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Contents SEPTEMBER 2009 www.mma.org.my

4 President’s Page
The First 100 days…

8 Secretary's Page
From the Desk of the Secretary

10 PPS Column
Quality in General Practice
Message from the
12

14
From the Desk of: Tan Sri Dato’ Seri Dr Mohd Ismail Merican
Better Prospects for Doctors Working in the Ministry of Health

SCHOMOS
EDITOR
SCHOMOS Meets Director-General of Health Medical Tourism: Are we ready for it?
Medical tourism is described as a practice of traveling across
16 Insurance international borders to obtain healthcare. This happens when citizens of
Update on Hospitalisation Plans for MMA Members other countries find quality healthcare cheaper in another country.
Singapore and Thailand have been in this business for a few years and
17 Press Statement Malaysia seems to be slowly catching up on its own bit in promoting
Australian Park Named After Malaysian Doctor medical tourism. We are more conducive to attract a bigger medical
tourist crowd but are we doing enough and do we have the correct focus?
18 Book Review One of the main concern is the brain drain from public hospitals to private
Clinical Atlas of Nasal Endoscopy hospitals. Doctors are fully aware that medical tourism flourishes well in
private hospitals especially when payment is in cash without any hassle
19 Letter to Editor from the local MCOs. Limited private practice in government hospitals,
1st MMA/MAAH Urban Outreach - Programme at SMK Sri Sentosa KL which was initially aimed for foreign patients, seems to have failed
miserably.
20 Mark Your Diary
Medical tourism promotes foreign exchange income and elevates our
21 Classified Advertisements standards, as we have to compete to be the best. One of the serious
constrain is lack of medical manpower particularly doctors and nurses.
24 Report Though we may have the highest number of medical schools per capita
Introductory Plantation Health Seminar in the world [23 medical faculties for a population of 27 million], we are
still running low in numbers of doctors in public hospitals. We also know
26 CME Update that the bubble will soon burst as the medical graduates are soon going
- Limbal Stem Cell as Potential Therapy to Blinding Corneal Conditions to graduate and will fill up all the empty post right up to the interiors of
28 - Colour Blindness East Malaysia. Maybe then we can promote medical tourism with
enough doctors for our rakyat and medical tourists.
30 Branch News
- MMA Wilayah Activities Our worries will not end with increase foreign patients [medical tourists]
32 - Briefing to the Private Sector on Influenza A (H1N1) in Penang in the next few years as we also may face challenges from foreign doctors
33 - MMA Perlis Pain Workshop having their practices in Malaysia after the AFTA comes into effect. It will
- MMA Perlis Dinner 2009 be rough turf for local doctors to keep up with this competition.
Malaysian doctors will be allowed to work within our region but how many
34 SP’s Korner of us will do so? I foresee tougher times in the future for doctors and
maybe the medical profession will not be a favorite choice anymore within
the next decade. Some serious proactive steps should be initiated now.
MMA EXECUTIVE COMMITTEE MEMBERS: 2009-2010
DR DAVID K. L. QUEK DR KULJIT SINGH Regulatory Requirements
President 2009-2011 Honorary Deputy Secretary Do we need more agencies, societies or associations to regulate doctors
and their practices? Are we not frustrated enough with By-laws and
DATO’ DR KHOO KAH LIN DATO’ DR SARJEET SINGH SIDHU Acts? We do not need any more governing instruments on our practices
Immediate Past-President Honorary Deputy Secretary
in the name of quality. It is often ridiculous to register in so many different
DR MARY SUMA CARDOSA DATO’ DR MOHAN SINGH PANNU registers, government agencies and societies, which portray quality
President-Elect Member control. The medical practice itself has its difficulty in managing MCOs,
insurances and ‘consulting’ pharmacies. It is not at all acceptable for
DATO’ DR N.K.S. THARMASEELAN DR HARVINDER SINGH doctors to face additional burden of complying with quality control
Honorary General Secretary Member societies. We should stand strong to reject any more regulating
instruments into our practice. Doctors are noble enough to self-regulate
DR HOOI LAI NGOH and practice within the domain of medical ethics and best patient care.
Honorary General Treasurer

My best wishes to all like always, and let us work out a better future for
EDITORIAL BOARD doctors. 

Editor: E d i t o r i a l B o a rd M e m b e r s :
Dr Kuljit Singh Datuk Dr N. Arumugam Dr Kuljit Singh
Dr Mary Suma Cardosa
Dr Chen Wei Seng Editor
E x - O ff i c i o :
Dato’ Dr N.K.S. Tharmaseelan Dr Saraswathi Bina Rai
Dr Andrew, Tan Khian Khoon
Dr Harvinder Singh
A d m i n i s t r a t i v e O ff i c e r DISCLAIMER:
Dr Krishna Kumar
(Publications): The views, opinions and commentaries expressed in the BERITA MMA (MMA News)
Matilda Cruz do not necessarily reflect those of the Editorial Board, MMA Council or
MMA President, unless expressly stated.

Published by: Printed by:

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 President’s Page
4
The First 100 days…
1. How has it been, the first 100 days in office?
As I have commented earlier some 2 months ago, the office of
President of the MMA has been quite demanding and taxing, yet it
is a very challenging learning process.
Clearly, not many doctors understand the burdens of office and the
mandated responsibilities of the President of the MMA. I certainly
did not expect such an onerous if ponderous task.
One could of course, just take this in one’s stride, and carry on as
per usual, accepting the position as President of the MMA as just
another feather in one’s cap of personal achievement or ambition.
But this, I believe would seriously undermine the status and
understated strength of purpose of the MMA.
Anyone who aspires to be an MMA leader must be aware of the
responsibilities and tasks ahead. He or she must necessarily wish
to do more, to represent the profession more robustly and with
fullest attention to details of the multifarious issues, which pertain
to the medical profession and healthcare scenario in the country
and beyond.
Not surprisingly, much is expected of the President as the
presumed spokesperson and the recognised opinion leader of what
must be the most respected association in our society, especially
when the MMA is seen to represent the interests of the largest
number of our doctors.
I think many among the public are aware that we still represent the
rational voice on healthcare issues in the country, and would like
very much to listen to our viewpoints, although increasingly with
more and more skepticism and mounting mistrust.
Certainly many officials in the MOH and the Health Minister himself
regards us highly as an important sounding board on all aspects of
health, which impinge on our Malaysian healthcare scene. I was
pleasantly surprised that a recent Malaysian public survey found
that doctors are widely regarded as having the second most
stressed profession! A few years back, some 72% of the public
polled also found us to be the most trusted among all other
professions! This gives us hope that we can still offer meaningful
and beneficial services to our rakyat, despite mounting grumblings
of physician carelessness and callousness.
Journalists, news editors and health officials expect the MMA to
have an opinion on myriad issues no matter how esoteric or fatuous
they might be (e.g. what do I think of so-and-so’s inane comment
that “masturbation may predispose to the H1N1 flu”?!!). Curiously
they all appear to believe that the President should readily have all
these information, ideas and opinions at his or her fingertips! The
President 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, no
matter how remotely connected! Perhaps this underscores the
respect and the expectation that the MMA is the de facto body
where our opinions matter and ought to be sought… We are
flattered, but at the same time bemused at the hysterical
approaches of some of these media people, anything to stoke the
interests of the readers!
It is with this in mind that I have felt compelled to try and actively
engage with as many organisations and authorities as possible, i.e.
any influential body that requires our input and ideas. How much
we 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, then
our doctors’ interests might not have been represented at all.
• MALAYSIAN MEDICAL ASSOCIATION • SEPTEMBER 2009
There are still quite a lot of
misgivings and negative
impressions about doctors in
private practice, the healthcare
system and the MMA in general—
that we are too concerned with our
own parochial interests, some of
which I have tried hard to dispel by
responding more with the
authorities that be. But all this
Dr David K.L. Quek
requires greater interaction and
positive dialogue on a personal President 2009 - 2011
level with more consistent
engagement and commitment.
2. What are your issues/plans for the MMA in the near and
longer term?
Many of the issues that have arisen during the first 100 days of my
presidency are not all new. However, these have been raised and
are now under discussion, with the view to some degree of
resolution or action. Among the most pressing issues include the
following:
a) R e v a m p a n d r e j u v e n a t e o u r M M A S e c r e t a r i a t and motivating
our staff to be more productive and professional;
b) E n c o u r a g e o u r m e m b e r s t o r e c o g n i s e t h e i r o w n i m p o r t a n t
i n d i v i d u a l r o l e as well as collectively, and instill increased
participation in the affairs of the medical profession, to remind
physicians about their calling, their vocation, their kindlier more
caring nature, as well as to remember to be our patients’
greatest advocate;
c) E n c o u r a g e o u r M M A l e a d e r s h i p ( E x c o a n d C o u n c i l
m e m b e r s ) t o t a k e u p m o r e r e s p o n s i b i l i t i e s, more in-depth
interests, develop and acquire training and leadership skills, so
that together we can better plan for more concerted policies and
a more meaningful, more participatory and influential role for our
august association, vis-à-vis healthcare and professional issues
in our country;
d) E n g a g e w i t h t h e M a l a y s i a n P h a r m a c e u t i c a l S o c i e t y ,
pharmacists in general and their leadership to move towards
greater professionalism, cooperation and collaboration;
e) W o r k w i t h o t h e r p h y s i c i a n g r o u p s towards greater unity of
purpose and direction, e.g. FPMPAM, Academy of Family
Physicians of Malaysia (AFPM), Academy of Medicine, MOH;
f) R e v i s i t t h e d i r e c t i o n a n d p o l i c i e s o f t h e M M A ’ s n a t i o n a l
h e a l t h p o l i c y c o m m i t t e e, including re-establishing an updated
blueprint for ‘Health for All’ Malaysians, including equity and
access issues;
g) R e - e n g a g e a n d c r i t i c a l l y r e v i e w t h e i s s u e o f s i n g l e - p a y e r
N a t i o n a l H e a l t h I n s u r a n c e S c h e m e for our Malaysian
healthcare system revamp, the continuing role of our private
sector, its possible integration or greater assimilation with the
public sector, reconsider other financing options, e.g.
DRGs/case-mix, catastrophic coverage/safety net, etc.;
h) L e a d d i s c u s s i o n s o n t h e i n a p p r o p r i a t e n e s s o f u n p o p u l a r
a n d u n n e c e s s a r y r e g u l a t i o n s on the private medical
practitioner, especially with regards the possible extension of
M S Q H a c c r e d i t a t i o n of private clinics, repeal of agreed-to
unpopular arbitrary regulations of the Private Healthcare
Facilities and Services Act 2006, working with the AFPM to
further strengthen primary care services and standards;
i) R e c o g n i s e t h e i m m i n e n c e o f n e w A F T A a n d M R A p o l i c i e s
when they come into play in 2010, and how they impact upon
our profession and our members, engage with the authorities
(MITI, MARTRADE, BIM, EPU) to mitigate the possible
professional implications on some sectors of our healthcare
providers;
cont’d...pg 5
 President’s Page (cont’d)
cont’d...from pg 4
j) A d d r e s s l o c a l c o n d i t i o n s o f h e a l t h c a r e, particularly the
concern of too m a n y m e d i c a l g r a d u a t e s in the immediate
future where training, supervision and experience may be
compromised. More than 2,000 new doctors now enter the job
market annually, and with the new scheme of 2-years of
housemanship, followed by another 2 years of compulsory
service (recently just revised downwards by the MMC and
MOH), these may be shortchanging our future doctors and their
professional skills and competency. There have been concerns
that our training positions may be inadequate for this larger
influx of recent years.
k) P u b l i c s e c t o r p r o f e s s i o n a l i s s u e s t o b e s t r e n g t h e n e d. At the
same time SCHOMOS will continue to fight for better and better
working conditions, fair and appropriate remuneration and
career prospects for our doctors in public service.
l) Too many Medical Schools. In the light of the above scenario,
MMA joins other bodies concerned as to the possible glut and
redundancy of future medical graduates. Too many are now
being produced or are returning. Medical schools and colleges
locally should be scrutinized so that the ‘mass production’ of
more graduates does not undermine the standards and the
needs of the country.
MMA subscribes to the view that there should be a moratorium
on new medical schools and that existing medical schools
should not be allowed to exceed their capacity to churn out
more graduates than have been agreed upon, without adequate
minimum standards of necessary skilled teacher-student ratio,
the availability of medical student clinical clerkship opportunities
in our overcrowded training hospitals, and the ‘needs’ basis for
the country.
m) M e d i c o - l e g a l c h a l l e n g e s. This will continue to escalate as
more 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 then
often are met with more medico-legal challenges and
complaints. With the rising costs in medical care, there is also a
tendency to expect greater clinical results, failing which disputes
on charges are rising, with mounting threats of litigation and
threats of professional complaints to MMC and the mass media.
n) E n g a g i n g w i t h o t h e r h e a l t h a n d m e d i c a l p r o f e s s i o n a l b o d i e s
o n t h e i n t e r n a t i o n a l l e v e l (WMA, CMAAO, MASEAN, IPPNW)
to spearhead consistent policies of common concerns, e.g.
global warming-climate change initiatives, human rights in
conflict 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 influenza
pandemic?
The MMA has under my lead chosen a cooperative and engaged
approach with regards this recent outbreak. We have taken the
lead to disseminate patient education and defuse public panic as
well as to support the MOH’s directives and plans to cope with this
novel pandemic.
We have also voiced our concerns as to the limited and frustrating
role of private sector doctors during the earlier phase of this
pandemic, the lack of consistent downstream transmission of
timely information, inadequacy of algorithms of clinical approaches
and therapies, confusing access to referral, medicines and
appropriate testing, etc. Happily, most of these have now been
ironed out and are much better understood and practiced.
We have also managed to successfully convene an urgent
Pandemic Flu Conference with the full cooperation from the MOH,
which was well received and actively attended by over 700
participants. We will continue to help voice our input and
suggestions to further improve the approach towards this still
unraveling pandemic, so that our public can be best served, and
our doctors better protected and empowered.
5
4. Do you think that MMA should be THE provider for CME /
CPD, or like the specialist register this should be given to the
Academy of Medicine or MMC?
There is no doubt that the MMA remains the best organisation to
administer and coordinate the CPD mechanism for doctors in the
country. Our approach has been simple and well documented, and
has served to ensure that doctors can keep track of their continuing
professional development efforts, when they register for such
activities. Of course we can further strengthen this mechanism to
include web-based learning and documentation and therefore more
accurate logging in of CPD points.
At this juncture, the MMA believes that the Academy and/or the
MMC do not have the logistical, secretarial or manpower support to
administer this duty. However, the MMA also hopes that we can be
offered greater incentive to continue this function, which we are
now performing without any due recognition or financial support.
While the specialist register is now within the purview of the
Academy of Medicine, its implementation is now incomplete and
delayed because of its requirement for registration fees, which we
understand is time limited. If the administration of CPD function is
to move anywhere, it should not further burden the practicing
physician. The fact that GPs and family physicians are making
efforts for continuing education and professional development
should be sufficient to ensure that the MMA continue to support
their endeavours, ultimately for our patients’ benefits.
5. Should it be compulsory for all doctors to have a certain
number of CPD/CME points over a certain period to continue
obtaining their APC?
With the implementation of the revised Medical Act some time in
2010 (?), we expect that the practicing license will be linked to proof
of CPD for physicians, the final quantum has yet to be finalised, but
is in the order of some 50 to 60 CPD/CME points over 2 years. This
will mandate that doctors take greater responsibility to update
themselves on a regular basis.
It is estimated that thus far only some 10 to 20% of our doctors
attend any sort of CPD programmes, and then only sporadically at
that! This expected rise in registration and collection for CPD
programmes/points will stretch our administrative function and
capacity, and thus we hope to be able to perform this with
adequate and fair support from the MOH or the MMC. Otherwise
this exercise may hit stumbling blocks of gridlock and missed
opportunities. Ensuring that more than 25,000 doctors get their
CPD registered points will be a definite challenge, but I believe we
are up to it. We are in the midst of streamlining registration
techniques such as the use of ID card readers and automatic data
capture/entry, but cost constraints are real issues.
6. When or should Malaysian doctors give up their role in
dispensing medications?
The short answer to this, is ‘NO’, not yet anyway. In my view, I think
we are still far from yielding our rights to dispensing medicines and
therefore separate prescription from dispensing. I urge the Minister
of Health to seriously avoid making any arbitrary and hurried action
with regards this contentious issue. This viewpoint persists despite
our continuing dialogue with the MPS and their continuing lobbying
for such a move.
Perhaps the most important reason against such a move is the fact
that our citizens have yet to learn the difference between what it
means to be a doctor and what the pharmacist’s role is. For too
long, our rakyat have come to assume that consulting with a doctor
for a health ailment meant being accompanied by some given
medicines for the healing process—no medicines, no charge, many
still feel and expect.
That the patient-doctor consultation process is a professional
exercise is rarely accepted as a means of fair remuneration for the
doctor, although increasingly more and more are accepting
specialist visits as such. Thus, the recognition of appropriate fees
cont’d...pg 6
• MALAYSIAN MEDICAL ASSOCIATION • SEPTEMBER 2009
 President’s Page (cont’d)
6
cont’d...from pg 5
for professional consultation must be made aware of and
inculcated into the public mindset.
Furthermore, pharmacists too are professionals, and are not merely
dispensers of drugs and medicines, nor convenient suppliers of
health and beauty products! They too have professional duties,
which command more than the simplistic view that their tasks are
simply to dish out cheaper discountable medicines and free drug
advice!
We need to continue to educate our patients and our rakyat that
both doctors and pharmacists are professionals who are
expensively and extensively trained for specific tasks at helping
patients obtain the best healthcare advice and experience. Until
such time, patients and our rakyat cannot abdicate their personal
duty and opt for the simplest way out.
Purchasing medicines without prescription or reviews at doctor
visits, is dangerous and self-defeating in the long term, and may
even be catastrophic. The public must recognised that most
scheduled medications should be used correctly and must be
supervised and monitored by their doctors; this step cannot be
dispensed with, just for saving a few dollars!
Our continuing professionalism demands that we expose such
wrongful illegitimate activities, so that together both doctors and
pharmacists can further enhance their roles up a few notches. We
need to re-educate our rakyat that doctors and pharmacists are not
just medication dispensers! Cost and convenience considerations
while important should be better managed and understood by all.
7. What is the MMA’s stand on private hospitals, insurance
companies and MCOs taking a percentage of professional fees for
administration? Isn’t this a form of kick back or fee splitting? What
about specifying and volume contracting for lower fees as well?
We are in principle opposed to any form of discounted business
arrangements, which encourage promises of greater volume of
patient referral to certain medical establishments. This inducement
can be construed as fee splitting and may constrain patient choice
unfairly based on pure economic incentives rather than professional
reasons. We recognise that some private hospitals are very
aggressively marketing their services with such incentives in mind
but which only undermines the professionalism and morale of their
doctors.
The MMC has already responded to queries by the MOH Amalan
Division, by stating categorically that volume discounts and bulk
purchasing of professional services (doctors fees) is tantamount to
kickback and fee splitting, and thus, should not be allowed and
may breach professional conduct. However, other non-
professional services such as laboratory tests, room charges and
pharmaceutical charges may be subject to market forces.
8. What are some other obstacles you face or anticipate
encountering?
Having not having enough time, personal resources and energy to
tackle all these issues. I worry about continuity of purpose and
involvement from our future leaders and membership. Too many
doctors are simply not interested enough, and expect a few
dedicated volunteers to take up the cudgels of responsibility and
action to get involved.
This is not to imply that as leaders (for a relatively short span of
time, 1 to 2 years), we can all make earth-shaking impacts which
last—but we have certainly to try leave some imprints which define
our better nature and perhaps would have left some legacy of
trickle-down, step-by-step advances in our lives and that of our
healthcare system and our profession.
Events may actually overtake us if we do not represent ourselves
more vigorously and with full support from our doctors—we need
greater participation and more support both ideologically and
• MALAYSIAN MEDICAL ASSOCIATION • SEPTEMBER 2009
physically. We need to increase our membership numbers to swell
our ranks of meaningful representation—30% is simply too small a
number as of now! We need our doctors to speak up and come
forward 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 and
perhaps not timely or quickly enough. The monthly Berita MMA
appears wanting in its reach. Dissemination of information and
news does not appear to be fast enough for our members. So
much so that some members have voiced frustrations and strong
views that the MMA leadership has not been seen to have done or
acted promptly enough concerning some urgent professional or
practice issues.
Doctors must learn to use the Internet more proactively and access
information and MMA’s standpoints on various issues, more
quickly. We continue to experience some hiccups with our MMA
website. We are trying to improve and upgrade this so that this
http://mma.org.my will be a much better, more speedy and
contemporary 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 constantly
updated news and views website, which focuses on mainly
professional and practice issues. I am also available for email
(drquek@gmail.com, or president@mma.org.my) inquiries, contacts
and commentaries, which may help reach out to more of our
concerned members out there.
Finally, members must understand that the mainstream media
(MSM) do not and have not always responded to all our press
releases. The MSM very rarely feel the need to publish any of our
many communications, and only those, which they feel are
newsworthy for the day or week. This means that most of our press
releases go unpublished despite our best efforts—most of the
publishing remains the prerogative of the editors and the reporters,
as frustrating as this may be to us, when we seem not to get our
message across to the public and the doctors at large.
However, there is a silver lining: most of the alternative internet
media such as Malaysiakini, Malaysian Insider, Malaysian Mirror,
Malaysian Medical Resources, Nutgraph have been receptive to our
press releases although some editing takes place. So please learn
to access these alternative media streams for more timely updates
and opinions from our MMA, and myself as the president.
9. Are there any controversies that are unpleasant to discuss in
the open, but which should be shared with all members?
Issues of involvement/engagement with the MOH: the MOH’s
general and still persistent view and perception that private sector
doctors and institutions are only interested in making money, are
too uncaring, too blasé as to public health issues such as
communicable 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 work
towards greater cooperation and commonality of purpose.
National issues which impact on health and human rights must be
addressed and be openly brought out into national consciousness:
national health financing issues, integration of public-private sector
plans, pharmacist-doctor separation of duties, planned Quality
assurance 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 and
potential declining standards, etc.
We must take the lead to expose injustices, perceived wrongdoings
and social inequities so that we can enhance civil society as a
whole, as part of a more enlightened professional movement. There
is much to do, but these are challenges, which I am convinced that
the MMA can make important contributions, and perhaps leave a
little impact of good and social justice in our wake. 
 Secretary's Page
8

From the Desk of the Secretary....

Fig. 1: Number of Meetings Per Ye a r

Dato’ Dr N.K.S. Tharmaseelan

Honorary General Secretary

he MMA is an organisation involved with the

T 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 N o t e : T h e re m a y a l s o b e a d d i t i o n a l e m e r g e n c y m e e t i n g s
would be virtually impossible for the office –bearers
Total Number of MOH Meetings 167
themselves to look after the affairs of the MMA. MMA Number of NGOs/Other Meetings 210
has thus, formed several Committees – 3 main and 28 MMA Exco Meetings 6
MMA Council Meetings 6
other Committees with 34 other representatives to HGS-Staff Meetings 6
several NGOs and MOH Committees. To function Managers/HGS Meetings 52

effectively, the Committees within MMA meet about

100 times a year. The total number of meetings with Fig. 2: MMA Membership Statistics
F rom 1 Jan - 31 July 2009
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 No P e rc e n t a g e

MMA to promote the welfare and look after the rights Life Members 26 1
Ordinary Members 225 7
and concerns of doctors (even non-members).
Renewals 2454 78
Doctors are urged to become members of the MMA Lapsed & Rejoined 201 6
and be more involved in the affairs of the MMA, after all Students 250 8

it is the only national association for doctors. 

Fig. 3: To t a l N u m b e r o f M M A M e m b e r s

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

• MALAYSIAN MEDICAL ASSOCIATION • SEPTEMBER 2009

 PPS Column
10
QUALITY IN GENERAL PRACTICE
Definition of Quality
The Institute of Medicine defines quality as:
“…….the degree to which health services for
individuals and the population increase the
likelihood of desired health outcomes and are
consistent with current professional knowledge.”
Donabedian argues that ‘every healthcare practitioners and every
healthcare institution has two major objectives: (1) to provide
care of the highest possible quality, and (2) to provide care at the
lowest possible cost. He identifies three components:
• S t r u c t u res: material resources, facilities, equipment and the
range of services at the practice level.
• P ro c e s s e s : what is done in giving and receiving care.
• Outcomes: the effects of care on the health status of the
patient and the community.
The ‘Health For All’ policy outlined a quality framework for
advancement of health promotion internationally. Colloquially
known as the Ottawa Charter, the framework identifies a series of
principles and strategies. The principles are:
• The prerequisites for health such as peace, shelter, education,
food, income, stable ecosystem, sustainable resources, social
justice 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 services
to those not likely to benefit (avoiding under use and overuse,
respectively).
3. Patient-centred – providing care that is respectful of and
responsive to individual patient preferences, needs and values
and ensuring that patient values guide all clinical decisions.
4. Timely – reducing waits and sometimes harmful delays for
both 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 quality
because 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 General
Practitioners)
• MALAYSIAN MEDICAL ASSOCIATION • SEPTEMBER 2009
by Dato’ Dr Mohan Singh
PPS Chairman
Donebedian, an American writer on medical quality talks about
quality in healthcare as examinable using the concepts of
structure, process and outcome.
Structure
This refers to the systems you have in place to deal with aspects
of running the practice. If you bulk bill all your patients or are a
cash only practice, you can get by very easily with a manual
accounting system. If you have multiple surgeries, issue
accounts to all your patients and have several categories of fee
level, your accounting needs may be better handled by a
computerized accounting system. The structure of your practice
will determine how you may best deal with patient accounts.
Process
Process 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?
Outcome
Outcome refers to what happens after an event occurs. In
financial terms this is the amount of money you take home from
the practice. In other areas of practice performance, outcomes
may be more difficult to measure readily.
(Source : www.racgp.org.au/runningapractice/evaluation)
Seven Steps to Patient Safety in General Practice
S t e p 1 : B u i l d a S a f e t y C u l t u re
• 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 quality
assurance.
• A strong safety culture requires – leadership, teamwork,
accountability, understanding, communication, awareness of
workload pressures and safety systems.
Step 2 : Lead and Support your Practice Te a m
• Talk about the importance of patient safety and demonstrate
you are trying to improve it by including an annual patient
safety summary in your practice report or your Practice
Quality Report.
• Include patient safety in in-house staff training, including the
use of improvement methods, and ask for it to be part of
continuing education outside of the practice.
• Promote safety in team meetings by discussing safety issues
and making it a standing agenda item.
Step 3 : Integrate your Risk Management Activity
• Regularly review patient records (e.g. using case note review
tools) so that areas of common harm such as delayed or
missed diagnoses/treatment can be identified.
cont’d...pg 11
 PPS Column (cont’d)
cont’d...from pg 10
• Involve wider primary healthcare team members in improving
patient safety and use information from as many sources as
possible to measure and understand safety issues in the
practice.
• Risk management is built into many aspects of a practice’s
work: complaints handling, infection control, monitoring
environmental risks, protecting vulnerable children, protecting
staff, insurance and reviewing repeat prescriptions before they
are signed.
• A key element of risk management is prevention. A safer
practice:
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 before
injection).
Step 4 : Pro m o t e R e p o r t i n g
• 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.
Step 5 : Involve and Communicate with Patients and the
Public
• Seek patients’ views, especially on what can be done to
improve patient safety, and use complaints as a vital part of a
modern, responsive practice.
• Encourage feedback using patient surveys and websites.
• Involve your practice population via patient groups, open
meetings or by inviting patient representatives to patient
safety meetings.
S t e p 6 : L e a r n a n d S h a re S a f e t y L e s s o n s
• Make the discussion of significant events and the national
analyses of patterns of risk everybody’s business, including
the wider primary healthcare team as appropriate, and act on
your findings.
• Share experiences with other practices by making your
patient safety lessons widely available.
S t e p 7 : I m p l e m e n t S o l u t i o n s t o P re v e n t H a r m
• Ensure that agreed actions to improve safety are documented,
action taken and reviewed, and agree who should take
responsibility 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 a
timescale and agree who will be responsible for carrying it out.
Agreed actions should be reviewed to be sure that they are
being 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.
11
o Try to find solutions which design out the problem so that
it 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 have
worked.
o Keep finding new solutions until the data shows
acceptable improvements.
(Source: Seven Steps to Patient Safety in General Practice, National
Patient Safety Agency, National Reporting and Learning Service)
Evaluating Physician Competence
There are two categories of methods for the formal assessment
of physician activities – the assessment of performance in test
situations, and the assessment of performance in actual practice.
Testing for competence is a broad and complex subject. It
seems, however, that testing for knowledge alone is insufficient.
The test situation should be so constructed as to elicit clinical
judgment and problem solving skills. Ability to elicit and interpret
sensory data (for example, in auscultation) should also be
included. It is likely that even the availability of multimedia
productions the assessment of actual patient care will remain the
ultimate test.
Actual practice may be assessed by observation, either directly
or through videotape; by records of care kept by the physician,
other professionals and, even, the patient; by interviews with the
physicians, or questionnaires; and by formal ways of obtaining
the opinions of other knowledgeable persons in the informal
network to which we have already referred.
Each of these methods has uses and limitations.
There is now no one best method for assessing physician
competence. We must rely on a system of assessment that
includes attributes, activities and achievements. Our quality
assurance system must also include attention to all three
components. In particular, health care programmes must not be
restricted by structural and process standards, and we must be
unalterably opposed to such suggestions so that these
programmes can experiment in new and more efficient ways of
achieving comparable outcomes. The search for more efficient
ways of achieving given outcomes is a major research
undertaking which must be conducted with rigorous controls by
fully qualified and unbiased investigators.
More important than the technical refinement of the system of
quality assurance that is adopted is the commitment to quality
which makes the system work.
Physicians must insist that any system for quality assessment be
congruent with a realistic view of what constitutes good care,
their obligations to safeguard the interests of their patients, and
the means at their disposal.
(Source: Evaluating Physician Competence, Avedis Donabedian, Bulletin
of the World Health Organization, 2000, 78 (6))
H e a l t h P re v e n t i o n a n d P ro m o t i o n i n G e n e r a l P r a c t i c e
More than any other area of medicine, general practice is the
specialty where GPs can help patients work toward being the
healthiest they can be. It is personalized case based on an
ongoing relationship with patients in the context of their family,
friends and community. Preventive case is based on a
partnership between a GP and a patient, designed to help each
patient reach his/her goals of maintaining or improving health.
cont’d...pg 13
• MALAYSIAN MEDICAL ASSOCIATION • SEPTEMBER 2009
 From the Desk of
12

Tan Sri Dato’ Seri Dr Mohd Ismail Merican

Director-General of Health, Malaysia

Better Prospects for Doctors Working

in the Ministry of Health

T
h e re h a v e b e e n m a n y l e t t e r s a n d c o m m e n t s
m a d e a b o u t t h e ro l e o f t h e M i n i s t r y o f H e a l t h
( M O H ) i n i m p ro v i n g t h e l o t o f d o c t o r s w o r k i n g i n
t h e p u b l i c s e c t o r. It is obvious that many do not know
how the gover nment machinery works. While the
MOH can come out with brilliant ideas and innovative
strategies, these may not mean much if the central
a g e n c i e s a re n o t s y m p a t h e t i c o r u n w i l l i n g t o d i g e s t t h e
a r g u m e n t s w e p u t f o r w a rd. You may sense that I
sound disappointed or frustrated but that is the re a l i t y.
Granted, the central agencies have done a lot under
t h e p re s e n t C h i e f S e c re t a r y, Ta n Sr i Mohd Si de k
Hassan and the Dire c t o r-General of Public Services
D e p a r t m e n t , Tan Sri Ismail Adam. Indeed, you cannot
get better supporters than these two fine gentlemen.
O u r S e c re t a r y - G e n e r a l o f H e a l t h , D a t o ’ S r i M o h d N a s i r
Mohd Ashraf, is also very supportive but what I find
disconcerting sometimes is the lack of urgency of the
i m p l e m e n t a t i o n o f i n s t r u c t i o n s f ro m t h e t o p . S o m e o f
o u r t h e m i d d l e m a n a g e r s e i t h e r re s p o n d s l o w l y t o
i n s t r u c t i o n s f ro m t h e t o p o r p u t i n c o n d i t i o n s u n k n o w n
t o t h e i r b o s s e s t o e n s u re t h a t a l l d e c i s i o n s m a d e a re
‘ c o r re c t ’ a n d ‘ f o l l o w p ro c e d u re s ” . T h e re i n l i e s t h e
b u re a u c r a t i c t r a p . P e r h a p s t h e y m e a n w e l l b u t t h e y
s e e m c o m f o r t a b l e b e i n g e n s l a v e d b y t h i s b u re a u c r a c y
and because of this and the fact that they thrive on
orthodox practices, decisions made collectively at the
t o p m a y s o m e t i m e s b e i m p l e m e n t e d m o n t h s l a t e r, that
t o o a f t e r s e v e r a l re m i n d e r s .
The Ministry of Health (MOH), as the primary government agency
responsible for providing healthcare to the public, is committed
to providing equitable, accessible and affordable healthcare
services to all Malaysians. The role is all the more daunting,
taking into consideration the mounting challenges in the planning
of optimum and acceptable services including changing disease
patterns, a well informed and demanding public, rising costs of
healthcare, new medical technologies and globalisation and
liberalisation.
One of the most important components in improving the
effectiveness of the healthcare delivery system is an efficient and
competent medical workforce. As such, the MOH is working
tirelessly to address the shortage of skilled medical and health
personnel, especially doctors. For this purpose, 24,135 posts of
doctors have been created. However, as of December 2008, only
57% (or 13,762 posts) have been filled. Only 2,545 of the posts
filled are specialists from various disciplines and grades (UD 41
and above).
Even though the current number of healthcare workers is far from
satisfactory, the Ministry of Health is commited to providing the
best healthcare to the public. In 2008,
government doctors provided services to 2
million in-patients and 62 million outpatients
in 2008. This year the number of patients seen has escalated
significantly following the current economic downturn and the
Influenza A (H1N1) pandemic.
To complicate matters, in 2008, only 60% of doctors are in the
public sector although they are responsible for serving 77.4% of
the total hospital beds in Malaysia. The remaining 40% of
doctors are in the private sector and are responsible for the
remaining 22.6% of hospital beds.
Our doctors and other allied health professionals have been
working very hard to provide the best of care for our patients
despite the many constraints, challenges and risks they face
everyday.
The Ministry of Health has been working very hard to improve the
terms and conditions of service, remuneration and working
conditions of the doctors. Various measures have been taken
and will be further implemented to ensure doctors continue to
serve in the MOH. These include the creation of new allowances,
improving current allowances such as the critical and on-call
allowances, providing incentives for those working extended
hours (RM80.00/hr) and those operating on Saturdays
(RM200/hr), allowing locum in private healthcare settings and
servicing private patients after office hours or during weekends
(full paying patients) and many more. In addition, the MOH has
created more opportunities for doctors to get promoted to higher
grades to retain them in the public health system even though the
monetary gain is relatively lower than in the private sector.
Efforts have also been made to improve the working environment
by providing conducive examination rooms for doctors especially
those in new hospitals with IT facilities. Those working in older
hospitals, sadly, are sharing rooms, making it difficult for them to
protect the privacy of their patients. The MOH has already made
an urgent appeal to the government to provide more resources to
upgrade these older hospitals in terms of renovations and
refurbishments, providing more ICU beds and examinations
rooms, modern equipments and others. The Government is
sympathetic and we hope to get clearance soon to be able to do
this in many of our older hospitals, some of which are more than
20 years old.
We do appreciate the sacrifices of our house officers and
doctors. We are doing everything in its power to fight for better
remuneration, allowances and better promotional prospects.
We have also made a proposal to set up the Medical Services
Commission. Many of our recommendations need the support
of central agencies in the government. We are also mindful of
the sacrifices of parents in funding medical education for their
children and has recommended to the Malaysian Medical
Council (MMC) to reduce the compulsory service from the
present 3 years to 2 years.
cont’d...pg 13

• MALAYSIAN MEDICAL ASSOCIATION • SEPTEMBER 2009

 From the Desk of (cont’d)
cont’d...from pg 12
We appreciate the long hours houseman and junior doctors have
put in. Housemanship training is a period of apprenticeship after
graduation from medical school before new graduates are given
full registration to practice independently as doctors. The 2-year
housemanship training is necessary to further improve the
capacity and capability of our trainee doctors. Upon completion
of the housemanship training, they will be confirmed in service
and be promoted to UD-44, a big jump considering that there are
doctors serving more than 4 years who are still on U-41. To
rectify this, the latter group will be automatically promoted to U-
44 by the end of this year. There are still some problems with
this exercise. Apparently many of our young medical officers
have not obtained their full registration from the Malaysian
Medical Council (MMC). It is obvious that the reason for the
delay is because our housemen have not applied for full
registration even after successful completion of their
housemanship. Attempts to get the various sections signed by
the relevant specialists may prove difficult as some of the
specialists may no longer be there. So I urge SCHOMOS to
inform all house officers to make sure they fill up the forms for full
registration well before they complete their housemanship to
avoid unnecessary delay in their promotion.
13
and mentors and set a good example for our younger colleagues.
The junior doctors must have the perseverance, resilience and
patience to go through the training expeditiously and obediently.
If they feel they are being shortchanged or treated unfairly, I will
be happy to see them.
As for medical officers who do not have specialisation, we are
working on a timed-based and flexible promotion for them. It
saddens me to learn that some of our medical officers (without
specialization) have retired on low grades even after putting in
long years of valuable and loyal service. With this proposal, they
will get promoted when due even if they stay on as ordinary
medical officers. Those who obtain their postgraduate
qualifications will of course be promoted earlier. With this new
initiative, the days of medical officers, some of whom are gurkhas
in 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 our
long term measures to bear fruit, the MOH has invited those
working abroad and those in the private sector to work with us.
We have already placed advertisements and hope they will
respond favourably and rise to the challenge of providing good
quality healthcare to all who seek treatment in this country.

Housemanship training program, to me, is the most important
part of a doctor’s career. It moulds the housemen to become
good and safe doctors. It is also the first big step for them in the
long journey of the medical profession. But for training to be
effective there has to be mutual respect between our younger
colleagues and the more senior ones. The senior doctors must
fulfill their responsibilities as service providers, teachers, trainers
The MOH, despite the many constraints, challenges and limited
resources, will strive to deliver the best medical and healthcare to
the public. We have a great team that is overworked and
stressed. We hope the central agencies will respond favourably
to all our many requests to improve the working conditions,
remunerations and career propects of our healthcare personnel.
They certainly deserve better. 

cont’d...from pg 11

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 environments
safe.
o Secondary – the early detection and prompt intervention to
correct departures from good health or to treat the early signs
of disease, e.g. cervical screening, mammography, blood
pressure monitoring and blood cholesterol checking.
Prevention Services
o Tertiary – reducing impairments and disabilities, minimizing
suffering caused by existing departures from good health or
illness, and promoting patients’ adjustment to chronic or
irremediable conditions, e.g. prevention of complications by
self monitoring of defined parameters supported by their GP.
GPs provide comprehensive, holistic health care to patients,
including preventive, curative and rehabilitative care on a
continuous and long term basis to all member of a community. A
key role of general practice is to prevent disease. 

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 treating
patients 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 improve
the 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 lowering
agents 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)
( N e x t i s s u e O c t – Q u a l i t y a n d S a f e t y i n H e a l t h c a re )
• MALAYSIAN MEDICAL ASSOCIATION • SEPTEMBER 2009
 SCHOMOS
14

SCHOMOS Meets Director-General of Health

by Dr Harvinder Singh
National 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

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

S 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) M e d i c a l S e r v i c e C o m m i s s i o n – 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) UD 44 Pro m o t i o n s – 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) E l a u n B a l i k K a m p u n g – Circular is on JPA website dated 1 January 2009.
4) H a rd s h i p A l l o w a n c e – 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) Public Health Pro m o t i o n a n d A l l o w a n c e I s s u e – DG commented that this issue had been solved at
MOH level and awaiting JPA approval.
6) H o u s e - Officers’ Grouses
i) Shift Duty – 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) H o u s e m a s h i p e x t e n s i o n - 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) M e m b e r s h i p D r i v e d u r i n g I n d u c t i o n o f n e w d o c t o r s – 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. 

• MALAYSIAN MEDICAL ASSOCIATION • SEPTEMBER 2009

 Insurance
16
Update on Hospitalisation Plans for
MMA Members
by Dr Hooi Lai Ngoh
Honorary General Treasurer &
Chairman MMA Insurance Committee
I am writing to provide an update and review of hospitalisation
medical plans available in collaboration with AON Insurance
Brokers (M.) Sdn. Bhd. for the benefit of members of the
Malaysian Medical Association.
1. Pacific Insurance Berhad 1982 – 2004
T h i s G ro u p M e d i c a l I n s u r a n c e S c h e m e i n c l u d e d t h e
f o l l o w i n g f e a t u re s :
(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 scheme
which was in force for a good 22 years. However, Pacific
Insurance Berhad gave notice of withdrawal effective from 1st
September 2004 since the amount of premium generated was
not substantial and the company suffered losses each year from
this scheme.
2. P a c i f i c I n s u r a n c e M e d i - C a re Insurance Scheme 2004 -
2009
This catered for the renewal policies of members insured
under the Group Medical Insurance Scheme which was
terminated 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 months
particularly relating to inadequate coverage for Hospital services
and supplies (sub limit RM2,000 to RM6,000 depending on the
plan selected). This was related to escalating medical charges
for Hospital services and supplies in recent years. Pacific
Insurance Berhad has informed members insured under this
scheme that it will not be inviting renewal of policies that fall due
from 1 January 2010.
3. J e r neh Insurance Berhad Hospitalisation Plan 2001 - 2008
The scheme was launched in 2001 and had the following
f e a t u re s :
(a) Daily room and board benefit ranging from RM150 to RM300.
(b) Reimbursement of major benefits including hospital
miscellaneous services, surgical fees and anaesthetist fees
on an “as charged” basis.
(c) Maximum benefit under any one disability ranging from
RM40,000 to RM75,000.
There was only one complaint from a member who wanted three
related medical conditions to be considered as separate
disabilities, and an amicable additional settlement was made to
conclude the case. Jerneh Insurance Berhad had to underwrite
losses every year from this scheme; in view of the unfavourable
claims statistics the company gave notice of withdrawal from the
scheme effective from 1 September 2008.
• MALAYSIAN MEDICAL ASSOCIATION • SEPTEMBER 2009
4. M e d i c a l P l a n s f ro m A l l i a n z L i f e I n s u r a n c e M a l a y s i a B h d
and Prudential Assurance Malaysia Bhd.
These two plans were short-listed in 2008 after an analysis of
existing hospitalisation plans available to the general public.
In view of the unfavourable claims experience of previous
Group Medical Insurance schemes for MMA members
mentioned above it was not possible to persuade any
insurance company to underwrite a special hospitalisation
scheme for doctors.
The Allianz plan allows entry up to 60 years of age whereas the
entry age for the Prudential plan is up to 70 years. Both plans
ensure guaranteed renewal up to 80 years of age.
T h e A l l i a n z p l a n p ro v i d e s t h e f o l l o w i n g :
(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 theatre
fees on an “as charged” basis.
(c) There is an overall annual limit ranging from RM25,000 to
RM150,000 and an overall lifetime limit ranging from
RM250,000 to RM1.5 million.
(d) Some outpatient services such as those for renal dialysis,
stroke and cancer treatment are covered with annual limits
ranging from RM5,000 to RM20,000 depending on the plan
selected.
(e) The amount deductible from the policy (zero, RM2,000,
RM5,000, RM10,000 or RM15,000) can be selected by the
insured member and the premium will be lower if the amount
deductible is increased.
(f) Premiums increase each time the member falls into a higher
age band.
T h e P r u d e n t i a l p l a n h a s t h e f o l l o w i n g f e a t u re s :
(a) Daily room and board benefit of RM200.
(b) Reimbursement for major benefits including hospital services
and supplies, surgical and anaesthetist/operation theatre
fees on an “as charged” basis subject to co-insurance at
10% 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 be
accessed from the MMA’s website at
http://www.mma.org.my/MemberServices/Insurance/tabid/73/D
efault.aspx otherwise please contact:
A O N I n s u r a n c e B ro k e r s ( M . ) S d n . B h d .
7th Floor, Bangunan Malaysian Re
No. 17, Lorong Dungun
Damansara Heights
50490 Kuala Lumpur
Tel: 03-2095 6628
Fax: 03-2095 6618
Contact Persons:
Mr. Sarjit Singh (Mobile: 016-2012413)
Email: sarjit_singh@aon-asia.com
Encik Zaidon Mohd (Mobile: 016-3756884)
Email: zaidon_mohd@aon-asia.com

Australian Park
Named After
Malaysian Doctor
M E L B O U R N E : The city of Ipswich, about
40km from Brisbane, has dedicated a new
18ha park in Redbank Plains to a much-
loved Malaysian doctor who has served the
local community for nearly 30 years.
Mayor of Ipswich Paul Pisasale said the
park was named after Dr Kamalakaran
‘Harry’ Ratnam “to celebrate his
professionalism, dedication, loyalty and
compassion to the Ipswich community.”
“Dr Ratnam, who arrived in Australia, and
in Ipswich in 1981 with his wife Raji after
an invitation from the Agent General of
Queensland in England, has served the
community ever since, and I believe it is
fitting for this magnificent park to be
named after him,” he said.
In 2007, Dr Ratnam, who is the younger
brother of former judge R.K. Nathan and a
first cousin of billionaire Tan Sri T. Ananda
Krishnan, was awarded the prestigious
Press Statement
17
Order of Australia Medal on the Queen’s work done in this area by Dr Harry Ratnam.”
birthday honours list for service to medicine
Queensland multimillionaire Maha
in Ipswich.
Sinnathamby, formerly of Rembau, Negri
Sembilan said Dr Ratnam should be “very
“I never dreamed in my life that I would get
an Order of Australia and then a park proud of his achievements.”
named after me,” he said. “I never expected
“The whole community of Ipswich loves
to be rewarded in this way.”
this man. He has done a lot for them,“ said
Sinnathamby, who has a boulevard named
Dr Ratnam, who had his early education at
after him.
St John’s Institution, Bukit Nanas, Kuala
Lumpur completed his schooling in Dublin,
Ireland. He then entered the Royal College Most of the 200 people who attended the
launch of the park at the weekend were Dr
of Surgeons and Physicians in Dublin,
graduating in 1977. Ratnam’s patients. -- Bernama 
Published: The Star Online Tuesday
Since coming to Ipswich, Dr Ratnam has
August 18, 2009
served on many health and welfare
committees, especially with the elderly.
It even prompted Jo-Ann Miller,
Queensland State Parliamentary Secretary
to the Minister of Health, to refer Dr
Ratnam as “an absolute hero” in
Queensland State Parliament in April 29,
2004.
Ipswich city councillor Victor Attwood, who
proposed the park be named after Dr
Ratnam, said he did it “in celebration of the
(Picture sourced from the Star Online)
 Book Review
18

Clinical Atlas of Nasal Endoscopy

Author: Balwant Singh Gendeh

T
he technological advancements in the expanding
field of rhinology has expedited the publication of
this Malaysian contribution entitled “Clinical Atlas of
Nasal Endoscopy”. In addition to his numerous academic
clinical publications, Prof Dato’ Dr B.S. Gendeh has
previously published two other books in his keen interest
to keep Malaysians updated in his subspecialty of the
nose. His two previous book publications were on “Sinus
Surgery: State of the Art Technique” in 2004 and
“Otorhinolaryngology” in 2006. Generally, books in
selective specialized fields tend to be expansive, but his
kind contribution towards rhinology may make this
knowledge more easily available to the local medical and
surgical fraternity. This vast collection of his own
descriptive clinical photographs and facts viewed through
the end of an endoscope, introduces the common man to
the fascinating world of rhinology. Moreover, nasal
endoscopy is a cousin to keyhole surgeries and similar to
developments in gastrointestinal endoscopy in opening up
new horizon in the state-of-the-art Minimally Invasive
Surgery.

The book has six chapters. Chapter one briefly

describes the development of nasal endoscopy. Price:
Chapter two emphasizes on how to perform out-
patient endoscopy and the clear visualization of RM90
the normal or abnormal anatomy of the nose and
paranasal sinuses. However, chapter three being the
longest covers the pathophysiology of the disease and the
common benign and malignant tumors of the nose and
paranasal sinuses. Chapter four focuses on patient
selection for surgery when optimum medical therapy fails
and describes in fair details the surgical procedures that
can be performed visualizing through the nasal
endoscope. Furthermore, this chapter will interest the
budding surgeons with special emphasis on endoscopic
sinus surgery. Chapter five lists the instruments the
trainee or the surgeon needs to know to be a good
craftsman. Finally, the last chapter takes the discussion of
the therapeutic procedures one step further, beyond the
nasal cavity to the cranial base. As rhinologist has gained
more experience in endoscopic sinus surgery, more areas
in the skull base are accessible and surgery is safe. It
discusses briefly the technological and surgical
advancements in the expanded endonasal approach
(EEA) to the ventral skull base. It conveys a message to
the reader to “watch this area” with a potential in the near
Website: http://www.ukm.my/penerbit
future. This collaborative effort has put the
otolaryngologist and the neurosurgeon to work
closely via the nose using the two holes and four hand
technique performing the operation simultaneously which
never happened before.
Clinical Atlas of Nasal Endoscopy, as an introductory atlas
contains over 170 illustrative coloured photographs with
additional CT and MRI images by a single author. This
book print obviously goes out to show about the author’s
passion for his subspecialty interest in rhinology and
anterior and ventral skull base surgery. I hope this book
helps the author spread his passion for rhinology and help
train more competent endoscopic sinus surgeons in
Malaysia in the very near future.
Department of Otorhinolaryngology, UKM Medical Centre,
Jalan Yaacob Latif , Bandar Tun Razak, Cheras, 56000-
Kuala Lumpur. E-mail:bsgendeh@gmail.com 
Reviewed by: Dr Kuljit Singh

• MALAYSIAN MEDICAL ASSOCIATION • SEPTEMBER 2009

 Letter to Editor
19

1st MMA/MAAH Urban Outreach -

Programme at SMK Sri Sentosa K L, 18 July 2000
Berita August 2009

In response to a complaint received
from a concern doctor as to why
General Practitioners located around
Sri Sentosa were not invited to
participate in the above programme,
below was the REPLY received from
Dr Nazeli Hamzah, Chairperson of
the Adolescent Health Sub-
Committee.
Sir,
The target participants consisted of 100
`selected` students who went through a
specific module to increase their resilience
so they are more able to be in control of
their actions and not be so easily influenced
by negative elements.
The facilitators were members of the
Adolescent Health Committee of MMA and
youth members of the Malaysian
Association for Adolescent Health
(MAAH). All the facilitators had
undergone training sessions to equip them
with the necessary skills.
Since studies have shown that adolescents
communicate better with their own peers
than with adults, we have always found that
youths make great facilitators with
supervision from adults. We are training a
pool of youths to be drawn upon when we
have similar projects.
As this was our first project in an urban
area we have not invited other doctors to be
involved. We will be happy to invite you to
join us for our subsequent programs.
I take this opportunity to invite all doctors
who have interest in Adolescent Health
issues in their community to please contact
the Adolescent Health Sub-Committee. We
will be more than happy to involve you in
our future activities.
Together we can make things happen.
Thank you. 
Dr Nazeli Hamzah
Chairperson
Adolescent Health Sub-Committee
Email: nazelihamzah@gmail.com
EDITORIAL NOTE: All ‘Letters to
Editor’ must have full name of the
authors and their membership
number. The Editorial Board reserves
the right to decline publishing any
letters/articles without names of
authors clearly spelt out.

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 Medical
Practice to meet the national healthcare delivery standards. AFPM has developed a two year (four semesters) Distance Learning Programme
for Diploma in Family Medicine. The objective of this Online Learning Programme is to provide flexibility in learning for all General Practitioners
who 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 the
cyberspace 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 with
a 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 a
period of six months.

Upon completion of the DFM Programme, the candidate may continue studying by enrolling on the Advanced Vocational Training Program for
two years to prepare for Membership Examination of the AFPM and the Fellowship Examination of The Royal Australian College of General
Practitioners. (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: chinym@afpm.org.my Website: www.afpm.org.my
 Mark Your Diary
20

OCTOBER 2009 Contact : Cik Natasha Alia bt Md Yusof University (UNU), Asia-Pacific Academy Consortium
Email : natasha@ummc.edu.my for Public Health (APACPH), World Health
AOEMM 11th Technical Update Contact : Prof M. T. Koh organization (WHO), The United nations Children's
“Health Impact Assessment” Email : kohmt@ummc.edu.my Fund (UNICEF) and Malaysian Public Health
Date : 10 October 2009 Specialists.
AOEMM 12th Technical Update Occupational Health Course for Medical Date : 23 - 25 November 2009
“Work Related Occupational Musculoskeletal Practitioners Venue : Dewan Kuliah UMS dan
Disorders” Date : 13 - 15 November 2009 Pusat Pendidikan Perubatan Desa
Date : 11 October 2009 Venue : To be determined Sikuati Kudat
Venue : To be determined Tel/Fax : 03 - 4044 6030 Email : franny@ums.edu.my
Tel/Fax : 03-4044 6030 Email : aoemm@aoemm.com / For further info: http://www.ums.edu.my/conferences
Email : aoemm@aoemm.com/ shafienaz@gmail.com
shafienaz@gmail.com Website : www.aoemm.com
Website : www.aoemm.com DECEMBER 2009
Second Seminar on Postgraduate Medical
9th World Congress International Association for Education in Malaysia Nutrition Communication Workshop
Adolescent Health (I.A.A.H) Date : 14 November 2009 Date : 3 December 2009
“Private Lives, Public Issues: Global Perspectives Venue : Grand Seasons Hotel, Kuala Lumpur Venue : International Medical University,
on Adolescent Sexual Health” Contact : Ms Alice Joseph/Ms Hema Bukit Jalil, Kuala Lumpur
Date : 28 - 30 October 2009 Tel : 03 - 4041 1375 Contact : Ms Danielle Ho / Ms Lee Ching Li
Venue : Shangri-la Hotel Fax : 03 - 4041 8187 Tel : 03 - 2731 7358 / 7249
Kuala Lumpur Email : info@mma.org.my Fax : 03 - 8656 7299
Contact : Datin Saadiah Ahmad Reg fee : RM100.00 (MMA Members) and Email : danielle_ho@imu.edu.my /
Tel : 03 - 2691 5379/ 03 - 2698 9966 RM150.00 (Non MMA Members) chingli_lee@imu.edu.my
Fax : 03 - 2691 3446 Website : http://www.imu.edu.my
Emails : mpaeds@gmail.com or AIDS After HAART
2009iaah@gmail.com Date : 14 November 2009 40th Union World Conference on Lung Health
Website : www.iaah2009.com Venue : Hospital Sg Buloh “Poverty and Lung Health”
Contact : Prof Suneet Sood Date : 3 - 7 December 2009
Email : suneetsood@yahoo.com or Venue : Cancun , Mexico
Health Wellness Workshop
Contact : Dr Noor Sham Yahya Luddin Online Reg : www.worldlunghealth.org
Healthy Weight, Healthy Life
drnoorsham@salam.uitm.edu.my
Date : 31 October 2009
Contact : Puan Ruhi Rights and Responsibilities of Government
Venue : International Medical University
Tel : 03-6120 3420 Doctors
Bukit Jalil, Kuala Lumpur
Fax : 03-6120 3423 Organised by Malaysian Medical Association and
Contact : Ms Danielle Ho / Dr Low Bee Yean
Website : http://mhr.uitm.edu.my Ministry of Health
Tel : 03- 2731 7358/7533
http://medicine.uitm.edu.my Date : 5 December 2009
Fax : 03 - 8656 7299
Venue : Auditorium, Ambulatory Care Centre
Email : danielle_ho@imu.edu.my /
Plantation Health Committee MMA Hospital Pulau Pinang
beeyean_low@imu.edu.my
“Introductory Plantation Health Seminar” Contact : Ms Azlin (SCHOMOS Secretariat)
Website : http://www.imu.edu.my
Date : 14 - 15 November 2009 Tel : 03 - 4041 1375
Venue : Jenderata Estate Fax : 03 - 4041 8187
38th MMA Perak Installation 2009
United Plantations Email : schomos@mma.org.my
Date : 31 October 2009
Teluk Intan, Perak
Venue : Royal Perak Golf Club
Contact : Ms Punitha Asia Pacific Primary Care Research Conference 2009
Tel : 05 - 2436543 / 016-5209022
Tel : 03 - 4041 1375 Date : 5 - 6 December 2009
Contact : Ms Malar
Fax : 03 - 4041 8187 Venue : City Bayview Hotel, Melaka
Email : mmaperak_2c@yahoo.com
Email : planthealth@mma.org.my Website : http://www.afpm.org.my/appcrc2009.htm
Website : www.mma.org.my
First Johor Medical Conference in Primary Care
Target Group : Doctors, Estate Hospital Assistants, 7th Asian Angle Closure Glaucoma Club Meeting
Jointly Organised by MMA Johor Branch and
Plantation Management (Managers Organised by Malaysia Society of Ophthalmology
Monash University
and Assistant Managers) & Malaysian Medical Association
Date : 31 Oct - 1 Nov 2009
Reg Fees : RM100.00 (MMA Members) Ophthalmological Society
Venue : Monash Clinical School Johor Bahru
RM150.00 (Non-Members) Date : 5 - 6 December 2009
Contact : Dr Kamarudin Ahmad
(2 breakfast and 2 lunches included) Venue : Crowne Plaza Mutiara Kuala Lumpur
Tel/Fax : 07-2364148
Contact : Majmin
H.P. : 012 - 7761061
25th Malaysia-Singapore Ophthalmic Congress 2009 Tel : 03 - 42517032
Email : kamaldr@yahoo.com
Theme: “Ophthalmology Today and Tomorrow” HP : 017 - 8821680
Organised by MMA Ophthalmological Society Email : majmin8@pd.jaring.my
(MMAOS) Website : www.aacgc.org
NOVEMBER 2009
Date : 20 - 22 November 2009
Venue : Renaissance Hotel, KL Occupational Health Course for Medical
Seminar and Technical Workshop
Contact : Ms Begum Practitioners
Mammalian RNAi and qPCR
Tel : 03-4041 1375 Date : 11 - 13 December 2009
Date : 3 - 4 November 2009 (Seminar)
Contact : Dr Jelinar Mohamed Noor Venue : To be determined
: 3 - 5 November 2009
(Hon Secretary) Tel/Fax : 03 - 4044 6030
(Technical Workshop)
Email : ophthal@mma.org.my Email : aoemm@aoemm.com /
Venue : International Medical University,
shafienaz@gmail.com
Kuala Lumpur
College of O & G Teaching Conference Website : www.aoemm.com
Contact : Ms Danielle Ho / Dr Leong Chee Onn
Date : 20 - 22 November 2009
Tel : 03 - 2731 7358 / 7528
Venue : One World Hotel Calling all Medical Graduates from KMC Manipal,
Fax : 03 - 8656 7299
Bandar Utama City Centre KMC Mangalore and Melaka Manipal Medical
Email : danielle_ho@imu.edu.my
Petaling Jaya College to join Annual Alumni Meet
cheeonn_leong@imu.edu.my
Tel : 03-4041 7088/4041 7541 Manipal Alumni Association Malaysia Annual
Website : http://www.imu.edu.my
Fax : 03-4041 9722 Convention
Email : dronghc@myjaring.net Date : 11 - 13 December 2009
Post Graduate Course on Paediatric Infectious
angeln@pd.jaring.my Venue : Rennaisance Hotel, Melaka
Diseases
Contact : Mr Kulen
“Paediatric Infectious Diseases”
2nd International Conference on Rural Medicine, Tel : 03 - 2282 7355
Date : 12 – 13 November 2009
ICORM 2009 Email : manipala@streamyx.com
Venue : Dewan Jemerlang
Organised by Sekolah Perubatan UMS, Persatuan Website : manipal.org.my
University of Malaya
Perubatan Desa Sabah (PERDESA), Kementerian
Tel : 03 - 7949 2065/7949 2732
Sains Teknologi dan Inovasi (MOSTI), United Nation
Fax : 03 - 7955 6114

• MALAYSIAN MEDICAL ASSOCIATION • SEPTEMBER 2009

 Classified Advertisements
21

ANNOUNCEMENT
PUBLIC HEALTH SOCIETY OF MMA CONGRATULATIONS
The Public Health Society of MMA has been in existence with the MMA
since the last few years. It has engaged in public health activities and The MMA congratulates the following
has worked very closely with other public health bodies, Ministry of
members:
Health and the public health departments of the various universities in
Malaysia. In the recent years there has been a decline in membership
from members of MMA who work in public health areas and other
MMA members who have interest in public health issues. DATO’ DR TEH LEI CHOO
Darjah Setia Pangkuan Negeri (DSPN)
The PHS now needs to hold an AGM to elect its office bearers. Through
this announcement, the PHS invites all MMA members/ Public Health
Specialists who have interest in public health issues to inform the
DR SANTOKH SINGH
secretariat regarding their contact address to assist them to join the PHS. DR REVATHY NALLUSAMY
DR LIM LAY HOOI
For further information please contact: DR ANITA BHAJAN MANOCHA
Puan Jalina at MMA House DR BALANATHAN KATHIRGAMANATHAN
Tel: 03- 4041 1375 Darjah Johan Negeri (DJN)
Email: publichealth@mma.org.my or
Dr S. Elangovan
H/P: 012-526 3293 DR TAN CHONG GUAN
Email: esgeron@gmail.com. Bintang Cemerlang Negeri (BCN)

The AGM will be held as soon as possible to elect the new committee.
Your urgent attention to this matter is highly appreciated. On being conferred the recent award by the
Yang di-Pertua Negeri of Penang
Thank you.
in conjunction with his
71st birthday celebration.
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
Tarikh : 5 hb Disember 2009
Masa : 8.30 pagi - 5.00 petang
Tempat : Auditorium, Ambulatory Care Centre, Hospital Pulau Pinang
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 Association
4th Floor, MMA House, 124, Jalan Pahang, 53000 Kuala Lumpur
Tel: 03 - 4041 1135 Fax: 03 – 4041 8187
Email: schomos@mma.org.my

Tarikh tutup pendaftaran: 30 November 2009

 Classified Advertisements
22

PUTRA MEDICAL CENTRE

P
UTRA MEDICAL CENTRE IS A 145 BEDDED
HOSPITAL strategically located in the Centre of
Alor Setar. We are expanding and growing with
a 8th Level New Wing. In line with our expansion, we would like to
CIRCUS invite applicants for the following Resident positions:-

“No one lives his life.

Disguised since childhood, • RADIOLOGIST • DERMATOLOGIST
Haphazardly assembled • OPHTHALMOLOGIST • PHYSICIAN
From voices and fears and little pleasures, • GENERAL SURGEON • NEUROSURGEON
We come of age as masks • UROLOGIST • ENT, HEAD & NECK SURGEON
Our true face never speaks.”
• ONCOLOGIST o DENTISTS
Rilke II,11
• NEUROLOGIST o DIETITIAN/NUTRITIONIST
“How would anyone know if you’re • GASTROENTEROLOGIST o RESIDENT MEDICAL OFFICERS
Sad or happy unless you are wearing a mask?” • OBSTETRICIAN & (Attractive Incom & Incentive
Mirrormask. GYNAECOLOGIST for Self-Drive MOs)
• PAEDIATRICIAN
No one recognizes the shadow
In my bedroom mirror until
I put on my mask.
THERE ARE ALSO VACANCIES FOR:
When I perform, the audience
• Nursing Supervisor • MSQH Coodinator
In the big top forget
Their tiger-striped anger, elephant • Training Manager • Operation Theatre Manager
Trunk despair, lion-tamer anxiety. • SRN Nurses & Midwives • Housekeeping Supervisor
The tight rope tension in necks • Cardiac Technician • Management Trainee
Disappear, All the Damocles fear • Finance Manager • Medical Equipment Technician
Are sword-swallowed. Their joy cannon • Nursing Manager
Balls to trapeze heights.

I am a consummate performer, Please send CV, Certificates, Testimonials and Photo (n.r) to:
Everybody loves me. Every night E-mail: pmc@puramedicentre.com.my
My saw-dust dread is exchanged
For star-dust dreams. Every morning
I wake, vowing never again For enquiries contact:
To be a clown. Mdm Shanti Kandaiyah: 017-5081658
But then the Ringmaster cracks Mdm Gan: 012-5820528
His whip, shouts, “The show Must go on!” Tel: 04 - 7342888 Fax: 04 - 7348882
Website: www.putramedicentre.com.my
by Dr Ng Kian Seng

www.adeg.com.sg

KL ADEG Aesthetic Dermatology Workshops

Who Should Attend & Why Attend:

The medical practitioners need to be armed with basic knowledge on aesthetic dermatology
which are not taught in medical school so that they will be able to advise their patients on
various 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 gain
basic 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 gain
knowledge on aesthetic procedures.

Please send completed form to:

Email: adeg.gcl@gmail.com or fax: +65 62548966 or
Mail form and cheque made payable to ADEG Pte Ltd to :
290, Orchard Road, #11-20, Singapore 238859.

• MALAYSIAN MEDICAL ASSOCIATION • SEPTEMBER 2009

 Classified Advertisements
23

CLINIC FOR SALE IN KULAI

Good Location in Taman Indahpura
Doctor Retiring
Contact: Dr Lau
H/P: 016 - 764 3066 KPJ Healthcare Berhad is a public listed healthcare
group owned and managed by Malaysians providing
Premier Healthcare Services. Since 1981, our network
Clinic or Equipment for SALE has expanded with full-facility of hospitals in Malaysia,
Indonesia, Bangladesh and Saudi Arabia. We are
Fully equipped for surgery with supported by Services and Companies in creating
excellent workplace and providing community value
Facilities for O.T and G.A and ensuring fiscal responsibility. Celebrating 28 years
at Mentakab, Pahang. of excellence and gearing up for the next phase of our
corporate growth, we invite resourceful and committed
Contact: Dr Subra – 019-2774455 professionals with the right attitude, skills and
experience to join our team
IMMEDIATE VACANCIES
MEDICAL OFFICER
Medical Officer in A & E
• 2 Positions Requirements:
• Basic remuneration (RM7,500.00 + EPF) negotiable. • MBBS or equivalent from recognized institutions
• Must be registered with MMC & possess current • Registered with the Malaysian Medical Council
APC. • Malaysian citizens or hold Permanent Resident
Status
Please contact Mr. Selva Raj
• At least 3 years working experience
Tel: 03 - 3324 3288 Ext 230 or
Email resume to: arunamari@hotmail.com. Interested applicants are invited to submit full resume
complete with working experience, copies of
certificate, contact number, current and expected salary
"CLINIC FOR SALE" and recent passport-sized photograph (n.r.),on or
before 15 October 2009 to:
Medical Clinic at strategic location in SEA Park
Section 21, PJ for takeover, reasonably priced. H R S e rv i c e s
K P J I P O H S P E C I A L I S T H O S P I TA L
Call: 016-949 7333 26, Jalan Raja Dihilir
30350 Ipoh, Perak
017-266 8289 Te l : 0 5 - 2 4 0 8 7 7 7 F a x : 0 5 - 2 4 0 8 7 4 5

or via e-mail
kamil@ish.kpjhealth.com.my

CLINIC FOR SALE

GENERAL PRACTICE WORK IN AUSTRALIA MOH registered clinic in
We are looking for General Practitioners to work in two populated surburb of Ipoh.
new multidisciplinary Medical Clinics in Adelaide, South Ready for immediate takeover, Doctor retiring.
Australia.
Contact: 012-5809189
The Clinics are operated by Adelaide Unicare and the University of (Between 5pm - 8pm)
Adelaide, a public university, established in 1874, and the third
oldest university in Australia. It is a member of the elite “Group of
Eight” Universities in Australia.
Benefits include: DERMATOLOGIST WANTED
• Assistance with registration and visa requirements;
• Assistance with relocation: travel, accommodation and suitable Every Monday to Friday
schooling etc.;
• A good, safe lifestyle close to the city centre; 2.00pm – 4.00pm in Seremban.
• Brand new purpose built facilities;
• High remuneration with a 2 to 5 year contract; Contact: 012 – 395 8848
• 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;
MEDICAL OFFICERS needed in
• Opportunity for academic appointment; NCI Cancer Hospital in Nilai.
• Opportunity for further training;
• Commencement late 2010/early 2011. Call: Stephanie: 06-8500999 Ext. 2333
Candidates must satisfy Australian Medical Board requirements and
or Email resume to: kywong@nci.com.my
assessments 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.
• MALAYSIAN MEDICAL ASSOCIATION • SEPTEMBER 2009
 Report
24

Introductory Plantation
Health Seminar
We would be also discussing the problems faced by the medical
team and the management in maintaining good health among the
plantation workers. There would be a question and answer
section at the seminar which we hope will benefit all participants.
by Dr J. R. Prushothaman
Committee Member, The topics of discussion are as follows:
Plantation Health Committee, MMA 1. Role and Responsibilities of Visiting Medical Officers
2. Role and Responsibilities of Estate Hospital Assistants
3. Chemical Regulations
he Plantation Health Committee headed by Dr Ravindran 4. Noise Regulations ( Oil Palm Mill)

T Naidu is planning to be more dynamic this year. We just

had our first committee meeting on the 6 September 2009
and we have confirmed our first Plantation Seminar to be held on
the 14 and 15 November 2009 with the first day being lectures
and the second day will be hands on training like A Walk Through
Survey, Line Site Visit, Crèche Visit and a demonstration on the
correct technique of spraying chemicals and personal protective
equipment. The venue has been confirmed and it will be held at
Jenderata Estate, United Plantations, Teluk Intan, Perak.
The Plantation Seminar will be useful for all doctors especially
V.M.O (Visiting Medical Officers) as well as for the Estate Hospital
Assistants (EHA). The Estate Managers and Assistant Managers
would also benefit in attending such seminars. The Management
would be aware of all the regulations and laws that govern the
health faced by their workers and the correct role of the V.M.O
and Estate Hospital Assistants.
5. Estate Sanitation and Health and Minimum Housing Act
6. Common Diseases in the Plantation
7. Personal Protective Equipment
The Plantations such as United Plantation, Sime Darby, National
Land Finance, FELCRA, FELDA and many more would benefit
from this seminar. The plantation industry in Malaysia has been
one of the major economy frontiers since the yester years of
British Colonization. After rubber and coconut, currently oil palm
has been a major booster for the Malaysian economy. Hence,
getting involved in health issues of our Plantation workers would
indirectly 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 not
hesitate to write to the Chairman, Plantation Health Committee
MMA. We would appreciate any feedback from the members. 

MEDICAL PROTECTION SOCIETY

An exciting and prestigious role with an international education team

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.
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.

Presenter positions would suit either full time or part time clinicians looking for
regular weekend or mid week work.

Doctors who are interested in applying should review the position description on www.medicalprotection.org/uk/careers
All 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 sarah.white@mps.org.uk 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 2009

MPS_MAL_FACPD_MMA_0909

Applicants 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.

PROFESSIONAL SUPPORT AND EXPERT ADVICE

 CME Update
26

“Limbal Stem Cell as Potential Therapy to

Blinding Corneal Conditions”
by Dr Bakiah Shaharuddin and the epithelium are continuously eroded and exposed the
Universiti Sains Malaysia corneal nerves. The eye would be inflamed and the
conjunctiva epithelium may replace the corneal epithelium
bringing together heavy vascularization, inflammation and its
milky coloured surface. Painful red eyes, secondary

T
he surface epithelium of the eye
comprises of conjunctiva at the
p e r i p h e r y, l i m b u s a t t h e t r a n s i t i o n
zone and the cor neal epithelium. Cor nea is
a s t r u c t u re a t t h e f ro n t o f t h e e y e w h i c h
a l l o w s l i g h t t o p a s s t h ro u g h t o re a c h re t i n a ,
which then transmits signals to the brain.
To p e r f o r m t h i s f u n c t i o n , c o r n e a m a i n t a i n s
i t s t r a n s p a re n c y b y p h y s i c a l l y b e i n g d e v o i d
of any blood vessels.
glaucoma and total blindness are conditions suffered by
these patients which reduce their quality of life.
The principle of treatment for limbal stem cell deficient
conditions include the use of amniotic membrane graft,
conjunctival-limbal autograft and penetrating keratoplasty.
Amniotic membrane grafting on its own usually fail to
regenerate the epithelium. Conjunctival-limbal autograft
needs a large size graft taken from patient’s other healthy eye
which would render the donor eye of developing secondary
limbal stem cell deficiency. If an allogenic source is used, the
cont’d...pg 27

The regeneration of corneal epithelium relies heavily on the

stem cells which are located at the limbus, the circumferential
structure area around it. Limbus also separates cornea from
the conjunctiva which is highly vascularized and is slightly
opaque. The stem cells are also protected by being deeply
buried and hidden by pigments which are abundant at the
limbal area. The stromal component of the limbus is also
richly innervated and vascular, to allow proliferation and
maintenance of the stem cells niche.

In limbal stem cell deficient conditions which in majority are

due to chemical injury, the limbus could be totally damaged

S t r u c t u re s o f t h e e y e

Day 20

Autologous graft c u l t u re d with amniotic membrane re a d y for Limbal stem cell deficiency in the right eye of patient with chemical
transplantation injury

• MALAYSIAN MEDICAL ASSOCIATION • SEPTEMBER 2009

 CME Update (cont’d)
cont’d...from pg 26
risk of graft versus host disease is also a risk. Penetrating
keratoplasty does not replace the stem cells thus it bears the
same complications and a high risk of graft rejection. This
makes the procedure prone to failure.
Limbal stem cells transplantation addresses the problem of
treating the limbus while keeping the eye ‘quiet’ for the
possibility of a more definitive procedure i.e penetrating
keratoplasty, to be performed to clear the scarred central part of
the cornea, at a much later date. By keeping the inflammation
at 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 or
specialization. The sources of limbal stem cells could be
derived from patient’s own tissue from a healthy eye which is
autologous in nature, from a living relative (allogenic), or from
a cadaveric source. Other autologous sources could be other
epithelial derivations from other types of stem cells i.e
embryonic or mesenchymal origins.
In a method of ex-vivo expansion, a limbal tissue explant may
be obtained from a small biopsy from the other healthy eye.
In the laboratory, the limbal explant was cultured using a
cryopreserved human amniotic membrane for two weeks.
27
After a successful process of tissue expansion, patient is
transplanted 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 transplant
after 3 days of surgery whereby alleviation of the pre-existing
painful red eyes is the first sign of recovery. Continuous
improvement in visual acuity may be observed during 12 to
18 months of follow up. Stabilisation of the limbal area by this
method will result in a marked improvement to the
subsequent second surgery which is normally undertaken to
clear the scarred central part of the cornea. In this instance,
penetrating keratoplasty, a surgery performed by removing
the central cornea of the patient and replace it with a
cadaveric donor cornea will fare more favourably.
The method described above, the “Newcastle method” was
carried out in a clinical trial at the Royal Victoria Infirmary in
Newcastle upon-Tyne. They have recruited 10 patients whom
were sufferers from chemical injury to the cornea. In their
clinical trial, all the patients had subjectively reported
considerable alleviation of eye pain. Most patients had also
improved their visual acuity at least 4 lines tested by Snellen
Chart. Following this success, the ophthalmology/limbal
stem cell team at Newcastle University will recruit more
patients into their clinical trial next year. 
 CME Update
28

COLOUR BLINDNESS

by A. Prof. Dr Andrew Tan Khian Khoon

What Is Colour Blindness

Colour blindness is not a form of blindness at all,
it is a condition whereby the person with this
condition finds it difficult to discriminate between
different colours, especially when many type and
shades or hues of colours are presented at the
same time. The commonest type of Colour
Blindness is Red-Green colour deficiency, which
is usually an inherited condition; other less
common forms include blue-yellow colour
deficiency. It is estimated by various studies that
worldwide, 2 to 8% of men are affected by this
Fig. 1: Ishihara Colour Blindness Fig 2: Ishihara Plate
condition. A recent study done in Singapore by Test Booklet
Chia A. et al in 2008 found that among 1249
secondary school students between the age of 13
to 15 years old, 5.3% of boys and 0.2% of girls were found
to have colour blindness.

Clinical Features
Contrary to popular belief, people with colour-blindness
seldom see things in black and white or shades of grey, they
are still able to see colours, though they may have a hard time
distinguishing between colours, say between red and green,
or blue and yellow, especially when they are presented with a
mix of many colours.

What Causes Colour Blindness

Colour blindness happens when photo-sensitive cells
(photoreceptors) in the retina do not function properly. Fig. 3: Farnsworth-Munsell 100-Hue Colour Vision Test Kit

Usually, people with colour blindness are born with it, it is

usually a sex-linked (X-linked recessive) chromosomal
disorder, which means it affects male much more than
female. A male with the colour blindness gene will be
manifested as colour blind, whereas a female with only one
colour blindness gene will not be colour blind (as female has
2 X-chromosomes), but instead will be a carrier and pass the
disease to her sons, a female will only be colour blind if she
has 2 colour blindness gene, one on each of her X-
chromosomes. Red-Green colour blindness usually results
from diseases of either long (L) or middle (M) wavelength-
sensitive visual photo pigmentation. It is the most common
single locus genetic disorder.
Besides this inheritable form of colour blindness, damage to
the retinal cells may also cause colour blindness, which may
affect different spectrum of colours, these aetiological factors
may be: ageing, diseases and drugs (e.g. certain drugs used
in treating arthritis), in extreme cases, these other disease
may lead to total blindness, whereas inheritable red-green
colour blindness does not lead to blindness.
Diagnosis
Eye doctors usually test for colour blindness using some
coloured plates with numbers or figures made up of many
dots of different colours, known as the ISHIHARA CHARTS.
cont’d...pg 29

• MALAYSIAN MEDICAL ASSOCIATION • SEPTEMBER 2009

 CME Update (cont’d)
29
cont’d...from pg 28

Remember proper counselling and career guidance early in

There are also other tests available for assessing the extent
school life is very important for sufferers of colour blindness,
of colour blindness for industrial or professional use, such as
as they may not be suitable for certain jobs, e.g. pilot, navy or
'Lantern Test' and '100 Hue Test'. More sophisticated electro
other jobs where discrimination of colours is of ultimate
diagnostic tests like Electro-retinogram (ERG) or Electro-
importance and cannot be compromised, otherwise, people
Oculogram (EOG) are also useful in diagnosing this condition.
with colour blindness can venture into most career.

Treatment
Recently, there were various experiments done in the United
Colour blindness cannot be cured, nor prevented - except by
States in laboratory animals that suggested gene therapy in
genetic counselling. (Though possibility of using genetic
adult animals may be useful in treating colour blindness,
engineering to repair/modify the colour blindness gene may
which will greatly give hope to people affected by this
be a possibility in the future).
condition in the future.

Diagnosing colour blindness early in life may prevent learning

Researchers from the University of Washington (Mancuso K.
problems during the school years, since many learning
et al, 2009 September 16) had described experiment whereby
materials rely heavily on colour perception.
a third type of cone pigment (opsin), was added to
dichromatic retinaes in adult monkeys to produce
Other forms of remedy for colour blindness include special
trichromatic colour vision behaviour which apparently does
lenses which are colour filters, available either in contact lens
not require an early developmental process. This provides a
or spectacle forms. Other ways to work around this disability
positive outlook for the potential of gene therapy to cure adult
include organising and labeling items of different colours to
with colour vision disorders. Other promising studies to date
avoid confusion. Remembering the order of things rather
include that done at the University of Florida (June 2008) in
than their colour may also help (e.g. the red light is always at
which cone targeted therapy was done using Adeno-assisted
the top a traffic light, followed by yellow and green.)
virus (AVV) vectors. 
 Branch News
30

MMA WILAYAH ACTIVITIES

1 2

by Dr Koh Kar Chai

Chairperson, Wilayah Persekutuan

As is the norm every year, come the ‘Puasa

Month’, there will be a dearth of activities as
our Muslim brethren go into a month long 3 4

fasting period and prepare for the ‘Hari Raya

Aidilfitri’ celebration at the end of it. During
this celebration week, many Malaysians will
go off on a holiday. Thus, most of the
Pharmaceutical companies will hold back on
their CPD activities for fear of a poor
participation of doctors.

The first activity that we at MMA

Wilayah embarked upon, immediately 1. Participants signing in early in 5 6
after the festivities was the ‘ K L E a r, the morning.
2. Even the Course Director
N o s e & T h ro a t S y m p o s i u m f o r
needs to sign in.
P r i m a r y C a re Physician’. This event 3. Our doctors in deep
was held on the 27 September, 2009 concentration
4. Dr Shailendra, Dr Loganathan,
under the auspices of MSO-HNS Dr Yap Yoke Yeow, Dr Kuljit
(Malaysian Society of 5. Dr Rahmat Omar
Otorhinolaryngologists, Head & Neck 6. Dr Balwinder, Dr Yeo Sek Wee
7. Dr S. Shailendra, Dr Kuljit,
Surgeons), MMA Wilayah, MMA Dr Pua Kin Choo (President of
Selangor and PMPASKL. MSO-HNS), Ms Darleena,
Dr KC Koh
7
A presentation on the C o n s e n s u s
G u i d e l i n e s o n t h e M a n a g e m e n t o f U p p e r R e s p i r a t o r y Tr a c t
I n f e c t i o n was also done at this event. This guideline was drawn
up by ENT Specialists from the MSO-HNS and Primary Care
D o c t o r s f rom MMA Wilayah. It was initiated about two years
back and finally presented this year.

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

Funding was available in the form of an educational grant from a

local Pharmaceutical company, for which we are grateful to have,
couldn’t accommodate the number of doctors who had replied to
since it requires a certain amount of financial allocation to
the invitation.
embark on such activities. It has been the norm for Multinational
Pharmaceuticals to be involved in such ventures, with most of
At the end of the day, our doctors left the venue armed with
our local Pharmaceuticals taking a back seat. Hopefully, with this
additional valuable information on the management of URTIs in
Symposium, we will see more similar activities being initiated by
the Primary Care setting, as well as some interesting knowledge
our local Pharmaceuticals.
on certain ENT disorders. 
We were pleasantly surprised with the overwhelming response by
our doctors in the Klang Valley. Apparently, the Pharmaceutical Don’t forget to mark your diary for the 5th PRIMARY
Company involved in handling the RSVPs had to turn down some CARE SYMPOSIUM on the 9 and 10 January, 2009.
doctors who wanted to attend the event as the lecture hall Website: www.mmawilayah.com

• MALAYSIAN MEDICAL ASSOCIATION • SEPTEMBER 2009

 Branch News
32
Briefing to the Private Sector on
Influenza A (H1N1)
Penang, 5 September 2009
by Dr Saraswathi Bina Rai
Penang
A
nother 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 in
Penang to have such a session. There had been two such
briefings before this year and both were held on a Sunday but the
attendance was never as envisaged. The State Health Director
planned the date with the Chairman of Penang Branch MMA and
PMPS President and a Saturday morning was agreed upon – 5th
September, 2009. It was very timely indeed as over the week
prior to the event, there were some changes in the management
of Influenza A (H1N1) and we were able to update the
participants 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 addition
emails were sent to about 400 private doctors, dentists (Yes, we
decided that dentists too should be informed) as well as to the
private hospitals. Not all doctors are members of MMA or PMPS
but we tried to reach as many as possible. We were quite
confident that most of the private doctors were aware of this
briefing but the decision to attend is a personal choice. The
Penang Branch of MMA was represented by Dr Praveen, the
Vice-Chairman; Dr Patrick Tan, the President of PMPS was
present as well (in between his surgeries); the State Health
Department was well represented by the Director - Dato’ Dr Teh
Lei Choo, Dato’ Dr Rosenah - the Consultant Physician, and the
District Health Officers. Yours truly wore the hats of MMA
Penang Branch and the State Epidemiology Unit – the unit to
receive all brickbats.
There were three presentations – Dato’ Teh took the lead and
gave an overall situation of the disease. This was followed by an
excellent presentation on the Medical Management of Influenza
• MALAYSIAN MEDICAL ASSOCIATION • SEPTEMBER 2009
A (H1N1) by Dr Chow Ting Soo, the Infectious Disease Physician
in the State. She was able to share her experience on the many
cases that she had handled at the Penang General Hospital. The
3rd presenter was Dr Chan Kwai Cheng, the Infectious Disease
Pediatrician at Penang General Hospital. Her topic was on the
Pediatric Management of Influenza A (H1N1). Each participant
was given a CD on the lectures presented – compliments of the
State Epidemiology Unit. The session was chaired by Dato’ Dr
Lim Yu Hoe, Consultant Physician at Penang General Hospital.
He had been given the task of taking the role as the State Liaison
Officer for Flu A. Personally, I believe it’s an excellent move.
Penang is a great place to work as there always has been great
cooperation between the private sector and Government and
between the Health and Hospitals and this has never been an
issue here. However, we do need someone to champion our
cause and Dato’ Lim may be the most apt person. He pointed
out that patient education was not effective enough and each
and every health personnel had a role to play in this. The public
was still not interested and there is lack of knowledge. It is every
health practitioner’s task to treat, prevent and to allay anxiety and
he stressed upon these simple but crucial messages.
There were hitches at the start of this briefing that was held at the
Auditorium of Hospital Pulau Pinang. The air-conditioning went
on strike and the hall projector refused to work (as always:
Murphy’s Law). Anticipating the worst, we had brought our own
LCD and notebook as well, so were able to rectify the situation,
and started right on schedule. Hence, albeit a tilted screen and
a few stiff necks it was a very fruitful morning and it’s a pity that
more doctors did not attend.
I believe it is their loss.
At the end of this very stressful
morning, sitting at home with a
book, I texted my appreciation to
all those involved in this
organisation and made this
happen. Maybe the reply from the
Health inspector from the Epid
Unit sums its all: “Satu Pasukan,
Puan”. One team! Yes, it’s nice
to be a part of this team! 
 Branch News
33

MMA PERLIS PAIN WORKSHOP

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

The 3rd Annual Dinner
and Installation Night
was also held at Putra
Palace Hotel on the
same night. The guest of
honor was Perlis Menteri
Besar, YAB Dato’ Seri Dr
Md Isa b. Sabu. The
night was graced by about 100 members and two
outstanding service awards were conferred to Dr Khairul
Shakir former Branch Secretary and Dr Hasna Hamzah,
former Branch Treasurer for their contributions in
establishing the Perlis branch. The awards were given
out by YAB MB. “Chain of Office” was handed over to
the new Chairman, Mr. Yeap Ewe Juan by Dr Hari Ram.
The night ended at 10.30pm and was a great success. 

Occupational Health for Health Care Professionals –

Caring for the Carers
Publisher : Malaysian Medical Association
ISBN Number : 978-983-99128-3-8
Editors : Dr G. Jayakumar & Assoc. Prof. Dr Retneswari Masilamani
Cover : Hard
Pages : 300 pages
Contents : 22 Chapters (Contributors from: Malaysia, Singapore , Japan,
India, Australia, United States of America, United Kingdom, UAE,
Egypt and South Africa)

TO PLACE ORDER:
Contact: Ms. Hema @ Tel: 03- 40411375 Email: soem@mma.org.my
Cost: RM88.00 (inclusive of postage within Malaysia)
Cheque payable to: Malaysian Medical Association
 SP’s Korner
34
SP’s Korner
by Dato’ Dr S. Pathmakanthan
Ipoh, Perak
This is my 200th contribution to this Korner. There was a
time in September 1985 when I got this queer urge of
propagating humour in a written form. I was then
encouraged by friends and colleagues. I particularly like to
single three of them – Dato’ Dr Joginder Singh and the late
Dato’ Dr Lim Say Wan both of whom were Editors of Berita
MMA during that period and Dato’ Dr Abdul Hamid.
And for some of the early years, I had to progress against
some prevailing odds to keep the budding voice of humour
growing in a conservative and mundane society where
mirthology is strictly controlled by theology and ethnicity.
After a span of 25 years, some humour is still taboo and can
only be nervously mentioned in isolation and in “silence” in
our “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 that
women use twice as many words as men because they have to repeat
everything they say.
He said,“What?”
WHAT IS IN A NAME – ANATOMY
The pastor asked if anyone in the gathering of the Church Hall would
like 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, had
a terrible motorcycle wreck and his scrotum was completely
crushed. The pain was excruciating and the doctors didn’t know if
they could help him.”
You could hear a muffled gasp from every man in the congregation
as only they can imagine the pain that poor Marvin must have
experienced.
“Marvin was unable to hold me or the children.” She went on. “And
every move caused him terrible pain. We prayed as the doctors
performed a delicate operation and it turned out they were able to
piece together the crushed remnants of Marvin’s scrotum and wrap
wire around and through it in places to hold it in place.”
Again, the men in the gathering were unnerved and squirmed
uncomfortable as they imagined the terrible surgery performed on
Marvin.
“Now,” she announced in a quivering voice,“thank God, Marvin is out
of hospital and the doctors say that with time his scrotum should
recover completely.” All the men sighed with obvious relief. The
Pastor 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. “I
just want to thank you all and also explain to my dear wife again that
the word is STERNUM.”
GOVERNMENT
A small boy was asked by his teacher, “What is the size of the
Government?”
“About 5 feet 2 inches,” he replied promptly.
“No, no, no,” said the teacher, “I mean how many members the
government has? How did you get 5 feet 2 inches anyway?”
“Well,” replied the boy. “My father is 6 feet tall and every night he
puts his hand to his chin and says,“I have had it up to HERE with the
Government!!”
• MALAYSIAN MEDICAL ASSOCIATION • SEPTEMBER 2009
HOW STUPID CAN YOU GET
Bob walked into the Royal Ipoh Club Long Bar at around 10.00pm. He
sat down next to Vella at the bar and looked up at the TV. The
10.00pm news was on. The news crew was covering a story of a man
on a ledge of a tall building preparing to jump. Vella looked at Bob
and 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 a
swan 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 news
and so I knew he would jump.”
Vella replied, “I did too. That really must have hurt!! I didn’t think
he’d do it again!!”
Bob took the money.
REAL DISPUTE – PRE – DNA STORY
A young boy comes running down the street looking for a cop. He
finds one and then begs, “Please, officer, come back to the bar with
me, my father’s in a fight.”
Well, they get back to the bar and there is three guys fighting like you
wouldn’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’s
what they’re fighting about.”
LYRICS OF INDIA
Surinder’s granduncle was booked into an SIA flight to Bombay. But as
this was his first time in an airplane, he made a few preparations that
were out of place. When the stewardess came around to take orders for
the in-flight meal, the granduncle declared loudly, “I have brought my
own lunch. Make sure you don’t charge me for food and drinks!”
So, as everybody was given their in-flight meal, the granduncle
began spreading out his own home-cooked meal. The man sitting
next to him was an American history researcher, who was curious
about 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 started
feasting.
“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 to
the 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 that
each 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 lawyers
and politicians start speaking honestly. Doctors were status quo.
Marvin murmurs:- “Two is company. Three is bad control.”