Two Experts Explain Why Coaching in Palliative Care Is Necessary for the Wellbeing of Our Population

WORDS DR JESRINA ANN XAVIER & DR LIEW KEAN YEW

FEATURED EXPERTS

DR JESRINA ANN XAVIER
Senior Lecturer
School of Management & Marketing
Faculty of Business & Law
Taylor’s University
DR LIEW KEAN YEW
Palliative Care Specialist
Hospital Ampang
INTRODUCING PALLIATIVE CARE
  • Palliative care is specialized medical care for people living with serious illnesses.
  • It aims to improve the quality of life for patients and their families associated with life-threatening illnesses.
  • Palliative care services were first offered in Malaysia in 1995, and they are gradually being included in the standard healthcare system.
RISING NEED OF PALLIATIVE CARE
  • The need for palliative care is on an upward trend all over the world due to the ageing population and the rising burden of chronic diseases.
  • In Malaysia, the proportion of palliative care needs to deaths hovered at 71% in the observed years. By 2030, it is observed that the growth for palliative care specifically will increase to 240%.
  • Sarawak, Perak, Johor, Selangor, and Kedah will become the top five Malaysian states with the highest needs in 2030.
COACHING IN PALLIATIVE CARE
  • Coaching in palliative care refers to the practice of providing support, guidance, and education to individuals facing terminal or life-threatening illnesses, as well as their families and caregivers.
  • It aims to improve quality of life by early detection and treatment of pain and symptoms.
  • It also enables patients and their families to take an active role in choosing how they will be treated, reclaiming a sense of control over their lives.
THE BENEFITS OF COACHING IN PALLIATIVE CARE
Improved Communication and Expression Skills
  • Anthony Grant, a revered psychologist, informs that coaching can be considered an emerging cross-disciplinary occupation, with the main goals being to improve performance, enhance well-being, and support organizational and individual change.
  • Palliative care coaching adopts a comprehensive strategy, acknowledging that every person’s experience with illness is distinct and multifaceted.
  • Coaching helps individuals develop their communication skills and express their needs, preferences, and concerns more effectively.
  • It can lead to increased satisfaction in care outcomes.
Assists in Enhancing Patient Wellbeing 

Through a coping mechanism, palliative care coaching assists patients and their families through goal setting, problem-solving, and symptom management.

Empowers Patients and Their Loved Ones to Make Informed Decisions
  • Making decisions about treatment options, advance care planning, and end-of-life care is rather challenging when undergoing treatments.
  • By providing information, the clarification of options, and assistance in weighing the advantages and disadvantages of various possibilities, coaching makes it easier for patients to advocate for their rights and choices.
Providing Patient-Centered Care
  • Coaches can deliver patient-centered care that respects people’s cultural backgrounds, attitudes, and beliefs.
  • Palliative care coaching helps patients, families, and healthcare professionals coordinate and collaborate, which promotes continuity of treatment to achieve shared objectives.

Experts Highlight the Urgent Need for Blood Donation in Malaysia and What We Can Do about This

WORDS DR FARZANA RIZWAN & DR IMAM SHAIK

FEATURED EXPERTS

DR FARZANA RIZWAN
Senior Lecturer
School of Medicine
Faculty of Health & Medical Sciences
Taylor’s University		 DR IMAM SHAIK
Senior Lecturer
School of Medicine
Faculty of Health & Medical Sciences
Taylor’s University

Blood transfusion is a lifesaving medical intervention for patients undergoing complex surgeries, experiencing blood loss due to trauma or childbirth, suffering from chronic illnesses and blood disorders, and even during cancer management.

VOLUNTARY BLOOD DONATION PROGRAMMES ARE CRUCIAL FOR MAINTAINING A SAFE AND ADEQUATE SUPPLY OF BLOOD AND BLOOD PRODUCTS
  • That said, currently only 2.2 % of Malaysians donate blood in a year, compared to 3.5–5% in the developed countries.
  • The pre-pandemic blood donation rate was 22.8 donors per 1,000 people, which declined to 19.7 to 22.5 donors per 1,000 population between 2020 and 2022.
  • However, the demand of blood and blood products has increased due to a rise in motor vehicle accidents and the increase in the number of transfusion-dependent patients.

According to our Health Minister Datuk Seri Dr Dzulkefly Ahmad, the country needs more blood donors to maintain a ‘safe zone’ of blood stock to meet the nation’s daily demand of at least 2,000 blood bags.

The Ministry of Health targets 35 to 40 donors per 1,000 population by 2030.

HOW CAN WE ACHIEVE THIS TARGET?
  • Young people 17 years old and above are urged to come forward to help achieve this goal.
  • The community needs to choose the right direction, have a positive mindset, and move away from the myths and negative perception surrounding blood donation.
  • Seek guidance from the good practices that are in place in other countries. For example, we can focus more on ‘targeted recruitment’ to obtain donations from specific ethnic groups if there are certain blood groups that are difficult to find in others.
  • Adopt innovative methods of education and engagement of young students to promote school-, college-, and university-based blood donation drives.
  • The use of mobile apps to facilitate online bookings, reminders, re-scheduling, and appointment cancellation systems provides convenience to the community. The use of mobile technology in tracking the donor eligibility and getting donor feedback would be helpful to make blood donation experience more pleasant and smooth.
DO YOU KNOW THAT DONATING BLOOD CAN ALSO BE GOOD FOR YOUR HEALTH?
  • Improves blood circulation to your tissues and organs.
  • Maintains iron balance—the difference between the amount of iron taken up by the body and the amount lost—in the body.
  • Reduces the risk of hardening and narrowing of the arteries from the accumulation of iron in the artery walls.
  • Reduces the risk of heart attack by reducing arterial blockages.
  • Reduces excessive iron in the blood and decreases the risk of certain cancers. Iron is a source of cancer-causing free radicals, which can damage cells and alter their functions.
  • A therapeutic phlebotomy—a procedure to reduce the excessive iron and number of red blood cells in the body—for individuals with blood diseases such as hereditary hemochromatosis, polycythemia vera, and other rare conditions.

Additionally, there are many medical privileges offered to donors in Malaysia, such as free outpatient treatment and hepatitis B vaccination, among others.

BECOMING A BLOOD DONOR IS A SIMPLE WAY TO CONTRIBUTE TO YOUR COMMUNITY

Check with local hospitals or blood donation centers to find out where and when you can donate your blood.

Reimagining Your Retirement with Entrepreneurship in Your Golden Years

WORDS PROFESSOR DR CHONG WEI YING

FEATURED EXPERT
PROFESSOR DR CHONG WEI YING
Deputy Director
Active Ageing Impact Lab
Taylor’s University.

The word “retirement” conjures images of endless days of relaxation, hobbies pursued at leisure, and perhaps occasional travel. However, this traditional view of retirement is rapidly evolving.

RETIREMENT IS JUST THE BEGINNING OF A NEW PHASE OF LIFE

Today, retirement is increasingly perceived not as an end but as a beginning—a phase of life during which individuals can leverage their decades of experience, skills honed over a lifetime, and a wealth of knowledge to contribute to society in meaningful ways.

The appeal of entrepreneurship has never been greater to individuals, attracting those who desire greater autonomy, choices, and possibilities for unlimited growth in their golden years.

WHY ENTREPRENEURSHIP?

The reasons for this shift are manifold.

Longer lifespan. For one, a longer lifespan has prompted individuals to redefine retirement. With the accumulated resources, such as financial savings and extensive professional networks, individuals might want to expand their activities to include continued work in some capacity, engaging in lifelong learning, pursuing new hobbies, or even starting new businesses after retirement.

Greater access to digital media. Additionally, the advent of the digital era has made access to information, resources, and networks easier than ever for individuals to start businesses from the comfort of their homes.

New goals. Individuals are encouraged to remain engaged, mentally alert, and physically active during their retirement years. Launching a business can offer a renewed sense of purpose, providing a compelling reason to greet each morning with enthusiasm and a goal to work towards. It embodies the pursuit of continued growth, learning, and self-challenge.

Leaving a legacy. In certain cases, embarking on entrepreneurship in later life serves as a powerful means to impart wisdom to the younger generations. This exchange across ages not only narrows the divide between the young and the elderly but also cultivates a culture of ongoing learning and cooperation. Embracing an entrepreneurial spirit in one’s retirement years not only enhances personal fulfilment but also benefits the economy and society at large through job creation, innovation stimulation, and economic growth.

IGNITING YOUR ENTREPRENEURIAL SPIRIT

Before deciding to jump into a business and get caught up in the excitement, it’s crucial to adopt a sober view of potential problems. You first must ask some questions early that might mitigate or prevent potential problems and avoid unnecessary grief.

Here are some practical questions designed to help you determine if starting a business during your golden years is the right decision for you:

  1. Do I have the skills and strengths required to start and manage a new business, or is it primarily seen as a hobby? How does this interest align with the practical aspects of running a business?
  2. Am I financially stable enough to start a business without jeopardizing my retirement savings? What funding options do I have in place?
  3. Do I have the physical and mental stamina required to start and manage a new business? How might this impact my health and lifestyle?
  4. How comfortable am I with taking risks at this stage in my life? Am I prepared for the possibility of failure
  5. Am I looking to build something that leaves a legacy, or am I interested in a venture that meets immediate goals? Who can provide advice and assistance?
  6. How can I leverage my professional and personal connections for support and growth opportunities? Who can be my mentor in the entrepreneurial journey?
  7. Is there a real demand for the product or service I plan to offer? How saturated is the market?
  8. Are there any cost-effective business models that can lower the business risk? How can these models significantly reduce financial exposure and operational risks?
  9. What is my exit strategy if the business doesn’t go as planned? How will this impact my future and finances?
  10. What are the legal implications of my business structure (for example: sole proprietorship, partnership, corporation), and how does it affect my liability and tax obligations? How do I ensure that my business practices comply with stated laws?

As you approach your golden years, it is you that will make the crucial decisions about whether to have a phase of relaxation or a stage for active participation, personal fulfilment, and societal contribution. Starting a business will not only transform your life but also enrich society, showcasing the untapped potential of your later years.

Three Experts Explain Why We Need to be Concerned about Obstetric Fistula

WORDS ASSOCIATE PROFESSOR DR KHINE PWINT PHYU, ASSOCIATE PROFESSOR DR GANESH RAMACHANDRAN & ASSOCIATE PROFESSOR DR ANITHA PONNUPILLAI

The International Day to End Obstetric Fistula, observed annually on 23 May, serves as a reminder of the silent suffering endured by women around the world.

FEATURED EXPERT
ASSOCIATE PROFESSOR DR KHINE PWINT PHYU
School of Medicine
Faculty of Health and Medical Sciences
Taylor’s University
OBSTETRIC FISTULA EXPLAINED IN 5 KEY POINTS

Click on the image for a larger, clearer version.

  1. Obstetric fistula is an excruciating childbirth injury resulting in an abnormal connection between a woman’s birth canal and bladder or rectum.
  2. The cause of obstetric fistulas lies in traumatic childbirth experiences. Prolonged and difficult labours subject women to prolonged pressure on the birth canal, resulting in inflammation, tissue damage, and death of cells.
  3. This can lead to the formation of fistulas, creating distressing symptoms such as urinary or faecal leakage, foul-smelling vaginal discharge, chronic vaginal infections, or painful sexual intercourse.
  4. Globally, 65% of obstetric fistula cases occur in girls under the age of 18, affecting impoverished and vulnerable girls and women.
  5. Despite its profound impact, obstetric fistula remains largely hidden in the shadows of societal taboos and healthcare disparities. However, empirically, because of the access most women in Malaysia have to good healthcare facilities, obstetric fistulas are exceedingly uncommon in our country.
FEATURED EXPERT
ASSOCIATE PROFESSOR DR GANESH RAMACHANDRAN
School of Medicine
Faculty of Health and Medical Sciences
Taylor’s University
3 FACTORS THAT INCREASE THE RISK OF OBSTETRIC FISTULA

Limited Access to Skilled Healthcare

Inadequate access to skilled birth attendants and emergency obstetric care can lead to prolonged labour without proper medical intervention. This is the leading cause of severe birth trauma and fistula formation.

Poor Socioeconomic Conditions

Due to poverty and lack of education, young women in underprivileged environments can be subjected to childhood marriages, teenage pregnancies, and associated complications that include fistula formation.

Social Stigma and Cultural Barriers

Some cultural beliefs and societal stigma surrounding childbirth-related injuries impede timely medical interventions. Misconceptions and shame prevent women from seeking the necessary healthcare, thus exacerbating the severity of obstetric fistulas.

FEATURED EXPERT
ASSOCIATE PROFESSOR DR ANITHA PONNUPILLAI
School of Medicine
Faculty of Health and Medical Sciences
Taylor’s University
INITIATIVES THAT MUST BE TAKEN TO REDUCE THE INCIDENCE OF OBSTETRIC FISTULAS

Promote Access to Quality Maternal Healthcare
  • Strengthen maternal healthcare services, especially in remote areas, is crucial.
  • Ensure healthcare for all, with emphasis on accessible care during pregnancy, labour, and after childbirth.
Health Education Initiatives
  • Public awareness campaigns and access to education are instrumental in dispelling myths and fostering early recognition of birth injuries.
  • Empower women with knowledge about childbirth complications.
  • Encourage proactive seeking of medical assistance and reduces the stigma surrounding fistulas.
Enhance Healthcare Infrastructure
  • Invest in healthcare infrastructure, including skilled birth attendants, surgical facilities, and postoperative rehabilitation services, play a crucial role.
  • Provide adequate resources and training for healthcare professionals to assist in ensuring timely diagnosis, treatment, and rehabilitation of obstetric fistula patients.
Conduct Population Studies and Research
  • Conduct comprehensive population studies on the prevalence and incidence of obstetric fistula to establish accurate regional data.
  • Use the data from these studies to dentify causative factors to shed light on the root causes and also to curtail and eliminate the factors responsible for obstetric fistulas.
WHAT ARE WE DOING IN MALAYSIA TO ADDRESS THE PROBLEM?

In Malaysia, extensive measures are taken to ensure that both urban and rural areas receive adequate care during pregnancy, labour, and childbirth.

Intensive training programs for midwives are conducted to ensure the delivery of babies with safe techniques and the timely diagnosis of serious postpartum complications, including obstetric fistulas.

Furthermore, urogynaecology departments have been established in both private and public sectors, staffed with trained urogynaecologists to effectively treat obstetric fistulas efficiently if at all they occur and provide comprehensive rehabilitation services.

Experts from Taylor’s University Explain How We Can End the Threat of Tuberculosis

WORDS DR SAPNA SHRIDHAR PATIL, DR AMEYA ASHOK HASAMNIS & PROFESSOR DR WEE LEI HUM

FEATURED EXPERTS

DR SAPNA SHRIDHAR PATIL
Senior Lecturer
School of Medicine
Faculty of Health & Medical Sciences
Taylor’s University
DR AMEYA ASHOK HASAMNIS
Senior Lecturer
School of Medicine
Faculty of Health & Medical Sciences
Taylor’s University
PROFESSOR DR WEE LEI HUM
School of Medicine
Faculty of Health & Medical Sciences
Taylor’s University

Tuberculosis remains a significant global health challenge, with an estimated 10.6 million people falling ill and 1.3 million people dying from the disease in 2022 alone—making it the second largest infectious disease killer after COVID-19.

In 2023, tuberculosis cases in Malaysia were recorded at 26,781 cases, a five percent increase from the previous year.

PREVENTABLE & CURABLE, YET IT REMAINS A DEADLY THREAT

Despite being preventable and curable, tuberculosis has remained a leading cause of death from infectious diseases for decades. The 2022 numbers were the highest since the World Health Organization (WHO) began global monitoring in 1995, and above the pre-COVID baseline.

However, after two years of the COVID-19 pandemic-related disruptions, there has also been a major global recovery in the number of people diagnosed with tuberculosis and treated in 2022. These figures likely suggest a sizeable backlog of people who developed tuberculosis in previous years, but whose diagnosis and treatment were delayed due to COVID-19 that affected access to and provision of health services.

HOW TUBERCULOSIS SPREADS COMMON SYMPTOMS OF TUBERCULOSIS
The bacteria causing tuberculosis spread through tiny droplets released from the nose and mouth into the air during sneezing, coughing, or talking.
  • Persistent coughing
  • Fever
  • Chills
  • Night sweats
  • Weight loss
  • Lack of appetite
  • Fatigue
  • Coughing blood

The disease thrives in crowded environments and typically affects the lungs (pulmonary tuberculosis), but it can also affect other sites (extrapulmonary tuberculosis).

MALAYSIA’S COMMITMENT TO ENDING THE DISEASE

In Malaysia, the National TB Control Programme and the National Strategic Plan align with the WHO targets to combat tuberculosis, reflecting the country’s commitment to ending the disease, supported by three key pillars.

  • The first pillar emphasizes integrated, patient-centered care and prevention, including early case detection, and successful implementation of the BCG vaccination programme. Screening of high-risk populations, such as prison inmates and substance abuse victims, is an important strategy in early detection and enabling of timely intervention.
  • The second pillar promotes government stewardship and accountability, ensuring quality-assured anti-tuberculosis drug supply, and reducing treatment costs to alleviate patient burden.
  • The third pillar focuses on research and innovation to improve detection, treatment, and control, focusing on developing new drugs and vaccines.
INDIVIDUAL AWARENESS OF PREVENTIVE METHODS IS VITAL

These methods include practicing hand hygiene, proper cough etiquette, and wearing masks in crowded places.

Quitting smoking, maintaining a balanced diet to strengthen the immune system, and avoiding close contact with active tuberculosis cases can greatly reduce risks.

Anyone who shows symptoms of tuberculosis must consult a doctor immediately.

IN CLOSING

Challenges in addressing tuberculosis, including disrupted access to diagnosis and treatment, call for continuous strengthening of current policies and health systems. Aligning national tuberculosis response with regional and global strategies is imperative for effective management.

In Malaysia, tuberculosis initiatives not only contribute to ending the disease, but also to bolster primary health care, achieving universal health coverage and advancing the UN Sustainable Development Goals.

A Counsellor Discusses the 3 ‘E’s for Strengthening Mental Health

WORDS NG SHAN NA

FEATURED EXPERT
NG SHAN NA
Head of the Centre for Counselling Services and Student Welfare
Taylor’s University

Every year on October 10, the world celebrates World Mental Health Day as a means of raising awareness about mental health issues and advocating for better mental health care and support, as well as ending the stigma associated with it.

THIS DAY SERVES AS A TIMELY REMINDER OF THE IMPORTANCE OF MENTAL HEALTH

Millions of individuals throughout the world battle with anxiety, despair, and numerous other mental health disorders, which are exacerbated by factors like the COVID-19 pandemic, economic uncertainty, and social isolation.

In Malaysia, there is as an estimated 1 in 3 adults are experiencing mental health issues, the second largest health problem after heart disease.

The urbanization of Malaysia, rising stress levels, and shifting lifestyles are some of the factors that have contributed to the growth in mental health issues among Malaysians.

MANY PEOPLE STRUGGLE IN SILENCE DUE TO THE STIGMA ASSOCIATED WITH SEEKING TREATMENT

Some of the stigmas faced within the community include the fear of discrimination and social ostracism, cultural beliefs, and a misunderstanding of the true meaning of mental health.

THE ESSENTIAL THREE ‘E’S

Mental health impacts how we think, act, and feel, and it guides us on how to handle stressors, engage with others, and make positive choices in life.

Thus, it is highly essential for us to learn about the 3Es:

  • Encouraging awareness of mental health and suicide prevention among the community.
  • Educating the community about the resources available for various mental health needs and suicidal behaviour.
  • Equipping the community with basic skills to strengthen their mental health and with basic suicide prevention skills.

With these 3Es, the community will be able to come forward to steer a positive environment in discussing mental health and its challenges.

Experts Highlight 2 Lesser-Known Breastfeeding Issues & How to Overcome Them

WORDS DR AISHAH MOHD HAFIZ & DR DURGA VETTIVEL

FEATURED EXPERTS

DR AISHAH MOHD HAFIZ
Senior Lecturer in Emergency Medicine
School of Medicine
Faculty of Health and Medical Sciences
Taylor’s University
DR DURGA VETTIVEL
Senior Lecturer in Family Medicine
School of Medicine
Faculty of Health and Medical Sciences
Taylor’s University
Lesser-Known Breastfeeding Issue 1
DYSPHORIC MILK EJECTION REFLEX (D-MER)
  • This describes a sudden, intense, onset of negative emotions, just before a ‘let down’ or the release of milk occurs.
  • It is estimated that 5% to 9% of breastfeeding mothers experience this at some point.
  • It can take place during direct feeding, expressing of milk, or whenever let down occurs—for example in response to a crying child.
  • Not much is known as to why D-MER occurs, but it could be due to a sudden drop in the level of dopamine or ‘happy hormones’ in the brain. What could have happened is that the suckling action during direct feed or mimicked by a breast pump secretes the hormone oxytocin, which stimulates milk production and release. Studies have shown that it also inhibits dopamine release.
  • Symptoms last only for a few minutes and disappear when the milk flow is established.
  • Most women who have experienced D-MER reports decreased frequency after the first 3 months, although it can persist as long as the mother breastfeeds or pumps her breast milk.
SYMPTOMS OF DYSPHORIC MILK EJECTION REFLEX (D-MER)
  • Sudden anxiety and irritability.
  • Sadness or hopelessness.
  • Anger.
  • Self-hate or low self-esteem.
  • Asinking feeling in the stomach or dread.
  • In some cases, the symptoms can be severe, such as suicidal ideation.
Lesser-Known Breastfeeding Issue 2
BREASTFEEDING AVERSION RESPONSE (BAR)
  • This describes a feeling of aversion (strong dislike or wanting to stop) while breastfeeding, which occurs the entire time the child is latched on to the mother’s breast. This can result in the mother developing a compulsion to unlatch.
  • Currently, there isn’t much research done into this matter.
  • An empirical study done in Australia concluded that BAR is unexpected and difficult for mothers. It may result in detrimental effects on maternal identity, mother-child bonds, and intimate family relationships. Some of the participants in this study described the experience as ‘skin crawling’ while others reported negative sensations that were ‘visceral’, ‘overwhelming’ and ‘uncontrollable’.
  • As of now, there has been no research done to study the prevalence of BAR among Malaysian women. We can only speculate whether BAR may be a key factor for the low rate of exclusive breastfeeding.
FACTORS THAT COULD UP THE RISK OF DEVELOPING BAR
  • Breastfeeding for the first time.
  • Breastfeeding 2 or more children at the same time.
  • Menstruation.
  • Breastfeeding during pregnancy.
WHAT TO DO IF YOU THINK YOU HAVE D-MER OR BAR
  1. Recognizing these conditions is an important first step.
  2. Experts recommend self-help strategies such as meditation, positive self-talk, and personal distraction (listening to music, etc) during the feeding or pumping sessions to better manage the negative emotions associated with these conditions. These little actions can help increase the mother’s levels of happy hormones.
  3. Don’t face these challenges alone. Talk about these negative emotions with your partner and loved ones and seek help from healthcare professionals such as lactation consultants, counsellors, or therapists.

You Aren’t Alone When It Comes to Infertility, Experts Say, So Here’s What You Can Do About It

WORDS DR KHINE PWINT PHYU & ASSOCIATE PROFESSOR DR GANESH RAMACHANDRAN

FEATURED EXPERTS

DR KHINE PWINT PHYU
Senior Lecturer in Obstetrics and Gynaecology
School of Medicine
Faculty of Health and Medical Sciences
Taylor’s University
ASSOCIATE PROFESSOR DR GANESH RAMACHANDRAN
Head of School
School of Medicine
Faculty of Health and Medical Sciences
Taylor’s University
THE INCIDENCE OF INFERTILITY IS ON AN UPWARD TREND WORLDWIDE
  • Infertility is defined as not being able to conceive after 1 year of unprotected sexual intercourse.
  • In women above 35, this duration is sometimes shortened to 6 months.
  • The World Health Organization estimates that 1 in 6 people are affected by infertility.
  • In Malaysia, there is a drop in fertility rates from 4.9 children per woman of childbearing age in 1970 to 1.7 in 2021.
CAUSES ARE VARIED, INVOLVING ISSUES IN EITHER PARTNER OR BOTH AND IN SOME CASES, THE CAUSES ARE DIFFICULT TO IDENTIFY

Female factors of infertility

  • Anovulation, or ovulation disorders, are situations where no eggs are released from the ovaries during the menstrual cycle. These disorders can be caused by:
    • Hormonal imbalances such as seen in polycystic ovary syndrome (PCOS) and excessive prolactin secretion.
    • Eating disorders.
    • Extremes of body weight.
    • Strenuous exercises.
    • Stress.
    • Chronic illnesses.
  • Blockage of fallopian tubes, caused by previous pelvic infections, inflammation of tubes, and pelvic adhesions which may be related to past surgery at the abdomen and pelvis. When the tubes are blocked, it will affect the transport of sperm to meet the eggs to achieve successful implantation and pregnancy.
  • Endometriosis, which is the presence of tissue that is normally found in the inner lining of the uterus, outside the uterine cavity, which may affect the function of the ovaries, uterus, and fallopian tubes.
  • Congenital abnormalities (malformations that develop before birth) of the uterus.
  • Uterine fibroids (non-cancerous growths which develop in and around the womb).

Male factors of infertility

  • Low sperm count, which can be seen in men with genetic defects, chronic health problems such as diabetes, liver or kidney diseases, or sexually transmitted infections like gonorrhoea. Abnormalities such as undescended testis and varicoceles (swollen veins within the scrotum) can also be causes.
  • Premature ejaculation.
  • Blockage or injury to the reproductive organs.
  • Usage of certain medications can affect sperm movement, quality, or lead to coital dysfunction.
  • Environmental and lifestyle factors such as use of tobacco, heavy alcohol, marijuana or steroids, exposure to toxins and exposure of the external genitalia to high temperatures.
BOTH PARTNERS NEED TO BE INVOLVED WHEN IT COMES TO FERTILITY TREATMENT

To support health education and increase awareness regarding numerous infertility issues faced by couples across the globe, World Infertility Awareness Month is observed every year in June. Many couples are not even aware they are infertile; hence this month serves to alert them of issues that may affect them as well as their available solutions.

While the causes of infertility are varied and can affect both partners, the burden and stigma are often shouldered by the female partner. In our part of the world, both issues are particularly pronounced.

Couples with fertility issues should therefore see a doctor in a timely manner to receive a proper assessment and effective treatment. As age is an important factor in conceiving, early medical intervention often leads to positive outcomes in a couple’s fertility journey.

Both partners should be involved in fertility consultation and management. The primary issues to address include if the woman is ovulating regularly, if the sperm cells in semen are healthy, if there are coital issues and any problems with fertilization and implantation, and if the woman is able to maintain the pregnancy.

To answer these questions, thorough evaluation should be done through taking a detailed medical and personal history, sexual history and performing a physical examination for both partners. The next steps would then be to test the couple with baseline investigations as well as specific evaluations.

Some common assessments include tests to ensure the fallopian tubes are patent (open and lacking blockage), tests to confirm ovulation, sperm counts, and ultrasound to look for abnormalities in the uterus, fallopian tubes, and ovaries.

MANAGING & TREATING INFERTILITY

Sometimes, simple lifestyle modification measures such as weight management, adequate exercise, cessation of smoking, and the limitation on alcohol consumption can solve infertility.

As for natural methods, frequency of sexual intercourse can be an issue and it is recommended that at least 3 times a week increases the probability of conceiving.

Timed intercourse during a women’s fertile period may be a strategy as well. Women usually ovulate about 12 to 14 days before the start of a next menstrual cycle and the fertile period is the five days before ovulation, the day of ovulation, and the day after ovulation.

The treatment for fertility issues depends on the cause. For women who experience problems with ovulation, medications to induce ovulation may be employed. As for women with endometriosis, fibroids, or other tubal diseases, surgery may also improve outcomes. For men, prescribing medications to improve sperm quality may help and surgery may be employed for men with structural abnormalities in their reproductive system.

When more simple methods are not successful, more complex procedures may be employed such as intra-uterine insemination (IUI), gamete intra-fallopian transfer (GIFT), and intracytoplasmic sperm injection (ICSI). For couples with unexplained infertility, increasing coital frequency in combination with IUI often results in successful pregnancies.

References:

  1. Ferlin, A., Raicu, F., Gatta, V., Zuccarello, D., Palka, G., & Foresta, C. (2007). Male infertility: role of genetic background. Reproductive biomedicine online, 14(6), 734–745. https://doi.org/10.1016/s1472-6483(10)60677-3
  2. Lipshultz, L. I., Howards, S. S., & Niederberger, C. (2009). Infertility in the male (4th ed.). Cambridge University Press. http://dlib.sbmu.ac.ir/site/catalogue/134959
  3. Krausz C. (2011). Male infertility: pathogenesis and clinical diagnosis. Best practice & research. Clinical endocrinology & metabolism, 25(2), 271–285. https://doi.org/10.1016/j.beem.2010.08.006
  4. Poongothai, J., Gopenath, T. S., & Manonayaki, S. (2009). Genetics of human male infertility. Singapore medical journal, 50(4), 336–347.

#GiveBack Campaign Calls for Proper & Safe Medical Waste Disposal

WORDS LIM TECK CHOON

On 15 June 2023, the second phase of the nationwide #GiveBack campaign was launched to promote responsible disposal of medical waste.

#GiveBack is a nationwide Environmental, Social and Governance (ESG) effort of GSK Malaysia in collaboration with pharmacy chains Alpro Pharmacy, AM PM Pharmacy, BIG Pharmacy, CARiNG Pharmacy Group, FirstCare Pharmacy, Health Lane Family Pharmacy, Mega Kulim Pharmacy, Park@city Pharmacy & Medical Supplies, Straits Pharmacy, and Sunway Multicare Pharmacy.

It is supported by the Malaysian Pharmacists Society (MPS).

FEATURED EXPERT
DR JONATHAN PAN
Vice President and General Manager
GSK Malaysia & Brunei

Dr Jonathan Pan, the Vice President and General Manager of GSK Malaysia & Brunei, says. “Our #GiveBack campaign supports these goals by offering the Malaysian public a convenient way to dispose of their used inhalers and leftover medicine blister packs responsibly, lessening their impact to our environment.”

In line with this goal, the campaign expanded its partnership with additional pharmacy partners and headthcare groups this year.

WHY #GIVEBACK IS IMPORTANT TO US
  • All around the world, healthcare systems contribute around 5.9 million tonnes of solid waste to landfills and over 4% of carbon emissions.
  • One significant issue is the disposal of pressurized asthma inhalers, as people often discard them before they are completely empty. As a result, the greenhouse gases in the propellants of these discarded inhalers are released into the environment, contributing to global warming.
  • Unfinished pills left in discarded blister packaging—the “packaging” of pills—can lead to leaching of chemicals into the ground or waterways, contaminating plants and animals and, eventually, people that consume these plants and animals.
FEATURED EXPERT
PROFESSOR AMRAHI BUANG
President
Malaysian Pharmacists Society (MPS)

Professor Amrahi Buang, President of the Malaysian Pharmacists Society (MPS) further adds, “GSK’s #GiveBack campaign is aligned with the Ministry of Health Malaysia’s ‘Returning Medicines’ campaign, and we urge all Malaysians to support this effort by bringing their used or unfinished asthma inhalers and blister packs to any of the collection points for proper disposal.”

MAKING AN ART OUT OF DISCARDED MEDICAL WASTE

During the launch, students from The Design School at Taylor’s University unveiled a sculpted art made of discarded blister packs and asthma inhalers.

This art serves to highlight the importance of proper medical waste disposal and its impact on the environment, while also providing an opportunity for the next generation to get involved in environmental advocacy.

The installation will be displayed during the GSK #GiveBack Roving Truck roadshow at high-traffic venues across the Klang Valley, stoking greater awareness and increased interest in sustainability.

HOW YOU CAN #GIVEBACK TO MOTHER EARTH

Any time of the year
Drop off your used blister packs and asthma inhalers (make sure that they are empty) at any of the following pharmacy outlets:

  • Alpro Pharmacy
  • AM PM Pharmacy
  • BIG Pharmacy
  • CARiNG Pharmacy Group
  • FirstCare Pharmacy
  • Health Lane Family Pharmacy
  • Mega Kulim Pharmacy
  • Park@city Pharmacy & Medical Supplies
  • Straits Pharmacy
  • Sunway Multicare Pharmacy

17 to 26 June 2023
Drop them off at the #GiveBack Roving Truck roadshow.

For more information about the campaign, visit your nearby pharmacy or hospital, or drop by the The Design School @ Taylor’s University’s Instagram (link opens in a new tab).

Here Is Everything You Need to Know About Inguinal Hernia

WORDS ASSOCIATE PROFESSOR DR KUMAR HARI RAJAH & ASSOCIATE PROFESSOR DR SOMANATHAN M N MENON

FEATURED EXPERTS
ASSOCIATE PROFESSOR DR KUMAR HARI RAJAH
School of Medicine
Faculty of Health & Medical Sciences
Taylor’s University
ASSOCIATE PROFESSOR DR SOMANATHAN M N MENON
School of Medicine
Faculty of Health & Medical Sciences
Taylor’s University

You may have heard of the term ‘hernia’ or ‘angin pasang’ once or twice before. Affecting both women and more commonly, men, many seek medical attention for reducible swellings which were discovered incidentally or swelling which suddenly appears during a period of physical straining.

WHAT IS HERNIA?

A hernia is defined as a protrusion, bulge, or projection of an organ or a part of an organ through the body wall that normally goes away on lying down.

They are extremely common and often seen in the groin.

Types of hernia. Click on the image to view a larger, clearer version.
Common risk factors 
  • Being a male
  • Family history
  • Smoking
  • Chronic obstructive pulmonary disease or COPD
  • Low body mass index or BMI
  • High intra-abdominal pressure
  • Collagen vascular disease
  • Thoracic or abdominal aortic aneurysm
  • History of open appendectomy
  • Undergoing peritoneal dialysis
INGUINAL HERNIA
  • The protrusion occurs through the inguinal canal in the body’s anterior abdominal wall.
  • By far the most common medical conditions in which primary care physicians refer patients for surgery, comprising approximately 96 percent of all groin hernias.
  • Generally, inguinal hernia affects all ages, but the incidence increases with regards to age.
  • Women manifest inguinal hernia later with a median age of 60 to 79 years, unlike that of men which is 10 years earlier.

Inguinal hernias are traditionally classified as one of the following three types:

  • Direct hernia. The hernia sac bulges directly through the posterior wall of the inguinal canal. It usually occurs in men over 40 years of age.
  • Indirect hernia, which passes through the internal inguinal ring alongside the spermatic cord, following the coursing of the inguinal canal.
  • Combined hernia. The hernia sacs are on both sides of the inferior epigastric vessels.
SIGNS THAT YOU MAY HAVE INGUINAL HERNIA
  • A bulge in the area on either side of the pubic bone; there may be a burning, gurgling or aching sensation at the bulge.
  • For male patients, pain and swelling can occasionally occur around the testicles, when the protruding intestine descends into the scrotum.
  • Pain or discomfort in the groin, especially when bending over, coughing, or lifting.
DIAGNOSING INGUINAL HERNIA
Physical examination

Most early inguinal hernias can be diagnosed by careful physical examination.

The physical examination begins by carefully inspecting the inguinal areas for bulges while the patient is standing.

Then, the patient would be asked to cough or strain down (Valsalva manoeuvre) while the physician observes for bulges.

Imaging

Although imaging is rarely needed to diagnose a hernia, it may be useful in certain clinical situations such as suspected sports hernia, recurrent hernia, uncertain diagnosis, and surgical complications, (especially chronic pain).

Magnetic resonance imaging (MRI) provides the most sensitive detection of a hidden hernia in a patient with clinical suspicion for hernia.

TREATING INGUINAL HERNIA

There is currently no medical recommendation about how to manage an inguinal hernia condition.

Wait and see

Watchful waiting is a recommended reasonable option, especially for hernia with minimal symptoms.

Repair

Most inguinal hernia repairs can be performed safely, accurately, and cost-effectively using local anaesthesia, through an open anterior approach.

Hernia repair using prosthetic mesh would be a good choice in patients with a direct hernia or older patients with a longstanding hernia and attenuated fascia.

What about surgery?

Traditional hernia surgery carries a high risk of chronic pain, and as many as 17% of patients can have significant pain for years.

This high incidence is likely due to the location of the mesh used for this kind of surgery. It may also be related to nerve scarification, mesh contraction, chronic inflammation, or osteitis pubis.

Fortunately, there are procedures that lower this chronic pain, for example, the open pre-peritoneal repair, where the nerves responsible for the chronic pain are avoided, leading to a lower incidence of this problematic complication.

There are also minimally invasive surgical procedures involving transabdominal preperitoneal (TAPP) repair and total extraperitoneal repair (TEP). These procedures facilitate the placement of the mesh without any need for suturing, allowing passive pressure of the peritoneal contents to keep the mesh in place.

CAN WE PREVENT INGUINAL HERNIA FROM HAPPENING TO US?

Yes, you can reduce the risk of developing an inguinal hernia by reducing the pressure on the abdominal wall.

  • Maintain a healthy weight. Extra weight will put more stress and pressure over the abdominal walls especially when one stands or moves.
  • Be active and do the right exercises. Many exercises are available but doing the right exercises without overexertion is the key. Exercises like increasing core strength, sit ups, cycling and yoga are helpful.
  • Avoid heavy lifting. Try not to lift objects if they are too heavy. If you must, adopt the right technique such as bending knees and lifting with your legs.
  • Consume foods high in dietary fibre to reduce incidence of constipation; constipation can trigger a hernia when one strains during the passing of stools.
  • Get treatment if you have urinary problems due to an enlarged prostate gland or if you have a chronic cough.

References:

  1. Onuigbo, W.I.B., & Nieze, G.E. (2016). Inguinal hernia. A review. Journal of surgery and operative care, 1(2). https://doi.org/10.15744/2455-7617.1.202
  2. Jenkins, J. T., & O’Dwyer, P. J. (2008). Inguinal hernias. BMJ (Clinical research ed.), 336(7638), 269–272. https://doi.org/10.1136/bmj.39450.428275.AD
  3. Öberg, S., Andresen, K., & Rosenberg, J. (2017). Etiology of inguinal hernias: A comprehensive review. Frontiers in surgery, 4, 52. https://doi.org/10.3389/fsurg.2017.00052
  4. Köckerling, F., & Simons, M. P. (2018). Current concepts of inguinal hernia repair. Visceral medicine, 34(2), 145–150. https://doi.org/10.1159/000487278