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: [email protected]

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/

Experts & Parents Come Together to Raise Awareness of Respiratory Syncytial Virus

WORDS LIM TECK CHOON

On 4 September 2023, the Pertubuhan Kumpulan Sokongan Ibu Bapa Dan Bayi Pramatang Malaysia (BPM) and the Galen Centre for Health and Social Policy partnered to organize a media roundtable called Taking a Closer Look at RSV.

RSV is short for respiratory syncytial virus, one of the most prevalent viruses that infect the respiratory system of mostly children below 3.

FEATURED EXPERT
ASSOCIATE PROFESSOR DR ADLI ALI
Head of Clinical Immunology
UKM Children’s Specialist Hospital

“RSV is a disease that has been around for a long time, yet the number of cases is still high. The actual burden of the disease is not known from the economic impact on the healthcare system which includes admission costs, utilization of respiratory supports, as well the economic and social impact on the family of patients. Therefore, prevention is very important in addressing the further progression of the disease in the country.”

FEATURED EXPERT
AZRUL ABDUL KHALIB
Founder and Chief Executive Officer
Galen Centre for Health and Social Policy

“With the varied guidelines on prevention, we need to prioritize and respond with more urgency to RSV which can have a life-long impact. Parents, caregivers and the community at large need to understand the severity of the disease, how it can affect the future of our nation and what can be done to address them immediately.”

Azrul also called for more streamlined guidelines for RSV prevention and to ensure the channels for parents to seek support and financial aid for their children are made more accessible.

Furthermore, increased availability of preventive options would help reduce mortality and save children’s lives.

 

Is Antimicrobial Resistance the Next Global Threat After COVID-19? Let’s Find Out

WORDS PROFESSOR DR SASHEELA SRI LA SRI PONNAMPALAVANAR

FEATURED EXPERT
PROFESSOR DR SASHEELA SRI LA SRI PONNAMPALAVANAR
Infectious Disease Professor
University Malaya Medical Centre (UMMC)

As Malaysia and most of the world transitioned to the endemic phase of COVID-19, it’s easy to forget that just two years ago, the pandemic had led to millions of lives lost, rise in unemployment rates, and the near-collapse of healthcare systems due to the tsunami of cases. Today, thanks to the quick development of medical innovations such as COVID-19 vaccines, we are now able to continue living our lives in the new normal, resuming productivity, and building towards economic recovery and growth.

Now that we have seen the long-lasting and devastating impact that a pandemic can leave, it is vital that we draw our attention to tackling another urgent public health crisis—antimicrobial resistance, which continues to rise to alarming levels across the world.

A SILENT PANDEMIC

Over the years, antimicrobial resistance has become an urgent health challenge on a global scale. This is because microbes such as bacteria, fungi, and viruses no longer respond to commonly used medicines, resulting in infections becoming harder to treat.

How antibiotic resistance happens. Click the image above for a larger, clearer version.

Antimicrobial treatment no longer serves their desired effect, which in turn will increase the risk of poor outcomes in patients with an infection caused by antimicrobial resistance.

During the COVID-19 pandemic, there was a significant increase in antibiotic prescriptions despite a relatively low bacterial co-infection rate.

The misuse of antibiotics in these patients can result in increased selective pressure for antimicrobial resistance leading to a lasting consequence of the COVID-19 pandemic .

Apart from overprescribing of antibiotics unnecessarily, the increased risk of antimicrobial resistance is compounded by the lack of awareness of appropriate antibiotic use and a poor understanding on the consequences of misusing antibiotics among the public .

It is estimated that drug resistance claims 700,000 lives every year, and this toll is projected to increase exponentially to 10 million a year by 2050 without immediate action.

CONCERNING IMPACTS OF ANTIMICROBIAL RESISTANCE

Development of new antibiotics may not be fast enough to replace those that have become less effective due to antimicrobial resistance

The discovery of antibiotics was a turning point in human history, revolutionizing medicine and increasing the survival rates of infected patients over time.

However, the growing burden of antimicrobial resistance threatens the return to a world with a scarcity of effective treatments for even common bacterial infections such as urinary tract infection, pneumonia, skin infection, and surgical site infections.

As the effects of antimicrobial resistance continue to increase today, the discovery and development of new antimicrobials is not able to keep up against the emergence of AMR.

There is an urgent need for new antibacterial drugs in the market, but with this, comes the importance of ensuring that these antibiotics are used wisely.

Patients should be prescribed antibiotics only when needed, at the right dose, frequency, and duration. Otherwise the new antibiotics will also suffer the same fate as its predecessors and eventually lose effectiveness .

Antimicrobial resistance can also result in productivity loss caused by sickness and premature death, as well as rise of healthcare cost that stems from prolonged hospital stays and care

Without effective tools for the prevention and adequate treatment of drug-resistant infections, treatment may fail for an increasing number of patients. There will also be an increased risk in major medical procedures such as surgery, chemotherapy, and organ transplants .

WHAT CAN WE DO TO REDUCE & PREVENT ANTIMICROBIAL RESISTANCE?
  1. We should only take antibiotics when prescribed by a doctor and correctly follow the prescription directions.
  2. Don’t demand for antibiotics and buy medication without a prescription, or share or take leftover antibiotics.
  3. Maintain strict infection prevention measures such as hand hygiene to reduce the spread of antimicrobial resistance organisms.
  4. There is now increasing evidence that certain vaccines currently available for infectious diseases can decrease the risks of AMR by preventing bacterial and viral infections. Keeping up to date on vaccination schedules. particularly for children and elderlies, may be able to reduce the use of antibiotics, and thus prevent antibiotic-resistant infections.
A CALL TO STAKEHOLDERS TO RISE UP & REDUCE THE SPREAD OF ANTIMICROBIAL RESISTANCE

Besides creating awareness among consumers and healthcare professionals, combatting antimicrobial resistance also requires action from governments, policymakers, and industry players to really address the crux of the issue.

Investment is required in antibiotic research and development, both as a tool to control novel disease outbreaks, and to treat known pathogens developing resistance to currently available treatments.

We must learn from the COVID-19 pandemic to address the next global and public health threat. We have seen that it is indeed possible for all parties to work together to reduce the spread of COVID-19—from citizens adhering to new SOPs, pharmaceutical companies driving innovations that led to the creation of vaccines and COVID-19 treatment, and governments who put in place and enforced guidelines for the people, while also supporting the R&D of these innovations.

The same urgency is needed so that we can prevent the next public health crisis.