinghPPS Chairman

Page 11: MMA September 09(L)

PPS Column (cont’d) 11

• MALAYSIAN MEDICAL ASSOCIATION • SEPTEMBER 2009

o Try to find solutions which design out the problem so thatit is difficult to get it wrong.

o Introduce the solution that fits and explain to everyone why.

o Test it using small scale change methods and keep checking until you feel it is fully implemented.

o Review the actions after a period of time to see if they haveworked.

o Keep finding new solutions until the data shows acceptable improvements.

(Source: Seven Steps to Patient Safety in General Practice, NationalPatient Safety Agency, National Reporting and Learning Service)

Evaluating Physician CompetenceThere are two categories of methods for the formal assessmentof physician activities – the assessment of performance in testsituations, and the assessment of performance in actual practice.

Testing for competence is a broad and complex subject. Itseems, however, that testing for knowledge alone is insufficient.The test situation should be so constructed as to elicit clinicaljudgment and problem solving skills. Ability to elicit and interpretsensory data (for example, in auscultation) should also beincluded. It is likely that even the availability of multimediaproductions the assessment of actual patient care will remain theultimate test.

Actual practice may be assessed by observation, either directlyor through videotape; by records of care kept by the physician,other professionals and, even, the patient; by interviews with thephysicians, or questionnaires; and by formal ways of obtainingthe opinions of other knowledgeable persons in the informalnetwork to which we have already referred.

Each of these methods has uses and limitations.

There is now no one best method for assessing physiciancompetence. We must rely on a system of assessment thatincludes attributes, activities and achievements. Our qualityassurance system must also include attention to all threecomponents. In particular, health care programmes must not berestricted by structural and process standards, and we must beunalterably opposed to such suggestions so that theseprogrammes can experiment in new and more efficient ways ofachieving comparable outcomes. The search for more efficientways of achieving given outcomes is a major researchundertaking which must be conducted with rigorous controls byfully qualified and unbiased investigators.

More important than the technical refinement of the system ofquality assurance that is adopted is the commitment to qualitywhich makes the system work.

Physicians must insist that any system for quality assessment becongruent with a realistic view of what constitutes good care,their obligations to safeguard the interests of their patients, andthe means at their disposal.

(Source: Evaluating Physician Competence, Avedis Donabedian, Bulletinof the World Health Organization, 2000, 78 (6))

HHeeaalltthh PPrreevveennttiioonn aanndd PPrroommoottiioonn iinn GGeenneerraall PPrraaccttiicceeMore than any other area of medicine, general practice is thespecialty where GPs can help patients work toward being thehealthiest they can be. It is personalized case based on anongoing relationship with patients in the context of their family,friends and community. Preventive case is based on apartnership between a GP and a patient, designed to help eachpatient reach his/her goals of maintaining or improving health.

• Involve wider primary healthcare team members in improvingpatient safety and use information from as many sources aspossible to measure and understand safety issues in thepractice.

• Risk management is built into many aspects of a practice’swork: complaints handling, infection control, monitoringenvironmental risks, protecting vulnerable children, protectingstaff, insurance and reviewing repeat prescriptions before theyare signed.

• A key element of risk management is prevention. A saferpractice:o Includes patient safety considerations in every decision

the practice makes;o Has complete and accurate medical records;o Uses computerized decision support and responds

appropriately to computer warnings, but does not let the computer stop them being alert;

o Uses regular systematic case note review to identify and measure adverse events;

o Does regular audits looking for avoidable acute admissions(many of which in the elderly are due to medication), interactions and patients lost to follow up (on anti-coagulation for example);

o Tries to anticipate risks (e.g. double-checking drugs beforeinjection).

SStteepp 44 :: PPrroommoottee RReeppoorrttiinngg• Record events, risks and changes, and include them in your

annual practice report.• Cascade safety incidents and lessons learned to all your staff

and other practices through your primary care organization.

SStteepp 55 :: IInnvvoollvvee aanndd CCoommmmuunniiccaattee wwiitthh PPaattiieennttss aanndd tthheePPuubblliicc• Seek patients’ views, especially on what can be done to

improve patient safety, and use complaints as a vital part of amodern, responsive practice.

• Encourage feedback using patient surveys and websites.• Involve your practice population via patient groups, open

meetings or by inviting patient representatives to patientsafety meetings.

SStteepp 66 :: LLeeaarrnn aanndd SShhaarree SSaaffeettyy LLeessssoonnss• Make the discussion of significant events and the national

analyses of patterns of risk everybody’s business, includingthe wider primary healthcare team as appropriate, and act onyour findings.

• Share experiences with other practices by making yourpatient safety lessons widely available.

SStteepp 77 :: IImmpplleemmeenntt SSoolluuttiioonnss ttoo PPrreevveenntt HHaarrmm• Ensure that agreed actions to improve safety are documented,

action taken and reviewed, and agree who should takeresponsibility for this.

• Use technology, where appropriate, to reduce risk to patients.• Involve both patients and staff as they can be key to ensuring

proposed changes is the right ones.• All actions, where possible, need to be simple, appropriate,

easy to achieve, measurable, sustainable and effective. Set atimescale and agree who will be responsible for carrying it out.Agreed actions should be reviewed to be sure that they arebeing implemented. The key steps are :o Raise awareness of the risk or issue.o Measure the size of the problem where possible.o Increase understanding of the problem and the potential

solution.o Identify the best solution to the problem.

cont’d...pg 13

cont’d...from pg 10

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12 From the Desk of

• MALAYSIAN MEDICAL ASSOCIATION • SEPTEMBER 2009

best healthcare to the public. In 2008,government doctors provided services to 2million in-patients and 62 million outpatientsin 2008. This year the number of patients seen has escalatedsignificantly following the current economic downturn and theInfluenza A (H1N1) pandemic.

To complicate matters, in 2008, only 60% of doctors are in thepublic sector although they are responsible for serving 77.4% ofthe total hospital beds in Malaysia. The remaining 40% ofdoctors are in the private sector and are responsible for theremaining 22.6% of hospital beds.

Our doctors and other allied health professionals have beenworking very hard to provide the best of care for our patientsdespite the many constraints, challenges and risks they faceeveryday.

The Ministry of Health has been working very hard to improve theterms and conditions of service, remuneration and workingconditions of the doctors. Various measures have been takenand will be further implemented to ensure doctors continue toserve in the MOH. These include the creation of new allowances,improving current allowances such as the critical and on-callallowances, providing incentives for those working extendedhours (RM80.00/hr) and those operating on Saturdays(RM200/hr), allowing locum in private healthcare settings andservicing private patients after office hours or during weekends(full paying patients) and many more. In addition, the MOH hascreated more opportunities for doctors to get promoted to highergrades to retain them in the public health system even though themonetary gain is relatively lower than in the private sector.Efforts have also been made to improve the working environmentby providing conducive examination rooms for doctors especiallythose in new hospitals with IT facilities. Those working in olderhospitals, sadly, are sharing rooms, making it difficult for them toprotect the privacy of their patients. The MOH has already madean urgent appeal to the government to provide more resources toupgrade these older hospitals in terms of renovations andrefurbishments, providing more ICU beds and examinationsrooms, modern equipments and others. The Government issympathetic and we hope to get clearance soon to be able to dothis in many of our older hospitals, some of which are more than20 years old.

We do appreciate the sacrifices of our house officers anddoctors. We are doing everything in its power to fight for betterremuneration, allowances and better promotional prospects.We have also made a proposal to set up the Medical ServicesCommission. Many of our recommendations need the supportof central agencies in the government. We are also mindful ofthe sacrifices of parents in funding medical education for theirchildren and has recommended to the Malaysian MedicalCouncil (MMC) to reduce the compulsory service from thepresent 3 years to 2 years.

TThheerree hhaavvee bbeeeenn mmaannyy lleetttteerrss aanndd ccoommmmeennttssmmaaddee aabboouutt tthhee rroollee ooff tthhee MMiinniissttrryy ooff HHeeaalltthh((MMOOHH)) iinn iimmpprroovviinngg tthhee lloott ooff ddooccttoorrss wwoorrkkiinngg iinn

tthhee ppuubblliicc sseeccttoorr.. IItt iiss oobbvviioouuss tthhaatt mmaannyy ddoo nnoott kknnoowwhhooww tthhee ggoovveerrnnmmeenntt mmaacchhiinneerryy wwoorrkkss.. WWhhiillee tthheeMMOOHH ccaann ccoommee oouutt wwiitthh bbrriilllliiaanntt iiddeeaass aanndd iinnnnoovvaattiivveessttrraatteeggiieess,, tthheessee mmaayy nnoott mmeeaann mmuucchh iiff tthhee cceennttrraallaaggeenncciieess aarree nnoott ssyymmppaatthheettiicc oorr uunnwwiilllliinngg ttoo ddiiggeesstt tthheeaarrgguummeennttss wwee ppuutt ffoorrwwaarrdd.. YYoouu mmaayy sseennssee tthhaatt IIssoouunndd ddiissaappppooiinntteedd oorr ffrruussttrraatteedd bbuutt tthhaatt iiss tthhee rreeaalliittyy..GGrraanntteedd,, tthhee cceennttrraall aaggeenncciieess hhaavvee ddoonnee aa lloott uunnddeerrtthhee pprreesseenntt CChhiieeff SSeeccrreettaarryy,, TTaann SSrrii MMoohhdd SSiiddeekkHHaassssaann aanndd tthhee DDiirreeccttoorr--GGeenneerraall ooff PPuubblliicc SSeerrvviicceessDDeeppaarrttmmeenntt,, TTaann SSrrii IIssmmaaiill AAddaamm.. IInnddeeeedd,, yyoouu ccaannnnoottggeett bbeetttteerr ssuuppppoorrtteerrss tthhaann tthheessee ttwwoo ffiinnee ggeennttlleemmeenn..OOuurr SSeeccrreettaarryy--GGeenneerraall ooff HHeeaalltthh,, DDaattoo’’ SSrrii MMoohhdd NNaassiirrMMoohhdd AAsshhrraaff,, iiss aallssoo vveerryy ssuuppppoorrttiivvee bbuutt wwhhaatt II ffiinnddddiissccoonncceerrttiinngg ssoommeettiimmeess iiss tthhee llaacckk ooff uurrggeennccyy ooff tthheeiimmpplleemmeennttaattiioonn ooff iinnssttrruuccttiioonnss ffrroomm tthhee ttoopp.. SSoommee ooffoouurr tthhee mmiiddddllee mmaannaaggeerrss eeiitthheerr rreessppoonndd sslloowwllyy ttooiinnssttrruuccttiioonnss ffrroomm tthhee ttoopp oorr ppuutt iinn ccoonnddiittiioonnss uunnkknnoowwnnttoo tthheeiirr bboosssseess ttoo eennssuurree tthhaatt aallll ddeecciissiioonnss mmaaddee aarree‘‘ccoorrrreecctt’’ aanndd ‘‘ffoollllooww pprroocceedduurreess””.. TThheerreeiinn lliieess tthheebbuurreeaauuccrraattiicc ttrraapp.. PPeerrhhaappss tthheeyy mmeeaann wweellll bbuutt tthheeyysseeeemm ccoommffoorrttaabbllee bbeeiinngg eennssllaavveedd bbyy tthhiiss bbuurreeaauuccrraaccyyaanndd bbeeccaauussee ooff tthhiiss aanndd tthhee ffaacctt tthhaatt tthheeyy tthhrriivvee oonnoorrtthhooddooxx pprraaccttiicceess,, ddeecciissiioonnss mmaaddee ccoolllleeccttiivveellyy aatt tthheettoopp mmaayy ssoommeettiimmeess bbee iimmpplleemmeenntteedd mmoonntthhss llaatteerr,, tthhaattttoooo aafftteerr sseevveerraall rreemmiinnddeerrss..

The Ministry of Health (MOH), as the primary government agencyresponsible for providing healthcare to the public, is committedto providing equitable, accessible and affordable healthcareservices to all Malaysians. The role is all the more daunting,taking into consideration the mounting challenges in the planningof optimum and acceptable services including changing diseasepatterns, a well informed and demanding public, rising costs ofhealthcare, new medical technologies and globalisation andliberalisation.

One of the most important components in improving theeffectiveness of the healthcare delivery system is an efficient andcompetent medical workforce. As such, the MOH is workingtirelessly to address the shortage of skilled medical and healthpersonnel, especially doctors. For this purpose, 24,135 posts ofdoctors have been created. However, as of December 2008, only57% (or 13,762 posts) have been filled. Only 2,545 of the postsfilled are specialists from various disciplines and grades (UD 41and above).

Even though the current number of healthcare workers is far fromsatisfactory, the Ministry of Health is commited to providing the

Tan Sri Dato’ Seri Dr Mohd Ismail MericanDirector-General of Health, Malaysia

Better Prospects for Doctors Working in the Ministry of Health

cont’d...pg 13

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13From the Desk of (cont’d)

and mentors and set a good example for our younger colleagues.The junior doctors must have the perseverance, resilience andpatience to go through the training expeditiously and obediently.If they feel they are being shortchanged or treated unfairly, I willbe happy to see them.

As for medical officers who do not have specialisation, we areworking on a timed-based and flexible promotion for them. Itsaddens me to learn that some of our medical officers (withoutspecialization) have retired on low grades even after putting inlong years of valuable and loyal service. With this proposal, theywill get promoted when due even if they stay on as ordinarymedical officers. Those who obtain their postgraduatequalifications will of course be promoted earlier. With this newinitiative, the days of medical officers, some of whom are gurkhasin the department, being neglected or overlooked for promotion,will be history. Please be patient while we work on this.

To address the shortage in the short term while waiting for ourlong term measures to bear fruit, the MOH has invited thoseworking abroad and those in the private sector to work with us.We have already placed advertisements and hope they willrespond favourably and rise to the challenge of providing goodquality healthcare to all who seek treatment in this country.

The MOH, despite the many constraints, challenges and limitedresources, will strive to deliver the best medical and healthcare tothe public. We have a great team that is overworked andstressed. We hope the central agencies will respond favourablyto all our many requests to improve the working conditions,remunerations and career propects of our healthcare personnel.They certainly deserve better. �

We appreciate the long hours houseman and junior doctors haveput in. Housemanship training is a period of apprenticeship aftergraduation from medical school before new graduates are givenfull registration to practice independently as doctors. The 2-yearhousemanship training is necessary to further improve thecapacity and capability of our trainee doctors. Upon completionof the housemanship training, they will be confirmed in serviceand be promoted to UD-44, a big jump considering that there aredoctors serving more than 4 years who are still on U-41. Torectify this, the latter group will be automatically promoted to U-44 by the end of this year. There are still some problems withthis exercise. Apparently many of our young medical officershave not obtained their full registration from the MalaysianMedical Council (MMC). It is obvious that the reason for thedelay is because our housemen have not applied for fullregistration even after successful completion of theirhousemanship. Attempts to get the various sections signed bythe relevant specialists may prove difficult as some of thespecialists may no longer be there. So I urge SCHOMOS toinform all house officers to make sure they fill up the forms for fullregistration well before they complete their housemanship toavoid unnecessary delay in their promotion.

Housemanship training program, to me, is the most importantpart of a doctor’s career. It moulds the housemen to becomegood and safe doctors. It is also the first big step for them in thelong journey of the medical profession. But for training to beeffective there has to be mutual respect between our youngercolleagues and the more senior ones. The senior doctors mustfulfill their responsibilities as service providers, teachers, trainers

o Tertiary – reducing impairments and disabilities, minimizingsuffering caused by existing departures from good health orillness, and promoting patients’ adjustment to chronic orirremediable conditions, e.g. prevention of complications byself monitoring of defined parameters supported by their GP.

GPs provide comprehensive, holistic health care to patients,including preventive, curative and rehabilitative care on acontinuous and long term basis to all member of a community. Akey role of general practice is to prevent disease. �

Prevention is often defined as having three levels:o Primary – the promotion of health and the prevention of

illness, e.g. immunization and making physical environmentssafe.

o Secondary – the early detection and prompt intervention tocorrect departures from good health or to treat the early signsof disease, e.g. cervical screening, mammography, bloodpressure monitoring and blood cholesterol checking.

cont’d...from pg 12

cont’d...from pg 11

Prevention Services

Level General Practice Example

Health enhancement/promotion Health lifestyle counseling including nutrition and physical activity advice.Risk avoidance/remaining healthy Ensuring that those at low risk of disease remain at low risk through immunization,

encouragement of breastfeeding and physical activity.Risk reduction Targeting individual patients or groups with a moderate or high risk of disease or injury. Includes

advising on smoking, alcohol, unsafe sexual practices, mammography and screening and treatingpatients for risk factors such as high blood pressure and raised serum cholesterol levels, opportunistic screening for depression.

Early detection Screening those detected with diseases at an asymptomatic stage when treatment can improvethe outcome. Risk is assessed through consideration of the evidence applied to particular patients or groups. Includes recommending mammography screening, pap tests, faecal occult blood test for colon cancer.

Complication reduction Prescribing treatments for those with an illness to prevent further complications, including influenza immunization for those with a chronic disease, pneumococcal vaccination for smokers,use of warfarin in the presence of atrial fibrillation to reduce the incidence of stroke, lipid loweringagents to reduce the incidence of subsequent coronary events, best practice management of chronic disease, e.g. tight control in diabetes, hypertension.

(Source: The Role of General Practice in Prevention and Health Promotion, Policy endorsed by the 48th RACGP Council, 18 May 2006)

((NNeexxtt iissssuuee OOcctt –– QQuuaalliittyy aanndd SSaaffeettyy iinn HHeeaalltthhccaarree))

• MALAYSIAN MEDICAL ASSOCIATION • SEPTEMBER 2009

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14 SCHOMOS

• MALAYSIAN MEDICAL ASSOCIATION • SEPTEMBER 2009

SCHOMOS with MMA Exco were fortunate to have met up with Tan Sri Dato’ Sri Dr Ismail Merican,

Director-General of Health, Malaysia recently on 1 September at Sheraton Imperial, Kuala Lumpur.

This yearly informal meeting was held in conjunction with the Ramadan Buka Puasa. Dr Mary Suma

Cardosa, President-Elect, represented Dr David Quek, the President of MMA.

Many issues were brought up during this informal meeting and DG was kind enough to listen to SCHOMOS

and update us on many important issues. Below is a summary of the issues discussed.

1) MMeeddiiccaall SSeerrvviiccee CCoommmmiissssiioonn – DG had already prepared and presented a comprehensive proposal to

JPA and Ministry of Finance. This is awaiting approval before this matter can be brought up to Cabinet.

2) UUDD 4444 PPrroommoottiioonnss – Currently on-going with many teething problems, but is optimistic that this exercise

can and must be completed by October 2009. DG gave his personal assurance that he will personally

look into this matter with great importance.

3) EEllaauunn BBaalliikk KKaammppuunngg – Circular is on JPA website dated 1 January 2009.

4) HHaarrddsshhiipp AAlllloowwaannccee – SCHOMOS brought this issue to DG’s attention because the circular is not yet

available although the approval was announced by the Health Minister recently.

5) PPuubblliicc HHeeaalltthh PPrroommoottiioonn aanndd AAlllloowwaannccee IIssssuuee – DG commented that this issue had been solved at

MOH level and awaiting JPA approval.

6) HHoouussee - Officers’ Grouses

i) SShhiifftt DDuuttyy – DG clearly stated that this practice is a “no-no” and is shocked that certain departments in

certain hospitals are still practicing this policy and vowed to investigate the matter with SCHOMOS help.

ii) HHoouusseemmaasshhiipp eexxtteennssiioonn - House officers’ grouses regarding extension of housemanship due to failure

of completion of log book as a result of OT closure in Hospital Taiping was also brought to DG’s attention.

He sympatised with the house officers and promised to look into this matter.

7) MMeemmbbeerrsshhiipp DDrriivvee dduurriinngg IInndduuccttiioonn ooff nneeww ddooccttoorrss – DG agreed to help SCHOMOS on this matter

whereby a slot will be alotted to SCHOMOS during the induction period for membership drive.

SCHOMOS will also be organising a second seminar on “Rights and Responsibilities of Government

Doctors” on 5 December, 2009 in Penang. The first such seminar was held last year in Kuala Lumpur with

overwhelming response. DG has consented to deliver the keynote address at this seminar. It is hoped that

many government doctors will take this opportunity to attend this one day seminar. �

SCHOMOS Meets Director-General of Health

by Dr Harvinder SinghNational SCHOMOS Chairman

Front row L – R : Dato’ Dr N.K.S. Tharmaseelan, Dr Harvinder Singh, Tan Sri Dato’ Seri Dr Hj. Mohd Ismail Merican, Dr Mary Suma Cardosa, Dr Hooi Lai Ngoh and Dato’ Dr Khoo Kah Lin

Back row L – R : Dato’ Dr Mohan Singh, Dr S. Thevendran, Dato’ Dr Maria Ithaya Rasan, Dr S. Elangovan and Dr Kuljit Singh

Page 15: MMA September 09(L)

DNA MgzAd.ai 9/12/09 11:29:38 AM

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44.. MMeeddiiccaall PPllaannss ffrroomm AAlllliiaannzz LLiiffee IInnssuurraannccee MMaallaayyssiiaa BBhhddaanndd PPrruuddeennttiiaall AAssssuurraannccee MMaallaayyssiiaa BBhhdd..These two plans were short-listed in 2008 after an analysis ofexisting hospitalisation plans available to the general public.In view of the unfavourable claims experience of previousGroup Medical Insurance schemes for MMA membersmentioned above it was not possible to persuade anyinsurance company to underwrite a special hospitalisationscheme for doctors.

The Allianz plan allows entry up to 60 years of age whereas theentry age for the Prudential plan is up to 70 years. Both plansensure guaranteed renewal up to 80 years of age.

TThhee AAlllliiaannzz ppllaann pprroovviiddeess tthhee ffoolllloowwiinngg::(a) Daily room and board benefit ranging from RM80 to RM300.(b) Reimbursement for major benefits including hospital services

and supplies, surgical and anaesthetist/operation theatrefees on an “as charged” basis.

(c) There is an overall annual limit ranging from RM25,000 toRM150,000 and an overall lifetime limit ranging fromRM250,000 to RM1.5 million.

(d) Some outpatient services such as those for renal dialysis,stroke and cancer treatment are covered with annual limitsranging from RM5,000 to RM20,000 depending on the planselected.

(e) The amount deductible from the policy (zero, RM2,000,RM5,000, RM10,000 or RM15,000) can be selected by theinsured member and the premium will be lower if the amountdeductible is increased.

(f) Premiums increase each time the member falls into a higherage band.

TThhee PPrruuddeennttiiaall ppllaann hhaass tthhee ffoolllloowwiinngg ffeeaattuurreess::(a) Daily room and board benefit of RM200.(b) Reimbursement for major benefits including hospital services

and supplies, surgical and anaesthetist/operation theatrefees on an “as charged” basis subject to co-insurance at10% or a minimum of RM3,000 - RM6,000 as selected.

(c) There is a lifetime limit of RM225,000.(d) Cover for outpatient renal dialysis and cancer treatment on

an “as charged” basis subject to 10% co-insurance amount.(e) Premium will be charges based on entry age (next birthday)

and will remain unchanged at each renewal.�

The details of these two hospitalisation schemes can beaccessed from the MMA’s website athttp://www.mma.org.my/MemberServices/Insurance/tabid/73/Default.aspx otherwise please contact:

AAOONN IInnssuurraannccee BBrrookkeerrss ((MM..)) SSddnn.. BBhhdd..7th Floor, Bangunan Malaysian Re

No. 17, Lorong DungunDamansara Heights50490 Kuala Lumpur

Tel: 03-2095 6628Fax: 03-2095 6618

CCoonnttaacctt PPeerrssoonnss::Mr. Sarjit Singh (Mobile: 016-2012413)

Email: [email protected] Zaidon Mohd (Mobile: 016-3756884)

Email: [email protected]

Update on Hospitalisation Plans for MMA Members

by Dr Hooi Lai NgohHonorary General Treasurer & Chairman MMA Insurance Committee

I am writing to provide an update and review of hospitalisationmedical plans available in collaboration with AON InsuranceBrokers (M.) Sdn. Bhd. for the benefit of members of theMalaysian Medical Association.

11.. PPaacciiffiicc IInnssuurraannccee BBeerrhhaadd 11998822 –– 22000044TThhiiss GGrroouupp MMeeddiiccaall IInnssuurraannccee SScchheemmee iinncclluuddeedd tthheeffoolllloowwiinngg ffeeaattuurreess::

(a) Daily room and board benefit ranging from RM100 to RM150.(b) Reimbursement for hospital services and supplies, intensive

care unit and theatre benefits on an “as charged” basis.(c) Cover for daily hospital income was incorporated.(d) There was an overall annual limit.

There were no complaints from members about this schemewhich was in force for a good 22 years. However, PacificInsurance Berhad gave notice of withdrawal effective from 1stSeptember 2004 since the amount of premium generated wasnot substantial and the company suffered losses each year fromthis scheme.

22.. PPaacciiffiicc IInnssuurraannccee MMeeddii--CCaarree IInnssuurraannccee SScchheemmee 22000044 --22000099This catered for the renewal policies of members insuredunder the Group Medical Insurance Scheme which wasterminated in 2004. The features included:

(a) Daily room and board benefit ranging from RM80 to RM400.(b) There were sub limits for hospital services and supplies,

intensive care unit, surgical fees and other benefits.(c) There was an overall annual limit.

There has been two complaints from members in recent monthsparticularly relating to inadequate coverage for Hospital servicesand supplies (sub limit RM2,000 to RM6,000 depending on theplan selected). This was related to escalating medical chargesfor Hospital services and supplies in recent years. PacificInsurance Berhad has informed members insured under thisscheme that it will not be inviting renewal of policies that fall duefrom 1 January 2010.

33.. JJeerrnneehh IInnssuurraannccee BBeerrhhaadd HHoossppiittaalliissaattiioonn PPllaann 22000011 -- 22000088TThhee sscchheemmee wwaass llaauunncchheedd iinn 22000011 aanndd hhaadd tthhee ffoolllloowwiinnggffeeaattuurreess::

(a) Daily room and board benefit ranging from RM150 to RM300.(b) Reimbursement of major benefits including hospital

miscellaneous services, surgical fees and anaesthetist feeson an “as charged” basis.

(c) Maximum benefit under any one disability ranging fromRM40,000 to RM75,000.

There was only one complaint from a member who wanted threerelated medical conditions to be considered as separatedisabilities, and an amicable additional settlement was made toconclude the case. Jerneh Insurance Berhad had to underwritelosses every year from this scheme; in view of the unfavourableclaims statistics the company gave notice of withdrawal from thescheme effective from 1 September 2008.

16 Insurance

• MALAYSIAN MEDICAL ASSOCIATION • SEPTEMBER 2009

Page 17: MMA September 09(L)

17Press Statement

Australian ParkNamed AfterMalaysian Doctor

MMEELLBBOOUURRNNEE:: The city of Ipswich, about40km from Brisbane, has dedicated a new18ha park in Redbank Plains to a much-loved Malaysian doctor who has served thelocal community for nearly 30 years.

Mayor of Ipswich Paul Pisasale said thepark was named after Dr Kamalakaran‘Harry’ Ratnam “to celebrate hisprofessionalism, dedication, loyalty andcompassion to the Ipswich community.”

“Dr Ratnam, who arrived in Australia, andin Ipswich in 1981 with his wife Raji afteran invitation from the Agent General ofQueensland in England, has served thecommunity ever since, and I believe it isfitting for this magnificent park to benamed after him,” he said.

In 2007, Dr Ratnam, who is the youngerbrother of former judge R.K. Nathan and afirst cousin of billionaire Tan Sri T. AnandaKrishnan, was awarded the prestigious

work done in this area by Dr Harry Ratnam.”

Queensland multimillionaire MahaSinnathamby, formerly of Rembau, NegriSembilan said Dr Ratnam should be “veryproud of his achievements.”

“The whole community of Ipswich lovesthis man. He has done a lot for them,“ saidSinnathamby, who has a boulevard namedafter him.

Most of the 200 people who attended thelaunch of the park at the weekend were DrRatnam’s patients. -- Bernama �

Published: The Star Online Tuesday August 18, 2009

(Picture sourced from the Star Online)

Order of Australia Medal on the Queen’sbirthday honours list for service to medicinein Ipswich.

“I never dreamed in my life that I would getan Order of Australia and then a parknamed after me,” he said. “I never expectedto be rewarded in this way.”

Dr Ratnam, who had his early education atSt John’s Institution, Bukit Nanas, KualaLumpur completed his schooling in Dublin,Ireland. He then entered the Royal Collegeof Surgeons and Physicians in Dublin,graduating in 1977.

Since coming to Ipswich, Dr Ratnam hasserved on many health and welfarecommittees, especially with the elderly.

It even prompted Jo-Ann Miller,Queensland State Parliamentary Secretaryto the Minister of Health, to refer DrRatnam as “an absolute hero” inQueensland State Parliament in April 29,2004.

Ipswich city councillor Victor Attwood, whoproposed the park be named after DrRatnam, said he did it “in celebration of the

Page 18: MMA September 09(L)

future. This collaborative effort has put theotolaryngologist and the neurosurgeon to work

closely via the nose using the two holes and four handtechnique performing the operation simultaneously whichnever happened before.

Clinical Atlas of Nasal Endoscopy, as an introductory atlascontains over 170 illustrative coloured photographs withadditional CT and MRI images by a single author. Thisbook print obviously goes out to show about the author’spassion for his subspecialty interest in rhinology andanterior and ventral skull base surgery. I hope this bookhelps the author spread his passion for rhinology and helptrain more competent endoscopic sinus surgeons inMalaysia in the very near future.

Department of Otorhinolaryngology, UKM Medical Centre,Jalan Yaacob Latif , Bandar Tun Razak, Cheras, 56000-Kuala Lumpur. E-mail:[email protected]

RReevviieewweedd bbyy:: DDrr KKuulljjiitt SSiinngghh

The technological advancements in the expandingfield of rhinology has expedited the publication ofthis Malaysian contribution entitled “Clinical Atlas of

Nasal Endoscopy”. In addition to his numerous academicclinical publications, Prof Dato’ Dr B.S. Gendeh haspreviously published two other books in his keen interestto keep Malaysians updated in his subspecialty of thenose. His two previous book publications were on “SinusSurgery: State of the Art Technique” in 2004 and“Otorhinolaryngology” in 2006. Generally, books inselective specialized fields tend to be expansive, but hiskind contribution towards rhinology may make thisknowledge more easily available to the local medical andsurgical fraternity. This vast collection of his owndescriptive clinical photographs and facts viewed throughthe end of an endoscope, introduces the common man tothe fascinating world of rhinology. Moreover, nasalendoscopy is a cousin to keyhole surgeries and similar todevelopments in gastrointestinal endoscopy in opening upnew horizon in the state-of-the-art Minimally InvasiveSurgery.

The book has six chapters. Chapter one brieflydescribes the development of nasal endoscopy.Chapter two emphasizes on how to perform out-patient endoscopy and the clear visualization ofthe normal or abnormal anatomy of the nose andparanasal sinuses. However, chapter three being thelongest covers the pathophysiology of the disease and thecommon benign and malignant tumors of the nose andparanasal sinuses. Chapter four focuses on patientselection for surgery when optimum medical therapy failsand describes in fair details the surgical procedures thatcan be performed visualizing through the nasalendoscope. Furthermore, this chapter will interest thebudding surgeons with special emphasis on endoscopicsinus surgery. Chapter five lists the instruments thetrainee or the surgeon needs to know to be a goodcraftsman. Finally, the last chapter takes the discussion ofthe therapeutic procedures one step further, beyond thenasal cavity to the cranial base. As rhinologist has gainedmore experience in endoscopic sinus surgery, more areasin the skull base are accessible and surgery is safe. Itdiscusses briefly the technological and surgicaladvancements in the expanded endonasal approach(EEA) to the ventral skull base. It conveys a message tothe reader to “watch this area” with a potential in the near

Clinical Atlas of Nasal EndoscopyAuthor: Balwant Singh Gendeh

PPrriiccee:: RRMM9900PPrriiccee:: RRMM9900 Website: http://www.ukm.my/penerbit

• MALAYSIAN MEDICAL ASSOCIATION • SEPTEMBER 2009

Book Review18

Page 19: MMA September 09(L)

In response to a complaint receivedfrom a concern doctor as to whyGeneral Practitioners located aroundSri Sentosa were not invited toparticipate in the above programme,below was the REPLY received fromDr Nazeli Hamzah, Chairperson ofthe Adolescent Health Sub-Committee.

Sir,

The target participants consisted of 100`selected` students who went through aspecific module to increase their resilienceso they are more able to be in control oftheir actions and not be so easily influencedby negative elements.

The facilitators were members of theAdolescent Health Committee of MMA andyouth members of the Malaysian

Association for Adolescent Health(MAAH). All the facilitators hadundergone training sessions to equip themwith the necessary skills.

Since studies have shown that adolescentscommunicate better with their own peersthan with adults, we have always found thatyouths make great facilitators withsupervision from adults. We are training apool of youths to be drawn upon when wehave similar projects.

As this was our first project in an urbanarea we have not invited other doctors to beinvolved. We will be happy to invite you tojoin us for our subsequent programs.

I take this opportunity to invite all doctorswho have interest in Adolescent Healthissues in their community to please contactthe Adolescent Health Sub-Committee. We

will be more than happy to involve you inour future activities.

Together we can make things happen.

Thank you. �

Dr Nazeli HamzahChairpersonAdolescent Health Sub-CommitteeEmail: [email protected]

EDITORIAL NOTE: All ‘Letters toEditor’ must have full name of theauthors and their membershipnumber. The Editorial Board reservesthe right to decline publishing anyletters/articles without names ofauthors clearly spelt out.

1st MMA/MAAH Urban Outreach - Programme at SMK Sri Sentosa K L, 18 July 2000

Berita August 2009

19Letter to Editor

ACADEMY OF FAMILY PHYSICIANS OF MALAYSIA

Akademi Kedoktoran Keluarga Malaysia

Diploma in Family Medicine (DFM ) 2010/2011

The Academy of Family Physicians, Malaysia recognizes the need for training all General Practitioners to a level of competence in Good MedicalPractice to meet the national healthcare delivery standards. AFPM has developed a two year (four semesters) Distance Learning Programmefor Diploma in Family Medicine. The objective of this Online Learning Programme is to provide flexibility in learning for all General Practitionerswho meet the entry requirement.

The course delivers high level teaching materials covering all subject areas of interest to General Practitioners. With the Online tutorial support,Online assignment and MCQ test system, the students will be exposed to information technology and update their professional skills via thecyberspace community.

The next academic year will start on January 2010 and it is open to all General Practitioners in Malaysia. The first semester will commence witha workshop to be held on the first week of the semester followed by the first four modules, which are to be completed each month over aperiod of six months.

Upon completion of the DFM Programme, the candidate may continue studying by enrolling on the Advanced Vocational Training Program fortwo years to prepare for Membership Examination of the AFPM and the Fellowship Examination of The Royal Australian College of GeneralPractitioners. (MAFP/ FRACGP)

Application form can be downloaded from:

http:// www.afpm.org.my/v2 / member.htm

The CLOSING DATE is 15th December 2009

Mr. Chin Yew Meng

For further details, please contact AFPM office: DFM Programme Manager

The Academy of Family Physicians of Malaysia Room 6, 5th Floor, MMA House, 124, Jalan Pahang, 53000 Kuala Lumpur, Malaysia

Tel: +06-03-4041 7735 Fax: +06-03-4042 5206 Email: [email protected] Website: www.afpm.org.my

Page 20: MMA September 09(L)

OCTOBER 2009

AOEMM 11th Technical Update“Health Impact Assessment”Date : 10 October 2009AOEMM 12th Technical Update“Work Related Occupational MusculoskeletalDisorders”Date : 11 October 2009Venue : To be determinedTel/Fax : 03-4044 6030Email : [email protected]/

[email protected] : www.aoemm.com

9th World Congress International Association forAdolescent Health (I.A.A.H)“Private Lives, Public Issues: Global Perspectiveson Adolescent Sexual Health”Date : 28 - 30 October 2009Venue : Shangri-la Hotel

Kuala LumpurContact : Datin Saadiah AhmadTel : 03 - 2691 5379/ 03 - 2698 9966Fax : 03 - 2691 3446Emails : [email protected] or

[email protected] : www.iaah2009.com

Health Wellness WorkshopHealthy Weight, Healthy LifeDate : 31 October 2009 Venue : International Medical University

Bukit Jalil, Kuala Lumpur Contact : Ms Danielle Ho / Dr Low Bee YeanTel : 03- 2731 7358/7533Fax : 03 - 8656 7299Email : [email protected] /

[email protected] : http://www.imu.edu.my

38th MMA Perak Installation 2009Date : 31 October 2009Venue : Royal Perak Golf ClubTel : 05 - 2436543 / 016-5209022Contact : Ms MalarEmail : [email protected]

First Johor Medical Conference in Primary CareJointly Organised by MMA Johor Branch andMonash UniversityDate : 31 Oct - 1 Nov 2009Venue : Monash Clinical School Johor BahruContact : Dr Kamarudin AhmadTel/Fax : 07-2364148H.P. : 012 - 7761061Email : [email protected]

NOVEMBER 2009

Seminar and Technical WorkshopMammalian RNAi and qPCRDate : 3 - 4 November 2009 (Seminar)

: 3 - 5 November 2009 (Technical Workshop)

Venue : International Medical University, Kuala Lumpur

Contact : Ms Danielle Ho / Dr Leong Chee Onn Tel : 03 - 2731 7358 / 7528Fax : 03 - 8656 7299Email : [email protected]

[email protected] Website : http://www.imu.edu.my

Post Graduate Course on Paediatric InfectiousDiseases“Paediatric Infectious Diseases”Date : 12 – 13 November 2009Venue : Dewan Jemerlang

University of MalayaTel : 03 - 7949 2065/7949 2732Fax : 03 - 7955 6114

University (UNU), Asia-Pacific Academy Consortiumfor Public Health (APACPH), World Healthorganization (WHO), The United nations Children'sFund (UNICEF) and Malaysian Public HealthSpecialists.Date : 23 - 25 November 2009Venue : Dewan Kuliah UMS dan

Pusat Pendidikan Perubatan Desa Sikuati Kudat

Email : [email protected] further info: http://www.ums.edu.my/conferences

DECEMBER 2009

Nutrition Communication WorkshopDate : 3 December 2009 Venue : International Medical University,

Bukit Jalil, Kuala Lumpur Contact : Ms Danielle Ho / Ms Lee Ching LiTel : 03 - 2731 7358 / 7249Fax : 03 - 8656 7299Email : [email protected] /

[email protected] : http://www.imu.edu.my

40th Union World Conference on Lung Health“Poverty and Lung Health”Date : 3 - 7 December 2009Venue : Cancun , MexicoOnline Reg : www.worldlunghealth.org

Rights and Responsibilities of GovernmentDoctorsOrganised by Malaysian Medical Association andMinistry of HealthDate : 5 December 2009Venue : Auditorium, Ambulatory Care Centre

Hospital Pulau PinangContact : Ms Azlin (SCHOMOS Secretariat)Tel : 03 - 4041 1375Fax : 03 - 4041 8187Email : [email protected]

Asia Pacific Primary Care Research Conference 2009Date : 5 - 6 December 2009Venue : City Bayview Hotel, MelakaWebsite : http://www.afpm.org.my/appcrc2009.htm

7th Asian Angle Closure Glaucoma Club MeetingOrganised by Malaysia Society of Ophthalmology& Malaysian Medical AssociationOphthalmological SocietyDate : 5 - 6 December 2009Venue : Crowne Plaza Mutiara Kuala LumpurContact : Majmin Tel : 03 - 42517032 HP : 017 - 8821680Email : [email protected] : www.aacgc.org

Occupational Health Course for MedicalPractitionersDate : 11 - 13 December 2009Venue : To be determinedTel/Fax : 03 - 4044 6030Email : [email protected] /

[email protected] : www.aoemm.com

Calling all Medical Graduates from KMC Manipal,KMC Mangalore and Melaka Manipal MedicalCollege to join Annual Alumni MeetManipal Alumni Association Malaysia AnnualConventionDate : 11 - 13 December 2009Venue : Rennaisance Hotel, MelakaContact : Mr KulenTel : 03 - 2282 7355Email : [email protected] : manipal.org.my

Contact : Cik Natasha Alia bt Md YusofEmail : [email protected] : Prof M. T. KohEmail : [email protected]

Occupational Health Course for MedicalPractitionersDate : 13 - 15 November 2009Venue : To be determinedTel/Fax : 03 - 4044 6030Email : [email protected] /

[email protected] : www.aoemm.com

Second Seminar on Postgraduate MedicalEducation in MalaysiaDate : 14 November 2009Venue : Grand Seasons Hotel, Kuala LumpurContact : Ms Alice Joseph/Ms HemaTel : 03 - 4041 1375Fax : 03 - 4041 8187Email : [email protected] fee : RM100.00 (MMA Members) and

RM150.00 (Non MMA Members)

AIDS After HAARTDate : 14 November 2009Venue : Hospital Sg BulohContact : Prof Suneet SoodEmail : [email protected] orContact : Dr Noor Sham Yahya Luddin

[email protected] : Puan RuhiTel : 03-6120 3420Fax : 03-6120 3423Website : http://mhr.uitm.edu.my

http://medicine.uitm.edu.my

Plantation Health Committee MMA“Introductory Plantation Health Seminar”Date : 14 - 15 November 2009Venue : Jenderata Estate

United Plantations Teluk Intan, Perak

Contact : Ms PunithaTel : 03 - 4041 1375Fax : 03 - 4041 8187Email : [email protected] : www.mma.org.myTarget Group : Doctors, Estate Hospital Assistants,

Plantation Management (Managers and Assistant Managers)

Reg Fees : RM100.00 (MMA Members) RM150.00 (Non-Members)(2 breakfast and 2 lunches included)

25th Malaysia-Singapore Ophthalmic Congress 2009 Theme: “Ophthalmology Today and Tomorrow”Organised by MMA Ophthalmological Society(MMAOS)Date : 20 - 22 November 2009Venue : Renaissance Hotel, KLContact : Ms Begum Tel : 03-4041 1375 Contact : Dr Jelinar Mohamed Noor

(Hon Secretary)Email : [email protected]

College of O & G Teaching ConferenceDate : 20 - 22 November 2009Venue : One World Hotel

Bandar Utama City CentrePetaling Jaya

Tel : 03-4041 7088/4041 7541Fax : 03-4041 9722Email : [email protected]

[email protected]

2nd International Conference on Rural Medicine,ICORM 2009Organised by Sekolah Perubatan UMS, PersatuanPerubatan Desa Sabah (PERDESA), KementerianSains Teknologi dan Inovasi (MOSTI), United Nation

20

• MALAYSIAN MEDICAL ASSOCIATION • SEPTEMBER 2009

Mark Your Diary

Page 21: MMA September 09(L)

21Classified Advertisements

ANNOUNCEMENTPUBLIC HEALTH SOCIETY OF MMA

The Public Health Society of MMA has been in existence with the MMAsince the last few years. It has engaged in public health activities andhas worked very closely with other public health bodies, Ministry ofHealth and the public health departments of the various universities inMalaysia. In the recent years there has been a decline in membershipfrom members of MMA who work in public health areas and otherMMA members who have interest in public health issues.

The PHS now needs to hold an AGM to elect its office bearers. Throughthis announcement, the PHS invites all MMA members/ Public HealthSpecialists who have interest in public health issues to inform thesecretariat regarding their contact address to assist them to join the PHS.

For further information please contact:Puan Jalina at MMA House

Tel: 03- 4041 1375Email: [email protected] or

Dr S. ElangovanH/P: 012-526 3293

Email: [email protected].

The AGM will be held as soon as possible to elect the new committee.Your urgent attention to this matter is highly appreciated.

Thank you.

Dr S. Elangovan Secretary, Public Health Society, MMA

SCHOMOS SEMINAR‘RIGHTS AND RESPONSIBILITIES OF GOVERNMENT DOCTORS’

Anjuran Bersama

Persatuan Perubatan Malaysia & Kementerian Kesihatan Malaysia

Perasmian oleh:

YBhg Tan Sri Dato’ Seri Dr Hj Mohd Ismail Merican

Objektif:• Menyampaikan maklumat-maklumat penting berkenaan keperluan perkhidmatan dan kebajikan pekerja kepada para doctor;• Menyampaikan tugas dan tanggungjawab para doctor yang berkhidmat dengan kerajaan;• Membantu usaha Kementerian Kesihatan Malaysia untuk meningkatkan tahap perkhidmatan kesihatan di Negara ini.

Yuran Pendaftaran:MMA Member: Percuma

Non-MMA Member: RM50.00

Untuk keterangan lanjut, sila hubungi:Puan Azlin, SCHOMOS Secretariat, MMA

Malaysian Medical Association4th Floor, MMA House, 124, Jalan Pahang, 53000 Kuala Lumpur

Tel: 03 - 4041 1135 Fax: 03 – 4041 8187Email: [email protected]

Tarikh tutup pendaftaran: 30 November 2009

CONGRATULATIONSThe MMA congratulates the following

members:

DATO’ DR TEH LEI CHOODarjah Setia Pangkuan Negeri (DSPN)

DR SANTOKH SINGHDR REVATHY NALLUSAMY

DR LIM LAY HOOIDR ANITA BHAJAN MANOCHA

DR BALANATHAN KATHIRGAMANATHANDarjah Johan Negeri (DJN)

DR TAN CHONG GUANBintang Cemerlang Negeri (BCN)

On being conferred the recent award by the Yang di-Pertua Negeri of Penang

in conjunction with his 71st birthday celebration.

Tarikh : 5 hb Disember 2009Masa : 8.30 pagi - 5.00 petangTempat : Auditorium, Ambulatory Care Centre, Hospital Pulau Pinang

Page 22: MMA September 09(L)

22 Classified Advertisements

• MALAYSIAN MEDICAL ASSOCIATION • SEPTEMBER 2009

KL ADEG Aesthetic Dermatology WorkshopsWho Should Attend & Why Attend:

www.adeg.com.sg

The medical practitioners need to be armed with basic knowledge on aesthetic dermatologywhich are not taught in medical school so that they will be able to advise their patients onvarious skin rejuvenation procedures and also carry out some of the more simple procedures

ADEG workshops are designed to equip medical practitioners(GPs and specialists) to gainbasic and practical knowledge on evidence based skin rejuvenation procedures on Asian skin.For detailed formation on ADEG workshops, please visit www.adeg.com.sg

Please sign up for the workshop to be held in Kuala Lumpur immediately if you wish to gainknowledge on aesthetic procedures.

Please send completed form to:Email: [email protected] or fax: +65 62548966 orMail form and cheque made payable to ADEG Pte Ltd to : 290, Orchard Road, #11-20, Singapore 238859.

C I R C U S“No one lives his life.

Disguised since childhood,Haphazardly assembled

From voices and fears and little pleasures,We come of age as masks

Our true face never speaks.”Rilke II,11

“How would anyone know if you’reSad or happy unless you are wearing a mask?”

Mirrormask.

No one recognizes the shadowIn my bedroom mirror until

I put on my mask.

When I perform, the audienceIn the big top forget

Their tiger-striped anger, elephantTrunk despair, lion-tamer anxiety.

The tight rope tension in necksDisappear, All the Damocles fear

Are sword-swallowed. Their joy cannonBalls to trapeze heights.

I am a consummate performer, Everybody loves me. Every nightMy saw-dust dread is exchanged

For star-dust dreams. Every morningI wake, vowing never again

To be a clown.

But then the Ringmaster cracksHis whip, shouts, “The show Must go on!”

by Dr Ng Kian Seng

PUTRA MEDICAL CENTRE IS A 145 BEDDEDHOSPITAL strategically located in the Centre ofAlor Setar. We are expanding and growing with

a 8th Level New Wing. In line with our expansion, we would like toinvite applicants for the following Resident positions:-

Please send CV, Certificates, Testimonials and Photo (n.r) to:E-mail: [email protected]

For enquiries contact:Mdm Shanti Kandaiyah: 017-5081658

Mdm Gan: 012-5820528Tel: 04 - 7342888 Fax: 04 - 7348882Website: www.putramedicentre.com.my

• RADIOLOGIST• OPHTHALMOLOGIST• GENERAL SURGEON• UROLOGIST• ONCOLOGIST• NEUROLOGIST• GASTROENTEROLOGIST• OBSTETRICIAN &

GYNAECOLOGIST• PAEDIATRICIAN

• DERMATOLOGIST• PHYSICIAN• NEUROSURGEON• ENT, HEAD & NECK SURGEON

o DENTISTSo DIETITIAN/NUTRITIONISTo RESIDENT MEDICAL OFFICERS

(Attractive Incom & Incentive for Self-Drive MOs)

PUTRA MEDICAL CENTRE

• Nursing Supervisor• Training Manager• SRN Nurses & Midwives• Cardiac Technician• Finance Manager• Nursing Manager

• MSQH Coodinator• Operation Theatre Manager• Housekeeping Supervisor• Management Trainee• Medical Equipment Technician

THERE ARE ALSO VACANCIES FOR:

Page 23: MMA September 09(L)

23Classified Advertisements

CLINIC FOR SALE IN KULAIGood Location in Taman Indahpura

Doctor RetiringContact: Dr Lau

H/P: 016 - 764 3066

Clinic or Equipment for SALEFully equipped for surgery with

Facilities for O.T and G.Aat Mentakab, Pahang.

Contact: Dr Subra – 019-2774455

IMMEDIATE VACANCIES Medical Officer in A & E

• 2 Positions• Basic remuneration (RM7,500.00 + EPF) negotiable. • Must be registered with MMC & possess current

APC.Please contact Mr. Selva Raj

Tel: 03 - 3324 3288 Ext 230 or Email resume to: [email protected].

CLINIC FOR SALEMOH registered clinic in

populated surburb of Ipoh.Ready for immediate takeover, Doctor retiring.

CCoonnttaacctt:: 001122--55880099118899(Between 5pm - 8pm)

MEDICAL OFFICERS needed inNCI Cancer Hospital in Nilai.

Call: Stephanie: 06-8500999 Ext. 2333or Email resume to: [email protected]

DERMATOLOGIST WANTEDEvery Monday to Friday

2.00pm – 4.00pm in Seremban.Contact: 012 – 395 8848

"CLINIC FOR SALE"Medical Clinic at strategic location in SEA ParkSection 21, PJ for takeover, reasonably priced.

Call: 016-949 7333017-266 8289

KPJ Healthcare Berhad is a public listed healthcaregroup owned and managed by Malaysians providingPremier Healthcare Services. Since 1981, our networkhas expanded with full-facility of hospitals in Malaysia,Indonesia, Bangladesh and Saudi Arabia. We aresupported by Services and Companies in creatingexcellent workplace and providing community valueand ensuring fiscal responsibility. Celebrating 28 yearsof excellence and gearing up for the next phase of ourcorporate growth, we invite resourceful and committedprofessionals with the right attitude, skills andexperience to join our team

MEDICAL OFFICER

Requirements:• MBBS or equivalent from recognized institutions• Registered with the Malaysian Medical Council• Malaysian citizens or hold Permanent Resident

Status• At least 3 years working experience

Interested applicants are invited to submit full resumecomplete with working experience, copies ofcertificate, contact number, current and expected salaryand recent passport-sized photograph (n.r.),on orbefore 15 October 2009 to:

HHRR SSeerrvviicceessKKPPJJ IIPPOOHH SSPPEECCIIAALLIISSTT HHOOSSPPIITTAALL

2266,, JJaallaann RRaajjaa DDiihhiilliirr3300335500 IIppoohh,, PPeerraakk

TTeell:: 0055--22440088777777 FFaaxx:: 0055--22440088774455

oorr vviiaa ee--mmaaiillkkaammiill@@iisshh..kkppjjhheeaalltthh..ccoomm..mmyy

• MALAYSIAN MEDICAL ASSOCIATION • SEPTEMBER 2009

MEDICAL OFFICERS needed inNCI Cancer Hospital in Nilai.

Call: Stephanie: 06-8500999 Ext. 2333or Email resume to: [email protected]

GENERAL PRACTICE WORK IN AUSTRALIA

We are looking for General Practitioners to work in twonew multidisciplinary Medical Clinics in Adelaide, SouthAustralia.

The Clinics are operated by Adelaide Unicare and the University ofAdelaide, a public university, established in 1874, and the thirdoldest university in Australia. It is a member of the elite “Group ofEight” Universities in Australia.Benefits include:• Assistance with registration and visa requirements;• Assistance with relocation: travel, accommodation and suitable

schooling etc.;• A good, safe lifestyle close to the city centre;• Brand new purpose built facilities;• High remuneration with a 2 to 5 year contract;• Ideal for husband/wife team;• Working within a coordinated and integrated “one-stop”

primary healthcare model;• A population approach to healthcare service delivery;• Practice nurses, allied health professionals and diagnostic

services on site;• Student training, teaching and research;• Opportunity for academic appointment;• Opportunity for further training;• Commencement late 2010/early 2011.

Candidates must satisfy Australian Medical Board requirements andassessments to work as a Doctor in Australia.

To apply, email your CV and contact details to Mr Ivan Lee at:recruitment.ivan @gmail.com Enquiries to 0129 117 260.

Page 24: MMA September 09(L)

MPS is the world’s leading indemnifier of health professionals covering more

than 260,000 doctors and dentists worldwide. As part of our commitment

to improved professionalism, quality and safety, MPS is embarking on a

significant expansion of the risk management and educational services we

provide members.

There is an opportunity for Malaysian doctors with an interest and expertise in

communications and risk management to join our world class medical faculty

to become a trained presenter.

Presenting risk management and communications programs to your medical

and clinical colleagues as a MPS faculty member is an exciting and prestigious

opportunity that can enhance your reputation as a professional expert.

Presenter positions would suit either full time or part time clinicians looking for

regular weekend or mid week work.

Successful candidates must:

� Be a medical graduate with significant post graduate experience

� Have experience in training, education and/or presenting

� Have extensive experience in one or more of the following areas; medical

education, communication skills training, formal post graduate psychological

or counselling training and risk management or medicolegal experience

linked with a medical protection organisation or healthcare facility

� Be based in Malaysia.

Both local (overnight) and international travel may be required.

MEDICAL PROTECTION SOCIETY

PROFESSIONAL SUPPORT AND EXPERT ADVICE

An exciting and prestigious role with an international education team

Doctors who are interested in applying should review the position description on www.medicalprotection.org/uk/careersAll applications must include a letter detailing how they meet the minimum requirements, necessary experience and profile description

outlined in the position description.

Applications should be forwarded by email to [email protected] or mail to: Faculty and Education Support Coordinator, MPS Educational Services Asia Pacific, P.O. Box 1013, Milton, Queensland Australia 4064

Applications must arrive by 23 October 2009Applicants who are shortlisted will need to be available for a video or teleconference w/c 26 October 2009 and a selection interview in

Singapore on 13 November 2009. All travel costs to this event will be met by MPS in accordance with standard policies.

We are an equal opportunities employer.

MP

S_M

AL_FA

CP

D_M

MA

_0

909

by Dr J. R. PrushothamanCommittee Member, Plantation Health Committee, MMA

The Plantation Health Committee headed by Dr RavindranNaidu is planning to be more dynamic this year. We justhad our first committee meeting on the 6 September 2009

and we have confirmed our first Plantation Seminar to be held onthe 14 and 15 November 2009 with the first day being lecturesand the second day will be hands on training like A Walk ThroughSurvey, Line Site Visit, Crèche Visit and a demonstration on thecorrect technique of spraying chemicals and personal protectiveequipment. The venue has been confirmed and it will be held atJenderata Estate, United Plantations, Teluk Intan, Perak.

The Plantation Seminar will be useful for all doctors especiallyV.M.O (Visiting Medical Officers) as well as for the Estate HospitalAssistants (EHA). The Estate Managers and Assistant Managerswould also benefit in attending such seminars. The Managementwould be aware of all the regulations and laws that govern thehealth faced by their workers and the correct role of the V.M.Oand Estate Hospital Assistants.

Introductory Plantation Health Seminar

We would be also discussing the problems faced by the medicalteam and the management in maintaining good health among theplantation workers. There would be a question and answersection at the seminar which we hope will benefit all participants.

The topics of discussion are as follows: 1. Role and Responsibilities of Visiting Medical Officers2. Role and Responsibilities of Estate Hospital Assistants3. Chemical Regulations4. Noise Regulations ( Oil Palm Mill)5. Estate Sanitation and Health and Minimum Housing Act6. Common Diseases in the Plantation7. Personal Protective Equipment

The Plantations such as United Plantation, Sime Darby, NationalLand Finance, FELCRA, FELDA and many more would benefitfrom this seminar. The plantation industry in Malaysia has beenone of the major economy frontiers since the yester years ofBritish Colonization. After rubber and coconut, currently oil palmhas been a major booster for the Malaysian economy. Hence,getting involved in health issues of our Plantation workers wouldindirectly improve our Malaysian Economy.

If any doctors and visiting medical officers have any doubts,problems or topics that they want to be addressed, please do nothesitate to write to the Chairman, Plantation Health CommitteeMMA. We would appreciate any feedback from the members. �

24 Report

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and the epithelium are continuously eroded and exposed thecorneal nerves. The eye would be inflamed and theconjunctiva epithelium may replace the corneal epitheliumbringing together heavy vascularization, inflammation and itsmilky coloured surface. Painful red eyes, secondaryglaucoma and total blindness are conditions suffered bythese patients which reduce their quality of life.

The principle of treatment for limbal stem cell deficientconditions include the use of amniotic membrane graft,conjunctival-limbal autograft and penetrating keratoplasty.Amniotic membrane grafting on its own usually fail toregenerate the epithelium. Conjunctival-limbal autograftneeds a large size graft taken from patient’s other healthy eyewhich would render the donor eye of developing secondarylimbal stem cell deficiency. If an allogenic source is used, the

“Limbal Stem Cell as Potential Therapy toBlinding Corneal Conditions”

by Dr Bakiah ShaharuddinUniversiti Sains Malaysia

TThhee ssuurrffaaccee eeppiitthheelliiuumm ooff tthhee eeyyeeccoommpprriisseess ooff ccoonnjjuunnccttiivvaa aatt tthheeppeerriipphheerryy,, lliimmbbuuss aatt tthhee ttrraannssiittiioonn

zzoonnee aanndd tthhee ccoorrnneeaall eeppiitthheelliiuumm.. CCoorrnneeaa iissaa ssttrruuccttuurree aatt tthhee ffrroonntt ooff tthhee eeyyee wwhhiicchhaalllloowwss lliigghhtt ttoo ppaassss tthhrroouugghh ttoo rreeaacchh rreettiinnaa,,wwhhiicchh tthheenn ttrraannssmmiittss ssiiggnnaallss ttoo tthhee bbrraaiinn..TToo ppeerrffoorrmm tthhiiss ffuunnccttiioonn,, ccoorrnneeaa mmaaiinnttaaiinnssiittss ttrraannssppaarreennccyy bbyy pphhyyssiiccaallllyy bbeeiinngg ddeevvooiiddooff aannyy bblloooodd vveesssseellss..

The regeneration of corneal epithelium relies heavily on thestem cells which are located at the limbus, the circumferentialstructure area around it. Limbus also separates cornea fromthe conjunctiva which is highly vascularized and is slightlyopaque. The stem cells are also protected by being deeplyburied and hidden by pigments which are abundant at thelimbal area. The stromal component of the limbus is alsorichly innervated and vascular, to allow proliferation andmaintenance of the stem cells niche.

In limbal stem cell deficient conditions which in majority aredue to chemical injury, the limbus could be totally damaged

LLiimmbbaall sstteemm cceellll ddeeffiicciieennccyy iinn tthhee rriigghhtt eeyyee ooff ppaattiieenntt wwiitthh cchheemmiiccaall

iinnjjuurryy

AAuuttoollooggoouuss ggrraafftt ccuullttuurreedd wwiitthh aammnniioottiicc mmeemmbbrraannee rreeaaddyy ffoorr

ttrraannssppllaannttaattiioonn

SSttrruuccttuurreess ooff tthhee eeyyee

DDaayy 2200

cont’d...pg 27

26 CME Update

• MALAYSIAN MEDICAL ASSOCIATION • SEPTEMBER 2009

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After a successful process of tissue expansion, patient istransplanted without the need for use of anti-rejection drugs,as the original source of tissue is patient’s own cells.

Most patients would experience the benefit of this transplantafter 3 days of surgery whereby alleviation of the pre-existingpainful red eyes is the first sign of recovery. Continuousimprovement in visual acuity may be observed during 12 to18 months of follow up. Stabilisation of the limbal area by thismethod will result in a marked improvement to thesubsequent second surgery which is normally undertaken toclear the scarred central part of the cornea. In this instance,penetrating keratoplasty, a surgery performed by removingthe central cornea of the patient and replace it with acadaveric donor cornea will fare more favourably.

The method described above, the “Newcastle method” wascarried out in a clinical trial at the Royal Victoria Infirmary inNewcastle upon-Tyne. They have recruited 10 patients whomwere sufferers from chemical injury to the cornea. In theirclinical trial, all the patients had subjectively reportedconsiderable alleviation of eye pain. Most patients had alsoimproved their visual acuity at least 4 lines tested by SnellenChart. Following this success, the ophthalmology/limbalstem cell team at Newcastle University will recruit morepatients into their clinical trial next year. �

risk of graft versus host disease is also a risk. Penetratingkeratoplasty does not replace the stem cells thus it bears thesame complications and a high risk of graft rejection. Thismakes the procedure prone to failure.

Limbal stem cells transplantation addresses the problem oftreating the limbus while keeping the eye ‘quiet’ for thepossibility of a more definitive procedure i.e penetratingkeratoplasty, to be performed to clear the scarred central part ofthe cornea, at a much later date. By keeping the inflammationat bay, patient would benefit from a pain-free condition.

Limbal stem cells are part of the ‘adult somatic stem cells’which have limited potential of differentiation orspecialization. The sources of limbal stem cells could bederived from patient’s own tissue from a healthy eye which isautologous in nature, from a living relative (allogenic), or froma cadaveric source. Other autologous sources could be otherepithelial derivations from other types of stem cells i.eembryonic or mesenchymal origins.

In a method of ex-vivo expansion, a limbal tissue explant maybe obtained from a small biopsy from the other healthy eye.In the laboratory, the limbal explant was cultured using acryopreserved human amniotic membrane for two weeks.

cont’d...from pg 26

27CME Update (cont’d)

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• MALAYSIAN MEDICAL ASSOCIATION • SEPTEMBER 2009

CME Update

by A. Prof. Dr Andrew Tan Khian Khoon

What Is Colour BlindnessColour blindness is not a form of blindness at all,it is a condition whereby the person with thiscondition finds it difficult to discriminate betweendifferent colours, especially when many type andshades or hues of colours are presented at thesame time. The commonest type of ColourBlindness is Red-Green colour deficiency, whichis usually an inherited condition; other lesscommon forms include blue-yellow colourdeficiency. It is estimated by various studies thatworldwide, 2 to 8% of men are affected by thiscondition. A recent study done in Singapore byChia A. et al in 2008 found that among 1249secondary school students between the age of 13to 15 years old, 5.3% of boys and 0.2% of girls were foundto have colour blindness.

Clinical FeaturesContrary to popular belief, people with colour-blindnessseldom see things in black and white or shades of grey, theyare still able to see colours, though they may have a hard timedistinguishing between colours, say between red and green,or blue and yellow, especially when they are presented with amix of many colours.

What Causes Colour BlindnessColour blindness happens when photo-sensitive cells(photoreceptors) in the retina do not function properly.

Usually, people with colour blindness are born with it, it isusually a sex-linked (X-linked recessive) chromosomaldisorder, which means it affects male much more thanfemale. A male with the colour blindness gene will bemanifested as colour blind, whereas a female with only onecolour blindness gene will not be colour blind (as female has2 X-chromosomes), but instead will be a carrier and pass thedisease to her sons, a female will only be colour blind if shehas 2 colour blindness gene, one on each of her X-chromosomes. Red-Green colour blindness usually resultsfrom diseases of either long (L) or middle (M) wavelength-sensitive visual photo pigmentation. It is the most commonsingle locus genetic disorder.

COLOUR BLINDNESS

Fig. 1: Ishihara Colour BlindnessTest Booklet

Fig 2: Ishihara Plate

Fig. 3: Farnsworth-Munsell 100-Hue Colour Vision Test Kit

cont’d...pg 29

Besides this inheritable form of colour blindness, damage tothe retinal cells may also cause colour blindness, which mayaffect different spectrum of colours, these aetiological factorsmay be: ageing, diseases and drugs (e.g. certain drugs usedin treating arthritis), in extreme cases, these other diseasemay lead to total blindness, whereas inheritable red-greencolour blindness does not lead to blindness.

DiagnosisEye doctors usually test for colour blindness using somecoloured plates with numbers or figures made up of manydots of different colours, known as the ISHIHARA CHARTS.

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CME Update (cont’d) 29

There are also other tests available for assessing the extentof colour blindness for industrial or professional use, such as'Lantern Test' and '100 Hue Test'. More sophisticated electrodiagnostic tests like Electro-retinogram (ERG) or Electro-Oculogram (EOG) are also useful in diagnosing this condition.

TreatmentColour blindness cannot be cured, nor prevented - except bygenetic counselling. (Though possibility of using geneticengineering to repair/modify the colour blindness gene maybe a possibility in the future).

Diagnosing colour blindness early in life may prevent learningproblems during the school years, since many learningmaterials rely heavily on colour perception.

Other forms of remedy for colour blindness include speciallenses which are colour filters, available either in contact lensor spectacle forms. Other ways to work around this disabilityinclude organising and labeling items of different colours toavoid confusion. Remembering the order of things ratherthan their colour may also help (e.g. the red light is always atthe top a traffic light, followed by yellow and green.)

cont’d...from pg 28

Remember proper counselling and career guidance early inschool life is very important for sufferers of colour blindness,as they may not be suitable for certain jobs, e.g. pilot, navy orother jobs where discrimination of colours is of ultimateimportance and cannot be compromised, otherwise, peoplewith colour blindness can venture into most career.

Recently, there were various experiments done in the UnitedStates in laboratory animals that suggested gene therapy inadult animals may be useful in treating colour blindness,which will greatly give hope to people affected by thiscondition in the future.

Researchers from the University of Washington (Mancuso K.et al, 2009 September 16) had described experiment wherebya third type of cone pigment (opsin), was added todichromatic retinaes in adult monkeys to producetrichromatic colour vision behaviour which apparently doesnot require an early developmental process. This provides apositive outlook for the potential of gene therapy to cure adultwith colour vision disorders. Other promising studies to dateinclude that done at the University of Florida (June 2008) inwhich cone targeted therapy was done using Adeno-assistedvirus (AVV) vectors. �

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• MALAYSIAN MEDICAL ASSOCIATION • SEPTEMBER 2009

Branch News

couldn’t accommodate the number of doctors who had replied tothe invitation.

At the end of the day, our doctors left the venue armed withadditional valuable information on the management of URTIs inthe Primary Care setting, as well as some interesting knowledgeon certain ENT disorders. �

Don’t forget to mark your diary for the 5th PRIMARYCARE SYMPOSIUM on the 9 and 10 January, 2009.Website: www.mmawilayah.com

by Dr Koh Kar ChaiChairperson, Wilayah Persekutuan

As is the norm every year, come the ‘PuasaMonth’, there will be a dearth of activities asour Muslim brethren go into a month longfasting period and prepare for the ‘Hari RayaAidilfitri’ celebration at the end of it. Duringthis celebration week, many Malaysians willgo off on a holiday. Thus, most of thePharmaceutical companies will hold back ontheir CPD activities for fear of a poorparticipation of doctors.

The first activity that we at MMAWilayah embarked upon, immediatelyafter the festivities was the ‘‘KKLL EEaarr,,NNoossee && TThhrrooaatt SSyymmppoossiiuumm ffoorrPPrriimmaarryy CCaarree PPhhyyssiicciiaann’’. This eventwas held on the 27 September, 2009under the auspices of MSO-HNS(Malaysian Society ofOtorhinolaryngologists, Head & NeckSurgeons), MMA Wilayah, MMASelangor and PMPASKL.

A presentation on the CCoonnsseennssuussGGuuiiddeelliinneess oonn tthhee MMaannaaggeemmeenntt ooff UUppppeerr RReessppiirraattoorryy TTrraaccttIInnffeeccttiioonn was also done at this event. This guideline was drawnup bbyy EENNTT SSppeecciiaalliissttss ffrroomm tthhee MMSSOO--HHNNSS aanndd PPrriimmaarryy CCaarreeDDooccttoorrss ffrroomm MMMMAA WWiillaayyaahh. It was initiated about two yearsback and finally presented this year.

It was felt that since this Consensus Guideline is meant for theuse by Primary Care Doctors, an input is required from this groupof medical practitioners. Hence, the role of MMA Wilayah in theformulation of this Consensus Guideline by the provision of inputby our Wilayah Primary Care Doctors.

Funding was available in the form of an educational grant from alocal Pharmaceutical company, for which we are grateful to have,since it requires a certain amount of financial allocation toembark on such activities. It has been the norm for MultinationalPharmaceuticals to be involved in such ventures, with most ofour local Pharmaceuticals taking a back seat. Hopefully, with thisSymposium, we will see more similar activities being initiated byour local Pharmaceuticals.

We were pleasantly surprised with the overwhelming response byour doctors in the Klang Valley. Apparently, the PharmaceuticalCompany involved in handling the RSVPs had to turn down somedoctors who wanted to attend the event as the lecture hall

MMA WILAYAH ACTIVITIES1 2

3 4

61. Participants signing in early inthe morning.

2. Even the Course Directorneeds to sign in.

3. Our doctors in deepconcentration

4. Dr Shailendra, Dr Loganathan,Dr Yap Yoke Yeow, Dr Kuljit

5. Dr Rahmat Omar6. Dr Balwinder, Dr Yeo Sek Wee7. Dr S. Shailendra, Dr Kuljit,

Dr Pua Kin Choo (President ofMSO-HNS), Ms Darleena, Dr KC Koh

5

7

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• MALAYSIAN MEDICAL ASSOCIATION • SEPTEMBER 2009

Branch News

A (H1N1) by Dr Chow Ting Soo, the Infectious Disease Physicianin the State. She was able to share her experience on the manycases that she had handled at the Penang General Hospital. The3rd presenter was Dr Chan Kwai Cheng, the Infectious DiseasePediatrician at Penang General Hospital. Her topic was on thePediatric Management of Influenza A (H1N1). Each participantwas given a CD on the lectures presented – compliments of theState Epidemiology Unit. The session was chaired by Dato’ DrLim Yu Hoe, Consultant Physician at Penang General Hospital.He had been given the task of taking the role as the State LiaisonOfficer for Flu A. Personally, I believe it’s an excellent move.Penang is a great place to work as there always has been greatcooperation between the private sector and Government andbetween the Health and Hospitals and this has never been anissue here. However, we do need someone to champion ourcause and Dato’ Lim may be the most apt person. He pointedout that patient education was not effective enough and eachand every health personnel had a role to play in this. The publicwas still not interested and there is lack of knowledge. It is everyhealth practitioner’s task to treat, prevent and to allay anxiety andhe stressed upon these simple but crucial messages.

There were hitches at the start of this briefing that was held at theAuditorium of Hospital Pulau Pinang. The air-conditioning wenton strike and the hall projector refused to work (as always:Murphy’s Law). Anticipating the worst, we had brought our ownLCD and notebook as well, so were able to rectify the situation,and started right on schedule. Hence, albeit a tilted screen anda few stiff necks it was a very fruitful morning and it’s a pity thatmore doctors did not attend. I believe it is their loss.

At the end of this very stressfulmorning, sitting at home with abook, I texted my appreciation toall those involved in thisorganisation and made thishappen. Maybe the reply from theHealth inspector from the EpidUnit sums its all: “Satu Pasukan,Puan”. One team! Yes, it’s niceto be a part of this team! �

by Dr Saraswathi Bina RaiPenang

Another briefing on Influenza A (H1N1) was held in Penang(for the 3rd time this year in the state) to the private sector.The idea was mooted by the State Health Director, Dato’

Dr Teh Lei Choo following a request by a private practitioner inPenang to have such a session. There had been two suchbriefings before this year and both were held on a Sunday but theattendance was never as envisaged. The State Health Directorplanned the date with the Chairman of Penang Branch MMA andPMPS President and a Saturday morning was agreed upon – 5thSeptember, 2009. It was very timely indeed as over the weekprior to the event, there were some changes in the managementof Influenza A (H1N1) and we were able to update theparticipants accordingly.

To ensure all the private doctors were aware this time around,flyers were sent through MMA and PMPS to all their members;letters were sent individually to the private hospitals; In additionemails were sent to about 400 private doctors, dentists (Yes, wedecided that dentists too should be informed) as well as to theprivate hospitals. Not all doctors are members of MMA or PMPSbut we tried to reach as many as possible. We were quiteconfident that most of the private doctors were aware of thisbriefing but the decision to attend is a personal choice. ThePenang Branch of MMA was represented by Dr Praveen, theVice-Chairman; Dr Patrick Tan, the President of PMPS waspresent as well (in between his surgeries); the State HealthDepartment was well represented by the Director - Dato’ Dr TehLei Choo, Dato’ Dr Rosenah - the Consultant Physician, and theDistrict Health Officers. Yours truly wore the hats of MMAPenang Branch and the State Epidemiology Unit – the unit toreceive all brickbats.

There were three presentations – Dato’ Teh took the lead andgave an overall situation of the disease. This was followed by anexcellent presentation on the Medical Management of Influenza

Briefing to the Private Sector onInfluenza A (H1N1)

Penang, 5 September 2009

Briefing to the Private Sector onInfluenza A (H1N1)

Penang, 5 September 2009

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33Branch News

The 3rd Annual Dinnerand Installation Nightwas also held at PutraPalace Hotel on thesame night. The guest ofhonor was Perlis MenteriBesar, YAB Dato’ Seri DrMd Isa b. Sabu. Thenight was graced by about 100 members and twooutstanding service awards were conferred to Dr KhairulShakir former Branch Secretary and Dr Hasna Hamzah,former Branch Treasurer for their contributions inestablishing the Perlis branch. The awards were givenout by YAB MB. “Chain of Office” was handed over tothe new Chairman, Mr. Yeap Ewe Juan by Dr Hari Ram.The night ended at 10.30pm and was a great success. �

by Dr Hari Ram Ramayya

On 1 August 2009, two events were organised by MMA Perlis.

The first was a Pain Workshop held at Putra Palace Hotel at 2.00pm. The speakers were Mr. Jaya Prakas Rao, General Surgeon, HTF,

Mr. Yeap Ewe Juan, Orthopaedic Surgeon HTF and guest speaker was Dr Mary Suma Cardosa, Consultant Anesthesiologist, Hospital

Selayang. The Workshop was attended by about 30 doctors including GPs and ended at 6.00pm.�

MMA PERLIS DINNER 2009

MMA PERLIS PAIN WORKSHOP

Occupational Health for Health Care Professionals –

Caring for the Carers

TO PLACE ORDER:Contact: Ms. Hema @ Tel: 03- 40411375 Email: [email protected]

Cost: RM88.00 (inclusive of postage within Malaysia)Cheque payable to: Malaysian Medical Association

PPuubblliisshheerr :: MMaallaayyssiiaann MMeeddiiccaall AAssssoocciiaattiioonn IISSBBNN NNuummbbeerr :: 997788--998833--9999112288--33--88EEddiittoorrss :: DDrr GG.. JJaayyaakkuummaarr && AAssssoocc.. PPrrooff.. DDrr RReettnneesswwaarrii MMaassiillaammaannii CCoovveerr :: HHaarrdd PPaaggeess :: 330000 ppaaggeessCCoonntteennttss :: 2222 CChhaapptteerrss ((CCoonnttrriibbuuttoorrss ffrroomm:: MMaallaayyssiiaa,, SSiinnggaappoorree,, JJaappaann,,

IInnddiiaa,, AAuussttrraalliiaa,, UUnniitteedd SSttaatteess ooff AAmmeerriiccaa,, UUnniitteedd KKiinnggddoomm,, UUAAEE,,EEggyypptt aanndd SSoouutthh AAffrriiccaa))

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HOW STUPID CAN YOU GETBob walked into the Royal Ipoh Club Long Bar at around 10.00pm. Hesat down next to Vella at the bar and looked up at the TV. The10.00pm news was on. The news crew was covering a story of a manon a ledge of a tall building preparing to jump. Vella looked at Boband said,“Do you think he’ll jump?”Bob said,“You know, I bet he’ll jump.”Vella replied,“Well, I bet he won’t.”Bob place a RM10 bill on the bar and said,“You’re on!”Just as Vella placed his money on the bar, the guy on the ledge did aswan dive off the building, falling to his death.Vella was very upset, but willingly handed his RM10 to Bob saying,“Fair’s fair. Here is your money.”Bob replied,“I can’t take your money. I saw this on the 5.00pm newsand so I knew he would jump.”Vella replied, “I did too. That really must have hurt!! I didn’t thinkhe’d do it again!!”Bob took the money.

REAL DISPUTE – PRE – DNA STORYA young boy comes running down the street looking for a cop. Hefinds one and then begs, “Please, officer, come back to the bar withme, my father’s in a fight.”Well, they get back to the bar and there is three guys fighting like youwouldn’t believe. After a while the cop turns to the kid and says,“Okay, which one is your father?”The kid looks up at the cop and says, “I don’t know, officer. That’swhat they’re fighting about.”

LYRICS OF INDIASurinder’s granduncle was booked into an SIA flight to Bombay. But asthis was his first time in an airplane, he made a few preparations thatwere out of place. When the stewardess came around to take orders forthe in-flight meal, the granduncle declared loudly,“I have brought myown lunch. Make sure you don’t charge me for food and drinks!”So, as everybody was given their in-flight meal, the grandunclebegan spreading out his own home-cooked meal. The man sittingnext to him was an American history researcher, who was curiousabout the food.“Excuse me, what is that drink?” he asked.The granduncle picked up the yogurt-based lassi drink and said,“Milk of India!”The granduncle took out several pieces of chapattis and startedfeasting.“And what is that dish?’ asked the curious American.“Wheat of India!” replied the granduncle proudly.Finally, the granduncle took out some desserts. He offered some tothe American.“What is it?” asked the American.“Sugar of India!” replied the old man.After the meal, everyone was settling down when there was a loud“Pooooooooot” from the granduncle.“What was that?” asked the American in disgust.The old man replied coolly,“That’s air of India!”

MINI – BITES(1) You know that children are growing up when they start asking

questions that have answers.(2) “If stupidity got us into this mess, then why can’t it get us out?”

- Will Rogers(3) “Any government that robs Peter to pay Paul can always depend

upon the support of Paul.”- Rings a bell, eh!

(4) The more you observe politics, the more you’ve got to admit thateach party is worse than the other.

- Will Rogers(5) An amateur golfer is one who addresses the ball twice: once

before swinging, and once again after swinging.(6) “We don’t want to go back to tomorrow, we want to go forward.”

- Dan Quayle(7) Terrorists pollute the nation’s water supply with truth serum.

Society is rocked to its foundation as everyone including lawyersand politicians start speaking honestly. Doctors were status quo.

Marvin murmurs:- “Two is company. Three is bad control.”�

bbyy DDaattoo’’ DDrr SS.. PPaatthhmmaakkaanntthhaannIIppoohh,, PPeerraakk

This is my 200th contribution to this Korner. There was atime in September 1985 when I got this queer urge ofpropagating humour in a written form. I was thenencouraged by friends and colleagues. I particularly like tosingle three of them – Dato’ Dr Joginder Singh and the lateDato’ Dr Lim Say Wan both of whom were Editors of BeritaMMA during that period and Dato’ Dr Abdul Hamid.

And for some of the early years, I had to progress againstsome prevailing odds to keep the budding voice of humourgrowing in a conservative and mundane society wheremirthology is strictly controlled by theology and ethnicity.

After a span of 25 years, some humour is still taboo and canonly be nervously mentioned in isolation and in “silence” inour “fragmented but one” society.

TALK, TALK!!A husband, proving to his wife that women talk more than men,showed her a study which indicated that men use, on the average,only 15,000 words a day, whereas women use 30,000 words a day.She thought about this for a while and then told her husband thatwomen use twice as many words as men because they have to repeateverything they say.He said,“What?”

WHAT IS IN A NAME – ANATOMYThe pastor asked if anyone in the gathering of the Church Hall wouldlike to express “Praise for answered prayers”.A lady stood up and walked to the podium.She said,“I have a Praise. Two months ago, my husband, Marvin, hada terrible motorcycle wreck and his scrotum was completelycrushed. The pain was excruciating and the doctors didn’t know ifthey could help him.”You could hear a muffled gasp from every man in the congregationas only they can imagine the pain that poor Marvin must haveexperienced.“Marvin was unable to hold me or the children.” She went on. “Andevery move caused him terrible pain. We prayed as the doctorsperformed a delicate operation and it turned out they were able topiece together the crushed remnants of Marvin’s scrotum and wrapwire around and through it in places to hold it in place.”Again, the men in the gathering were unnerved and squirmeduncomfortable as they imagined the terrible surgery performed onMarvin.“Now,”she announced in a quivering voice,“thank God,Marvin is outof hospital and the doctors say that with time his scrotum shouldrecover completely.” All the men sighed with obvious relief. ThePastor rose and tentatively asked if anyone else had something to say.A man stood up and walked slowly to the podium.He said,“Hi, I’m Marvin.” The entire congregation held its breath. “Ijust want to thank you all and also explain to my dear wife again thatthe word is STERNUM.”

GOVERNMENTA small boy was asked by his teacher, “What is the size of theGovernment?”“About 5 feet 2 inches,” he replied promptly.“No, no, no,” said the teacher, “I mean how many members thegovernment has? How did you get 5 feet 2 inches anyway?”“Well,” replied the boy. “My father is 6 feet tall and every night heputs his hand to his chin and says,“I have had it up to HERE with theGovernment!!”

SP’s Korner

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• MALAYSIAN MEDICAL ASSOCIATION • SEPTEMBER 2009

SP’s Korner

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