Seafarer’s Health: Navigating Wellness in Offshore Waters

WORDS LIM TECK CHOON
PHOTO MEDSEA

Malaysia has thriving petrochemical and fishing industries, which result in a significant offshore workforce. From oil rig workers to fishermen, thousands spend extended periods at sea, facing unique health challenges. This highlights the importance of maritime health, a specialized field focused on preventing, treating, and managing health issues specific to seafaring populations.

WHAT ARE THE MAIN HEALTH ISSUES FACED BY MARITIME WORKFORCE?
FEATURED EXPERT
ANUJ VELANKAR
General Manager of MedSea

According to Anuj Velankar, General Manager at MedSea and a former maritime captain, data from MedSea reveals that the following are the most common chronic health issues among seafarers:

  • High blood pressure or hypertension (67% of all chronic conditions reported on board)
  • Diabetes
  • High cholesterol or hypercholesterolemia
  • Gout

“Non-communicable diseases pose significant health risks to seafarers, potentially leading to complications and even medical emergencies,” he adds, pointing out that these medical emergencies also necessitate vessel diversions and delays.

CHALLENGES IN ADDRESSING HEALTH ISSUES IN A MARITIME ENVIRONMENT
FEATURED EXPERT
DR KATHERINE SINCLAIR
Senior Medical Advisor of MedSea

Dr Katherine Sinclair reveals that the maritime environment can give rise to the following challenges when it comes to managing chronic conditions.

  • Limited access to medical care
  • Long periods away from home
  • Physical demands of the job

These challenges often cause seafarers to neglect their chronic conditions.

“While crewmembers are often aware of their own chronic conditions, managing these conditions can sometimes be overlooked, posing significant risks to safety onboard,” Dr Sinclair reveals.

She adds: “Captains typically lack the bandwidth to closely monitor the health of crewmembers. Therefore, management should consider implementing proactive measures such as regular health check-ups, providing health education and ensuring access to necessary medical resources.”

SUGGESTIONS FOR ORGANIZATIONS TO PREVENT COMMON INJURIES AND ILLNESSES AMONG SEAFARERS
  • Pre-employment medical examination (PEME) to aid in detecting underlying conditions and monitoring the general health of seafarers. This will ensure that those going to sea are in their optimal condition, which will aid in reducing illnesses and accidents at sea.
  • Provide support for those with chronic conditions, by developing programmes that encourage seafarers to be open about the support they need for their chronic conditions. This can help prevent them from hiding their conditions and ensure they receive the necessary care.
  • Promote healthy lifestyles. Actively encourage all seafarers to maintain healthy diets, engage in regular exercise and avoid tobacco use. Provide resources and create a supportive environment can help seafarers adopt these healthy habits.
  • Ensure that seafarers follow recommended medical treatment prescribed by their doctors. Regular check-ups and adherence to medical advice are crucial for managing health conditions effectively.
  • Practice early intervention. If there are any changes in a crew member’s medical condition, it is essential to ensure that medical attention is sought as soon as possible. Early intervention can prevent minor issues from becoming serious health emergencies.

An Expert Explains What Many People Tend to Misunderstand about Palliative Care

WORDS LIM TECK CHOON

FEATURED EXPERT
DR HAYATI YAAKUB
Consultant General Physician
Sunway Medical Centre

Palliative care is often misunderstood. Many think it’s only for those nearing the end of life, but that couldn’t be further from the truth.

“Palliative care isn’t just about managing physical pain,” Dr Hayati Yaakub explains. “It provides emotional and psychological support to both patients and their families throughout their entire journey.”

THE DIFFERENCE BETWEEN HOSPICE CARE AND PALLIATIVE CARE
  • Dr Hayati clarifies that hospice care is a part of palliative care but is only for patients when treatment is no longer aimed to cure. It focuses on managing symptoms during the remaining phase of life.
  • Palliative care focuses on improving the quality of life for patients and their loved ones throughout the entire journey.
  • Unlike traditional medical care, palliative care mainly focuses on treating the disease holistically and being patient-centred, ensuring comfort in every aspect of the patient’s and family’s experiences.
  • “In a world where only 14% of people globally receive the palliative care they need, this underscores the importance of expanding the support, especially as Malaysia’s ageing population continues to grow,” says Dr Hayati.

Dr Hayati recalls how, one month after her patient passed away, a family member returned to her for emotional support. “He had fallen into depression,” she shares, “and his inability to manage the emotional strain was affecting his work and overall well-being.”

The story highlights a crucial, often overlooked aspect of palliative care—it extends beyond the patient’s passing.

PALLIATIVE CARE EXPLAINED IN MORE DETAIL
  • The word “pallative” is derived from the Latin word ‘pallium’, which means ‘cloak’.
  • Palliative care focuses on ‘cloaking’ or relieving the suffering of those with life-threatening illnesses and improving their quality of life.
  • Palliative care can be introduced at any stage of a serious illness, working alongside ongoing treatment to improve the patient’s quality of life by managing symptoms and providing comprehensive support.
  • Beginning from the patient’s diagnosis and continuing through the patient’s treatment, the palliative care physician will work alongside other specialists such as oncologists and cardiologists to offer both physical and emotional support to the patient and their families.
THE PALLIATIVE CARE SYSTEM IN MALAYSIA

According to Dr Hayati, the palliative care in Malaysia can be categorized into:

  • Hospital-based hospices
  • Community-based hospices, primarily run by non-governmental organizations (NGOs)

While both categories are tended by healthcare professionals, community-based hospices are especially beneficial for patients who prefer not to remain in a hospital.

WHO SHOULD CONSIDER GETTING PALLIATIVE CARE?

Among those that would benefit from palliative are people that are suffering from chronic diseases such as cardiovascular diseases, cancer, chronic respiratory diseases, AIDS, and diabetes.

Dr Hayati explains: “With these diseases, patients may struggle with symptoms like shortness of breath or pain. Palliative care can help alleviate the symptoms and manage the comorbidities associated with the disease.”

“In cases of cancer, it assists patients in managing the side effects of chemotherapy or radiation such as nausea or vomiting, allowing them to live as fully as possible,” she adds.

By integrating palliative care into the overall healthcare plan, patients can continue to receive treatment for their illness while also benefiting from the additional support provided through palliative care.

MORE THAN JUST TREATMENT

Dr Hayati further reveals that palliative care can offer emotional and spiritual support for patients’ families and caregivers in navigating the challenges of their loved one’s illness.

“Beyond emotional care, they can also rely on palliative care providers for practical assistance such as patient care education, caregiver support and education, access to necessary equipment, and spiritual guidance,” she explains.

“This ensures that they are not alone throughout the entire process, even after the patient passes away. By offering consistent, compassionate and clear communication, palliative providers build trust and provide stable support systems for families and caregivers.”

PALLIATIVE CARE IS NOT AN ACT OF GIVING UP; IT IS A COMPASSIONATE APPROACH

Dr Hayati assures us that palliative care should not be seen as a sign of giving up.

“Rather, it should be viewed as a compassionate approach that empowers patients and their families to live as actively as possible throughout the healthcare journey,” she states.

 

How Continuous Monitoring Is Changing the Way We Monitor Glucose Levels at Home

WORDS DR NGU SIE TEIN

FEATURED EXPERT
DR NGU SIE TEIN
Medical Officer
Columbia Asia Hospital – Miri

Continuous monitoring of blood glucose and blood pressure has transformed how we manage our health at home. Let’s explore how this technology is changing diabetes care.

WHAT IS CONTINUOUS GLUCOSE MONIORING (CGM)?
  • CGM uses a small wearable device with a tiny sensor under the skin to track glucose levels throughout the day.
  • It sends real-time data to a smartphone or insulin pump.
  • It offers a less intrusive alternative to finger pricks.
HOW DO WE BENEFIT FROM CGM?
  • Real-time insights. Instantly access glucose data to make informed decisions about diet, exercise, and medication. This insight encourages greater adherence to both medication and lifestyle recommendations, leading to more effective diabetes management.
  • Pattern recognition. Identify how meals, activity, and stress affect glucose levels.
  • Early detection. Take steps to prevent dangerous high or low blood sugar episodes even before they occur.
  • Reduced risk of diabetes-related complications such as kidney, nerve, and eye damage as well as hospitalizations. This will significantly enhance our overall well-being.
  • Greater independence. We can take control of our diabetes management with continuous data.
  • Reduces the need for frequent clinic visits by enabling remote check-ins and efficient in-person appointments focused on specific concerns.
It is important to note that while CGM can reduce the need for frequent in-person visits, it cannot completely replace them. Regular in-person check-ups remain crucial for comprehensive care, including physical examinations, foot checks, and other essential assessments.
HOW DO HEALTHCARE PROFESSIONALS USE CGM?

Doctors and nurses use CGM data to:

  • Create personalized treatment plans for their patients.
  • Make informed decisions about their patient’s medication and insulin dosing.
  • Develop tailored lifestyle recommendations for their patients.
HOWEVER, THERE ARE SOME CHALLENGES WHEN IT COMES TO THE USAGE OF CGM
  • Cost of devices and sensors. The upfront cost and ongoing expense for troubleshooting, calibration, and replacement of sensors can be considerable for some individuals.
  • Potential skin irritation and infections at the sensor insertion sites.
  • Some people may struggle with wearing the device consistently, especially during sleep or physical activities.
  • Stress and anxiety. Some individuals may feel overwhelmed by the constant monitoring.

Addressing these challenges requires collaboration between healthcare providers, manufacturers, and users to optimize device use and enhance its benefits.

IN CONCLUSION

Despite its drawbacks, continuous glucose monitoring remains a valuable tool in modern diabetes management.

It empowers patients and healthcare professionals alike, offering the potential to significantly improve quality of life and reduce complications.

International SOS Urges Organizations to Take Proactive Measures in Protecting Employee Heart Health

WORDS LIM TECK CHOON

FEATURED EXPERT
DR OLIVIER LO
Group Medical Director, Occupational Health Services
International SOS

As World Heart Day approaches on September 29, International SOS calls upon organizations worldwide to implement proactive measures to safeguard their workforce against cardiovascular disease (CVD).

A CALL FOR ACTION

“Organizations worldwide have a Duty of Care to foster work environments that promote the heart health of their employees,” says Dr Olivier LO, “as this can play a significant role in preventing cardiovascular disease.”

He adds: “With World Heart Day upon us, it is a great reminder of the importance of heart health initiatives at work. Heart disease may significantly impact employers financially through direct costs like healthcare services and medications, as well as indirect costs such as absenteeism and presenteeism.”

“Additionally, there are costs associated with hiring temporary staff or overtime pay to cover absent employees, as well as potential increases in health insurance premiums,” he further elaborates.

SOBERING STATISTICS
  • CVDs remaining the leading cause of death globally, accounting for 17.9 million fatalities annually.
  • Recent data from International SOS reveals a concerning trend:
    • 34.5% increase in cardiovascular health-related assistance requests from 2021 to 2022
    • Further 18% increase from 2022 to 2023
    • 86% of heart-specific ailments were reported in the male population
  • These statistics underscore the growing need for comprehensive cardiovascular health support in the workplace.
7 PROACTIVE MEASURES FOR WORKPLACE CARDIOVASCULAR HEALTH

International SOS recommends the following strategies to mitigate cardiovascular risks among employees:

Measure 1: Create a Heart-Healthy Culture

Foster an environment that prioritizes health and wellbeing.

Measure 2: Encourage Regular Health Screenings

Offer screenings for blood pressure, cholesterol, and other risk factors.

Measure 3: Implement Healthy Eating Initiatives

Provide access to nutritious food options and educate employees on heart-healthy diets.

Measure 4: Promote Regular Physical Activity

Encourage exercise through workplace wellness programs and facilities.

Measure 5: Offer Stress Management Programs

Provide resources to help employees manage stress, a significant CVD risk factor.

Measure 6: Launch Education and Awareness Campaigns

Organize workshops on cardiovascular health to raise awareness.

Measure 7: Support Smoking Cessation

Provide resources for employees who wish to quit smoking, as tobacco use contributes to approximately 17% of all CVD deaths.

New Vaccine Approved to Protect Older Adults from Respiratory Syncytial Virus Disease

WORDS LIM TECK CHOON

AN INTRODUCTION TO RESPIRATORY SYNCYTIAL VIRUS
  • Respiratory syncytial virus (RSV for short) is a common virus that primarily infects the lungs and respiratory tract.
  • It spreads easily through respiratory droplets when an infected person coughs or sneezes.
  • The virus can survive on surfaces for several hours.
  • RSV is highly contagious and can infect almost all children by the time these children are 2 years old.
  • The virus causes cells in the respiratory tract to fuse together, forming large multinucleated cells, which is where it gets its name ‘syncytial’.


An overview of RSV disease. Click on the image to view a larger, clearer version.

For more information on RSV, catch up with Dr Lee Onn Loy in our previous article on this topic.
RSV AND ITS IMPACT ON OLDER ADULTS
FEATURED EXPERT
PROFESSOR DR AHMAD IZUANUDDIN ISMAIL
Deputy Director & Consultant Respiratory Physician
Hospital Al Sultan Abdullah Universiti Teknologi MARA (HASA UiTM)
  • RSV also significantly affects older adults. It is increasingly recognized as a major cause of respiratory illness in older adults, particularly those aged 60 and above.
  • Older adults with pre-existing conditions such as chronic obstructive pulmonary disease (COPD), heart disease, or weakened immune systems face a higher risk of developing severe outcomes from an RSV infection.
  • RSV can also worsen existing health issues, leading to conditions like congestive heart failure and worsening asthma.

“RSV can lead to severe outcomes especially among older adults with co-morbidities such as asthma, COPD and chronic heart failure,” says Professor Dr Ahmad Izuanuddin Ismail. “They also have increased risk of hospitalization following the RSV infection.”

He then elaborates: “It is important for us to protect patients aged 60 and above with co-morbidities. It is time we protect our older adults with underlying health conditions from RSV infection to enable them to lead a good quality of life especially in their golden age. By prioritizing the well-being of older adults, we can collectively foster a healthier and more vibrant society, ultimately enhancing the quality of life for all generations.”

VACCINATION AS A KEY METHOD TO REDUCE THE RISK OF SEVERE COMPLICATIONS
  • Vaccines are available to protect people against RSV.
  • Recently, GlaxoSmithKline Pharmaceutical Sdn Bhd (GSK) announced that their latest RSV vaccine for adults 60 years old or older has been approved in Malaysia.
  • The vaccine is approved based on positive data from a phase III trial, where the vaccine demonstrated high overall vaccine efficacy of 82.6% against lower respiratory tract disease.
  • This vaccine was generally well tolerated with an acceptable safety profile.
  • Some observed adverse events included injection site pain, fatigue, myalgia, and headache. These were typically mild to moderate and lasting within a few days after vaccination.

Following the approval of the vaccine, Dr Alap Gandhi, the Country Medical Director of GlaxoSmithKline Pharmaceutical Sdn Bhd (GSK) Malaysia and Brunei tells us: “Today’s announcement is a major step forward from a public health perspective, as it allows us to deliver an RSV vaccine in Malaysia to protect older adults.”

Reference: GlaxoSmithKline Pharmaceutical Sdn Bhd. (2024, September 25). GSK’s Arexvy is a vaccine approved to protect older adults from respiratory syncytial virus (RSV) disease in Malaysia [Press release, KKLIU 2755 / EXP 17.3.2025].

Healing Across Genders: The Bald Oncologist Tackles Cultural Norms in Malaysian Cancer Treatment

WORDS LIM TECK CHOON

FEATURED EXPERT
DR MALWINDER SINGH SANDHU
“The Bald Oncologist”
Consultant Clinical Oncologist
Pantai Hospital Kuala Lumpur
Website and Social Media

In the realm of oncology, gender plays a crucial role in shaping caregiving dynamics and communication between patients and healthcare providers. To give us a better understanding of this, Dr Malwinder Singh Sandhu, also known as “The Bald Oncologist”, joins to share some valuable insights into how gender influences caregiving responsibilities and impacts the support needs of patients navigating cancer treatment.

GENDER NORMS AND CANCER COMMUNICATION

Dr Malwinder reveals that, in Malaysia, cultural expectations and gender norms play a crucial role in shaping the way cancer patients communicate with healthcare providers, adhere to treatment plans, and cope with the challenges of the disease. These gender-specific factors have significant implications for both the diagnosis and management of cancer.

MEN WOMEN
  • Expected to be stoic.
  • May downplay symptoms or avoid discussing discomfort, leading to delayed diagnoses and inadequate symptom management.
  • Might feel more comfortable discussing symptoms but may be hesitant to talk about reproductive health, especially with male doctors.
  • Caregiving responsibilities often cause women to prioritize their family over their own health, which can lead to underreporting symptoms.
GENDER-SPECIFIC BARRIERS TO CANCER CARE 

According to Dr Malwinder, gender norms can also present barriers to accessing cancer care,

MEN WOMEN
  • Cultural pressures to remain strong may delay seeking treatment until symptoms are severe.
  • Men may also find it hard to adhere to treatment regimens if they feel it interferes with their work or provider roles.
  • Stigma surrounding certain cancers, like breast and cervical cancer, can cause delays in seeking care.
  • Balancing caregiving duties with their own health needs can also lead to treatment adherence challenges
PSYCHOLOGICAL IMPACT OF CANCER DIAGNOSIS & TREATMENT

“Men and women experience cancer’s psychological toll differently,” Dr Malwinder tells us.

MEN WOMEN
  • Often suppress emotions, internalizing anxiety and fear.
  • This can worsen their mental health, but men are also less likely to seek psychological support due to societal expectations of emotional strength.
  • While women may be more emotionally open, they often worry about becoming a burden on their families.
  • Guilt and anxiety about their family’s future are common psychological challenges.

One way to address these psychological challenges for both men and women is by joining a support group.

  • These groups provide a safe space for patients to share their concerns, gain emotional support, and learn how to cope with their illness from others facing similar experiences.
  • Support groups can help break down gender barriers, encouraging both men and women to open up about their struggles, and ultimately improve their overall mental health.
BODY IMAGE CONCERNS IN CANCER PATIENTS

“Changes in physical appearance from cancer treatments, such as surgery or chemotherapy, can cause body image issues,” says Dr Malwinder. “These concerns are also shaped by gender.”

WOMEN MEN
Physical changes, like hair loss or mastectomies, can severely impact a woman’s sense of identity, exacerbating stress and leading to potential identity crises. While not discussed as openly, men also struggle with body image issues, especially when treatments cause weakness or weight loss, challenging their sense of masculinity
HOW GENDER INFLUENCES OTHER ASPECTS OF CANCER CARE

Dr Malwinder further shares the following information.

MEN WOMEN
  • Treatment adherence and follow-up care. May be less consistent with follow-up appointments, especially if they feel “recovered” enough to resume their responsibilities.
  • Palliative care. Cultural norms of resilience may prevent men from discussing pain, leading to inadequate pain management.
  • Support. Tend to have smaller, less emotionally-focused support networks. Cultural expectations of strength can leave them feeling isolated, with limited community support.
  • Treatment adherence and follow-up care. While balancing family obligations can be a challenge, women are generally more consistent with follow-up care when encouraged by healthcare providers.
  • Palliative care. Women in traditional caregiving roles may prioritize their family’s needs, making them reluctant to seek end-of-life care.
  • Support. Often have wider social networks, supported by family and female friends, and are more likely to seek emotional support from community or religious groups.
DR MALWINDER’S RECOMMENDATIONS TO HEALTHCARE PROVIDERS FOR A MORE GENDER-INCLUSIVE APPROACH TO CANCER CARE
Diagnosis
MEN WOMEN
Oncologists should create a safe environment for men to express vulnerability without judgment. Healthcare providers should encourage women to prioritize their own health over caregiving responsibilities.
Treatment
MEN WOMEN
Treatment plans should accommodate men’s work commitments to improve adherence. Offer support for balancing family care and treatment helps women adhere to their treatment plans.
Follow-up Care
MEN WOMEN
  • Regular check-ins with encouragement to stay consistent in their care are vital.
  • Promote support groups to help deal with emotional and psychological challenges.
  • Support systems that alleviate caregiving burdens can improve treatment adherence.
  • Promote support groups to help deal with emotional and psychological challenges.
Caregiving Support
  1. Acknowledge the different strengths of male and female caregivers.
    • Support programs should cater to the strengths and challenges of both genders.
    • Female caregivers might need respite care and emotional support, while male caregivers could benefit from guidance in providing more emotional care.
  2. Encourage open communication.
    • Open conversations about caregiving and support can break down gender norms.
    • Male caregivers should be encouraged to engage emotionally, while female caregivers should feel empowered to ask for help and set boundaries.
  3. Expand support networks for male patients.
    • Community programs should be developed to help male cancer survivors and caregivers connect.
    • Tailored support groups for men can provide a space to discuss struggles and break cultural barriers.
  4. Establish family support structures.
    • Families should be educated on sharing caregiving responsibilities equally, encouraging sons and male relatives to take on more emotional caregiving roles.
  5. Leverage community and religious groups.
    • Community and religious organizations play a crucial role in providing social support, especially for female patients.
    • Encourage these groups to also support male patients and caregivers as an essential step to extend care networks.

The Hidden Dangers of Dengue: It’s More Than Just a Fever

WORDS LIM TECK CHOON

FEATURED EXPERT
DR SHANTHI RATNAM
Consultant Physician and Intensivist
Thomson Hospital Kota Damansara

Many people think of dengue as a mild illness, but the reality can be far more serious.

Severe dengue often requires hospitalization and can lead to internal bleeding, organ damage, and even death. What’s more, a second infection is more likely to be severe.

However, there’s another aspect of dengue that’s less well-known: post-dengue syndrome. This condition can leave lasting effects long after the initial infection has passed.

BAHWANEE’S LONG ROAD TO RECOVERY

Bahwanee Muthusamy’s experience with dengue fever was the beginning of a challenging journey that has lasted over 6 months.

“This was my second bout of dengue,” Bahwanee recalls. “At first, it seemed like just a mild fever but within a day, I had a terrible headache, vomiting, and diarrhoea. My platelet count dropped dangerously low.”

Bahwanee’s condition quickly became critical, affecting her liver. She spent 2 weeks in the hospital and another 2 months on medical leave.

Even simple tasks like driving or sitting up for long periods were impossible due to nerve compression in her lower back.

WHAT IS POST-DENGUE SYNDROME?

Dr Shanthi Ratnam explains that Bahwanee’s experience is known as post-dengue syndrome (PDS).

“It’s when symptoms of dengue fever persist for more than 6 weeks after the acute phase,” she says. “We’re still learning about how common it is, but some studies suggest it could affect between 18% and 50% of dengue patients.”

Dr Shanthi is an intensivist, a medical practitioner that specializes in the care of critically ill patients, such as those in the intensive care unit or ICU.

PDS can cause a range of symptoms, including:

  • Mild to overwhelming fatigue
  • Muscle and joint pain
  • Swelling of the joints (reactive arthritis)
  • Poor concentration
  • Dizziness

The challenge with PDS is that there’s no specific test to diagnose it. Doctors must rule out other possible causes before concluding that a patient has PDS.

LONG-TERM IMPACT OF PDS

PDS has turned Bahwanee’s life upside down.

“It’s affected everything,” she says. “Simple actions like climbing stairs are now exhausting. I can’t work like I used to. I’m dealing with hormonal issues, hair loss, and a weakened immune system. It’s been a nightmare.”

Dr Shanthi points out that PDS can also take a toll on mental health.

“It can severely affect a person’s quality of life,” she explains. “This is true especially for young, active people. The constant fatigue, pain, and inability to resume normal activities can be depressing.”

WHO IS AT RISK OF PDS?

While anyone can develop PDS, some groups are at higher risk:

  • Elderly patients
  • People with existing health conditions like hypertension, heart disease, obesity, or autoimmune diseases
  • Those who have had dengue before
RECOVERING FROM PDS

For people that are recovering from dengue, Dr Shanthi recommends the following:

  • Get plenty of rest. It is good to get 8 to 10 hours of sleep per night.
  • Eat a balanced diet rich in fruits and vegetables.

She also offers advice for caregivers of the following groups of people.

  • Children. Keep them home from school for a week before gradually resuming normal activities.
  • Older adults. Encourage frequent naps and sufficient nighttime rest.
  • People with diabetes or high blood pressure. Monitor blood pressure closely and consult with a doctor about medication adjustments.
  • People at high risk of bleeding. Watch for warning signs like dark, sticky stools.
GIVEN THE LONG-TERM IMPACT OF DENGUE, PREVENTION IS CRUCIAL

Dr Shanthi emphasizes the need for a comprehensive approach such as:

  • Eliminate mosquito breeding grounds, such as standing water in containers and rain gutters.
  • Consider innovative preventive strategies like the dengue vaccine.
About the Dengue Vaccine

The dengue vaccine, recently approved in Malaysia, is now available in private clinics and hospitals.

It’s given in 2 doses, 3 months apart.

Dr Shanthi recommends it for high-risk groups such as:

  • Elderly people with other health conditions
  • Obese individuals
  • People with high blood pressure, heart disease, or autoimmune conditions
  • People taking medications that can affect their immune system

Even those who have had dengue before, like Bahwanee, can get the vaccine 6 months later for protection against other strains of the dengue virus.

A CALL TO ACTION

Both Dr Shanthi and Bahwanee stress the importance of taking dengue seriously.

“We need to renew our commitment to fight dengue on all fronts,” says Dr Shanthi.

Bahwanee adds: “Dengue is often dismissed as merely a fever but look at what happened to me. I’m so glad there’s a dengue vaccine now because dengue is everywhere, so no one is safe. We need to take it seriously and be proactive to combat this threat together.”

Unmasking the Shingles Threat: Pain, Prevention, and the Power of Vaccines

WORDS LIM TECK CHOON


An overview of shingles. Click on the image to view a larger, clearer version.

5 ESSENTIAL FACTS ABOUT SHINGLES
  1. Shingles, also known as herpes zoster, is a viral infection that causes a painful skin rash that takes on a pattern known to Malaysians as “snake”.
  2. Chinese superstition held that should the “snake head” meet the “snake tail” as the rash spreads, it will cause death. Of course, this is not true. The rash can be painful, but it is not typically fatal.
  3. The “snake” is actually caused by varicella zoster virus (VZV), the same virus responsible for chickenpox.
  4. What happens is that after a person recovers from chickenpox, the virus still remains in an inactive or dormant state in their nervous system.
  5. Shingles develop when this virus becomes active again or reactivates. This can be common particularly among older adults or those with weakened immune systems.

Reactivation of dormant chickenpox virus can lead to the development of shingles. Click for a larger, clearer version.

THE SYMPTOMS OF SHINGLES
Rash
  • Shingles typically manifests as a painful rash that develops into blisters, often appearing on one side of the body, commonly on the chest, abdomen, or face.
Pain and Emotional Distress
  • The pain can be severe. It is often described as burning, stabbing, or shock-like.
  • The intense pain can lead to significant emotional distress, impacting daily activities and quality of life.
  • Due to the pain, many individuals report difficulties in sleeping, concentrating, and performing routine tasks.
Flu-like Symptoms
  • Many individuals also commonly experience flu-like symptoms such as fever and fatigue.
COMPLICATIONS OF SHINGLES
Post-herpetic Neuralgia (PHN)
  • This is a condition characterized by persistent nerve pain that can last for months or even years after the rash has healed.
  • The risk of developing PHN increases with age.
  • It affects approximately 10-20% of those who contract shingles, particularly in older adults.
Economic and Emotional Impact
  • People with shingles have to face costs associated with medical treatment, lost workdays, and the potential long-term care needed for complications like PHN.
  • The emotional toll and the risk of complications highlight the importance of preventive measures, particularly vaccination.
VACCINATION AGAINST SHINGLES 
  • Vaccination is a highly effective way to prevent shingles and its complications.
  • The recombinant zoster vaccine (RZV) has shown remarkable efficacy in clinical trials.
  • This is a non-live, recombinant subunit adjuvanted vaccine that enhances the immune response, helping the body to fight off the virus before it can reactivate and cause shingles.
  • The vaccine is administered in 2 doses, with the second dose given 2 to 6 months after the first.
  • It provides up to 97% protection against shingles in adults aged 50 and older.
  • Studies indicate that RZV maintains an efficacy rate of over 80% against shingles even several years after receiving the vaccination.
RECOMMENDATIONS FOR THE VACCINE
  • Health authorities recommend that adults aged 50 and over should receive the shingles vaccine, regardless of whether they have had shingles or chickenpox in the past.
  • Additionally, individuals aged 18 and older who are immunocompromised or at increased risk for shingles should also consider vaccination.
  • The optimal time to receive the vaccine is as soon as one reaches the eligible age, as the risk of shingles increases with age.

Reference: GlaxoSmithKline Pharmaceutical Sdn Bhd. (2024, September 10). GSK shingles vaccine now available in Malaysia [Press release, KKLIU 2560 / EXP 29.01.2025].

Supplements, Rebates, and Savings: Reforming Policies for Wellness in Budget 2025

WORDS DATUK DR RAJEN MANIKA

FEATURED EXPERT
DATUK DR RAJEN MANIKA
President and Council
Malaysian Dietary Supplement Association (MADSA)

As we await the upcoming Budget 2025, set to be tabled in Parliament this October, we are presented with a critical opportunity to reassess the current tax policies, particularly on dietary and health supplement products.

THE QUESTION THAT MUST BE ADDRESSED IS: SHOULD HEALTH AND WELLNESS BE TAXED?

The simple answer is no, and yet, dietary supplements in Malaysia are currently subjected to a 5% sales and service tax (SST), with certain finished products also facing a 5% import duty.

This taxation is an unnecessary financial burden on Malaysians striving to maintain or improve their health.

Revising these tax policies is not just an economic adjustment; it is a vital step towards enabling all Malaysians to adopt healthier lifestyles, a change that has been long overdue, especially since the last review request was in 2021.

BALANCING PROTECTION AND QUALITY IMPROVEMENT

To fully understand the urgency of this issue, it’s important to consider how these taxes are not only affecting consumers, but also hindering the growth and quality of the local supplement industry.

The imposition of import duties on selected ingredients and finished dietary supplements is counterproductive. Instead of protecting local industries, these duties end up increasing production costs and consequently, retail prices.

In reality, the local supplement industry is heavily dependent on imported ingredients, and as of yet, there is no viable alternative.

For instance, let’s take a look at fish oil. Malaysia’s tropical waters simply do not yield the cold-water fish required to produce high-quality fish oil. The import duty on this essential ingredient does nothing to protect local industries, because there is no local equivalent that can meet the demand or quality.

By removing these import duties, production costs would decrease, and these savings could be passed on to consumers, making health supplements more affordable and accessible to the general public.

This is not just a matter of economic efficiency; it’s about prioritizing the health of our nation.

SST EXEMPTION FOR DIETARY SUPPLEMENTS?

The current application of SST on dietary supplements is another area in dire need of reform.

Currently, several dietary supplements containing ingredients such as vitamins, fish oil, spirulina, essence of chicken, Haruan fish, and more are imposed a 5% SST. On the other hand, all pharmaceutical products, including ascorbic acid (vitamin C), elemental iron, and medications containing multivitamins and minerals are tax exempted.

Exempting dietary supplements from SST aligns with the principle of allowing individuals the freedom to make informed choices about their healthcare. By removing SST from these products, the government can make them more affordable, encouraging more Malaysians to invest in their health.

Furthermore, as more Malaysians turn to dietary supplements, we can expect a decrease in non-communicable diseases (NCDs), which will ultimately lead to reduced healthcare costs for the government. It will be a clear win-win situation, where the public gains access to better health resources and the government reduces its long-term financial burden.

INTRODUCE LIFESTYLE TAX RELIEF AND TARGETED SUBSIDY STRATEGIES

In addition to removing taxes and import duties, the government should consider including dietary supplements in the existing lifestyle tax relief.

Tax reliefs have proven effective in encouraging healthier behaviors, and extending this benefit to include supplements would provide financial relief to those actively investing in their health.

However, broad-based subsidies can create a dependency that is counterproductive in the long term. Instead, the government should implement targeted subsidies for vulnerable groups, ensuring that financial assistance reaches those who need it most without fostering a culture of reliance. An end-of-subsidy monitoring plan could also be established to evaluate the effectiveness of these measures, ensuring they are both sustainable and successful in their intended goals.

Achieving long-term success in dietary supplementation requires a multi-faceted approach. It is imperative that local government agencies collaborate with supplement producers and relevant NGOs to educate the public about the benefits of dietary supplements. Through comprehensive education campaigns and awareness programs, we can empower consumers to make informed decisions about their health, dispelling myths and misinformation along the way.

For instance, the current ‘Tolak Ubat Tidak Sah’ campaign by the Ministry of Health could be similarly applied to dietary supplements as a friendly, accessible means to educate and spread awareness.

By adopting these measures, the government can support consumer health choices, enhance the quality of local products, and create a more competitive and vibrant supplement market.

Now is the time for action. By revising tax policies, offering targeted subsidies, and educating the public, we can ensure that dietary supplementation becomes an integral part of Malaysia’s approach to health and wellness. The health of our nation depends on it.

Understanding and Navigating Migraine with a Consultant Neurologist

WORDS LIM TECK CHOON

FEATURED EXPERT
DR HIEW FU LIONG
Consultant Neurologist
Sunway Medical Centre

Migraine is often mistaken for a simple headache or even misunderstood as a mental illness. However, it is a chronic neurological disease that has no known cure.

It significantly affects a large portion of the Malaysian population. Research shows that migraines disproportionately impact women more than men, with 1 in 4 women and 1 in 12 men experiencing migraines at some point in their lives.

WHAT IS MIGRAINE?

“Migraine is not just a headache; it is frequently accompanied by other symptoms like dizziness, nausea, vomiting, fatigue, sensitivity to light (photophobia), and fear of loud sounds (phonophobia),” explains Dr Hiew Fu Liong.

He adds that migraines can also involve emotional aspects and are known as recurrent episodes of severe headaches.

MIGRAINE EPISODES TYPICALLY PROGRESS THROUGH 4 PHASES
  1. Prodrome. Subtle warning signs such as malaise, fatigue, and food cravings.
  2. Aura. Sensory disturbances like visual flashes or heightened sound sensitivity.
  3. Attack. Intense, unilateral head pain coupled with aversion to light and sound, lasting from 4 to 72 hours.
  4. Post-drome. Lingering lethargy that may persist for a few days
THERE ARE A FEW TYPES OF MIGRAINES

Dr Hiew identifies several types of migraines:

  • Migraine without aura. The most common type, characterized by sudden and severe pain localized to one side of the head.
  • Migraine with aura. Accompanied by blurred vision or auditory hallucinations, often serving as precursors to pain.
  • Basilar migraine. Primarily involves dizziness, vomiting, and auditory hallucinations without the typical head pain.
  • Ocular migraine. Involves eye pain or temporary vision loss in one eye.
  • Catamenial migraine. Affects women during their menstrual period, indicating a link to hormonal fluctuations.
  • Hemiplegic migraine. A severe form that not only includes intense head pain but also paralysis on one side of the body.
UNDERSTANDING THE TRIGGERS & RISK FACTORS IS ESSENTIAL TO MANAGE MIGRAINES

Triggers can include sudden weather changes, dehydration, sensitivity to strong odors, caffeine consumption, and exposure to loud noises, among others.

HOW MIGRAINE IS TREATED & MANAGED

The primary goal of migraine treatment is to manage the condition effectively. By consulting a neurologist, patients can develop personalized strategies to either prevent migraines or better manage their symptoms.

“There are two main treatment options: one to stop the pain and another to prevent the migraine attacks,” notes Dr Hiew.

Pain relief treatments include painkillers, while preventive treatments involve anti-epileptic, anti-hypertensive, and antidepressant medications.

Advanced treatments, such as calcitonin gene-related peptide (CGRP) receptor blockers, are also available, targeting the trigeminal nerve to prevent migraine attacks.