UKM & AMM Organized Liver Cancer Awareness Day in Conjunction with World Cancer Day

WORDS LIM TECK CHOON

February 4 was World Cancer Day. In conjunction with World Cancer Day 2024, the Gastroenterology and Hepatology Unit, Department of Medicine and the Faculty of Medicine, Universiti Kebangsaan Malaysia (UKM) collaborated the Academy of Medicine Malaysia (AMM) organized a Liver Cancer Awareness Day event at Komune Living & Wellness, Bandar Tun Razak, Cheras, Kuala Lumpur.

THE MINISTER OF HEALTH CALLS FOR REMOVAL OF GREATER AWARENESS OF CANCER AMONG MALAYSIANS

The event was officiated by YB Datuk Seri Dr Dzulkefly Ahmad, our Minister of Health, and witnessed by the residents of Bandar Tun Razak.

In his speech, Datuk Seri Dr Dzulkefly congratulated the UKM Faculty of Medicine for organizing a community program that has the community closer to the university.

“Approximately 48,639 new cancer cases and 29,530 cancer deaths were reported in 2020 in Malaysia. And more worryingly, experts have predicted that the incidence of cancer in Malaysia will increase 2 times by 2040,” he shared.

He further stated: “There is no doubt that cancer is on the rise. I strongly believe that, as a community, we should learn what cancer is and most importantly to remove the taboo behind the word ‘cancer’.”



LIVER CANCER IS ONE OF THE TOP 5 MOST COMMON CANCERS IN MALAYSIA

“Currently, liver cancer is one of the 5 most common cancers in Malaysia; others are breast cancer, colorectal cancer, lung cancer and nasopharyngeal cancer,” Datuk Seri Dr Dzulkefly revealed. “Primary liver cancer, which starts from within the liver itself, unfortunately, has one of the worst prognoses because it is often diagnosed at a late stage when symptoms appear.”

Our Minister of Health also added that obesity is often associated with an increased risk of fatty liver disease known as metabolic dysfunction associated fatty liver disease (MAFLD), which is becoming the main cause of liver cancer.

However, liver cancer can be prevented either through hepatitis B immunization or early treatment of liver disease detected in patients with known hepatitis or cirrhosis.

LIVER CANCER DAY OFFERED EDUCATIONAL EVENTS & HEALTH SCREENING FOR ALL ATTENDANTS

The objective of the Liver Cancer Awareness Day event was to increase community awareness of liver cancer in addition to knowing more about liver cancer, its symptoms, risk factors, detection, and prevention.

A public forum on liver cancer was held during the event. This forum became a platform for liver cancer patients to share their experiences. Additionally, a group of panelists from the Ministry of Health Malaysia, University Hospitals, agencies and medical associations discussed the issue of public access to affordable cancer medicine in an effort to bridge the gap between the rich and the needy when it comes to cancer care.

In addition to public forums, the Liver Cancer Awareness Day event also provided attendants with screening services such as mammograms by Majlis Kanser Nasional (MAKNA), metabolic disease screening, hepatitis B and C screening, and fatty liver screening as well as consultation by experts, health fairs, quizzes, and lucky draws.

Meanwhile, the Malaysian Relief Agency (MRA) donated food packs to 90 residents of Bandar Tun Razak, Cheras. The participation of residents in this area was made via a community network between the UKM Faculty of Medicine and the residents of Bandar Tun Razak, Kuala Lumpur.

AUSPICIOUS GUESTS ADDED IMPACT TO THE EVENT

In addition to the gracious presence of the esteemed Minister of Health, the Liver Cancer Awareness Day event was attended by: Professor Dato’ Dr. Hanafiah Harunarashid (Pro Vice Canselor Kuala Lumpur Campus UKM), Professor Dr. Abdul Halim Abdul Gafor (Dean of the Faculty of Medicine UKM), Professor Datin Dr Marina Mat Baki (Deputy Dean of Industry Community and Partnerships Affairs), Professor Dato’ Dr Razman Jarmin (Director of Hospital Canselor Tuanku Muhriz UKM), Professor Dato’ Dr Ismail Sagap (Director of Hospital Pakar Kanak-Kanak UKM), Professor Dr Rosmawati Mohamed from the Academy of Medicine Malaysia, as well as various hospital directors and heads of department.

This program was made possible by the efforts of the Dean of the UKM Faculty of Medicine, Professor Dr Abdul Halim Abdul Gafor, and members of the faculty’s top management.

 

Malaysian Medics International (MMI) Responds to Zero HO Protocol

WORDS MALAYSIAN MEDICS INTERNATIONAL (MMI)

We are deeply concerned regarding the article released on 15th January by CodeBlue highlighting the implementation of a “Zero HO Protocol” within the medicine department of the University Malaya Medical Centre (UMMC). This protocol aims to address the critical shortage of house officers (HO) in different medical units as the services provided by house officers are now prioritised based on departmental workload.

Some of the key points of the protocol are as follows:

  1.  ICU prioritization with stable patients being admitted to medicine department wards and at-risk patients being placed in the Intensive Care Unit (ICU).
  2. Encouraging medical officers to perform procedures like IV cannula insertion and blood tests themselves to emphasize clinical judgement and discourage unnecessary test requests.
  3. Proposal for task sharing among medical officers, lecturers and consultants.
  4. Emphasis on mindfulness during patient admission as patient management is the responsibility of the admitting doctor.

House officers and medical officers are the grassroots of the healthcare system to achieve peak efficiency. Thus, we humbly call upon the Ministry of Health and Ministry of Higher Education to consider the following:

Decrease in manpower resulting in more harm than good

The diminishing numbers of house officers in the healthcare system are manifesting as a significant concern with multifaceted repercussions.

The increased workload on the existing staff is leading to burnout, adversely affecting their overall well-being.

Service reductions or cuts to cope with the strain could potentially compromise access to crucial medical services for patients, raising serious concerns about healthcare delivery and patient safety.

Hence, urgent attention is needed to address extreme shortages and maldistribution.

A targeted approach could involve expediting the intake of medical graduates into the housemanship system for a quicker transition from graduation to practical training. This would also overcome the “brain dead” issue which has been a concerning trend in the healthcare system.

On the other hand, Singapore offers a shorter time between graduation and work compared to waiting around six months in Malaysia. Hence, with a shorter gap, more medical graduates are able to work sooner to reduce the shortage of house officers.

Task delegation, focusing on critical departments, is crucial for effective management without compromising quality. Public hospitals should identify critical departments that are particularly affected by the shortage and maldistribution of HOs, as it would allow task prioritisation based on urgency and importance. Task delegation should focus on ensuring that essential responsibilities are managed effectively without shortage drawbacks. This emphasizes the need for immediate attention and comprehensive strategies from healthcare authorities to rectify this concerning trend and fortify the resilience of the healthcare system.

Collaboration between MOH and MOHE

Efficient collaboration between the Ministry of Health (MOH) and the Ministry of Higher Education (MOHE) is essential to bridge gaps and ensure better healthcare outcomes.

Clear communication with specific objectives and anticipated outcomes is necessary to foster a more cohesive and effective healthcare system.

Implementing interdisciplinary training programs for medical students, tailored to their academic schedules can provide essential skills learning for them.

Therefore, the workload among our healthcare workers can be reduced by providing opportunities for medical students to sharpen their skills under supervision.

Moreover, assessing the skills and competencies of available healthcare professionals ensures that responsibilities are delegated to individuals with appropriate expertise.

This diversified approach ensures a more efficient distribution of tasks, compensating for the diminished workforce and minimizing the impact on patient care. Early intervention at the foundation level can mitigate the issue of doctor shortage.

In conclusion

We urge the Ministry of Health and the Ministry of Higher Education to promptly consider and address the aforementioned issues. While this protocol might be perceived as a temporary drastic measure taken to cope with the decrease in house officers or medical officers, it could impact the present and future of Malaysia’s healthcare sector.

Thank you.

MALAYSIAN MEDICS INTERNATIONAL
TERM 2023/2024

About Malaysian Medics International (MMI)

MMI is an international medical student-led organization that aims to connect, educate, and cultivate. Since our inception in 2013, we have grown into a global network of more than 200 leaders from seven countries around the world. Presently, we are an active advocate for inclusivity and diversity, reform in medical education, and the welfare of our junior doctors and medical students.
Website: malaysianmedics.org
Email: admin@malaysianmedics.org


References:

  1. Zainuddin, A., & Su-Lyn, B. (2024, January 17). UMMC’s medicine department mulls ‘Zero HO protocol’, with indefinite critical Houseman shortage. CodeBlue. https://codeblue.galencentre.org/2024/01/15/ummcs-medicine-department-mulls-zero-ho-protocol-with-indefinite-critical-houseman-shortage/
  2. Zainuddin, A. (2024, January 19). MOH and MOHE must resolve their ‘Bad blood’: Musa Nordin. CodeBlue. https://codeblue.galencentre.org/2024/01/18/moh-and-mohe-must-resolve-their-bad-blood-musa-nordin/
  3. Zainuddin, A. (2024a, January 18). UMMC doctors tout parallel houseman system, full independence from MOH. CodeBlue. https://codeblue.galencentre.org/2024/01/16/ummc-doctors-tout-parallel-houseman-system-full-independence-from-moh/

An Expert Discusses What Happened to the Generational Endgame Bill of Malaysia

WORDS MUHAMMAD ZAID ZAINUDDIN

FEATURED EXPERT
MUHAMMAD ZAID ZAINUDDIN
Lecturer (Anatomy)
Centre of Preclinical Science Studies
Faculty of Dentistry
Universiti Teknologi MARA (UiTM)
IN RECENT NEWS

In November 2023, the Dewan Rakyat passed the Control of Smoking Products and Public Health Bill.

The Bill aims to regulate the sale and purchase of tobacco products, smoking materials, tobacco substitute products, and smoking devices, which includes smoking products such as electronic cigarettes or vape.

Though the passing of the bill is a positive step for the country’s public healthcare system and future generations, it has left members of the parliament and public health experts outraged.

WHY THE OUTRAGE?

The passed Control of Smoking Products and Public Health Bill is a watered-down version of the ambitious proposal initiated by our former Minister of Health, Khairy Jamaluddin.

The previous bill, dubbed the “Generational Endgame Bill”, proposed to prohibit persons born on or after 1 January 2007 from purchasing and smoking tobacco products, substitute tobacco products and smoking substances which includes e-cigarettes and vapes.

The bill passed in November 2023 removed this bold clause that would give rise to a smoke-free Malaysian generation in the future.

WHAT WOULD HAPPEN IF THE GENERATIONAL ENDGAME BILL WAS PASSED IN ITS ORIGINAL PROPOSED FORM?

In terms of impact on healthcare, the proposed Generational Endgame policy would ban smoking and vaping for those born in 2007 and onwards for the rest of their lives.

Ideally, this will create a smoke-free generation in the coming decades and save north of RM6 billion ringgit per year in terms of healthcare expenditure in the years to come.

This is stipulated by 2020 data, whereby the country had spent RM6.2 billion to treat three major diseases caused by smoking; lung cancer, heart disease, and chronic obstructive pulmonary disease. This cost was estimated to increase to RM8.8 billion by 2030 and will increase further if smoking had not been curbed.

THEN, WHY WAS THE GENERATIONAL ENDGAME CLAUSE DROPPED?

The Generational Endgame clause was dropped after considering the views from the Attorney-General’s Chambers, who claimed potential constitutional arguments.

The clause is unconstitutional.

In brief, the passing of the bill would create unequal treatment under the law between persons born before 1 January 2007, and individuals born after.

This is contradictory to Article 8 (1) of the Federal Constitution, which states that every person shall be equal under the law and have equal protection of the law.

The proposed bill would be unconstitutional as it would create two sets of laws for two different groups of citizens based on age.

Socio-economic impact on Malaysians.

An assessment of Malaysia’s Generational Endgame Policy by Oxford Economics, published in September 2023, states that the policy would be unlikely to deliver a reduction in healthcare costs. This is because future smokers would switch to illicit products.

This is on the basis that Malaysia has one of the largest illicit tobacco problems globally, with an estimated 57% of all cigarette sales in 2022 occurring through illicit channels.

An argument against the bill claims that a total ban of tobacco products would just expand the illicit tobacco market.

Impact on the economy.

The report also estimates that the legal tobacco industry in Malaysia currently supports a RM983 million contribution to the country’s GDP, RM3.3 billion in tax receipts, and 7,940 jobs.

A total ban of tobacco products would decrease these economic benefits on top of having to sustain an expensive expenditure on policy implementation, public communication, and enforcement programmes in addition to efforts needed to control the expanding of illicit markets.

IS THIS THE END OF THE GENERATIONAL ENDGAME POLICY?

Absolutely not!

The passing of the current bill is a small step forward toward achieving the Generational Endgame policy.

Though not banning the selling of tobacco products in its entirety, the Control of Smoking Products and Public Health Bill protects the younger generation from modern smoking devices, a rampant disease amongst our teenage youths.

The bill prohibits the sale and purchase of tobacco products, smoking materials, or substitute tobacco products as well as the provision of any services for smoking to under 18-year-olds, ultimately curbing the increase of smoking and vaping habit amongst children and teenagers.

IN CONCLUSION

Though our healthcare workers and policy makers are working hard to curb the rise of smoking and vaping, it is of the highest importance to maintain public awareness of the dangers of smoking and vaping. Such public awareness should be promoted and reiterated from generation to generation.


References:

  1. Bernama. (2023, December 7). Experts: Anti-smoking bill first step towards a smoke-free generation. NST Online. https://www.nst.com.my/news/government-public-policy/2023/12/987431/experts-anti-smoking-bill-first-step-towards-smoke-free
  2. Choy, N.Y. (2023, November 23). Health minister pledges to table Generational Endgame bill on tobacco before the end of Parliament sitting. The Edge Malaysia. https://theedgemalaysia.com/node/690959
  3. Harun, H. N. (2023, November 28). GEG dropped due to constitutional arguments – Dr Zaliha. NST Online. https://www.nst.com.my/news/government-public-policy/2023/11/984010/geg-dropped-due-constitutional-arguments-dr-zaliha
  4. Cabello, K. (2023, October 6). An assessment of Malaysia’s ‘Generational Endgame Policy’. Oxford Economics. https://www.oxfordeconomics.com/resource/gegmalaysia/

Are You Aware of Your Child’s Handwashing Habits? Here’s Why You Should Be

WORDS LIM TECK CHOON

FEATURED EXPERT
PROFESSOR EMERITA DR ELIZABETH SCOTT
Chair of the Global Hygiene Council
FIRST, THE BIG CONCERN
  • Infectious diseases are the leading cause of death all over the world.
  • Every year, there are about 525,000 children under 5 that perish from diarrhoea-related diseases.
  • A single emerging infectious disease can cost the global economy anything from USD30–50 billion.
  • There is also the rise of drug-resistant infections to worry about.
WHAT DO OUR CHILDREN HAVE TO DO WITH THIS?

Professor Dr Elizabeth Scott reveals that about 1.8 million children under the age of 5 die each year from diarrhea-related diseases and pneumonia.

However, it does not have to be this way. Professor Dr Scott shares that:

  • Simple handwashing could protect 1 in 3 children from diarrhoea.
  • Likewise, handwashing can shield 1 in 5 children from pneumonia.

Access to handwashing essentials such as soap and water, and hand washing education in schools not only fosters good hygiene habits but can help to improve attendance,” she goes on to explain.

She adds: “Furthermore, early hygiene habits potentially enhance child development in some settings.”

Are you washing your hands correctly? Click for a larger, clearer image.
OUR KIDS AREN’T WASHING THEIR HANDS ENOUGH OR CORRECTLY, THOUGH!

Results of the Global Hygiene Council’s survey on nearly 5,000 parents, primary school teachers
and children aged between 5 and 10 found that:

  • 40% of primary school children are not always using soap when washing their
    hands at school.
  • 27% of primary school children did not learn how to wash their hands at school.
  • Only 37% of parents and teachers know that hands can still contain germs when they are visibly clean.
  • 47% of primary school children believe that if their hands are visibly clean, they will not get sick.
  • 65% of primary school children say they have seen people in their school not wash their hands after going to the toilet.
  • 50% of parents and teachers believe that children’s handwashing habits have little effect on whether they get ill.
OH DEAR, IS THERE ANYTHING THAT CAN BE DONE ABOUT THIS?

The Global Hygiene Council offers the following recommendations, which they call the ‘four pillars of change’:

Pillar 1: Build on lessons learned from the COVID-19 pandemic.

Link lessons learned from the implementation of hygiene practices in previous pandemics (such as handwashing, mask wearing, and surface disinfection) to provide policy guidance for future public health campaigns and infection, prevention and control policies.

Pillar 2: Mainstream AMR-sensitive infection prevention and control tools.

Direct more focus on infection prevention and investment in new antimicrobials, vaccinations, and antimicrobial stewardship. National action plans on antimicrobial resistance should be adapted to include hygiene and Water, Sanitation, and Hygiene (WASH) recommendations for home and community settings.

Pillar 3: Quantify the economic benefits of hygiene.

Consider hygiene education and access to appropriate hygiene facilities as a critical and cost-effective solution for facilitating hygiene behaviour change and protecting against the spread of infectious diseases in schools, at workplaces, and throughout communities.

Pillar 4: Establish strong hygiene habits.

Make public communications campaigns easy to understand and built on evidence-based approaches. Highlight the personal impact that changing hygiene behaviour has on the health of families and communities with respect to reducing the risk of infection.

PROTECTING FUTURE GENERATIONS AGAINST PANDEMICS

To protect against future pandemics, including the threat of antimicrobial resistance, there is a need for greater public awareness of the role of targeted hygiene practices in preventing infections within home and community settings.

Future public health campaigns and infection prevention and control policies should include clear and practical information on evidence-based practices, as well as ensuring adequate access to clean water and hygiene resources to help prevent the spread of infections, including those that are drug resistant.


References:

  1. World Health Organization. (2021, March 10). Diarrhoea. https://www.who.int/health-topics/diarrhoea
  2. McArthur D. B. (2019). Emerging infectious diseases. The nursing clinics of North America, 54(2), 297–311. https://doi.org/10.1016/j.cnur.2019.02.006
  3. Liu, L., Johnson, H. L., Cousens, S., Perin, J., Scott, S., Lawn, J. E., Rudan, I., Campbell, H., Cibulskis, R., Li, M., Mathers, C., Black, R. E., & Child Health Epidemiology Reference Group of WHO and UNICEF (2012). Global, regional, and national causes of child mortality: An updated systematic analysis for 2010 with time trends since 2000. Lancet (London, England), 379(9832), 2151–2161. https://doi.org/10.1016/S0140-6736(12)60560-1
  4. Ejemot, R. I., Ehiri, J. E., Meremikwu, M. M., & Critchley, J. A. (2008). Hand washing for preventing diarrhoea. The Cochrane database of systematic reviews, (1), CD004265. https://doi.org/10.1002/14651858.CD004265.pub2
  5. Aiello, A. E., Coulborn, R. M., Perez, V., & Larson, E. L. (2008). Effect of hand hygiene on infectious disease risk in the community setting: a meta-analysis. American journal of public health, 98(8), 1372–1381. https://doi.org/10.2105/AJPH.2007.124610

Hospital in the Home: Can It Close the Gap for Overcrowded Hospitals?

WORDS DR KHOO CHOW HUAT

FEATURED EXPERT
DR KHOO CHOW HUAT
Managing Director (Healthcare and Hospital Operations)
Sunway Healthcare Group

We’ve heard a lot of news of how patients had to wait hours—even days—to be allocated a bed at Malaysian public hospitals.

However, even the private hospitals are beginning to experience such shortages in beds.

PRIVATE HOSPITALS REACHING CAPACITY

As recent as July this year, the Association of Private Hospitals Malaysia has confirmed a report that many private hospitals are also reaching its capacity, causing delays in admissions.

This is not just a local problem, as countries like the UK and US also face bed shortages.

It’s high time for us to switch gears and consider bringing the hospital into the home.

BRINGING THE HOSPITAL INTO THE HOME

At the current hospital I work at, we had a taste of this when the COVID-19 pandemic hit and we set up a 24-hour telemedicine command centre manned by doctors and nurses, which received thousands of calls.

Many hospitals began to realize that it is possible and expedient to consult with patients in their own homes.

However, in the post-pandemic era, calls are just not enough.

Some hospitals in the US and Singapore have begun to allow their patients home earlier, but proceed to monitor them through video calls, remote monitoring devices such as blood pressure devices, glucose tests, and oximeter, that transmit data through an app on a mobile, and educational materials to guide patients and their families.

THE BENEFITS OF MANAGING PATIENTS AT HOME

In countries like Australia, some hospitals even manage sub-acute patients at homes. These services provided in the state of Victoria alone are the equivalent of what a 500-bed facility could offer in one year. Patients are given IV fluids, oxygen, medication, insulin, and other forms of treatment in their homes. They have found that the patients treated in this way do just as well, if not better, in their homes.

Patients, especially the elderly, are less likely to contract hospital-acquired infections, and have lower rates of anxiety and confusion since they are in a familiar environment.

There have also been many studies that found that patients treated in their own homes have a lower rate of readmission—as much as 60% less likelihood of readmission within 30 days, and 37% less within 90 days, according to a study in the American Journal of Managed Care.

Their expenses from hospital admission till post discharge up to 90 days were also 11% lower than those who did not benefit from home care.

A MALAYSIAN PERSPECTIVE

In Malaysia, most home nursing providers are independent and not linked to a particular hospital. They provide valuable assistance in areas such as rehabilitation, wound dressing, post-operative care and such.

While effective, they may be disjointed from the patient’s initial treatment and not part of an established care plan. Concurrently, how many hospitals consider pre-admission and post-discharge as part of the continuum of care for their patients?

In Sunway we see the transition from hospital to home as an integral and often neglected part of the patient’s recovery process. As such, beyond the regular home nursing procedures mentioned, our multi-disciplinary home healthcare team consisting of physiotherapists, wound care nurses, geriatricians and more, is moving towards a more integrated approach of healthcare delivery.

For example, we hope to combine our telemedicine consultations with physical visits at home during pre and post-operative programmes to expedite mobility and administer antibiotics or certain cancer treatment in patients’ own homes.

I believe this is where healthcare is headed towards: bringing the hospital to homes, while leaving hospitals to focus on things that can only be done in hospitals.

While the overburdening of hospitals and bed shortage is a complex issue to tackle, I hope both the private and public sectors would join hands to find solutions for the sake of patients and healthcare workers.


Reference: Racsa, P., Rogstad, T., Stice, B., Flagg, M., Dailey, C., Li, Y., Sallee, B., Worley, K., Sharma, A., & Annand, D. (2022). Value-based care through postacute home health under CMS PACT regulations. The American journal of managed care, 28(2), e49–e54. https://doi.org/10.37765/ajmc.2022.88827

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.

Can the World Truly Be Free of Fear of Cancer in the Next 25 Years? Experts Believe So

WORDS LIM TECK CHOON

On 5 September 2023, Siemens Healthineers hosted Creating a World Without Fear of Cancer: A Critical Dialogue, a panel discussion for local healthcare experts and leaders to share their thoughts on whether the world can indeed be free of fear of cancer within the next 25 years.

This may seem odd at the surface as cancer cases continue to rise—indeed, the number of cases in Malaysia is projected to double by 2040!

However, we are also seeing a rise in technological innovations that allow for more precise and earlier detection of cancer, as well as more effective forms of treatment through customized therapy that capitalizes on recent breakthroughs in genetics, immunotherapy, and more.

Hence, it is possible that, over the next 2 decades, we will see a shift from cancer as a ‘death sentence’ to a manageable long-term or chronic disease with higher survival rates. In other words, a world without fear of cancer.

We managed to get a front row seat at this panel discussion, and we’re pleased to share the highlights with you.

WHO’S AT THE PANEL DISCUSSION?
  • Fabrice Leguet, Managing Director of Siemens Healthineers Southeast Asia
  • YB Dr Kelvin Yii, Special Advisor to the Health Minister
  • Serena Yong, CEO of Regency Specialist Hospital
  • Professor Ricky Sharma, Global Head of Clinical Affairs at Varian
  • Ranjit Kaur, former President and current board member of Reach to Recovery International (RRI)
HIGHLIGHTS OF THE PANEL DISCUSSION
FEATURED EXPERT
YB DR KELVIN YII LEE WUEN
Special Advisor to the Minister of Health
  • “The National Strategic Plan for Cancer Control aims to make cancer prevention, management, and control accessible and affordable through partnerships with stakeholders,” says YB Dr Kelvin Yii. “The goal is to reduce the cancer burden, promote understanding of cancer, encourage prevention and early diagnosis to alleviate patient fears.”
  • The backbone to this effort is the Public Private Partnerships (PPPs) that involve strategic partnerships between government and private hospitals.
  • Current, most of the medical innovations for cancer diagnosis and management are centred around private hospitals, thus putting them out of reach of many Malaysians, especially those in the B40 group.
  • Through PPP, efforts such as government hospital patients getting follow-up treatments at private hospitals can be made possible while still at a reasonable cost partly funded by the Ministry of Health Malaysia.
  • Dr Kelvin admits that funding is a significant challenge at the moment.
FEATURED EXPERT
PROFESSOR RICKY SHARMA
Global Head of Clinical Affairs
Varian Medical Systems
  • “Cancer is a disease that can evolve and mutate to evade treatments,” Professor Ricky Sharma states. “The importance of patient data cannot be understated, as well as patient experiences of treatment from country to country.”
  • He underscores the importance of using patient data to deliver a personalized patient experience. “It has to be from a holistic point of view,” he elaborates. “We need to be asking important questions from the patients’ perspective: ‘Is treatment accessible? Are patients being treated with the respect they deserve? How and where are clinical decisions being made and the treatments being administered?'”
  • In light of the objectives set by the Ministry of Health Malaysia, such as the digitalization of all their healthcare facilities by 2030, Professor Ricky Sharma believes that this would allow for more accessible healthcare to people of all economic status, regardless of location.
  • For example, he cites the use of a virtual cockpit, which allows a healthcare professional to deploy customized treatment plans, analyze and provide results of imaging tests, etc to multiple hospitals without having to physically travel to those places. This would save time and improve productivity and efficiency.
  • Furthermore, digitalization of the medical workplace would allow for more flexible work hours for the staff, which is an effective way to reduce burnout. He and Ranjit Kaur bring out the fact that the medical profession has one of the highest suicide rates in the world, and this move to digitalization would help reduce the prevalence of burnout and mental issues that could help reduce such tragedy.
FEATURED EXPERT
FABRICE LEGUET
Managing Director
Siemens Healthineers Southeast Asia
  • Fabrice Leguet believes the next step in comprehensive cancer care will be to move beyond today’s fragmented cancer care landscape towards a more integrated approach.
  • He cites the shift of cancer screening from tertiary hospitals to general practitioners’ clinic as an example of such an approach. Having screening services available to clinics, especially at more rural areas of Malaysia, would go a long way in increasing the number of cancer cases detected at an early stage and, hence, the chances of better treatment outcomes and fewer deaths.
  • “By partnering with healthcare providers, we accelerate the transfer of knowledge in oncology across clinical, technical and managerial fields and fast-track the adoption of integrated innovative technologies across the continuum of cancer care,” he says.
  • “While we leverage our access to global best practices and the latest technological innovations, we take a ‘fit for purpose’ approach, where solutions are adapted to the local context in close collaboration with our partners in the region,” he adds.
  • He further says, “Every strategic partnership, every technological innovation, and every collaboration with policy makers will bring us one step closer to creating a world without fear of cancer.”
FEATURED EXPERT
SERENA YONG
Chief Executive Officer
Regency Specialist Hospital
  • Serena Yong shares that the private medical healthcare sector welcomes the partnership with the Ministry of Health via PPP programmes.
  • “By integrating insights from different fields, we can achieve more diverse and effective outcomes,” she states.
  • “Patient well-being at the heart of our mission,” she goes on to add, “so this partnership expedites the integration of connected health solutions, ensuring swifter access to care. Moreover, it facilitates the expansion of teleconsultation services and the implementation of predictive analytics on a broader scale, ultimately contributing significantly to our patients’ journey toward improved health outcomes.”
FEATURED EXPERT
RANJIT KAUR
Former President and Current Board Member
Reach to Recovery International (RRI)
  • In spite of technological advances, Ranjit Kaur reiterates the importance of community support and holistic approaches that emphasizes the patient’s emotional well-being alongside their medical treatments.
  • “In a world where technology drives improvement in various aspects of our lives, we must also prioritize empathy, timely care access and comprehensive support systems for patients, not only in Malaysia but worldwide,” she says. “Each patient journey is often daunting and worrisome, but by paying greater attention to these details, we can help individuals look beyond their diagnosis and find confidence in their ability to overcome cancer.”
  • Given that the oncologists in Malaysia are still concentrated in urban areas such as the Klang Valley, Ranjit highlights the efforts of the Ministry of Women, Family and Community Development to provide very affordable lodging for families that have to travel to these urban areas for a family member’s cancer treatments. She calls for the Malaysian government to look into providing more similar assistance and services to enable Malaysians from outside of urban areas that are traveling long distances for cancer treatments.
  • She and YB Dr Kelvin Yii agree that the government of Malaysia should prioritize the Ministry of Health in the yearly budget. Ideally, the Ministry of Health should be getting the most, if not the lion’s share of, the annual budget to allow PPP programmes to make healthcare treatments, especially for cancer, accessible to all Malaysians regardless of race, gender, and socioeconomic status.

Asia Pacific Women’s Cancer Coalition Releases Important Data on Women’s Cancers

WORDS LIM TECK CHOON

The Asia-Pacific Women’s Cancer Coalition recently launched a report called Impact and Opportunity: The Case for Investing in Women’s Cancers in Asia Pacific.

WHAT’S IN THE REPORT?

Published by the Economist Impact and supported by the pharmaceutical company Roche, this report presents a detailed examination of the burden of women’s cancer, specifically breast and cervical cancer, in 6 countries in the Asia Pacific region: India, Indonesia, Malaysia, the Philippines, Thailand, and Vietnam.

The report includes detailed snapshots of the breast and cervical cancer burden, incidence, and mortality in each of the 6 countries mentioned above. Readers will access the following information:

  • Current cancer care capacity status
  • Existing policies and planning
  • Prevention and screening measures
  • Diagnosis and resource capacity
  • Quality of treatment and access
  • Levels of awareness and education about breast and cervical cancer

The report furthermore identifies the gaps and opportunities for relevant stakeholders to improve the provision of assistance to women dying from these cancers every year in Asia Pacific.

THE MALAYSIAN SNAPSHOT

The full-size images may not display properly on certain desktop devices due to technical limitations.

If you experience this issue, to get the full-size image (warning: these images are huge), click on each thumbnail and then save the image or open it in a new tab.

THE REPORT IS ONLINE—READ IT HERE!
Click here for the full report at the Asia-Pacific Women’s Cancer Coalition website. The link leads to a PDF file.

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.