How Blockchain Technology Can Improve Malaysian Healthcare

WORDS ASSOCIATE PROFESSOR TS DR AFIZAN BIN AZMAN

BLOCKCHAIN TECHNOLOGY UNBLOCKS LIMITATIONS IN MANY INDUSTRIES

Created in 2008, blockchain technology is a decentralized ledger that can be used to verify and trace multi-step transactions in healthcare, retail, supply chain, financial industries, and more.

Having reduced compliance costs and speed-up data transfer processing, users can also confirm secured transactions using this technology without the requirement for a central clearing authority.

Closer to home, Malaysia started its efforts in blockchain technology in 2015, with the Securities Commission (SC) and Bank Negara Malaysia (BNM) as important parties in the movement.

Moving forward, the Malaysian Industry-Government Group for High Technology (MIGHT) has said that Malaysia would be adopting blockchain by 2025 and many banking institutions are requested to explore and adopt this technology into their financial systems.

CURRENT PROBLEMS IN THE POST-COVID-19 HEALTHCARE SECTOR 

Privacy issues when it comes to medical data

From a healthcare perspective, every healthcare institution treats medical data as a highly privacy-sensitive element. The thought of giving patients control of access to their records and the exchange of health data between institutions raises the risks of data exposure and opens up issues around trust and security.

However, currently the problems of the medical record system include a lack of security, difficulty in transferring medical records between multiple healthcare institutions due to system complications, human errors when recording, storing, and transferring patients’ data, and unwanted tampering of data.

Indeed, post-COVID-19, Malaysia for one has been dealing with issues related to the healthcare system. MySejahtera turned into a national scandal after the Public Accounts Committee (PAC) revealed that the COVID-19 contact tracing mobile application had been developed for the government without a contract with the application developers.

Inefficiencies of an outdated medical record system

When medical records are mixed-up, not up to date or stored incorrectly, this can severely endanger the well-being and health of a patient.

Hence, the inefficiency of an antiquated medical record system will surely jeopardize the patient’s transfer process between different medical institutes due to complications with the patient’s medical data exchange.

These issues can lead to more serious issues down the line

These issues can become a stumbling block that contributes greatly to even bigger, unfavourable problems such as heavy monetary losses to healthcare institutions due to complications with patient’s medical data, which can lead to legal consequences.

HOW BLOCKCHAIN TECHNOLOGY CAN ADDRESS THESE ISSUES

Ensures medical data integrity and privacy 

Blockchain’s distributed ledger technology in healthcare makes it easier to:

  • Transfer patient medical records securely
  • Improve healthcare data security
  • Control the medication supply chain
  • Aid genetic code study in the medical field

It is known that the MySejahtera application had infused blockchain technology into its system during its conceptualization. The application could have functioned better had it covered the whole process ranging from user registration, vaccines supply-chain, contact to Pusat Pemberian Vaksin (PPV), medical officers, and more.

Help address major shortages in medications

The private general practitioner (GP) clinics, pharmacies, and hospitals in Malaysia suffered major shortages of various prescription and over-the-counter medications since last May, due to COVID-19 lockdowns in Shanghai, China, and Russia’s war in Ukraine.

More than an acute problem, the extraordinarily severe drug shortage in Malaysia this year revealed the need to boost the country’s medicine security for future international issues in the global pharmaceutical supply chain, as Malaysia is a net importer of pharmaceutical products.

Blockchain technology can help with medicine shortages through proper analysis at hospitals. Through this data analysis with untampered data, it can help to solve the issue in the pharmaceutical supply chain by establishing proof of ownership. Before reaching patients, drug ownership changes from the manufacturer to the distributor, and then to the pharmacist by easily cloning Radio Frequency Identification (RFID) tags. Using blockchain’s ability, more features can be periodically added to the chain.

Aid in improving overwork and toxic working culture in hospitals

The issue on the over workload and toxic working culture in public hospitals also can be solved if the Ministry of Health integrates digital innovation into its systems. Many manual processes can be automated and data transfer from one doctor to another can be updated timely at their fingertips, fostering a favourable environment between patients and doctors.

LOOKING AHEAD

There are several processes and new regulatory procedures related to blockchain that need to be standardized and coordinated.

As a catalyst for change, Malaysia should look into this as a core pillar to move the needle forward. Blockchain technology is ready, and so are we.

Should We Be Worried About COVID-19 in Our Wastewater?

WORDS DR SAPNA SHRIDHAR PATIL & ASSOCIATE PROFESSOR DR VENUGOPALAN KULANKARA BALAN

Recently, our Ministry of Health detected SARS-CoV-2, the virus responsible for COVID-19, during wastewater surveillance at airports in the country. It was also reported that China has begun SARS-CoV-2 wastewater surveillance for selected cities after the cessation of the country’s zero COVID policy.

WASTEWATER SURVEILLANCE EXPLAINED

In wastewater surveillance, samples of untreated sewage from selected communities and institutions are routinely collected and sent to laboratories for identification and quantification of virus content and testing for different or new virus variants.

Benefits of wastewater surveillance
  • It provides a rapid real-time ‘snapshot’ of the disease prevalence in the community where the wastewater was sampled from.
  • Wastewater surveillance also addresses challenges of disease under-reporting due to asymptomatic infections, self-home treatment, and delayed or absent notifications from medical practitioners.
  • Information from wastewater surveillance can be used to monitor disease burden patterns, reintroduction or emergence of a new pathogen/variant, and even evaluate the impact of community behavioural campaigns such as masking and physical distancing.

An example of the importance of wastewater surveillance is the detection, in 2022, of wild polio virus in sewage samples during routine testing in London and New York before any clinical cases were reported. This prompted the local health authorities to implement immediate measures to enhance the coverage of primary polio vaccination together with polio boosters in at-risk communities.

Limitations of wastewater surveillance

However, wastewater surveillance cannot replace the existing disease notification system and clinical testing as the wastewater comes from pooled community sewage samples and cannot be used for individual diagnosis.

Apart from this, technical and logistic challenges can also affect the accuracy of the results of wastewater surveillance.

Nonetheless, the information from an effective wastewater surveillance system can greatly complement existing notification system, as it provides an early warning alert for local health authorities to implement prompt targeted interventions in the communities at risk.

WASTEWATER SURVEILLANCE & COVID-19 DETECTION

Since the emergence of the COVID-19 pandemic in 2020, there has been ongoing research into the transmission dynamics and ways to curb the disease spread.

It is known that the SARS-CoV-2 virus spreads mainly through oral and nasal secretions. However, the virus is also shed in stools for prolonged periods of time. Individuals infected with the virus can shed the virus in their stools, irrespective of whether they have symptoms of COVID-19.

Wastewater surveillance has been implemented in many countries as an environmental monitoring tool to rapidly detect the presence of the SARS-CoV-2 virus in a community and enable local health authorities to be aware of the transmission risk factors, emergence of new variants, and the impact of community preventive measures.

Hong Kong

Hong Kong detected the delta variant in the sewage samples since the end of December 2020 and strengthened public health interventions by informing the public about the common symptoms, and the importance of continuing physical distancing and masking, in addition to hand hygiene and respiratory etiquette.

United States

In July 2022, California researchers reported that sampling of community wastewater in San Diego detected the presence of the alpha, delta, epsilon, and omicron COVID-19 variants up to 14 days before they started appearing on nasal swabs. This implies that wastewater surveillance applied to transportation-based sanitation systems can serve as an early indicator of possible community transmission.

SO, SHOULD WE BE WORRIED ABOUT COVID-19 IN OUR WASTEWATER?

The general public need not be alarmed by the news regarding the detection of the SARS-CoV-2 virus in human waste.

As COVID-19 has now become endemic across most countries around the world, the detection of the SARS-CoV-2 virus in sewage samples is not an unusual finding.

From the Ministry of Health’s initial reports, the variants isolated are already in circulation in Malaysia and the risk posed to human health and the environment is minimal.

However, being aware of such a system enables all of us to be better receptive of updated information shared by the Ministry of Health from time to time.

Children More Vulnerable to Infections During These Post-Pandemic Times?

WORDS DR LIM YIN SEAR & DR MAHFUZAH MOHAMED

DR LIM YIN SEAR
Senior Lecturer of Paediatrics
School of Medicine
Faculty of Health and Medical Sciences
Taylor’s University		 DR MAHFUZAH MOHAMED
Guest Lecturer of Paediatrics
School of Medicine
Faculty of Health and Medical Sciences
Taylor’s University
NEW NORMAL LEADS TO  NEW ‘CULTURE SHOCK’ FOR A CHILD’S IMMUNE SYSTEM

For the duration of the COVID-19 pandemic, children were predominantly confined to their home and as a result, were less exposed to common bacteria and viruses. This will render younger children’s immune system to develop poorly.

From March 2022 onwards, as life seemed to make its way back to normality, children started to attend school, enrichment classes, and sports activities again.

This has led to many young kids falling ill with diseases such as influenza, hand-foot-and-mouth disease, and lung infections. An elevated frequency of visits to the doctor has worried many parents that their children may have weakened immune system (we say that these children are then immunocompromised).

ARE CHILDREN REALLY MORE PRONE TO INFECTIONS POST-PANDEMIC?

Currently, there is no scientific data to show that children are more prone to infections after the pandemic.

HOWEVER, THERE ARE CERTAIN FACTORS THAT CAN INDIRECTLY UP THE RISK OF INFECTIONS IN CHILDREN

A briefing by UNICEF on the impact of COVID-19 on children has shown that the prevalence of unhealthy diets such as snacking has increased. This may be due to a lack of easy access to fresh food and financial constraints, possibly leading to childhood obesity and malnourishment.

Additionally, a sedentary lifestyle and the lack of exercise could contribute to childhood obesity, escalating vulnerability to infections.

Another major issue that arose during the MCO period was the disruption of essential health services including childhood immunisations. In a recent WHO pulse survey, 90% of countries reported disruptions to routine immunisations. Immunisations are of utmost importance for preventing certain infectious diseases.

Another important issue that needs to be taken seriously is the mental health of children and their caretakers. The Adverse Childhood experience (ACE) study showed that adverse childhood experiences in categories of abuse, household challenges, and neglect are not only associated with worse mental health outcomes, but also with chronic health conditions such as diabetes, heart disease, chronic obstructive pulmonary disease, liver disease, and cancer.

POSSIBLE SIGNS THAT YOUR CHILD MAY HAVE A WEAK IMMUNE SYSTEM 
  • Frequent and recurrent pneumonia, bronchitis, sinus infections, ear infections, meningitis, or skin infections
  • Inflammation and infection of internal organs
  • Blood disorders, such as low platelet count or anaemia
  • Digestive problems, such as cramping, loss of appetite, nausea, and diarrhoea
  • Delayed growth and development
  • Autoimmune disorders, such as lupus, rheumatoid arthritis, or type 1 diabetes
TOO CLEAN ISN’T ALWAYS GOOD

Some parents go to the extreme to create a “super clean” environment to protect their children and forbid the children to play or touch anything or anyone that has not been sanitised. This isn’t necessarily a good thing, and here’s why.

In the early years, our immune system is a blank canvas. Although infectious disease is a legitimate cause for concern, and a certain level of cleanliness is necessary, children need to develop an immunity to common pathogens.

Overprotecting children from germs is detrimental to their development. Therefore, parents need to balance between a clean environment rather than a sterile environment.

HOW ABOUT HAND-WASHING AND SANITISING?

Studies have shown that soap and water are better equipped to remove more germs from one’s hand than hand sanitiser does.

However, it is still recommended to use hand sanitisers when washing with soap is not an option.

LET’S TALK ABOUT VITAMIN D

Generally speaking, children with a balanced diet and outdoor activities would attain the daily requirement of nutrients.

A minimum of 400 IU (10 µg/day) of vitamin D is recommended for children and adolescents, especially among exclusively breastfed infants and all children and adolescents who are not routinely exposed to sunlight.

Vitamin D supplementation is only recommended to those who are unable to obtain an adequate amount of vitamin D from their diet or have inadequate exposure to sunlight.

Care should be taken while consuming vitamin D supplementation. A daily vitamin D intake of 2,000 IU or more puts one at risk of vitamin D toxicity. The signs and symptoms of toxicity include headache, a metallic taste in one’s mouth, pancreatitis, nausea, and vomiting.