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Comment
by Dr Helmy Haja Mydin
IT is common knowledge that life as
a junior doctor in public hospitals is
not a bed of roses despite the various
improvements that have been put in
place over the past few years. One of
the most common complaints that can
be heard is about the lack of doctors.
But it is less common to hear anyone
mention there being too many patients
at hospitals.
Recently, a friend lamented that
her caseload could easily be reduced
by half if her patients did not present
with chronic diseases that could (and
should) have been easily dealt with at
a primary care setting. It is not difficult
to see how presentations of conditions
such as hypertension or diabetes are
better managed in the community,
thus bringing into question the duty
of primary care as well as individual
responsibility.
The role of primary care should
not be underestimated. It deals with
the bread and butter of medicine, and
should be at the forefront of co-ordi-
nating services when the patient needs
care from other health-care sectors. It is
also a place where a holistic approach
to public health policy allows such
policies to be transformed to practice
on the ground.
There is plenty of evidence to sug-
gest that a good relationship with your
general practitioner is associated with
better and more appropriate care. One
can go so far as to suggest that condi-
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Primary care is
just as important
tions such as heart attacks and strokes
are almost completely preventable, if
risk factors are managed appropri-
ately in the community.
There has to be a degree of per-
sonal responsibility too. The old adage
“prevention is better than cure” holds
true in most circumstances. We tend
to have the unfortunate habit of seek-
ing help or looking after ourselves
only when physical manifestations
of our illnesses appear, neglecting
our bodies at other times while our
insides scream for a bit of tender lov-
ing care.
Anecdotes are aplenty. I recently
came across a diabetic patient who
presented me with a gangrenous toe,
but who had previously decided not
to take any of his blood sugar-lower-
ing medication because he felt well
himself.
Unfortunately, primary health-care
in Malaysia is provided in a rather
erratic manner without sufficient
horizontal or vertical co-ordination.
Information is not readily transfer-
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als in areas that are economically
and socially deprived, as it is these
places that tend to bear the brunt of
chronic disease epidemics.
The general public needs to be
educated so that they see primary
care as a resource to manage their
chronic diseases, and secondary
care for more acute emergencies.
Simple measures such as proper
compliance with medication and
leading a healthy lifestyle will go
a long way in not only improving
one’s well-being, but in helping to
ease the strain on our health-care
able between health-care profes- system.
sionals leading to fragmentation and At present, most urbanites tend
duplication of care, a situation that to visit private general practition-
is worsened by our habits of jump- ers. The downside to this approach
ing from one general practitioner to is that due to financial costs, they
another. tend to be hesitant on visiting
This calls for a streamlining of the their family doctors for routine
current system into one where good check-ups, and only do so when
communication unites the disparate an emergency arises.
entities within it. A better flow of This is where the government
information between health-care might be able to step in and play
professionals will help improve situa-
tions, as this will allow for a smoother
transaction with colleagues at second-
ary care and earlier acknowledge- letters
letters@thesundaily.com
ment of a patient’s medical history.
Methods such as electronic medical
records and even personal handheld
pen drives should be looked into. Upgrade funicular
It would also be useful for the
government to elevate the speciality
of family medicine and to encourage
before lives are lost
medical students and junior doctors I READ that the Penang Hill Funicu-
to seek attachments in the primary lar broke down recently with over
care setting, both for practical and 300 passengers having to endure
research purposes. There should also the steep walk to safety. What will
be a move to place such profession- happen next? Is it going to take the
loss of life before someone takes
action?
The railway is not safe, it does not
meet international safety standards.
It does not have a backup system
to mechanically or electrically
move the train to a safe location to
disembark the passengers safely
when the funicular breaks down.
The system and the structure are
obsolete, old and breaking apart.
As a user, I am entitled to know
that the manufacturer’s design,
installation, warranty and liability
are in full compliance with the lat-
est international safety standards.
To meet these standards the entire
system has to be upgraded. Each
component has to be inspected
and its manufacturer’s warranty
assured before it can be installed.
Then the whole system has to be
tested and commissioned, before it
can be signed off. There is no short
cut when it comes to safety.
Shut down unsafe hostels
THE authorities should take a look at
the practice of some institutions of
higher learning that use multistorey
shop houses as hostels for some of
their students.
These hostels are death traps
since they have only one stair-case
for the students to enter and leave
the building. Some of these hostels
are used to house between 30 and
60 students, thus making evacua-
tion a difficult task in case of a fire.
In addition, every window has
been fixed with metal grilles, hence
making the hostel a fire trap for
these students.
To make matters worse, the
Why use asbestos pipes?
I RECENTLY came across a burst
water pipe in Petaling Jaya being
replaced with an asbestos cement
pipe. It is well known that exposure
to asbestos can cause “asbestos
cancer” or mesothelioma which
affects the mesothelial layer of the
lungs, heart, etc.
The situation is particularly wor-
rying in view of the rising incidence
of cancer – the disease is the third
biggest killer in the country.
It would be reassuring to the
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a role by providing incentives to
both the individual and the general
practitioner by providing health-
care vouchers to the former and
financial remuneration to the
latter; provided that they both take
part in the scheme of placing more
emphasis on disease prevention.
There is great scope for im-
provement for our primary care
setting and it is hoped that this
sector will get the backing that it
needs.
But at the end of the day, the
management of any disease or ill-
ness boils down to the relationship
between the health-care profes-
sional and the patient. Both have
to play their role to ensure that the
partnership is successful.
Dr Helmy Haja Mydin is health-care
policy fellow at the Malaysia Think
Tank (www.wauBebas.org). Com-
ment: lettters@thesundaily.com.
The Penang Heritage Trust
proposal to modify and change
selective parts of an obsolete and
aging railway will put people’s lives
at risk.
I am not convinced that having
the middle station is beneficial
since it still forces the passengers
to rush across the steps and other
inconveniences to board the next
train, except perhaps as a museum.
And what a wonderful museum it
would make. The passengers could
disembark and visit or stay on the
train and hear the train’s monitors
tell of the funicular’s history. It
would ensure that a large part of
the funicular stays intact.
How can two funicular systems
proposed by the Penang Heritage
Trust be cheaper than one, it is not
logical unless they plan to take short
cuts.
Someone in authority needs to
step in and proceed with the total
upgrade before a more serious ac-
cident happens.
Brian Evans
Via email
ground floor units are used as
restaurants and motor workshops
where a lot of flammable material
is used and stored.
These institutions should
promptly move the students to safer
buildings. The management should
be charged with endangering the
lives of students if they refuse to do
so and charged with manslaughter
if any student is killed in a fire.
The Fire and Rescue Department
should shut down these hostels
before a tragedy strikes.
Zahar
Kuala Lumpur
public if the authorities could carry
out studies on the long-term effects
on public health, if any, resulting
from the distribution of potable
water through asbestos cement
pipes. In the early 1990s due to
public outcry newly-laid asbestos
cement pipes for water supply in
Manila were removed and replaced
with galvanised iron pipes.
M.G. Deva
Kuala Lumpur