An Associate Professor Shares How the Role of the Pharmacist Has Evolved Over the Years

WORDS LIM TECK CHOON

FEATURED EXPERT
ASSOCIATE PROFESSOR DR WONG PEI SE
School of Pharmacy
International Medical University (IMU)

This year, the theme of the World Pharmacists’ Day is Pharmacy strengthening health systems. In light of this, we’re pleased to have Dr Wong Pei Se joining us to share her thoughts on the role of community pharmacists in our healthcare system.

MALAYSIANS ARE CONSULTING PHARMACISTS MORE THEN EVER

In 2015, the National Survey on the Use of Medicines (NSUM) found that only 5% of the respondents would consult a pharmacist on health problems.

Just 6 years later, in 2021, it was reported that Malaysians on average visited community pharmacies 31 times a year. This is comparable to the average in developed countries such as Australia, the US, and the UK!

This could be spurred by the growing awareness of the role of a pharmacist as a result of the COVID-19 pandemic. That was when people began to rely more on their pharmacist for information and guidance on the use of medications, sanitizers, masks, and more to stay safe and healthy during the pandemic.

Even then, many Malaysians may still overlook how the pharmacist behind the counter can be a reliable first stop for medical and general health advice, beyond the scope of the pandemic.

GUIDANCE & EDUCATION ON GENERAL MINOR AILMENTS

“Community pharmacists can help manage minor ailments, give advice and help to educate the public on different aspects of ailments and treatments available,” says Dr Wong Pei Se.

She adds, “Pharmacists are also able to guide customers onto the right medical path – when you are not sure whether you need to see a doctor, or even which doctor you need to see.”

THE BIGGEST ROLE OF A PHARMACIST

No, it’s not to sell medications and over-the-counter products!

The biggest role a pharmacist can play in their community is to support healthy living and self-care in that particular community. They are in an optimal position to help members of the community prevent or reduce their risk of illnesses as well as to stay healthy through basic health advice on exercise regimes, good nutrition, and health supplements.

Dr Wong explains further: “We want to intervene before people get a heart attack, before a stroke, before diabetes leads to kidney problems. These are things that we can manage at the community level so that people don’t end up going to the hospital.”

To that end, many pharmacies provide screening and monitoring services for blood pressure, sugar and cholesterol levels.

Although there are many devices that can be used at home, this service is an alternative for those who are not willing to invest in a device or who are just not comfortable self-administering these tests.

The availability of these services is convenient for people that are unable or unwilling to make a trip to a hospital or clinic.

People also don’t have to delay their monitoring for months as they wait for their follow-up appointments at a clinic or hospital.

CONVENIENCE & ACCESS

Ultimately, people find pharmacies easily accessible and hence very convenient. After all, as Dr Wong shares, there were over 3,000 pharmacies in Malaysia—you can find 1 every 5 to 10 km in urban areas.

Furthermore, there is hardly any need to for registrations or making an appointment in advance.

“The consultation is free when you just need to ask a few questions, or if you are unsure of the medical severity of your condition; these are factors that make a big difference,” says Dr Wong.

As an example, Dr Wong brings up that many people with skin problems such as acne are more likely to visit a pharmacy first. In such a situation, the pharmacist can guide these people through the many options of skincare available and also advise them to visit a doctor if the situation warranted it.

“Pharmacists have become a very accessible primary care service provider,” says Dr Wong. “When clinics are overcrowded and when there is an unexpected burden on the system, pharmacies can help to optimize a healthcare system.”

SO, WHAT’S IN THE FUTURE FOR PHARMACISTS IN MALAYSIA?

In the past few years, digital platforms have been pushed to the fore by the pandemic and pharmacies have not been left out of this technological leap.

“During the lockdowns, pharmacies started doing deliveries and digital health platforms became a very common communication method,” says Dr Wong.

During the pandemic, it was common for long-time customers of a pharmacy to send messages over WhatsApp to ask for advice as well as to place orders products ahead of time for convenient pick-ups or deliveries. This trend continues beyond COVID-19 and has contributed further to the convenience of the consumer.

On a bigger scale, personalized medicine and pharmacogenomics are trends that are moving the industry forward.

Personalized medicine allows for a patient’s treatment to be tailored to their unique genetic makeup, lifestyles and health conditions. Therefore, such treatment is optimized to be most effective and appropriate for them as each individual.

Pharmacogenomics looks into how one’s individual genetics affect the effectiveness of medicine. “It studies how our different genetics will affect how and when you should take a particular medicine, how it is absorbed into your body, how it interacts with your body, the side effects that you may have,” explains Dr Wong.

However, pharmacogenomics is not something that can be done across the board, as pharmacogenomic tests are costly and are available only for certain treatments, for example cancer.

CHALLENGES IN THE WAY INTO THE FUTURE

The perception of certain members of the public can be a significant hurdle that pharmacists will need to overcome.

“The pharmacy is seen as a business. There is a perception that pharmacists only want to sell their products: People feel that the more I talk to you, the more you will want to sell me things,” Dr Wong explains as a reason as to why some people still remain reluctant to engage a pharmacist.

Privacy is also a big issue. Unlike at the clinic, a pharmacy doesn’t have private consultation rooms. This could hinder people from asking more personal issues. “If you have a very private question and you see ten people ahead of you, you probably wouldn’t want to ask it,” muses Dr Wong.

Nonetheless, Dr Wong reiterates that the community pharmacist still holds a unique position of being part of the community. Being privy to certain lifestyles and habits of the neighbourhood, the pharmacist has unique insight on the community as well as the opportunity to build relationships and walk together with their customers not just through sickness, but in health.

IMU Professor Shares How Evolving Role of Pharmacists Can Lead to Better Medicine Safety

WORDS PROFESSOR ONG CHIN ENG

FEATURED EXPERT
PROFESSOR ONG CHIN ENG
Dean of School of Pharmacy
International Medical University (IMU)
UNSAFE MEDICATION PRACTICES AND MEDICATION ERRORS A LEADING CAUSE OF INJURY AND AVOIDABLE HARM 

Globally, the cost associated with medication errors has been estimated at USD42 billion every year.

Furthermore, throughout the world each year, adverse drug events—harm resulting from medication use —cause billions of visits to hospital emergency departments.

LEARNING ABOUT MEDICATION SAFETY CAN REDUCE AND EVEN PREVENT THE RISK OF HARM FOR YOU AND YOUR LOVED ONES

Errors can occur at different stages of the medication use process. These include but not limited to patient receipt of the incorrect prescription (such as receiving the wrong drug or the correct drug but at the wrong dosage), harmful drug-to-drug interactions, errors in the drug preparation or delivery, and inappropriate or overprescribing of certain drug groups such as opioids.

Medication errors can also occur as a result of weak medication systems and/or human factors such as fatigue, poor environmental conditions or staff shortages. These issues can affect prescribing, transcribing, dispensing, administration and monitoring practices, which can then result in severe harm, disability and even death.

ENSURING THE SAFE PRESCRIBING AND DISPENSING OF MEDICATION TO PATIENTS

In conjunction with World Pharmacist Day on 25 September, it is a timely reminder to the pivotal role of this healthcare provider in safeguarding the proper and safe use of medicines.

Pharmacists ensure that patients not only get the correct medication and dosing, but that they have the guidance they need to use the medication safely and effectively.

However, as healthcare providers with expertise and focus on medications, there is an opportunity for the pharmacists to expand their role as patient safety leaders, working with patients and other providers to improve patient care outcomes and prevent medication errors.

While traditionally pharmacists have been perceived as ‘behind the glass’ dispensing medications, in the changing healthcare landscape they are increasingly seen as critical partners in the multi-disciplinary care team addressing complex patient needs.

Particularly in response to the recent COVID-19 pandemic, there are some clear opportunities for hospital and community pharmacists to assume a greater role in pressing patient safety issues, access to medications, medication adherence, readmission reductions, and medication safety.

Pharmacists have a unique expertise and knowledge base that can support improvements in medication error rates and play a critical role in the reporting process, such as providing appropriate feedback to providers. This may result in improved prescribing practices and greater teamwork as well as improving pharmacist confidence and feeling of self-worth in the care team.

ANTIMICROBIAL STEWARDSHIP (AMS) PROGRAMMES

Antimicrobial resistance is a growing public health threat and inappropriate use of antimicrobials (including antibiotics, antivirals, and antifungals), has further aggravated the resistance.

Pharmacists have an important role within AMS programmes, including developing and managing antimicrobial guidelines; reviewing individual patient regimens to optimize therapy; educating healthcare staff on the appropriate use of antimicrobials; and monitoring and auditing outcomes.

Pharmacists are central to the delivery of education on stewardship to healthcare professionals, patients and members of the public. Pharmacists are also key healthcare educators in the community, as they are often the first point of contact for the public and have a responsibility to be a source of information and education on antimicrobial use and resistance.

AMS programmes have been proven effective at improving clinical outcomes, reducing adverse events, and reducing resistance. Given the success of the AMS model, pharmacist role in other medication stewardship programmes may increase.

PHARMACISTS OFFER UNIQUE SKILLSETS TO ADVANCE PAIN AND OPIOID STEWARDSHIP PROGRAMMES

Other therapeutic areas, such as glycaemic control and thrombotics, may also be suitable targets for future programmes.

As evidence continues to demonstrate the success of stewardship programs, medication stewardship could become a central aspect of the pharmacists’ role in ensuring patient safety.

COUNSELING SERVICES AND COMMUNICATION ON POTENTIALLY UNSAFE MEDICATION COMBINATIONS

Increasing medication reconciliation by the community pharmacist following hospital discharge has the potential to reduce adverse events, reduce patient hospital readmissions, and even reduce the risk of death.

PROVISION OF LONG-TERM CARE

From a healthcare policy and care delivery standpoint, there is an ever-increasing focus on providing long-term care as a means of increasing the quality and safety of care. As patient care delivery evolves from episodic to longitudinal, organizations will restructure to care for patients across the continuum.

This evolution will reinforce the need for team-based care to ensure care coordination, patient safety, and optimal patient outcomes. Pharmacists play a great role in supporting a transition to longitudinal patient care and can serve to enhance pharmacist patient safety services.

Central to this longitudinal care is the home medication review (HMR) process. The intent of the HMR is to support the quality use of medicines and assist minimizing adverse drug events by helping patients to better understand and manage their medicines through a medication review conducted by a pharmacist in the home.

An HMR is a collaborative process between the referring doctor (referrer), pharmacist, patient, and where appropriate, a carer.

Currently, there are 3 HMR services provided by Malaysian government hospitals and health clinics, namely neurology/stroke, psychiatry, and geriatrics.

During the HMR interview process, the pharmacist will aim to improve the patient’s understanding of the medicines.

After the initial interview, the pharmacist will produce a HMR report that outlines the findings. This report aims to improve the referrer’s understanding of how the patient is using the medicines and provide recommendations that will assist the referrer and patient in developing a medication management plan.

If clinically indicated, up to two follow-up services can be conducted, with a focus on the resolution of medication-related problems identified at the initial interview.

DIGITAL HEALTH & TELEPHARMACY

Digital health and telepharmacy have gained increasing importance in the delivery of health care, largely due to COVID-19 pandemic.

There are some innovative models of telepharmacy services aimed at optimizing and improving access to pharmacy care, resulting in improved patient safety and outcomes.

Such innovative technology improves access and affordability for consumers, breaks down geographical barriers to accessing pharmacy services and medicines, and empowers pharmacists to manage medication risks for consumers.

The use of digital health records, electronic prescriptions, and real-time prescription monitoring, for example, provides ample opportunities for pharmacists to ensure the safe and quality use of medicines.

THE FUTURE

As the topic of medication error is continually pushed to the forefront of patient safety initiatives, the role of pharmacists will continue to evolve. This will broaden the opportunities pharmacists have to become integral change makers in the reduction of adverse events and improvement of healthcare safety.

IMU Opens the First Free Student-Led Dietetics & Wellness Clinic in Malaysia

WORDS LIM TECK CHOON

The International Medical University (IMU) recently opened the doors of the IMU Student Dietetics and Wellness Clinic. It had its official launch on 19 September 2023.

HIGHLIGHTS OF THE LAUNCH

HealthToday had the opportunity to meet the staff of the clinic as well as Professor Dr Winnie Chee, the Pro Vice-Chancellor Academic of IMU, to find out more about the clinic.

We are greatly indebted to them for their time and their willingness to provide answers to the following questions!

WHAT SERVICES ARE AVAILABLE AT THE CLINIC?

It offers many services comparable to other dietetics clinics. However, the clinic offers these services free of charge.

Individualized Meal Planning

It can be challenging to navigate through various foods to plan the right meals for one’s optimal health and maintenance of one’s ideal body weight.

 The staff of this clinic can meet with an individual and their loved ones to help design personalized daily meals based on the individual’s health status, their food preferences, and other factors.

Given that a healthy, balanced diet is key to good management of chronic diseases such as type 2 diabetes, high blood pressure, and more, this service will be especially helpful to those with these conditions.

YOU MAY FIND INIVIDUALIZED MEAL PLANNING HELPFUL IF YOU HAVE THE FOLLOWING:
  • Overweight or obesity
  • Gout
  • Diabetes
  • High blood pressure
  • High blood cholesterol
  • Chronic kidney disease
  • Anaemia
  • Irritable bowel syndrome (IBS)
  • Gastroesophageal reflux disease (GERD)
  • Chronic or long-term gastritis
Body Composition Analyzer

This is a series of non-invasive tests to measure a person’s fat mass and muscle mass.

These tests are also a good way to find out whether the person is at risk of not getting enough nutrients to maintain good health and proper functioning of the body (malnutrition).

A student dietitian can advise the individual accordingly based on the test results.

To register for your free session, click here. The link opens in a new tab.

Public Talks and Workshops

Members of the public can attend educational talks, cooking demonstrations, and more—free, of course!

They can follow the social media of the clinic (see below) to stay updated on upcoming talks and other public events.

WHERE IS THIS CLINIC?

It’s located at the International Medical University building at the following address:

Student Dietetics & Wellness Clinic
Level LG at the International Medical University
126 Jalan Jalil Perkasa
57000 Bukit Jalil
Kuala Lumpur

Opening hours: Monday to Thursday, 10.00 am to 4.00 pm during the final year dietetics practicum semesters.
Check the social media of the clinic (see below) for the latest updates.

Find the clinic on Google Maps

Do I Have to Travel to the Clinic Personally to Obtain Its Services?

Since the clinic has just opened its doors, for the time being only face-to-face consultation is available.

There are plans for telehealth services in the future, however. Interested parties can follow the social media of this clinic (see below) for future updates.

SO, IT’S A CLINIC STAFFED BY STUDENTS?

Yes, it’s a student-led diet clinic is a clinic managed and run by final year dietetics students.

These students are supervised by registered dietitians that are part of the IMU staff and they work in close collaboration with the public and communities in the surrounding area in Bukit Jalil and beyond.

Professor Dr Winnie Chee proudly tells us that while the clinic was conceptualized by the IMU School of Health Sciences, the enthusiastic students were responsible for all the planning, resources, programmes, and marketing of the services, as well as quality monitoring and management of the day-to-day operations of the clinic.

Wait, So Are These Students ‘Real’ Dietitians?

Don’t worry, these are final year dietetic students under the Bachelor of Science (Hons) Dietetics with Nutrition programme under the School of Health Sciences at IMU.

Therefore, they possess the necessary knowledge to help their clients.

What they lack is real world experience, which will be provided by this clinic. It will give these students training and experience on how to set up and manage a dietetics clinic as well as to instill in them an entrepreneurial mindset—thus making them more well-rounded dietitians when they graduate!

Throughout it all, every session will be supervised by a clinical educator, who is a registered dietitian.

If a medical emergency were to occur, the person will be directed to relevant healthcare professionals at IMU Health that are just nearby.

Hence, you don’t have to worry about receiving ‘inferior’ advice and help from this clinic!

HOW DO I MAKE AN APPOINTMENT?

Just fill in the online form found on their Facebook page.

HOW LONG IS EACH SESSION?

It can vary on a case-by-case basis.

Typically, the first session may take up to 1 hour. During this session, you may be asked to go through some simple, non-invasive tests and be asked about your medical history, current dietary preferences, etc.

Subsequent sessions—also free—may take about 30 minutes. The clinic will follow-up with you during these sessions to monitor your progress. If you’re having difficulties following your new meal plan, the staff will offer advice and help to get you back on track.

STAY CONNECTED WITH THE CLINIC
Facebook | Instagram

First Large-Scale Diabetes Cohort Study Launched in Malaysia

WORDS LIM TECK CHOON

On 10 July 2023, the Seremban Diabetes (SeDia) Cohort Study, was officially launched by Duli Yang Maha Mulia Yang Di Pertuan Besar Negeri Sembilan, Tuanku Muhriz ibni Almarhum Tuanku Munawir in Seremban.

PURPOSE OF THE SeDia COHORT STUDY

This study was launched to holistically explore all the factors involved in the development of diabetes as well as the complications experienced by people with diabetes in this country.

THE HISTORY OF THE STUDY

The genesis of the SeDia Cohort Story began on 17 May 2022 when the Ministry of Health Malaysia and the International Medical University signed a memorandum of understanding for the establishment of this study.

The research protocol of the study received the approval of the Medical Research and Ethics Committee (MREC) on 17 March 2023.

OVER 12,000 PARTICIPANTS SIGNED UP TO AID INVESTIGATION

This SeDia Cohort Study will cover a period of 12 years.

The first important step now is to obtain data that is socio-culturally relevant to the local community. So far, over 5,000 patients and over 7,000 of their family members have voluntarily registered as part of the Diabetes Registry of Klinik Kesihatan Seremban.

The investigators will use digital systems and data infrastructure to collect these participants’ personal and medical information.

Blood samples will also be obtained from these participants for genetic profiling, to study individual predisposition to diabetes and, for people with diabetes, their predisposition to complications and response to medications as well as physical and dietary interventions.

These participants will be followed regularly, with the process of data collection conducted every 3 years over the next 12 years.

Additionally, details of the participants’ life events, such as hospital admission and deaths, will be collected and updated every year.

STUDY HOPES TO IMPROVE DIABETES PREVENTION & MANAGEMENT IN MALAYSIA

Using the data obtained from these participants, the investigators will study and analyze the complex web of factors that contribute to the development of diabetes and its complications.

These factors include genetics and family history of diabetes to lifestyle and environmental factors, dietary regimes, physical activity, socio-economic levels, and healthcare delivery.

The investigators believe that the understanding of these complex factors and the connection between them would enable us to uncover optimal strategies for diabetes prevention and treatment.

Such strategies would enable implementation of evidence-based policies and programmes to address the escalating burden of diabetes in Malaysia.

ACCESS WILL BE GRANTED TO LOCAL & INTERNATIONAL RESEARCHERS

To establish the SeDia Cohort as a study of national significance, local and international researchers will be granted access to SeDia Cohort to conduct further analysis and studies, subject to approval of the MREC.

FUNDING INFORMATION

The SeDia Cohort study will be funded through public funds, which includes contributions from corporations and individuals.

Here’s EVERYTHING That Mom and Dad Should Know About Hand, Foot & Mouth Disease

WORDS LIM TECK CHOON

FEATURED EXPERT
ASSOCIATE PROFESSOR DR ERWIN J KHOO
Consultant Paediatrician and Head of Paediatrics Department
International Medical University (IMU)
WHY KIDS ARE VULNERABLE TO HAND, FOOT, AND MOUTH DISEASE

It’s hard to avoid hand, foot, and mouth disease recently, as it’s either affecting children in the country or appearing in the news.

Simply put, young kids are at risk of catching this disease because they are active, mobile, and curious.

According to Associate Professor Dr Erwin Khoo, toddlers tend to have a messy habit of touching and putting everything they come across into their mouths. This puts them at risk of the disease.

THE CULPRITS RESPONSIBLE FOR THE DISEASE

That will be viruses, the most common ones being Coxsackie A16 and Enterovirus 71.

According to Dr Erwin:

  • These viruses can be found in the respiratory tract and faeces, as well as in the fluid-filled blisters that form on the hands and feet of someone with hand, foot, and mouth disease.
  • The usual incubation period—the time period from infection to the first appearances of symptoms— is between 3 and 7 days, but it can also be and can go up to 2 weeks.
  • The virus can remain contagious for several days, even when it’s on hard surfaces.
  • As a result, the virus can spread easily amongst those in close contact with the infected child. One can also catch the virus from touching toys, eating utensils, and other objects that had been handled by the infected child.
  • One can also catch the virus from not properly washing their hands after performing routine childcare tasks on the infected child, such as changing diapers.
COMMON SYMPTOMS OF HAND, FOOT, AND MOUTH DISEASE
  • Fever
  • Sores around the mouth
  • Rashes
Rashes on the feet. Click for larger, clearer image.

Widespread rashes across the body are commonly seen on children with this disease, which may lead some people to confuse it with chickenpox.

Dr Erwin shares that unlike chickenpox, however, the rashes of a child with hand, foot, and mouth disease typically form at the hands and feet (hence the name of the disease) as well as sometimes on the knees, elbows, and buttocks.

IT CAN ALSO AFFECT ADULTS

This disease commonly affects children under the age of 6, but adults can also get infected and develop the disease.

Research has suggested that adults usually experience milder symptoms when compared to children.

Hence, it is possible for adults to pass the virus on to children under their care.

ONE CAN GET THIS DISEASE MORE THAN ONCE

Dr Erwin explains that this is because there are different strains of viruses that cause this disease. Because of this, any immunity developed by the body after an infection is only temporary.

HOW IS HAND, FOOT, AND MOUTH DISEASE TREATED?

“There is no cure or specific treatment for this disease,” Dr Erwin shares.

Currently, treatment revolves around managing the symptoms and making the child as comfortable as possible.

Dr Erwin points out that the disease typically goes away on its own between 7 and 10 days.

OKAY, BUT CAN WE PREVENT THE DISEASE FROM AFFECTING US OR OUR CHILDREN, THEN?

Unfortunately, we currently have no means to fully prevent hand, foot, and mouth disease from happening to us or our children.

SOMEONE AT HOME HAS THIS DISEASE. WHAT SHOULD WE DO?

Dr Erwin advises the following:

  • Be extra careful and limit contact with the infected individual.
  • Practice good hand hygiene. Wash or disinfect hands regularly, especially after caring for an infected child. It’s also good to wipe down common areas, such as the living and dining areas, as well as commonly handled objects such as toys, doorknobs, etc with disinfectant.
  • Don’t share food and eating utensils.
  • Avoid touching the eyes or nose.

Do the above up to 10 days after the infected individual started showing symptoms.

If your child is confirmed by a doctor to have hand, foot, and mouth disease, it is prudent to have the child stay at home to avoid passing the infection on to others.

WHAT CAN PARENTS DO TO HELP PROVIDE THE BEST TLC TO A CHILD WITH HAND, FOOT, AND MOUTH DISEASE?

Dr Erwin advises the following:

  • The paediatrician will prescribe appropriate medications for fever, pain relief, and reduction of inflammation of mouth ulcers. Parents wishing to use medications outside of the doctor’s prescription should consult the paediatrician first.
  • Give the child easy-to-swallow foods, such as soups and porridges.
  • Have the child drink plenty of fluids to avoid getting dehydrated. Offer them their favourite drinks or juices.
  • For painful mouth ulcers, consider using cold treats such as ice cream, jelly, and yoghurt to provide soothing pain relief. Parents can also consider alcohol-free mouth rinses and oral gels for the child.
  • Have the child shower or bathe regularly, as this will help soothe their sores. Avoid using harsh soaps and body scrubs on the child, as these may irritate their skin further.
  • Afterward, apply a towel gently to dry the child, to avoid breaking the blisters on the child’s skin. harsh soaps and scrubs that further irritate the skin.
  • If the child’s sleeping area has air-conditioning, switch it off at night. This is because air conditioning can create a dry environment that will reduce the child’s saliva production. This can cause the child’s mouth ulcers to hurt more.
  • If cooling is needed, such as due to hot weather, a humidifier or even just leaving a bowl of water in the room can prevent an excessively dry environment from forming.
  • If the child can’t sleep or rest due to pain, consult the paediatrician about the use of a pain reliever at night.

Dr Erwin points out that there are many “home remedies” being passed around, such as using coarse salts or enzyme water on a child with this disease. There is no evidence that such “remedies” actually work, and in most cases, they only irritate the skin and cause more pain and discomfort!

WHAT ABOUT COMPLICATIONS? ARE THERE ANY?

Usually, plenty of rest at home can help a child with hand, foot, and mouse disease recover, with over-the-counter treatments sufficient to relieve symptoms such as fever, rashes, and/or red spots.

However, in some cases, painful ulcers in the mouth can prevent a child from eating, drinking, and swallowing normally.

“This can lead to dehydration. Serious cases of dehydration require medical attention,” Dr Erwin states.

To keep an eye out for signs of dehydration, parents can do the following:

Take note of poor urine output, dry mouth, and lack of tears when they cry.

These are possible signs of severe dehydration.

Seek immediate medical attention when your child experiences the following:
  • Rapid breathing
  • Disorientation
  • Drowsiness
  • Giddiness
  • Stiff neck
  • Seizures
  • Fever for more than 3 days
  • Not eating and drinking
IT MAY SEEM OVERWHELMING WHEN YOUR CHILD HAS HAND, FOOT, AND MOUTH DISEASE, BUT TAKE A DEEP BREATH

Dr Erwin encourages parents to take a different outlook.

“If you can arrange to take some time off from work, maybe with a doctor’s letter for your employer, just stay home and spend this time with your kids. It is easy to overlook how quickly they grow up!” he says.

IMU Counsellors Open Up About Mental Health Issues Among University Students

WORDS LIM TECK CHOON

The 2015 Malaysian National Health and Morbidity Survey found the prevalence of mental health problems has increased from 10.6% in 1996 to 29.2% in 2015.

The prevalence is highest among those aged 16 to 19, with 18.3% having depression and 10% having suicidal thoughts.

Some of the factors associated with this increase include:

  • Unemployment
  • Financial difficulties
  • Family and relationship problems
  • Poor coping skills
  • Insufficient social support
WHAT IS KEEPING OUR YOUTH FROM SEEKING HELP?

Barriers that are keeping young adults from seeking help include:

  • Poor understanding of mental health problems
  • Fear of social stigma or embarrassment
  • Lack of social support
  • Difficulty in accessing professional services

Counsellors of the International Medical University (IMU) recently issued a statement that mental health issues can be even more prevalent among tertiary students that study abroad.

To circumvent this issue, International Medical University (IMU) and other tertiary education institutes often work closely with their partner schools to ensure full support and care for the wellbeing of their students, and to provide benchmarks on how their students are actually coping overseas.

Such support can come in the form of student-led initiatives such as peer-to-peer support—when students effectively reach out to one another—as well as counselling sessions with academic leads, senior tutors, and/or professional advisers.

WATCH OUT FOR THESE SIGNS

According to the IMU Self-Development Unit counsellors, we should watch out for these signs

  • Disturbed sleep patterns, such as difficulties falling asleep or waking up, waking up in the middle of the night, or excessive sleep.
  • Emotional outbursts, such as being very sensitive and easily irritated or angry.
  • Persistent fatigue.
  • Poor concentration, such as losing track of conversations.
  • Significant changes in eating habits and/or weight change that is not caused by a health issue.
  • Withdrawal from social activities—not making eye contact, being less active or significantly quieter or not participating when in social groups.

The IMU Self-Development Unit notes that some of these warning signs can be easily misunderstood or misconstrued in different social contexts. Hence, it is important to have patience in understanding a person’s behaviours when these could indicate possible mental health risk.

OFFER SUPPORT & HELP

The next step is to offer support to someone who is struggling, and the IMU Self-Development Unit counsellors says that listening to our intuition is very important.

Very often, the signs are there that tell us something is wrong, but we may turn a blind eye and ignore them. In some instances, we may even feel concerned about our own safety.

Here is their advice, based on the NEC model:

  1. Notice. Tell the person what you’ve observed that has worried you, such as “I noticed that you haven’t been eating/sleeping much lately.”
  2. Express concern. Let them know that you are worried about them and offer them space and privacy to listen to them and support them in any way such.
  3. Connect them to someone who can help. Suggest a person or resource where they can get the help they need or offer to accompany them when they are ready to seek professional help.
For a more comprehensive list of mental health resources across Malaysia, check out https://sites.google.com/view/psymalaysia/ (link opens in a new tab).

Is Tuberculosis Still a Disease That We Should Be Worried About?

WORDS LIM TECK CHOON

FEATURED EXPERT
PROFESSOR DR JAMES KOH KWEE CHOY
Head of Division of Medicine
School of Medicine
International Medical University (IMU)

Tuberculosis, often abbreviated as TB, has been around for a long time. In fact, it was known as “consumption” back in the 1800s.

Perhaps this is what many of us rarely spare this disease a thought unlike, say, dengue and COVID-19.

WHAT CAUSES TUBERCULOSIS

It is caused by the bacteria Mycobacterium tuberculosis.

TUBERCULOSIS CAN ATTACK DIFFERENT PARTS OF THE BODY

“It can attack different parts of the body, with the lungs–referred to as pulmonary tuberculosis– being the most common,” says Professor Dr James Koh Kwee Choy,

These different parts of the body include the lymph nodes and bones (usually the spine), in rare cases in the gut. The bacteria can also attack the brains of people with suppressed immune system, such as those living with HIV. Such cases of tuberculosis are called extrapulmonary tuberculosis (EPTB for short).

Symptoms and prevention of tuberculosis. Click on the image to view a larger, clearer version.
WHO IS AT RISK OF CATCHING THIS DISEASE?

According to Prof James, the most susceptible groups of people are:

  • The elderly
  • People with lowered immunity, including young children whose immune system is still developing
  • People with suppressed immune system, such as those on chronic steroid therapy and people living with HIV
  • People living in overcrowded living spaces, such as the poor and migrant workers, as this close proximity makes it easy for the bacteria to be passed on from person to person
HOW EASILY DOES TUBERCULOSIS SPREAD?

Similarly to all respiratory diseases, it is spread by water droplets that come from coughing or spitting.

However, the bacteria responsible for this disease need to be in significant amount in water droplets for the disease to spread.

“You have to be in quite close contact and in a situation where there’s prolonged exposure. Generally, more than eight hours a day,” says Prof James.

It is also worth noting that the bacteria can become dormant in the body of the host, and someone with dormant bacteria will not pass the bacteria on to others.

Similarly, people with only extrapulmonary tuberculosis—the infection doesn’t affect their lungs—will not spread the bacteria to other people.

THE SYMPTOMS OF TUBERCULOSIS

Detecting tuberculosis at its early stage can be challenging because the symptoms may not show immediately.

“You could have been exposed long ago, and the bacteria will stay latent or dormant in the body and hibernate. Symptoms can come up months or even years later,” says Prof James.

SYMPTOMS OF PULMONARY TUBERCULOSIS (TUBERCULOSIS IN THE LUNGS)
  • Chronic cough
  • Profuse sweating at night
  • Unexplained weight loss
  • Recurrent rise in body temperature in the evenings
SYMPTOMS OF EXTRAPULMONARY TUBERCULOSIS (TUBERCULOSIS IN OTHER PARTS OF THE BODY)
  • Swollen lymph nodes
  • Chronic back pain and fragile bones
  • A sensitive gut and
  • Seizures, headaches, confusion and even alterations in personality if the brain is infected
WHAT TO DO IF YOU BELIEVE THAT YOU HAVE TUBERCULOSIS

“Don’t wait to cough up blood,” says Prof James. “See a doctor if you have had a persistent cough for two weeks!”

Also see a doctor if you have unexplained night sweats and weight loss together with swollen lymph nodes or chronic back pain.

“If you are aware that you’ve been exposed to someone with TB, someone you share a working or living space with, then you might also want to see a doctor to be screened,” Prof James adds.

HOW IS THIS DISEASE TREATED?

Treatment is straightforward, but can take place over a long period of time.

Once the treatment is started, a person will be non-infective in ten to 14 days. In hospitals, a patient will be put in isolation but there is no prescribed quarantine period. “The most important thing is to wear a mask and wash your hands frequently,” Prof James says.

Antibiotics to overcome tuberculosis

A combination of 4 antibiotics will be prescribed for a period of 6 months to a year, depending on which part of the body is affected,” explains Prof James.

There are newer medications can potentially treat tuberculosis within 3 months, but Prof James shares that, unfortunately, they are not yet available in Malaysia. “At the moment, we’re still using the old regime,” he says.

It is crucial to take these antibiotics on time and as prescribed by the doctor

Otherwise, the bacteria can become resistant to the antibiotics. “This can escalate into extensively drug-resistant TB (XDR TB) and multidrug-resistant TB (MDR TB) – or what is commonly known as superbugs!” Prof James warns.

“Those with MDR/XDR TB can spread it to others and unfortunately for that someone, because the bacteria is already resistant, it becomes very hard to treat. These cases will need a lot of alternative medications involving injections and much longer therapy for up to 2 years. It gets very, very complicated,” he further explains.

WHY ARE WE STILL CONCERNED ABOUT TUBERCULOSIS? WE ALREADY HAVE THE BCG VACCINE TO PROTECT US FROM IT

The Bacille Calmette-Guerin (BCG for short) vaccine is given to Malaysians when they are babies and at primary school.

While the vaccine confers protection against tuberculosis, its effectiveness decreases over the years,

“By the time we are adults, many of us no longer have immunity against the disease,” says Prof James.

Tuberculosis cases in Malaysia are on the rise

Malaysia is still considered a country with a high incidence rate, estimated at 92 per 100,000 population. Prof James reveals that we have about 20,000 to 25,000 new cases every year, with an average of 1,500 to 2,000 resulting deaths.

Interestingly, the number of cases went down during the lock down, when we were wearing masks and practicing social distancing as well as movement control orders. It is when the SOPs are relaxed that the number of cases is up again.

CAN’T WE JUST GET A BOOSTER SHOT?

Sadly, there is no such booster shot currently in existence!

Prof James advises that the best way to keep tuberculosis at bay is to ensure a healthy lifestyle. “Generally, a person who is healthy with a good immune system should be able to fight off TB on their own.”

It is also important to be aware of the symptoms and seek early treatment. “If left for too long, even after recovery, tuberculosis can leave scarring on the lungs that will forever curb a person’s lung capacity,” Prof James states.


Also, it is equally important to stay healthy after recovering from tuberculosis. “Maintain a good diet, exercise, don’t smoke. You can get re-infected with TB and that can be quite bad,” says Prof James.

A Dentist Sets the Record Straight on How Kids Can Have Healthy Teeth

WORDS LIM TECK CHOON

FEATURED EXPERT
DR YOGESWARI SIVAPRAGASAM
Senior Lecturer and Consultant in Paediatric Dentistry
School of Dentistry
International Medical University (IMU)
Tip 1
START EARLY—CLEAN YOUR BABY’S GUMS AT LEAST TWICE A DAY

“It is easy to overlook oral care in babies – after all, they won’t have teeth till months later!” says Dr Yogeswari Sivapragasam,

  • Get a clean, damp washcloth.
  • Use the washcloth to gently wipe clean your baby’s gums.
  • Also gently clean the front of your baby’s tongue.

You should do this after every breastfeeding.

“Besides that, parents should also get advice from healthcare practitioners, such as a nurse advisor at community clinics or paediatricians, on how to care for their child’s oral health from birth, which includes what to do when their teeth first appear,” Dr Yogeswari further advises.

Tip 2
DELAY ADDING SALT & SUGAR INTO YOUR KID’S DIET

Dr Yogeswari advises us to hold back the introduction of added salt and sugar into their child’s diet.

This is because getting your child hooked early on sweet or salty foods can increase their risk of dental problems as well as chronic health conditions (obesity, type 2 diabetes, etc) later in life.

Instead, let your child develop a liking for naturally unsweetened and unsalted foods.

Tip 3
TAKE YOUR KID TO THE DENTIST REGULARLY & MAKE THESE VISITS AS FUN AS POSSIBLE

Children should receive their first dental check-up when they are 1 year old.

“Remember this: first birthday, first dental check-up!” says Dr Yogeswari.

After the first dental visit, you are advised to bring your kid to the dentist every 6 months.

“While it is unlikely that they will have any dental problems at this young age, this will help young children have a positive experience rather than associate dental visits with pain and fear,” Dr Yogeswari further adds. “Regular visits will help to normalize the experience of visiting a dentist and will go a long way towards preventive care.”

Of course, regular visits to the dentist will also help to detect early any potential problems with your kid’s oral health and tooth development, and allow the dentist to address these problems without further delay.

Tip 4
KEEP AN EYE OUT FOR UNUSUAL CHANGES IN BEHAVIOUR

Your child sometimes refuses certain foods or refuses to brush their teeth. “While this may be easily explained as the child being fussy or picky, there could be another reason behind it,” says Dr Yogeswari.

For example, your child may have developed cavities or gum disease, and the constant pain and discomfort may cause them to refuse foods that need to be chewed.

“This may inadvertently lead them to avoid whole foods such as apples and chicken,” Dr Yogeswari elaborates, “and choose softer foods instead, many of which are processed and contain higher levels of salt, sugar and fat. Over time, this may lead to nutritional deficiencies or chronic conditions that can affect a child’s health into adulthood.”

The constant pain can also cause irritability and affect their ability to concentrate during lessons in school.

“In addition, poor oral health can also affect a child’s self-esteem if they are teased due to the appearance of their stained or rotten teeth. This may cause them to avoid social activities or become withdrawn,” Dr Yogeswari adds.

As such, be alert and check for possible dental problems if your child suddenly appears to be unwilling to chew or becomes irritable without any apparent cause.

5 Popular Dengue Myths Debunked by a Family Medicine Specialist

WORDS LIM TECK CHOON

FEATURED EXPERT
ASSOCIATE PROFESSOR DR VERNA LEE KAR MUN
Family Medicine Specialist
International Medical University (IMU)
Myth 1
YOU ONLY CATCH DENGUE ONCE IN YOUR LIFETIME 

Unfortunately, no.

“There are 4 dengue serotypes,” says Associate Professor Dr Verna Lee Kar Mun.

Serotype is a word used to describe a strain of microorganism, which means that there are 4 different types of the dengue virus that can infect us.

This means that each of us can get infected up to 4 times, once with each serotype, and achieve total immunity to dengue only after being infected with all 4 serotypes!

“However, before you start thinking it’s a good idea to get infected four times, bear in mind that subsequent infections are likely to be more serious than the first,” warns Assoc Prof Dr Verna, “and each infection only increases your chances of getting severe dengue.”

Myth 2
YOU’RE GETTING BETTER WHEN YOUR FEVER GOES AWAY

Well, things are not so simple.

You see, according to Assoc Prof Dr Verna, there are 3 different stages of dengue fever.

  • Febrile phase: 1 to 2 days of high fever that begins suddenly. During this time, we’re likely to have experience aches, headache with pain behind the eyes, flushed faces, and sometimes blotchy skin or rashes.
  • Critical phase: the fever subsides, and we may feel that we are getting better. However, these 1 to 2 days are also a period when our blood capillaries may leak plasma, leading to a sudden drop in blood pressure and sending us into shock.
  • The next phase will depend on the outcome of the critical phase. We may get better after receiving proper medical treatment and proceed to the recovery phase, or we may get worse and experience severe dengue instead.

“Many viral illnesses such as dengue are self-limiting, which means they will naturally subside,” Assoc Prof Dr Verna shares. “In most cases, patients only need self-care at home, and the most important thing to remember is to take plenty of fluids to prevent the dehydration that comes with plasma leakage.”

“Anyone who gets dengue fever should aim to drink at least 3 litres of water daily for the first 3 days,” she adds.

Myth 3
DENGUE IS ONLY A SMALL CONCERN; AFTER ALL, YOU CAN GET BETTER FROM PRACTICING SELF CARE AT HOME

Not necessarily true.

“An estimated 1% of patients will experience severe dengue, also known as haemorrhagic dengue, which will require hospitalization,” says Assoc Prof Dr Verna.

She goes on to explain that one may begin to experience bleeding during the febrile phase, usually in the skin or gums. If the bleeding weren’t managed well, the dengue will worsen during the critical phase, forcing us to be admitted into the hospital.

“Those with a healthy immune system usually recover in 2 days, but if there is inflammation affecting the organs such as the heart, liver or brain, it can take up to a week, longer if there are other complications,” she goes on to say.

Myth 4
YOU SHOULD ONLY TEST FOR DENGUE AFTER 3 DAYS 

“It is true that the initial symptoms are vague, as a fever can be a sign of many different illnesses,” says Assoc Prof Dr Verna.

However, with dengue, the high fever usually comes suddenly.

“The S1 dengue rapid antigen test can detect dengue from the first day, so don’t delay seeking medical advice if you suddenly develop a high fever,” she advises.

Delay in getting tested may lead to severe consequences, as we will enter the critical phase 1 to 2 days after catching dengue—a time when our condition can suddenly take a turn for the worse!

Myth 5
ONCE YOUR NEIGHBOURHOOD HAS BEEN FOGGED, THERE IS NO NEED TO DO ANYTHING ELSE TO PREVENT DENGUE

Not true.

Assoc Prof Dr Verna reveals that while fogging helps to kill adult mosquitoes and getting rid of stagnant water in public drains and other places helps to prevent breeding sites, this method are only partially effective.

To illustrate, millions are spent on fogging efforts every year—an estimated RM777 million was spent on fogging efforts in the 2009 to 2010 period—but dengue remains prevalent to this day. There is even evidence that mosquitoes have grown resistant to the common insecticides used in fogging!

“On a personal level, all of us can do something at home to help prevent mosquito bites and breeding sites. We need to make a bigger effort to protect ourselves and our loved ones by making sure our home environment is clear of any breeding sites, covering up exposed skin and using mosquito repellents, especially during sunrise and sundown,” she advises.

Rise of the Superbugs

WORDS LIM TECK CHOON

FEATURED EXPERT
PROFESSOR CHIN BEEK YOKE
Associate Dean
School of Health Sciences
International Medical University (IMU)

Superbug is a term coined to describe multi-drug resistant bacteria.

Medications that are usually effective on them, such as antibiotics, just don’t work as effectively anymore. “These are bacteria that circumvent the effects of antibiotics and proliferate or multiply uncontrollably in the host,” explains Professor Chin Beek Yoke.

EVERY BACTERIAL SPECIES CAN BE A SUPERBUG

Any species of bacteria can develop a resistance to antibiotics and become a superbug.

“Bacteria are very smart. They will mutate to overcome antibiotics. Once bacteria has the resistance gene in them, they can duplicate and combine with different species of bacteria. That’s how bacteria propagate their multi-drug resistance in nature,” Prof Chin shares.

WE HAVE A ROLE IN CREATING SUPERBUGS

According to Prof Chin, a key reason why superbugs are prevalent is the unnecessary and over-prescription of antibiotics.

GOOD HABITS TO ADOPT
  • Take antibiotics only when necessary. Diseases that are not caused by bacteria do not require antibiotics!
  • Complete your full course of antibiotics—finish all the antibiotics your doctor gave you. Don’t stop just because you think you are feeling better.
  • Avoid using unapproved or black market antibiotics that are not at full strength and do not work as effectively as genuine ones
IMPROPER DISPOSAL OF ANTIBIOTICS MAY ALSO PLAY A ROLE

People tend to dispose of antibiotics incorrectly, and this can be a problem.

“We pour it down the drain, or throw it into the trash. The excess antibiotics then get into our ecosystem, in the soil, or may end up in rivers and water bodies,” says Prof Chin.

GOOD HABIT TO ADOPT
The correct way to dispose of the extra antibiotics is to bring them to your nearest pharmacy. Many pharmacies are equipped to dispose of extra medicines in the appropriate manner.
THEN THERE’S THE ISSUE OF ANTIBIOTICS IN ANIMAL AND FISH FEED…

Another cause is the use of antibiotics in feed for domestic animals or fish. When humans consume the meat from these animals and fish, they also consume the residual antibiotics present in these products.

This unintended consumption of antibiotics may modify the bacterial environment in our bodies and render us susceptible to future bacterial infections.

GOOD HABIT TO ADOPT
Purchase foods that are obtained from sources that are free of antibiotics.
HOW TO MINIMIZE POSSIBLE CONTACT WITH SUPERBUGS

Multidrug resistant bacteria are everywhere, but we can do a few things to reduce coming in contact with them.

PRACTICE GOOD HYGIENE
  • Wipe surfaces and clean items that come into our household
  • Wash all fruits and vegetables after purchase, before storage, and before cooking. This will prevent the bacteria from propagating
  • If you wish to try fruits from stalls and supermarkets in order to ‘test before buying’, wipe them first with a wet wipe
  • Wear shoes and socks when travelling in areas where contaminated soil or water is prevalent
DON’T PANIC TOO MUCH ABOUT COMING IN CONTACT WITH SUPERBUGS, HOWEVER!

Prof Chin explains that having them on your skin alone doesn’t mean that you will become infected and suffer.

“Your skin is a very good protective organ,” she says. “Bacteria or pathogens can only enter when there is a cut. So, if you don’t have a cut or laceration, you will be fine. Just make sure to wash your hands and feet or any exposed areas.”

The same goes for the times when you ingest bacteria. “You will usually have enough stomach acid to kill these superbugs, and most of the time you have enough innate immune cells in your body to fight them off,” she explains.

However, people with health conditions that weaken their immune system should take precautions to reduce their odds of contracting bacterial infections; they should consult their doctor on the best ways to do this.