PERSATUAN PERUBATAN MALAYSIA • MALAYSIAN MEDICAL

Transcription

PERSATUAN PERUBATAN MALAYSIA • MALAYSIAN MEDICAL
April 2016
Berita MMA Vol. 46 No. 4
(For Members Only)
PP 1285/02/2013 (031328)
P E R S A T U A N
P E R U B A T A N
M A L A Y S I A
•
MALAYSIAN
MEDICAL
ASSOCIATION
beritaMMA Vol.46 • April 2016
MMA EXECUTIVE COMMITTEE
2015 – 2016
President
Dr Ashok Zachariah Philip
[email protected]
Immediate Past President
Dr H. Krishna Kumar
[email protected]
Contents
ExCo
4
President’s Message
8
From the Desk of the Hon. General Secretary
Lead Article
President–Elect
Dr John Chew Chee Ming
[email protected]
10
Honorary General Secretary
Dr Ravindran R. Naidu
[email protected]
14
Honorary General Treasurer
Dr Gunasagaran Ramanathan
[email protected]
Honorary Deputy Secretaries
Dr Ganabaskaran Nadason
[email protected]
Dr Rajan John
[email protected]
SCHOMOS Chairman
Mr Vasu Pillai Letchumanan
[email protected]
PPS Chairman
Dr Muruga Raj Rajathurai
[email protected]
Editorial
6
Workplace Stress: A Collective Challenge
SCHOMOS
MMA Tri-Event: An Overview
PPSMMA
16
MMA Tri-Event: Towards Excellence Series
SMMAMS
18
MMA Tri-Event: ABC of Housemanship
20
Let’s Discuss Housemanship
56th MMA AGM
23
Manifesto of Candidates
General
34
CAP-italizing Prevention
36
Women Empowerment Seminar
Editorial Board 2015 – 2016
38
Health & Healthcare Disparities
Editor
Dato’ Pahlawan Dr R. Mohanadas
[email protected]
40
T&CM in Today’s Healthcare
41
Humour
Ex-Officio
Dr Ravindran R. Naidu
[email protected]
MMA in the Press
42
MOHE Must Resolve Trainee Doctors Issues, Says MMA
Editorial Board Members
Assoc Prof Dr Jayakumar Gurusamy
[email protected]
46
Mark Your Diary
Dr Gayathri K. Kumarasuriar
[email protected]
Dr Juliet Mathew
[email protected]
Prof Dr M. Nachiappan
[email protected]
Publication Assistant
Ms Malar
[email protected]
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Published by
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ISSN 0216-7140 PP 1285/02/2013 (031328) MITA (P) 123/1/91
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The Malaysian Medical Association does not warrant, represent or endorse the accuracy,
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and other information does not necessarily reflect those of the Malaysian Medical Association.
Nothing in this disclaimer will exclude or limit any warranty implied by law that it would be
unlawful to exclude or limit.
beritaMMA Vol.46 • April 2016
4
exco • editorial
Stop the Bashing!
Dato’’ P
Pahlawan
hl
D
Dr R
R. M
Mohanadas
h
[email protected]
Editor
~~~
Are we not embarrassing
and demoralising the
majority of our younger
colleagues who are still
passionate about the
profession?
I
~~~
t was intended to be a relaxed
Sunday, 20 March 2016, I had
yet to see the day’s newspapers
or the online news, I received a
message from a senior Accountant
friend, and it read: Your profession
is confused, after years of being on
anti-cholesterol drugs, you say it does
not prevent heart attacks, and today,
you doubt the quality of your own
doctors, I have lost confidence.
Subsequently I realised, it was the
headlines of a leading newspaper
that Sunday: Unfit to be Doctors,
and in the three pages that followed,
with headings like, Not cut out to be
Doctors and Faking it for Medicine
that invited such a damaging remark
from a friend. Imagine the impression
created on the general public then.
Yes, this has not been a particularly
kind month for the medical profession.
We all know there are issues
pertaining to selection of students in
some medical schools overseas, the
varying quality of medical education,
large numbers of new doctors
graduating, longer waiting period for
housemen appointments, difficulties
encountered in housemen training
and the like. But does the medical
profession deserve such bashing,
such disparaging remarks, are we not
shooting ourselves at our own feet?
Do we realise the damage we are
causing to the general public who
depend so dearly on our healthcare
system for their well-being? Do we
beritaMMA Vol.46 • April 2016
realise the negative impact to our own
younger doctors and housemen, the
majority of them who work tirelessly
and conscientiously to support
our healthcare system? Are we not
embarrassing and demoralising the
majority of our younger colleagues
who are still passionate about the
profession? We have to think again,
loads of negative publicity is neither
helping us nor the next generation of
doctors.
Again, these are not issues that
appeared overnight. It has been
there for some years, repeatedly
highlighted in small doses by the
profession and all other stakeholders.
It has to be fixed, indeed all issues are
being discussed at various levels, and
hopefully all these challenges will be
addressed sooner than later.
Minimum entry qualifications for
Medicine, Dentistry and Pharmacy in
this country is specified. All Institutions
are required to abide by these, and if
they do not, they risk the closure of
the programme and/or the institution.
The SPM criteria of a minimum of
credit B4 is being reviewed. Indeed,
in my own observation, candidates
who apply to private Medical Schools
with the minimum B4 credits are very
few. Most would have had a few
distinctions. Nevertheless, distinctions
in all science subjects are on the
cards, and could be implemented
soon as minimum criteria. Several
private Medical Schools conduct
formal interviews and a few conduct
an English Language Proficiency Test.
But again, you can never be right on
assessing the aptitude of a candidate.
It is difficult in one interview.
On the varying quality of new
graduates, it is to be expected, and
it is not new. This would depend
mainly on the strengths of the
Institutions they have graduated
from. However, the 24 months period
of housemanship, which is intended
to be a period of supervised training,
should be able to address this. Then,
will a Pre-Registration Examination
help? It would to some extent, but
who are the graduates who need to
appear for such exams and who need
not, is a bone of contention. Some
have compared this to the Certificate
in Legal Practice Examinations, its
conditions and its pass rates. We have
had too much of unnecessary publicity
on the inadequate competencies
and skills of some Housemen. This
is really an issue for the employer,
the Ministry of Health with the great
expertise they have and network of
hospitals for training. The Ministry
and the Malaysian Medical Council
have made the ground rules clear, the
requirements to designate a hospital,
public or private, as a Housemen
Training Centre. If the private sector
wishes to participate, then, abide by
the guidelines.
There are challenges in the current
environment, but not insurmountable,
just that those in the corridors of
power need to speed up their
decisions. However, this negative
publicity generated by the profession
and media is not helping anyone. We
are only undermining the trust and
faith of the general population in our
profession.
One of the objectives of the Malaysian
Medical Association, formulated as
early as 1959, is: To participate in the
conduct of medical education, as may
be appropriate. Our records show the
direct involvement of the MMA and its
leadership then in the setting up of the
Faculty of Medicine at the University
of Malaya, and later representing to
the Government the need for the
second and third Medical Faculties
in the country. We should continue
to provide input, more directly to
the relevant authorities from time to
time, at the same time trying to steer
away from the negative image that
could be created. MMA Branches
could contribute at the grass roots
by conducting forums for school
counsellors and directly engaging
with senior secondary school students
on criteria of admissions to medical
schools, the danger of pursuing
studies in institutions that admit
students with below average results,
career prospects in medical sciences,
and the demands and expectations in
medical education. We would need
that type of service and guidance, at
the same time, dispelling the notion
that academic excellence equals
medicine!
For now, let’s preserve the sanctity of
our noble profession.
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6
exco • president’s message
Dr Ashok Zachariah Philip
[email protected]
[email protected]
President
M
ost people know the saying
about money being the root of
all evil. The actual quotation,
from the King James Version, is “For
the love of money is the root of all
evil”. I am not sure how many agree
with that statement. For me, money
is a useful marker of value. It makes it
easier for us to get what we value and
to dispose of what we have. Imagine
conducting our complex modern
lifestyles by barter trade! And yet, our
attitude to this essential lubricant of life
and commerce is strangely ambivalent.
We all need it, but we are somehow
ashamed of this need. In the case of
doctors, we don’t even have to be selfloathing. Society will kindly loathe us
if we happen to insist on receiving fair
recompense for our labours.
I am writing on this because of meetings
the MMA has been having with
Managed Care Organisations (MCOs),
Third Party Administrators (TPAs)
and the Competition Commission of
Malaysia (MyCC). A constant thread
through these discussions has been
the idea that “market forces” should
determine how much a doctor
charges. Market forces, according to
theory, should adjust prices according
to supply and demand. However, this
does depend on the market having
access to information. In the case of
medical care and health, I think we can
all agree that the problem is not a lack
of information but a profound lack of
comprehension.
Almost every doctor these days has
felt that sinking feeling caused by the
patient who drags papers out of his
pocket or bag and says “I’ve been
reading online about my symptoms”.
There is no lack of information out
there, but it is almost impossible for
the layman to process. Even when
guided by their doctor, many people
find it difficult to make the informed
decisions that in theory are the hallmark
of optimal medical care. I think even
doctors find it difficult to make clear
and rational decisions about their own
health, especially outside their own
fields of specialisation, because of
beritaMMA Vol.46 • April 2016
Treat Money As
A Tool
the inevitable emotional component
to being a patient. How much more
difficult it must be for a layman.
Given that there is such a lack of
comprehension of the available
information, it would be almost
impossible for there to be the sort of
rational, self-interested “demand” that
can help set prices in a free market. For
instance, I can quite easily determine
if I need another mobile phone, and
make a fairly informed determination
of the features I want, and then choose
the phone I want. That helps set the
~~~
If the minimum
consultation provides the
doctor with a fair return
on his time and effort, he
will consider objectively
the management the
patient needs
~~~
price that manufacturers can charge,
though of course things like the
“cool” factor can also affect pricing.
However, in the field of medicine there
are so many courses of treatment or
action that reasonable practitioners
might recommend for the same set
of symptoms in the same patient. The
patient, unable to really understand all
the information given to him, might in
fear choose the most expensive and
radical treatment under the impression
that expensive is synonymous with
good. On the other hand the more
penurious or miserly might choose the
cheapest alternative – which might in
the long term end up more expensive,
because it might be ineffective.
There is another strand to this, of
course – the question of supply. As
many General Practitioners (GPs) will
testify, opening a new practice now is
expensive, and there are many clinics
vying for a piece of the pie. When
a young doctor, deep in debt after
renovating and equipping his clinic, sits
and waits for too few patients, won’t
the promise of being on the panel of a
big company or MCO be too tempting
to ignore? Can we blame him if, in his
eagerness to be signed on, he offers a
ridiculously low consultation fee? After
all, he reasons, a few ringgit is better
than nothing.
The more experienced GPs will see the
fallacy here. You have to spend time
and employ staff to see the patients –
not to mention all the other overheads
of private practice. If you charge too
low, the consultation fees will not
cover these costs. You will actually
lose money seeing the patients from
these panel companies and MCOs.
Unfortunately, by the time our young
GP finds this out, he is contractually
bound to see the patients. The only
way out that some see is to prescribe
more drugs than needed or to mark
the drug prices up (or both). Though
one can understand why this is done,
it is still unethical and such behavior
cannot be condoned.
The best way out of this for both patient
and doctor, I think, is for a minimum
consultation fee to be imposed. The
Competition Commission believes a
minimum fee is anti-competitive, but in
an environment where consumers are
not competent to make an informed
decision a minimum fee will protect
them from being given unnecessary
drugs and treatments. If the minimum
consultation provides the doctor with a
fair return on his time and effort, he will
consider objectively the management
the patient needs. On the other
hand, if “market forces” and powerful
companies force him to undercut
himself, ultimately it will be the patient
who suffers. In the long term, trust
in the profession will be undermined
– and at present, let us not forget,
doctors are among the most trusted
professionals in the country.
In this respect, I believe the medical
profession stands with the legal
profession. The Bar Council has
minimum fees for many services, and
believes that allowing undercutting
would serve their clients badly. Perhaps
we should work together to make the
point to the authorities that it is not a
good idea to try to regulate without
comprehending. I only wish that we
could do this more often before a law
is passed!
8
exco • hgs
From the Desk of the
Hon. General
Secretary
Dr Ravindran R. Naidu
[email protected]
Hon. General Secretary
12 February 2016
Meeting with Dr Ahmad Razid, Director
Medical Practice Division with Dr
Federa and Dr Hashinderjeet, En
Azahar, Representative from Urusetia,
Dr Maha, Secretary of Association of
Private Hospitals of Malaysia (APHM),
Datin Fadhillah from Malaysian Medical
Council (MMC), and Dr Shan from
Federation of Private Practitioners. MMA
was represented by Dr Muruga Raj,
Chairman PPS, Dr Arasu, Secretary PPS,
and Dr Ravindran R. Naidu, Hon. General
Secretary. This meeting was called
with a view to regulate all Third Party
Administrators (TPAs) and Managed Care
Organisations (MCOs).
Issues discussed were:
1. Preparation of contracts or agreements – This should be based on good medical practice and good business practice.
We have requested that all contracts or agreements be standardised so that it will be easy for the doctors.
2. The contents should be balanced so that it is fair to both parties as currently it is beneficial to TPAs and MCOs only.
3. To review consultation fees which should comply with the 13th Schedule of the Private Healthcare Facilities and
Services Act 2006. The consultation fee is also to be fixed based on the diagnosis. It was suggested a fair consultation
fee be charged based on the diagnosis and time spent on the patient.
4. The price of drugs to be standardised.
5. Delay in remuneration to the doctors. The TPA Representative mentioned that the delay in payment is usually due
to mistakes in the submission of claims. However, it was clarified that if the companies delay payments, then advise
our doctors not to sign a contract with these companies.
6. Preparation of a MCO Bill. The MMA requested the Medical Practices Division of the Ministry of Health (MoH) to
formulate the MCO Bill which is the only way to control them.
The MMA brought to the attention that a reply has been received from Bank Negara that they have no regulatory
requirements and control over TPAs or MCOs.
15 February 2016
Public Lecture Series by YABhg Tun Dr Siti
Hasmah in conjunction with the launching
of the Tun Dr Siti Hasmah Lecture Series
on Public Health organised by Perdana
University. This was followed by launching
of the book “Battling Adversity” by YABhg
Tun Dr Siti Hasmah. This book was authored
by Associate Professor Dato’ Dr Andrew
Mohanraj.
beritaMMA Vol.46 • April 2016
18 February 2016
Meeting with En Mazmalek Bin Mohamad – Commissioner
Personal Data Protection Malaysia under the Ministry of
Communications and Multimedia Malaysia
1. The Minister of Communications and Multimedia
Malaysia has rejected the Minister of Health’s request
to exempt doctors from registering with the Personal
Data Protection Act (PDPA).
2. The Commissioner informed that their only concern is
DATA. The Medical Act does not state how to store,
manage, monitor, and delete the DATA.
3. Whereas the PDPA clearly addresses all the above
issues.
4. The Commissioner requested that MMA and APHM
work together to formulate the guidelines for the
Code of Practice for medical compliance under the
5.
6.
7.
8.
PDPA. Currently the MMC has requested that they will
formulate the Code of Practice. But the Commissioner
stressed that according to law, they being a regulatory
body, cannot formulate the Code of Practice.
The Commissioner requested MMA to advise the
members to register as they will be sending their
enforcement officers soon to make sure clinics comply.
The penalty for not registering is a maximum of
RM500,000.00 and the maximum compound will be
50% which is RM250,000.00.
All doctors need to display their registration certificate
in their clinics
MMA highlighted that they have no objections to
register. However asking to pay is not acceptable as
most of the General Practitioners are not doing well.
The Commissioner has given an assurance that he will
look into this matter.
18 February 2016
Meeting with The Malaysia Competition Commission (MyCC).
This was attended by Tan Sri Norma, Chairman, Dato’ Abu
Samah, CEO, Encik Iskandar Ismail, Director Enforcement
Division, and Ms Ayuda Sari ismail, Director Strategic Planning &
International Affairs Division.
It was confirmed that the fee schedule under the Private
Healthcare Facilities and Services Act is not against the
Competition Commission Act 2010. Any fee quoted in any
regulations is not contravening the Competition Commission
Act 2010.
It has been clarified that price fixing is not allowed under the Competition Commission Act 2010. A range in the fees
is allowed.
Docquity
A Private and Secure, Doctors-Only Professional Network for MMA
MMA has partnered with Docquity, a mobile networking and
collaboration channel, to set up a doctors-only professional
network for members of MMA. With this partnership, MMA
members can use this mobile channel to collaborate with
trusted peers across geographies in real time. The ability to
exchange and learn from medical experiences in real time
over a secure doctors-only network is valuable and can
potentially save lives. MMA is partnering with Docquity to
create and establish such a doctors-only exclusive network
for all MMA members. Groups can be formed within the
Council and National Working Committee.
The Docquity application allows private and secure
discussions with individual doctors or group discussions
with multiple doctors. The App is private in a way that it
is only for doctors and one needs to be invited to join.
The app is secure because Docquity has stringent security
features to protect the discussions that occur. You can share
images, reports, X-rays or give and receive second opinions
on patient conditions during your private conversations
with other trusted members.
This is our community, our network and initiative to
help connect all our members onto a single network
and create a precedent in collaborative care. The Docquity
(www.docquity.com) Mobile Application can be
downloaded from the Apple App Store and Google
Play Store.
beritaMMA Vol.46 • April 2016
10
lead article
Workplace Stress:
A Collective Challenge
E
very year since 2003, on the 28th April the International Labour Organization (ILO)
celebrates the World Day for Safety and Health at Work. The purpose is to promote
the prevention of occupational accidents and diseases globally. It is an awarenessraising campaign intended to focus international attention on emerging trends in the field of
occupational safety and health and on the magnitude of work-related injuries, diseases and
fatalities worldwide. The theme for this year is ‘Workplace Stress: A Collective Challenge’.
Dr Jefferelli Shamsu
Shamsul
Bahrin
[email protected]
Regional Head
Occupational Medicine
and Health Protection
BASF Asia Pacific
Member MMA
Selangor
Workplace stress can be relevant to medical doctors from various perspectives such as
treating doctor, occupational health physician, employee, supervisor, or employer. A
treating doctor may see patients who have bodily symptoms of stress. An occupational
health physician may diagnose stress in an organisation and propose intervention
programmes. Doctors are often employees themselves and subject to stressors affecting
their organisation. Some also supervise junior health professionals and have an important
role in early detection and referral of stress cases among their subordinates.
Many doctors have their own practice and hence determine the work environment which
affects themselves and their staff. Doctors themselves can be the source of stress!
National Institute for Occupational Safety and Health (NIOSH) defines job stress as the
harmful physical and emotional responses that occur when the requirements of the job do
not match the capabilities, resources, or needs of the worker. A physically strong worker
is less likely to develop job stress when performing physically demanding work compared
to a physically weak person. A manager with adequate time, budget and staff is less likely
to develop job stress compared to a manager with inadequate resources. An author who
prefers solitary work is less likely to develop job stress when performing individual work
compared to group work. Getting the right match is important in preventing stress in the
workplace.
Relationship between stress and health
Job stressors
‡ word load
‡ control
Individual factors
Acute reactions
‡ personality traits
‡ stage of career
psychological
‡ anxiety
‡ irritability
‡ coronary heart
physiological
‡ blood pressure
‡ muscle tonus
‡ back pain
‡ alcoholism
‡ tobacco use
development
‡ management
‡ career
security
relations
‡ physical
conditions
(noise, etc.)
disease
‡ infectious
diseases
styles
‡ interpersonal
Illness
‡ family situation ‡ social support
‡ financial status ‡ coping
behavioral
‡ concentration
‡ sleep problems
Non-work factors Buffer factors
from: Hurrel and Murphy, 1992
The relationship between workplace stress and health is complex. Stressors at the
workplace can be categorised into work-load, control, management styles, career security,
interpersonal relations and physical conditions.
There can be more than one category of stressor at the workplace. Individual factors such
as personality traits and stage of career development, non-work factors such as family
situation and financial status and buffer factors such as social support and coping influence
beritaMMA Vol.46 • April 2016
Officers in Yemen. House officers there felt underpaid,
experienced work overload, faced time pressure,
feared making mistakes, struggled to make decisions,
lacked resources and support, had poor relationship
with supervisors, felt insecure in their jobs, and work
demands affected their personal life (Sami et. al, 2001).
While the work conditions in Yemen may not be identical
to Malaysia, the house officers’ experience here would
probably be quite similar.
Ministry of Health Malaysia Module on Stress Intervention
at the Workplace
the reaction towards these stressors. Hence to
effectively manage stress at the workplace not only
job stressors need to be considered but also individual
factors, non-work factors and buffer factors.
Acute reactions toward stress include increased anxiety
and irritability, increased blood pressure and muscle
tone, reduced concentration and sleep disturbance.
This can lead to illnesses such as coronary heart disease,
susceptibility to infectious diseases, back pain, alcoholism
and tobacco use (Hurrel et. al. 1992). It is important that
employees, supervisors and doctors understand this
relationship. Stress should be considered as a potential
cause of: sleep disturbance by an employee, irritability
in an employee by a supervisor and back pain in an
employee by a doctor. Awareness of such relationship
allows the employee to seek further support. It will enable
the supervisor to initiate a discussion with the employee
and if necessary refer the employee for counselling. The
doctor will also remember to take appropriate history
before proceeding with further investigations.
Stress in the Malaysian workforce is common. It ranges
from 20% to 34% among teachers (Hadi et al. 2009)
(Masilamani et. al. 2012), 22% among dental officers (Rusli
et. al. 2006), 37% among nurses (Harmy et. al. 2003), 39%
among the police personnel (Masilamani et. al., 2013),
47% among factory workers (Fazil Z., 2004) and 68%
among managers and executives (Swee et. al. 2007).
The prevalence of stress among doctors is high: house
officers 65.2%, medical officers 41.9% and specialists
30.7% (Ruhaini et. al 2006). This is not surprising especially
among house officers and is supported by the findings of
a study on Stress and Emotional Burnout among House
Professor of Occupational Health, Dr K.G. Rampal
predicts that the prevalence of stress among
doctors in Malaysia will increase
(2013). This is due to
many doctors
e n te ri ng t he
workforce, fears
of inadequate
training and skills
an d pred i c t ed
reduced income
l e ve l s a nd j ob
insecurity. He further
recommended
the introduction of
stress management
programmes and
te ach i n g co p i ng or
survival skills to junior
doctors.
A posi ti ve st ep i n
this direction was
the publication of an
Intervention Module for
Stress at the Workplace
w h i ch cove re d stre ss ri sk asse ssme n t, how t o
manage stress, healthy lifestyle and monitor stress by the
Occupational Health Unit of the Ministry of Health Malaysia
in 2014. Today, Hospital Kuala Lumpur employees have
access to their counselling unit to discuss workplace
stress. The house officers and medical officers have
established peer support groups which are managed by a
psychiatrist and occupational health physician. Employees
with stress related and mental health conditions who are
returning to work are provided support. These are some
clear examples of improvements in managing stress in the
workplace.
However, more can be done to manage stress at the
workplace in Malaysia. A national workplace stress study
on all workers would identify who among our worker
population are at risk of stress and what are the causal
factors. The study population would need to include
foreign workers, who now form a significant portion of
our workforce, face the most stressful work conditions and
have the least social support.
It would also be interesting to assess the results of the
implementation of the Department of Occupational
Safety and Health Malaysia Guidelines on Managing
Stress and Violence in the Workplace (2001). The findings
of this study would enable us to develop intervention
programmes that focus on the worker population at risk
of stress and effectively address the causes. We should
consider enlarging the reach of stress intervention
beritaMMA Vol.46 • April 2016
12
lead article
measures currently only accessible to certain
work populations. For example could the
counselling services and return to work support
offered at Hospital Kuala Lumpur also be
offered at Ministry of Health hospitals and
health clinics and be extended to all workers?
Could the stress management in the workplace
module developed by Ministry of Health be
used by other Government organisations? How
about adopting stress management measures
originating or being practised overseas?
Many global companies such as BASF
encourages their entities throughout the
world to establish an employee assistance or
stress management programmes which cover
education on stress management, stress hotlines
and face-to-face counselling. Formal “work-life
balance” programmes are also available and
this demonstrates their commitment towards
balancing the social needs of their employees
and the business needs of the organisation.
Elements of a work-life balance programme
would include allowing flexible work hours, work
from home and career breaks. Appointment of
an occupational health doctor who regularly
interacts with employees and management is
common and their work scope would include
management of stress. Since tackling organisational
stressors can be difficult, some companies have decided
to focus their efforts on enhancing individual coping
ability through resilience training. To enhance resources
and reach to employees they have also nominated and
trained peer counsellors.
Employers in Japan have recently been required to
conduct Stress Assessments for their employees. The
British Medical Association offers round the clock
confidential nationwide counselling for doctors and
medical students. In some countries stress-related
conditions are compensable.
Tackling stress at the workplace would involve multiple
stakeholders. The Department of Occupational Safety
and Health, Ministry of Human Resources and Ministry
of Health would need to take the lead in any initiative
to enhance the current provisions. Universities and the
National Institute of Occupational Safety of Health
Malaysia could support the research and programme
development.
beritaMMA Vol.46 • April 2016
BASF’s Recommendations for managing
work-related stress brochure.
Occupational safety and health organisations including
the Society of Occupational and Environmental Medicine
of the Malaysian Medical Association and the Academy of
Occupational and Environment Medicine Malaysia could
provide expert input. Other stakeholders would include
the Social Security Organization whose objectives include
prevention of occupational injuries and disease among
contributors, employer and employee organisations such
as Malaysian Employers Federation and Malaysian Trade
Union Council who would want to protect the interest of
their members.
Should we not collectively accept the challenge to improve
stress management at the workplace? If we include this
as one of the strategies in the Occupational Safety and
Health Master Plan for Malaysia, I am optimistic that we
will progress even further. After all, we already have a
proven track record of improving stress management in
the workplace and strong collaboration between the key
stakeholders.
14
schomos
MMA Tri-Event:
An Overview
Dr Khi
Khiritharan
ith
M
Mannie
i R
Rajah
[email protected]
Honorary Deputy Secretary
National SCHOMOS
SCHOMOS and PPS, together with the contribution
from SMMAMS successfully organised the “Towards
Excellence Series” on 20 of February 2016. This series
consisted of the Women Empowerment Seminar, ABC of
Housemanship Seminar and GP Seminar and Scientific
Meeting, which were held simultaneously across three
halls at the Sheraton Imperial Hotel, Kuala Lumpur.
ABC of Housemanship
This seminar was organised by SCHOMOS and SMMAMS,
and was inaugurated by Dato’ Dr Haji Azman Bin Abu
Bakar (Director, Medical Development Division, Ministry
of Health). The main objective of this seminar was to
expose our future doctors to the working culture in our
hospitals.
This event was attended by more than 160 medical
graduates and final year medical students. Some came all
the way from Sabah and Sarawak. Senior consultants from
different departments with vast experience in houseman
training were present to guide our future doctors on how
to cope with the stress of housemanship. Among the issues
that were highlighted were the potential problems that
junior doctors could face, as well as what was expected of
them when they are posted in each department.
The participants were also exposed to the art of effective
communication and were given the opportunity for some
hands-on experience with common procedures. There
was a session where medical officers and housemen
shared their experiences with the participants. A senior
officer from the Malaysian Medical Council (MMC) was
also on hand to give a talk on how to go about applying
for housemanship. His topic also included points on what
doctors are entitled to.
Seeing that the feedback for the event was very
encouraging. SCHOMOS is planning to make this seminar
a yearly event.
Women Empowerment Seminar
SCHOMOS successfully organised a seminar for doctors
and the public, to empower women to step up as leaders
and promote gender equality. About 100 participants
attended this seminar, from the northern states to the
south.
Among the distinguished speakers who were present to
share their experiences were YBhg Tan Sri Rafidah Aziz
(Non-Executive Independent Chairperson of AirAsia X
Berhad), Prof Dr Kyung Ah Park (President of Medical
Women’s International Association – MWIA), Dr Mary
beritaMMA Vol.46 • April 2016
Dato’ Dr Haji Azman Bin Abu Bakar (Director, Medical Development
Division, Ministry of Health)
Suma Cardosa (Past President MMA) and Dr Gayathri K.
Kumarasuriar (Clinical Psychiatrist and Hypnotherapist,
Hospital Sultan Abdul Halim, S.P.). The main aim of the
talks was to bring about a positive change in the lives of
the participants.
The participants were rather ‘glued’ to their seats listening
to all the talks delivered by the charming speakers. The
seminar ended with a forum which gave participants a
chance to have a lively discussion with the speakers. Dr
Pamela Lee chaired and coordinated the event well.
Conference of Minds
On the same day, a conference of minds was organised
by SCHOMOS. Many Past Chairman and Chairperson of
SCHOMOS who had contributed many working papers in
Majlis Bersama Kebangsaan (MBK) were invited.
Dr Krishna Kumar (Immediate Past President MMA), Dr
Harwinder Singh and Dr Rosalind met with the SCHOMOS
ExCo and shared their experience in successfully
presenting MBK papers. They also contributed ideas for
future papers.
This meeting was chaired by the current SCHOMOS
Chairman, Mr Vasu Pillai. SCHOMOS would like to record
our gratitude to them for their valuable time and input.
From left to right: Mr Vasu Pillai (SCHOMOS Chairman) presenting a token of appreciation to Dato’ Dr Haji Azman Bin Abu Bakar (Director,
Medical Development Division, Ministry of Health) with Puventhiran Pannirselvam (SMMAMS Chairman) and Dr Arvindran Alaga (SCHOMOS
Vice Chairman) looking on.
among doctors, this Tri-Event managed to enlighten
the participants to the happenings around doctors and
the public.
SCHOMOS would like to thank PPS, SMMAMS, MMA
Secretariat, all the speakers, and the participants for taking
their time off during the weekend to join the seminars,
making it a success. A special thanks to Prof Dr Kyung Ah
Park for coming all the way from South Korea.
Meeting with Auditor General YBhg Tan
Sri Haji Ambrin Bin Buang and the External
Auditors for Kementerian Kesihatan Malaysia
On another note, SCHOMOS had had a conducive
meeting with the Auditor General to clarify certain issues.
Auditor’s name is being misused by many, in rejecting
doctor’s claims in hospitals and Klinik Kesihatan. The
finance staff in charge should notify the doctor if there are
any queries or rejection of their claims. However, these
are not done most of the time.
YBhg Tan Sri Rafidah Aziz (Non-Executive Independent Chairman of
AirAsia X Berhad)
Conclusion of The ‘Towards Excellence’ Series
The ‘Towards Excellence’ Series feedback was promising,
with further calls from participants for future events like
this to be organised. Apart from fostering goodwill
We are entitled to our claims as long as it is genuine and
all procedures were followed, based on existing circulars
and guidelines. Technical mistakes on claims need to
be highlighted to the respective doctors. We hope that
these issues will be ironed out as we are looking forward
to further correspondence with the Auditor General.
We have also requested the Auditor General to look into
the variations in handling claims from centre to centre, as
we feel that it should be standardised. SCHOMOS would
like to thank Tan Sri Haji Ambrin Bin Buang and his team
for engaging with MMA and answering all our queries.
beritaMMA Vol.46 • April 2016
16
ppsmma
MMA Tri-Event:
Towards Excellence Series
Dr Thirunavukarasu Ra
Rajoo
[email protected]
Honorary Secretary
National PPS
T
h e I n a u g u r a l To w a r d s
Excellence Series seminar,
organised by PPS and
SCHOMOS on 20 February 2016 at
Sheraton Imperial, Kuala Lumpur was
indeed a success.
The event covered issues involving
Government Doctors, to be precise,
exposing medical students and
equipping housemen to housemanship
training, women empowerment and
not forgetting pressing long-standing
issues faced by General Practitioners
on Managed Care Organisations
(MCOs) or Third Party Administrators
(TPAs) and also the Pharmacy Bill.
There were Lembaga Hasil Dalam
Negeri speakers, to address issues on
taxation.
The Organising Committee which
was Co-chaired by Dr Muruga Raj
and Mr Vasu Pillai, met just one time
throughout the planning of the event.
Most of the meetings were conducted
via WhatsApp and emails. Its high
time many of MMA’s meetings are
conducted using various technologies
available. This will definitely reduce
the operational cost, as it is too
costly to mobilise all our leaders from
different parts of Malaysia to just
attend a one to three-hour meeting.
Not forgetting our precious time
that we spend in our vocation and
family cannot be measured with the
compensation received. This will also
allow more members outside Greater
KL to participate in activities.
We arranged for an Event Management
Team to manage the entire seminar
which went on uneventfully and
many participants from the 480 odd
attendees were pleased with the flow
beritaMMA Vol.46 • April 2016
of the event without any hiccups. All
the stakeholders who participated
including the exhibitors were pleased
with the outcome of the event. This is
very important in keeping the event at
or below cost. Based on the successful
outcome of these few seminars
organised by the event management
team, it is obvious that we should leave
the organising to the professionals
whilst we, the medical professionals,
focus on the issues surrounding the
medical profession.
The Society of MMA Medical Students
(SMMAMS) was also included in the
Committee, in order to help them gain
exposure and also understand current
issues faced by the medical fraternity.
We believe a succession plan is
very vital in the sustainability of any
organisation. This should be cultivated
and more junior members should be
empowered and entrusted to carry out
important projects. This will give them
the confidence to do better as future
leaders in MMA.
It is very important to continuously
have dialogues with MCO/TPA
representatives at the same time,
getting the policymakers involved so
as to keep the momentum going till
we achieve what we are fighting for. Dr
Ahmad Razid, the Director of Medical
Practice Division and also Dr Harshinder
Singh who is in charge of MCOs/TPAs
at the Ministry of Health (MoH), were
present to give a detailed presentation
on MCO and its guidelines. They
acknowledged that the long term
solution is the Managed Care Bill which
is currently being drafted with MMA as
one of the participants together with
Malaysian Medical Council (MMC),
Association of Private Hospitals
of Malaysia (APHM), Academy
of Family Physicians of Malaysia
(AFPM), Federation of Private Medical
Practitioners’ Association Malaysia
(FPMPAM), Medical Practitioners
Coalition Association of Malaysia
(MPCAM), and Pertubuhan DoktorDoktor Islam Malaysia (PERDIM). As
the bill is being drafted, AMALAN
has acknowledged and is willing to be
the arbitrator to the conclusion of the
series of stakeholder engagements
that is ongoing between MMA and
the MCOs/TPAs. The minutes of the
Dr Muruga Raj, addressing the 150 odd
General Practitioners
Dr Ahmad Razid, taking questions from
attendees on issues regarding MCO/TPA
meeting will be published in the next
issue of Berita MMA.
The Pharmacy Bill which may change
the landscape of GP practice was also
addressed by Tuan Hj Ghazali from
the Pharmaceutical Service Division
of MoH. He was kind enough to
record all our concerns with regards
to the Pharmacy Bill. It was also
informed that the outcome of the
Rand Undang-Undang Farmasi (RUUF)
Stakeholders Meeting at Port Dickson
in December 2015, will be briefed to
the Health Minister on 8 March 2016.
We have also stated that the Medical
profession should be regulated by
doctors themselves via MMC as the
Pharmacists are being regulated by
their own. MMA is keeping close tabs
on the evolution of the Pharmacy Bill.
Lastly, we can only resolve issues
by being united. Please bear in
mind resolving long term issues is a
marathon and not a sprint and requires
lots of patience and endurance.
18
smmams
MMA Tri-Event:
ABC of Housemanship
Thum Chern Choong
[email protected]
Honorary Assistant Secretary
SMMAMS
The Committee of SMMAMS following a discussion with Dato’ Dr Azman Abu Bakar,
Director, Medical Development Division of the Ministry of Health, Malaysia
H
ousemanship is a daunting prospect, especially when you are a
medical student looking at the gap which you have to make a
huge leap over. Deemed stressful, tough, and depressive, many
medical students experience difficulties when they make the transition
into housemen. It was then a stroke of genius of the Malaysian Medical
Association for they held the ABC of Housemanship seminar on 20 February
2016, to dispel myths and prepare medical students for the next stage of
the journey: Housemanship. Being in the infancy of my medical career, it
is a privileged opportunity for me to be able to listen to the opinions and
perspectives of them who have been there and done that.
A word of congratulations has to be attributed to the Organisers for its
impressive line-up of speakers, whose excellent deliveries enlightened the
audience who were in the dark of what was in store in the future, and the
topic selection itself, which was both relevant and essential not only to
house officers, but also to the medical fraternity as a whole.
Tan Li Yin (left) and Thum Chern Choong
at the ABC of Housemanship seminar
~~~
As healthcare
professionals, it is
imperative we utilise
correct communication
skills to deliver bad
news clearly, honestly,
and sensitively
~~~
beritaMMA Vol.46 • April 2016
As healthcare professionals, it is imperative we utilise correct communication
skills to deliver bad news clearly, honestly, and sensitively in order for
patients to both understand and feel supported. One such framework
deemed helpful in practise to deliver bad news is the SPIKES model. It would
be interesting to know how many medical schools prepare their students
to deliver bad news using the model, and how effective it translates into
clinical practice when said students become housemen.
Specialists from various departments converged to speak about life in
their respective fortes, and the qualities of housemen which they prize
dearly. The theme was consistent across the board; they who are humble,
hardworking, and respectful are sought after. In short: Attitude determines
one’s aptitude.
This seminar opened my eyes to opportunities and challenges before me.
While it is a tough journey with a steep learning curve ahead, I shall not be
afraid, for I will not walk alone; every member of the profession is here to
assist me on this journey we all travel together.
Because, if you love your job, you do not have to work one more day of
your life.
20
smmams
Let’s Discuss
Housemanship
Puventhiran Pannir Selvam
[email protected]
Chairman
SMMAMS
Greetings to all medical students.
As you all know, a Housemanship
crisis issue has recently been sparked
up and has become quite a significant
topic of discussion among people in
and out of the medical field. Being
students of this field, I am sure this
issue is at the back of our minds and
thinking about the fact of whether
or not we will all be offered jobs in
the future can be quite worrying. I
am in your shoes as well but now,
the question is, why are we beating
ourselves up about this matter? Are
we going to quit our courses due to
this crisis? Or are medical schools
shutting down? Or is it that those who
have aspired to become doctors are
being forced to switch their courses
out of the medical field? The answer
is NO. Everything is going to remain
just as it is now.
At the end of the day, what matters
most is that we all stay focused on
what we aim to do and together as
Medicos, we will face all the humps
and bumps that come along our
journey. The fact is, we have no say in
how the system works. The system will
remain the same and all we can do is
to adapt and make the best out of it.
But now, there is another question.
beritaMMA Vol.46 • April 2016
Why is there an overflow of housemen
in the country in the first place? Is it
because of the excessive medical
graduates in Malaysia? Or is it due to
the lack of training hospitals? Or is it
due to the increasing extension rates
of housemen that is taking up the
placement of new medical graduates?
solved soon, then the time of waiting
for the upcoming batches of medical
graduates might experience a steep
increase. I hope the authorities
from the Ministry of Health (MoH) will
start investigating retrospectively
on the core reason of the increase in
extension rates among house officers.
In a recent statement by Datuk Dr
Noor Hisham, the Malaysian Director
General of Health, he said that 30%
of housemen undergo extension
of housemanship due to various
reasons resulting in the occupancy of
placement of new house officers in the
Government Hospitals. Hence, the
waiting period for medical graduates
is increasing as there are lack of
placements in the training hospitals.
He also mentioned that one of the
reasons for the increasing extension
rate is due to incompetency of the
house officers.
Being a final year medical student
myself, I am aware of the challenges
we go through and I know that it is not
easy to complete our medical degree
and finally obtain our DR title. So
when we are done, of course all of us
would be more interested in serving
the community rather than doing
odd jobs for months. There are even
instances where some lose interest
in the medical field after working
in other fields for such a long time.
People say that no matter what, one
should never forget the knowledge
acquired. However in reality, waiting
for months without medical exposure
has the power to rust and wear off
half of our existing knowledge. This
can be a significant factor resulting
in poor performances during the
Housemanship course.
B a s e d on a s u rv e y w hic h w a s
conducted by SMMAMS, the statistics
show that the average waiting period
for medical graduates who graduated
in the year 2015 is six to eight months.
If this problem is not looked into and
~~~
30% of housemen
undergo extension of
housemanship due to
various reasons resulting
in the occupancy of
placement of new
house officers in the
Government Hospitals
~~~
In our recent conversation with Dato’
Dr Azman, the Director of the Medical
Development Division in Ministry of
Health; he told us that the Ministry
is really looking into this matter right
now as this issue is mushrooming and
becoming chronic. It is honestly really
good to hear such news. We hope for
change for the betterment of future
doctors.
Ta k ing a ll thes e p o in ts into
consideration, we, the members
of SMMAMS will be meeting the
authorities of MoH soon to discuss
this ongoing issue on the status of
Housemanship in Malaysia. We hope
that MoH will take good measures to
improve the existing situation.
56th mma agm • manifestos
23
beritaMMA Vol.46 • April 2016
24
56th mma agm • manifestos
Candidates:
President-Elect
1. Dr Ravindran R. Naidu
2. Datuk Dr Kuljit Singh
Dear Colleagues,
Dr Ravindran R. Naidu
MMA Perak
[email protected]
On 27 May 2016 at the MMA AGM in Miri, Sarawak, you will be asked to vote for the
next President-Elect of MMA. I am seeking your support and your vote. This election
for President-Elect is about choosing a leader who has proven that he can produce
results on behalf of the entire profession. My dear colleagues, I have been a longstanding member of MMA and you have had the confidence to see me serve on
your behalf in the Malaysian Medical Association in several Committees and several
positions including Chairman of the PPS, as the Honorary Deputy Secretary,
Honorary General Treasurer, and currently as the Honorary General Secretary of
the MMA. In this time I have been effective in ensuring our interests are protected
and enhanced over the years. We require this same strong voice and advocacy in
leadership of our association. Real leadership is not about titles, positions or rising
through organisational charts. Real leadership is about inspiring other leaders to
support our goals.
What is the relevance of The Malaysian Medical Association to me and to all of us?
Many inside and outside the Association have said that the MMA is irrelevant and has
done nothing and therefore many splinter groups have blossomed over the years.
But in actual fact, MMA has been and is still doing what it is supposed to do for its
members. The problem is there is no publicity of what MMA has done and achieved.
It is this question of self-doubt and this question of relevance which I am prepared to
answer over the next two years if given a chance to lead this esteemed organisation.
We have to revolutionise this conservative image of the MMA with a positive cycle of
change and to achieve this change we have to do it conscientiously and consistently.
Some of these changes have to be immediate or short term while most will have to
be gradual, long term and take time. It is through an astute application of my time
and energy that I hope to achieve this. We need to reverse negative trends regarding
the image of Healthcare Professionals and repair internal differences and external
relationships with fellow professionals including the Ministry of Health.
I am committed to promoting change in a number of key areas of development
affecting our profession:
1. While focussing on how MMA can better interact, communicate and connect with
other medical organisations is critical , my duties and leadership in the MMA have
alerted me to the growing needs, pressures and daily challenges faced by our own
professionals.
2. To work and engage with the Ministry of Health. Engagement with the Ministry of
Health is an ongoing process and should not be discontinued.
3. The General Practitioners in this country are facing challenges which need to be
addressed by the MMA.
4. To suggest reforms for Medical Education in Malaysia.
5. To engage with the relevant authorities on National Healthcare Transformation and
restructuring.
6. Finding ways to better respond to the needs and problems of our younger doctors.
7. MMA membership must be flexible, affordable, relevant and accessible.
However, whatever I do must be based on the needs of members, and I pledge to
continue to engage with members in person and via our growing internet and social
media presence to ascertain their fears, concerns and ideas.
beritaMMA Vol.46 • April 2016
56th mma agm • manifestos
25
Candidates:
President-Elect
Dear Colleagues,
Datuk Dr Kuljit Singh
MMA Wilayah
[email protected]
gmail.com
My service in MMA close to 20 years will not be complete if I do not offer myself
as President-Elect 2016-2017. After sitting as Branch Chairman of Wilayah years
ago and active participation in two branches (Kedah inclusive), I had also served
the central MMA in various capacities as SCHOMOS National Chairman, Deputy
General Secretary for years together and finally as Honorary General Secretary
2013-2014. Besides leading post in the ExCo, I have also served as Editor BERITA
MMA: Five years and Internal Auditor for two years. Despite of having a break
from the ExCo between 2011-2013, I held the post of Honorary General Secretary
of Malaysia Medical Association Foundation. My experience and exposure in the
association is tremendous thus I am very passionate to do more.
After being one of the editors of the 55 years MMA History book at a relatively
middle age (mid-forties) I have understood the deeper workings of this association
and I am prepared to serve both the younger and senior group of doctors to manage
different level of problems and issues.
My mission in MMA as President would be to enhance networking with the private
stakeholders and Government ministries and agencies in order to achieve a better
system of healthcare for the patients and a practical one for the treating physicians
and general practitioners. The difficulties to survive as a doctor will be addressed
in a consultative way as I had done successfully in the last many years in MMA. My
strengths are that I would be able to engage different level of hierarchies in most
establishments in order to fulfill the aim of the association.
With my closeness and networking with the authorities and members, I can ensure
you that most of our issues will have a good closing and this will then be the right
impetus for more new members to join us in the future as we need to show a good
value proposition. Believe me I am committed to do that!
Please vote for me in Miri at the National AGM.
Thank you.
beritaMMA Vol.46 • April 2016
26
56th mma agm • manifestos
Candidates:
Honorary General Secretary
1. Dr Koh Kar Chai
2. Dr Thana Sehgaran
Shanmugam
Dear Colleagues,
I believe that the Malaysian Medical Association is still relevant in this day and age.
I believe that the members of this august body have the faith that the Malaysian Medical
Association will uphold the dignity of the medical profession.
I believe that the Malaysian Medical Association will strive to ensure that the ethical practice
of medicine in this country is allowed without hindrance to ensure quality and safe healthcare
delivery to our patients.
For all these to happen, the Malaysian Medical Association will need office bearers of good
standing who are able to understand the processes within and without the association to
ensure that its objectives are met.
Dr Koh Kar Chai
MMA Wilayah
[email protected]
The position of the Honorary General Secretary is of utmost importance as it supports the
President in ensuring the smooth management of the association. It takes on the secretarial
and administrative duties of this august body.
I believe that I am the person who is able to take on the role of the Honorary General Secretary
as I understand its responsibilities well and because I am able to tap on to my past experience
of holding various offices within MMA, both at branch level as well as central level in the
Executive Committee and Council. Notwithstanding is the knowledge acquired from holding
positions in the various MMA committees, bodies in the Ministry of Health as well as external
organisations.
Humbly counting on the support of each and every one of you.
Positions held in the Malaysian Medical Association
Wilayah Branch:
• Committee Member, MMA Wilayah 2005-2016
• Treasurer, MMA Wilayah 2006-2008
• Chairman, MMA Wilayah 2008-2010
• CPD Chairman, MMA Wilayah 2010-2012
MMA Central:
• Member, Committee on International Relations
2008-2010
• Chairman, AIDS/STIs Committee 2009-2013
• Member, Accident Prevention Committee 20112012
• Member, BERITA Editorial Board 2009-2012
• Member, CPR Committee, 2009-2012
• Honorary Secretary, Private Practitioners’ Section
2010-2011
• Chairman, Private Practitioners’ Section, 20112013
• Member, Health & Human Rights Committee 20112012
• Member, Fees Schedule Committee 2011-2012
• Chairman, SOCSO Committee 2011-2012
• Member, National Health Policy Committee 20112016
• Honorary Deputy Secretary 2013-2015
• Vice Chairman, Private Practitioners Section 20132014
• Member, House Management Committee 20132014
• Member, Staff Welfare Committee 2014-2015
• Assistant Secretary, Private Practitioners Section
2014-2016
• Chairman, TPA Subcommittee, Private Practitioners
Section 2014-2015
beritaMMA Vol.46 • April 2016
Other positions held
• Council Member, Malaysian AIDS Council 2009-2013
• Appointed Member, Drug Control Authority, National Pharmaceutical
Control Bureau, Ministry of Health, Malaysia 2011-2013
• Appointed Alternate Member, Drug Control Authority, National
Pharmaceutical Control Bureau, Ministry of Health, Malaysia 20142017
• Appointed Alternate Board Member (Vice President), Malaysian
Society for Quality in Health (MSQH) 2011-2012
• Appointed representative, Jawatankuasa Jagaan Yang DiUrus,
Kementerian Kesihatan Malaysia 2011-2012
• SIRIM
– Appointed Representative, Industry Standard committee on
Medical Devices (ISCR) 2011-2016
– Appointed Representative,Technical Committee on Plastic
Products 2011-2013
– Appointed Representative, Technical Committee on Quality
Management & Corresponding General Aspects for Medical
Devices (TC1) 2011-2013
– Appointed Representative, Technical Committee on Disposable
Single Use Devices (TC2) 2011-2014
• PhAMA Ethics Appeal Committee 2011-2012
• Appointed Representative, Council of the Confederation of Scientific
and Technological Associations in Malaysia (COSTAM) 2013-2016
• Appointed Member, Malaysian Adverse Drug Reactions Advisory
Committee(MADRAC), MOH, 2013-2015
• Appointed Member, Traditional & Complementary Medicine
Committee, MoH, 2014-2016
• Appointed Alternate Member, Jawatankuasa Teknikal Komponen
“Quality Use of Drugs” (JKPDUNAS) 2013-2017
• Appointed Member, Jawatankuasa Teknikal Komponen “Quality
Use of Medicines” 2015-2016
• Elected ExCo Member of Council, Federation of Scientific and
Technological Associations in Malaysia (COSTAM) 2014-2016
56th mma agm • manifestos
27
Candidates:
Honorary General Secretary
Dear Colleagues,
Dr Thana Sehgaran
Shanmugam
MMA Wilayah
[email protected]
I had obtained a Medical Degree in 1991 and a SEAMEO- TROPMED- CTZ scholarship
in 1996 to pursue a postgraduate degree in MSc Public Health (Epidemiology) at
College of Public Health College, Manila, Philippines University. I was gazetted as
a Public Health Specialist 13 years ago in July 2003. I had been recognised for
my Public Health Work in the field of epidemiology and disease control during
an outbreak of JE, Nipah, SARS and Avian Flu in Perak State. At Jengka Hospital,
Pahang and Teluk Intan Hospital, Perak. I was instrumental for the implementation of
MQSH, Accreditation and ISO 19001: 2004 certification. My clinical skill, knowledge
and practises in primary and secondary healthcare had helped in rural healthcare
delivery in Sarawak. I was assigned duties in almost all the hospitals in Sarawak.
Currently, I am posted in the Institute for Medical Research and is the driving force
for publication, bulletin authorship and an award-winning postal presentation.
I have been actively involved in the Malaysian Medical Association for the last ten
years in MMA Wilayah as a Committee Member, SCHOMOS, Honorary Secretary,
Vice Chairman and next Chairman of MMA Wilayah.
I am currently the Council Member, MMA Public Health Society Chairman and
Honorary Secretary for MMA VoC at MMA National. I am also a Council Member of
Selangor Indian Sports Council and Malaysian Indian Football Association outside
MMA’s circle.
I have served the Ministry of Health for last 24 years with an excellent record in five
states including East Malaysia & East Coastal States. I had proved myself in various
capabilities as State Epidemiologist, Hospital Director, Administer, Public Health
Physician and Researcher.
I am now ready to serve the position of Honorary General Secretary in Malaysian
Medical Association to translate my vast working experience into implantations
and best practises in Malaysian Medical Association with a vision to deliver the best
healthcare system and ensure Malaysian Medical Association is a recognisable entity
within Ministry of Health and Internationally.
beritaMMA Vol.46 • April 2016
28
56th mma agm • manifestos
Candidates:
Honorary Deputy Secretary
1. Dr Ravi
Venkatachalam
2. Dr Thomas Kana @
Kamarudin Kana
3. Dr Saraswathi Bina
Rai SK Nagalingam
4. Dr Edwin Leo Suppiah
5. Dr Navin @ Datesh a/l
Daneshwar
Dear Colleagues,
Many Happy Greetings. I offer myself for the post of Honorary Deputy Secretary at
the 56th AGM in Miri, Sarawak.
I had graduated from Stanley Medical College, Chennai in 1990. I started off my
Housemanship at the end of 1990 in HSA, JB and continued my MO posting in
Kuching, Sarawak and subsequently joined the armed forces for a short service
commission for two years and then back into Government Hospital posting in
Seremban before leaving to private practice. Since 1996, I have been and am still in
private practice in A&E settings till now.
Dr Ravi Venkatachalam
MMA Wilayah
[email protected]
I have been a Life Member in MMA for the last 20 years and had actively started in
MMA Wilayah as a Committee Member from 2011 and since then held the post of
Wilayah PPS Chairman and currently during our AGM last weekend 20 March 2016
got elected as Treasurer of the branch and will assume position coming June 2016.
I am also serving under the subcommittees of Constitution and Review Committee
and Action on Smoking and Health Committee.
During my tenure in MMA Wilayah, We have jointly conducted various medical
camps, sports activities and last year we had our Primary Care Symposium in October
2015 and our PPS subcommittee of six members actively took part in organising it
and it turned out to be a great success.
Currently, our nation is being faced by three major problems namely, Communicable
Diseases, top of the list is Dengue, Secondly, NCD which is a cluster of diseases
like T2DM, Dyslipidemia, HPT, Obesity and etc. Thirdly, the imbalance between
production of Doctors and placement in Government Hospitals. Anyways these
problems are already known and I give full support to the ExCo in whatever means
to solve these issues.
The other main issue is the decreasing membership in the organisation from time
to time. I am already working on some proposals from other areas to benefit our
members and also to enhance member benefit programmes if they were to join
MMA. I am looking at wellness practice programmes for GP’s to increase their
livelihood and also property investment models that will benefit the members in
the long run.
Given an opportunity to be elected as one of the Honorary Deputy Secretaries, I
pledge my full support and cooperation to be a good team player and work as a
team with the new ExCo that will be elected in coming AGM in Miri.
See you all at Miri AGM 2016.
Warm Regards and Thanks.
beritaMMA Vol.46 • April 2016
56th mma agm • manifestos
29
Candidates:
Honorary Deputy Secretary
Dear Colleagues,
As Chairman of the Organising Committee of the 56th National MMA AGM, I would
like to welcome you to our beautiful oil city, Miri.
I was born in Sibu, Sarawak in 1968. I got my Medical Doctor degree from UKM in
1994. After graduation, I did my Housemanship in Ipoh 1994/95. After serving MoH
until 2001, I joined the Faculty of Medicine and Health Sciences, Universiti Malaysia
Sarawak as a Lecturer in the Department of Family Medicine. My current post is
Deputy Dean (Undergraduate and Student Development).
Dr Thomas Kana @
Kamarudin Kana
MMA Sarawak
[email protected]
I joined the MMA as a Life Member in 2002 when I was doing my postgraduate
in Family Medicine in HUSM, Kubang Kerian, Kelantan. I was also then elected as
a Committee Member for MMA Kelantan. Back to Sarawak in 2004, I became a
Committee Member of MMA Sarawak. Serving MMA Sarawak for ten years from
Committee Member, Treasurer, Secretary, Vice Chairman, to Chairman. Since
2012/13, I was serving in MMA Council as a Representative from MMA Sarawak. I
was also active in the Academy Of Family Physician Malaysia as the Sarawak Section
Head since 2010 and a Council Member. We managed to successfully conduct
WONCA Asia Pacific Region 2014 in Kuching, Sarawak with 1,000 delegates.
I have served as an appointed Malaysian Medical Council member from 2012 until
2014, gaining experience about medical ethics, Medical Acts and Regulations,
accreditation of medical programmes, registration of doctors and issues related
to the medical profession. From 2014 until now, I served as a member of the
Accreditation Committee of Malaysian Medical Council.
The President of MMA with his vision, needs a strong and effective team to ensure
that MMA will regain respect and its credible reputation among members and
other agencies. I believe that I am able to give full support to the President, ExCo
and Council members, to ensure that the running of MMA must be following the
constitution.
With my vast experience, I can help to ensure that MMA’s record keeping would be
well organised and updated. Member recruitment among young doctors and Life
Membership for senior members will be my priority. Lapsed Members should be
reduced to zero by giving incentive, regular reminders and facilitation in the renewal
process. With pending issues faced by MMA such as Dispensing Separation, MCO/
TPA, TPPA, new Medical Act and internal administrative issues, MMA needs a united,
strong and capable ExCo to represent all doctors in Malaysia. With your support and
assistance, I now seek to be elected to the post of Honorary Deputy Secretary in the
upcoming election.
beritaMMA Vol.46 • April 2016
30
56th mma agm • manifestos
Candidates:
Honorary Deputy Secretary
Dear Colleagues,
I joined MMA in 1984 and have been an active member of the Penang Branch from
1995 to date.Over the years I have held various posts at the State Branch including
Chairperson and have served in the Council for many terms. I have also served in
various Committees of the MMA.
Dr Saraswathi Bina Rai
SK Nagalingam
MMA Penang
[email protected]
I am a Public Health person - trained and bred as such. As much as it is tempting to
extol and display here my background and my achievements on papers presented,
publications and all the numerous and varied organisations I am involved in and
have contributed to; all that is not of relevance nor is it going to make a difference
here.
Suffice to know that I am a Government employee for the past 30 odd years.
Integrity is of the utmost importance to me, in addition to punctuality. I speak my
mind and will always do the “right thing”. In applying for the post of the Honorary
Deputy Secretary here, I do not expect to move mountains but rest assured I will do
whatever it takes to get a job done – as long as it is morally and legally right. I am
at a stage in life where recognition and pats on the back for a job well done does
not make a difference to me. Personal satisfaction means more and there is nothing
I would like more than to see this Organisation that I am a part of move to great
heights, with all the members having the same vision. Our doctors face so many
challenges and problems from outside, so we need to be strong from within; we
need a team that can gel and work together without the drama.
I stand out on two aspects: the sole female candidate and the candidate with the
longest name...ever! But let this not be the reason for you to elect me. I wish to be
elected on merit and on your confidence that I am a capable candidate and will
be an asset to the ExCo. I have the greatest respect for both Dr John Chew and
Dr Ashok Philip – they are the reason I have applied for this post. I very much look
forward to working with them as one of the Honorary Deputy Secretaries this year.
However I can only do that if I have your mandate and your vote.
beritaMMA Vol.46 • April 2016
56th mma agm • manifestos
31
Candidates:
Honorary Deputy Secretary
Dear Colleagues,
My name is Dr Edwin Leo Suppiah.
I have been an active Member of the MMA Selangor Branch since 1990.
I am one of the five candidates contesting for the post of the MMA Honorary Deputy
Secretary.
I obtained my MBBS from Madras University, and did my MBA in Hospital
Management in UKM and my Postgraduate Diploma in Occupational Medicine also
from UKM.
Dr Edwin Leo Suppiah
MMA Selangor
[email protected]
I served in the Malaysian Armed Forces for two years and subsequently in a private
Hospital for 18 years. Since 2004 I have been practicing as a solo General Practitioner
in Selangor.
I have served as the MMA Selangor Branch Vice Chairman for two years and then
as the Chairman for another two terms in the 90s and again in 2012 and 2014. I also
served as the Branch Treasurer and the Secretary and PPSMMA Branch Chairman
during different years. As Selangor is eligible for two Council seats for the Chairman
and Vice Chairman subsequently as a result I have served in the Council for a total
of eight years. I have also served in the House Management Committee.
Selangor State has the largest number of members and the Branch has been very
active over the years.
After my experience in the Selangor Branch from 1990, holding all the different
posts over the years and serving in the Council for a total of eight years, I would
now like to offer my humble services as one of the Honorary Deputy Secretaries in
the Council.
I have been a General Practitioner for 12 years and I fully understand most of the
problems facing General Practitioners specifically and doctors in general. I will bring
up such issues to the ExCo and Council for their necessary action.
I practice and live in Selangor, so it will be very convenient for me to attend meetings
when necessary.
I am not promising any dramatic changes, but I will follow the constitution, which
states that the Honorary Deputy Secretary will assist the Honorary General Secretary
and deputise for him and shall be responsiblefor any other duties delegated to me
by the Council, ExCo or the Honorary General Secretary. I will carry out all duties
delegated to me to the best of my capability, using the experience gained over the
years in the Branch and the Council.
My fellow colleagues and friends, I am sure you will in your wisdom make the right
choice. I wish all the other candidates also good luck.
“Positive Thinking is not only about Expecting the Best to happen…but it is also
Accepting whatever happens is for the Best…”
Thank You.
beritaMMA Vol.46 • April 2016
32
56th mma agm • manifestos
Candidates:
Honorary Deputy Secretary
Dear Colleagues,
This association has been very close to my heart ever since I started my medical
career. I truly believe in its relevance and believe strongly that it remains the most
important body independently representing doctors in Malaysia. It has had its fair
share of trials and tribulations over the past few years but I am sure, with the proper
team of administrators, we will be able to restore the glory of the MMA.
Dr Navin @ Datesh a/l
Daneshwar
MMA Wilayah
[email protected]
My believe is that this association is for its members. It’s not primarily a charitable
association, a humanitarian association, a regulatory body per se. It’s an association
that solely should look after the welfare of its members who are of course all doctors.
A doctor’s welfare extends beyond his own gratification at a personal level. Being
a noble profession, I know doctors who find satisfaction in serving the community,
doing humanitarian work, coming up with better regulations to make our profession
ever so noble and this is what MMA will facilitate. To make their ambitions come
true by providing them the platform to speak, the muscle of funding, the voice of
thousands so that we may make the deaf hear once again.
That is my motive, of aspiring, to have the opportunity to steer MMA towards that
goal in my capacity in the ExCo. I have previously served at the state level in Kedah
for many years and recently was the National SCHOMOS Chairman 2014-15. As
you all may remember it was that year that my Committee brought you the deals
from car companies, AirAsia etc. We were determined to increase our membership
strength and thus some perks were required to bring in new members and to benefit
the existing ones. You must understand that with numbers we have strength. With
that we will ALWAYS remain relevant.
I hope that one day, soon enough, every doctor in Malaysia will be a member of the
MMA.
I look forward to your support if you too aspire to see MMA the way I envision it.
I am happy you serve.
beritaMMA Vol.46 • April 2016
%""
0'
! &#'.-01-
'&#
52-0//43.3.
52-0//43/3/
"##$"*( "#)#$"( Royal College of Surgeons in Ireland
Intercollegiate Basic Surgical Skills Course - Penang 2016
Month
June
September
December
Date
15 – 17th
7th – 9th
7th – 9th
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Penang Medical College
Penang Medical College
Penang Medical College
Intercollegiate Basic Surgical Skills Course
THREE DAY TECHNICAL TEACHING COURSE
Aimed at: Surgical trainees who are starting Basic Training in their first year.
•
Course Objectives:
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o repair of nerve and tendons
o introduction to safe laparoscopy
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Closing Date:
One month (exactly) before course date commencement.
Fee:
EURO 350.00 for Malaysians Nationals (Government Service)
EURO 750.00 for all others
Bank Draft to: The Royal College of Surgeons in Ireland
•
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Please note that there are only sixteen places available on each course. These are awarded on a first come, first served
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Malaysia
Email: [email protected]
34
general
CAP-italizing
Prevention
D
id you know that respiratory diseases are listed as the number 2 cause of
hospitalisation and death in Malaysia? Recent data shows that respiratory
diseases are recorded at a 12.41% hospitalization rate and 21.70% death rate
respectively.1 Respiratory diseases are a serious health problem among Malaysians
as we are often exposed to all types of viruses and bacteria in our warm tropical
weather. This is definitely a concern as one of the most pressing diseases in the
respiratory category is – Community Acquired Pneumonia (CAP).
Proff D
P
Dato’
t ’D
Dr Hj Abd
Abdul
Razak Muttalif
[email protected]
Senior Consultant Chest Physician
Institute of Respiratory Medicine
Hospital Kuala Lumpur
Life Member MMA Wilayah
~~~
Pneumonia is
an inflammatory
condition which
primarily affects the
oxygen-absorbing
areas of the lung, or
more simply: it’s a
lung infection
~~~
beritaMMA Vol.46 • April 2016
But first let us start with Pneumonia – what is Pneumonia?
Pneumonia is an inflammatory condition which primarily affects the oxygenabsorbing areas of the lung, or more simply: it’s a lung infection. It is usually
caused by a viral or bacterial infection, or less commonly known microorganisms2.
Pneumonia can cause respiratory failure by triggering a combination of infection
and inflammatory response – the lungs quickly gets filled with fluid and become
stiff. This stiffness, combined with severe difficulties in extracting oxygen may
require long periods of mechanical ventilation for survival.
Streptococcus pneumoniae is the most common bacterial cause of communityacquired pneumonia also known as Pneumococcal CAP. Pneumococcal CAP is one
of the leading causes of death and hospitalization worldwide.3 Pneumococcal CAP
can be classified as non-invasive, when bacteria cause infection in the lungs but are
not detected in the blood concurrently, or invasive, when bacteria also enter the
bloodstream (bacteraemia pneumonia) or another normally sterile site in the body.
While non-invasive forms of CAP are typically more common, the invasive types of
disease are generally more severe.
‘Community Acquired Pneumonia (CAP) is different than hospital-acquired
pneumonia where the disease is contracted by patients who live in a healthcare
system in a long-term capacity or have recently visited a hospital. A literal
understanding of CAP would be that you acquire pneumonia through your
everyday life in the community – mixing with people, being in crowded situations
and socializing – sounds pretty much like an average Malaysian’s life!
Asia currently is and is projected to continue being, home to a dominant share
of the world’s population. According to a United Nations report, the proportion
of elderly citizens (aged 60 and above) in the region is expected to increase from
9.9% in 2010 to 23.6% in 2050.4 In many developing countries, the number of
adults aged 65 years and below is expected to grow by more than 250%, with some
of the countries including Philippines, Malaysia, India and Bangladesh.5 These
statistics provide an overview of the alarming rates of the disease in adults and are
an indication for the urgent need to address the prevalence of pneumonia in adults.
~~~
Community-acquired pneumonia
is a vaccine-preventable disease
and vaccines have come a long way
from its conceptualization from two
centuries ago
~~~
There are many factors that cause a person to be easily
affected with pneumonia but it is especially dangerous
when they have a weak immune system. Pre-existing
health complications such as Chronic Obstructive
Pulmonary Disease (a lung disease that makes it hard
to breathe), asthma, renal or liver disease, cancer and
diabetes can make them more prone to developing
pneumonia.6 Additional external factors such as smoking,
increased alcohol intake and living conditions such as
long-term care residency also have a hand in reducing
the functionality of their immune systems, making them
more susceptible to the risk of infection and more prone
to complications and mortality.
CAP and 75% fewer cases of vaccine type Invasive
Pneumococcal Disease (IPD). This shows that vaccination
for CAP will indeed reduce the burden of the disease
significantly among adults.
It is important that we need to be aware of the serious
consequences of CAP – that can be easily contracted
when you pick up your grandchildren from kindergarten,
go to a crowded fair or market or even when you travel
to tourist destinations.
As CAPiTA demonstrates, immunization should definitely
be a priority as it is the most effective way to be protected
against CAP as well as other life-threatening infectious
diseases. The benefits of vaccination outweigh the costs
associated with its development and administration. It
also is a good economic option as it potentially prevents
death and hospitalization as well as reduces the cost
of treatment, care and rehabilitation, which is why
immunization is important in preventing CAP as well as
various other life-threatening diseases.
*This article has been published with the kind permission
of Pfizer Malaysia.
The elderly account for the majority of communityacquired pneumonia infections owing to their lower
immune capabilities which naturally weaken with age.
This includes even healthy, active older adults!7,8,9,10,11
For example, Hajj and Umrah are ideal conditions for
community-acquired pneumonia. Research has shown
that pneumonia is the largest cause of hospitalisation
of Hajj pilgrims during the Hajj season with more than
19.7% percent hospitalization rate.11 The Hajj attracts
millions of people from different parts of the world who
congregate in a limited area for an amount of time,
leading to the widespread of infectious diseases and
epidemics. As pneumonia spreads from person to person
through respiratory droplets from sneezing or coughing,
Hajj provides the ideal environment for the spreading of
the disease.
Good news however is that community-acquired
pneumonia is a vaccine-preventable disease and
vaccines have come a long way from its conceptualization
from two centuries ago. A recent study called CAPiTA
(Community-Acquired Pneumonia Immunization Trial
in Adults) investigated the efficacy of vaccination for
immunity in a form of group, or herd immunity, among
adults aged 65 years and older. This was the first trial
on pneumococcal conjugated vaccine in adults which
highlights the efficiency of conjugated pneumococcal
vaccine in adults. The CAPiTA findings reinforce the
crucial role that immunization plays an important role
in reducing the incidence and burden of vaccine-type
pneumococcal CAP and IPD among the elderly.
As reported in the study, there were 45.6% percent fewer
first episodes of vaccine-type CAP among vaccinated
subjects than in subjects who received placebo. It was
also found that the vaccinated group experienced 45%
fewer first episodes of non-bacteremic and non-invasive
1.
Adapted from 2014 Health Facts by Ministry of Health Malaysia. Available
at www.moh.gov.my . Accessed on 9 November 2015
2. McLuckie, A., ed. (2009). Respiratory disease and its management. New
York: Springer. p. 51.
3. Cunha, BA. Medscape. Community-acquired pneumonia. Updated
September 13, 2013. Available at http://emedicine.medscape.com/
article/234240-overview. Accessed April 2013.
4. United Nations. World population prospects: the 2008 revision.
Highlights. United Nations; 2009. Selected tables. http://esa.un.org/
unpd/wpp2008/pdf/WPP2008 Selected Tables 1.pdf.
5. Kinsella K, He W. US Census Bureau, International Population Reports,
P95/09-1, An Aging World 2008, US Government Printing Office:
Washington DC; 2009.
6. Adapted from “Pneumonia: Causes, Symptoms and Treatments”.
Available at: http://www.medicalnewstoday.com/articles/151632.php .
Accessed on 16 December 2015
7. Weinberger B, Herndler-Brandstetter D, Schwanninger A, et al. Biology
of immune responses to vaccines in elderly persons. Clin Infect Dis.
2008;46:1078.
8. Peto L, Nadjm B, Horby P, et al. The bacterial aetiology of adult
community-acquired pneumonia in Asia: a systematic review. Trans R Soc
Trop Med Hyg. 2014;108(6):326-37.
9. Rozenbaum MH, Pechlivanoglou P, van der Werf TS, et al. The role of
Streptococcus pneumoniae in community-acquired pneumonia among
adults in Europe: a meta-analysis. Eur J Clin Microbiol Infect Dis.
2013;32(3):305-16.
10. Said MA, Johnson HL, Nonyane BA, Deloria-Knoll M, O’Brien KL.
Estimating the burden of pneumococcal pneumonia among adults: a
systematic review and meta-analysis of diagnostic techniques. PLoS One.
2013;8(4):e60273. doi: 10.1371/journal.pone.0060273.
11. Adapted from “Vaccination during Hajj, Umrah, Pfizer launches awareness
campaign on Pneumonia”. Available at: http://www/brecorder.com/
business-a-economy/189/1242773/. Accessed on 3 October 2012.
beritaMMA Vol.46 • April 2016
36
general
Women Empowerment
Seminar
Dr JJuliet
D
li t Mathew
M th
[email protected]
Editorial Board Member
~~~
As the world is
becoming more and
more gender neutral,
women should
widen their thinking
perspective instead
of further isolating
themselves
~~~
The Empowering Ladies
(Left to right) Dr Delini Devi Ramadras, Dr Gayathri K. Kumarasuriar, Dr Kyung Ah Park,
Dr Mary Cordosa and Dr Lee Yew Fong
T
he Women Empowerment Seminar organised for the first time by MMA,
was held at the Sheraton Imperial Hotel, Kuala Lumpur on 20 February
2016. The seminar served the participants through three eloquent and
inspiring women speakers in the morning; they employed various thought
provoking methods and informative ways to proliferate the message of gender
equality across the hall.
Prof Dr Kyung Ah Park, Professor of Anatomy at Yonsei University College of
Medicine in Seoul, Korea and President of the Medical Women’s International
Association (MWIA) was the first speaker for the day. She started the morning on
a powerful note – ”Women Empowerment Is Not Men Hating!” She presented
her topic on “Work-Balance Life” and described ways of managing time while
still preserving the sanity of self. Her stress management methods were grouped
under the five balls of managing life – The Work Ball, The Home and Family Ball,
The Relationship Ball, The Friends Ball and The Self Care Ball. These addressed
the many roles women play in the society. She also particularly stressed the
importance of not succumbing to the “Superwoman Syndrome.”
Dr Mary Cordosa, Consultant Anaesthesiologist and Pain Specialist, also
the first female President of MMA, continued the morning with her talk titled,
“Celebrating the Achievements and Looking to the Future”. She raised a very
important question, one that should evoke enough awareness to strive for
improvement in all individuals – ”Are we the ones stopping ourselves?”. She
further elaborated on the positive changes that have taken place so far in history
in the fight towards gender equality. She provided much data on this and cited
beritaMMA Vol.46 • April 2016
explains, to acknowledge that men have their issues as
well, hence, we need to be fair to them too as we crusade
for our rights. “Stereotyped roles exist for both genders,”
she concludes strongly.
The highlight of the day’s event for me was the dynamic
presentation that afternoon by the Guest of Honour, Tan
Sri Rafidah Aziz, former Minister of International Trade
and Industry. Her show of confidence and professionalism
itself spelt empowerment in bold letters, as she tackled
on the subject of “Leadership – Male Champions for
Change”. She delivered her message loud and clear as
she stressed to the audience – “Forget about women
empowerment, talk about self-empowerment!” Women,
she exclaimed with a chuckle, were empowered way
before men were born. The globalising world, she added,
has generally given us easy access to gaining knowledge,
and has delivered higher competencies within various
industries, especially, the healthcare industry. However, it
has also evoked many types of new challenges.
YBhg Tan Sri Rafidah Aziz with MMA President, Dr Ashok Philip and
the Organising Committee
the various organisations involved in being responsible
for the major milestones that have been achieved in
the workforce thus far, through various platforms such
as the Convention on the Elimination of all Forms of
Discrimination against Women (CEDAW), Platforms for
Action and the Millennium Development Goals (MDG).
Dr Gayathri K. Kumarasuriar, Psychiatrist and Clinical
Hypnotherapist, ended the morning session with her
presentation titled, “Gender Equality for Women
Benefits Men Too”. She mesmerised the crowd with
her many amusing anecdotes, and her simple “storytelling” manner through which she managed to arrest
the floor’s attention to a standstill point. The participants
were initially breaking into giggles that soon became a
crescendo of laughter – a much-needed delight in the
midst of all the seriousness that morning with regards
to the subject at hand. She highlighted the fact that
mutual respect is simply necessary. There is a need, she
Hence, gender discrimination or marginalisation of any
groups for that matter, according to her, would only
worsen the process of growth and success. She further
advised that, as the world is becoming more and more
gender neutral, women should widen their thinking
perspective instead of further isolating themselves under
any feminine, gender equal or meritocracy groups. “The
real issue is not the gender,” she admonished. “There
must be a will to change and grow. Everyone must strive
to be champions to be better! Look beyond your little
circle and make sure no rules constraint you from moving
forward!”
I attended this seminar with an open mind, and at one
point, doubted my scepticism in questioning the real
necessity for women to form any more groups to tackle
the empowerment issue – do we not have enough groups
already? My thoughts were rightfully justified by the end
of the day. The take-home message for me was this –
empowerment from within is, as I have always believed it
to be, the core need to rule one’s life.
An inspiring day, indeed.
beritaMMA Vol.46 • April 2016
38
general
Health and Healthcare
Disparities
T
Dr Xavier Vincent Pere
Pereira1
Consultant Psychiatrist
Taylor’s University School of
Medicine
Live Member MMA
and
Dr Sharuna Verghis2
~~~
Malaysia is frequently
cited as an example
of having the lowest
burden of out-ofpocket payments for
healthcare in Asia
~~~
1
2
Associate Professor (Psychiatry), Taylor’s
University School of Medicine, and Chair of
the Health and Human Rights Committee,
Malaysian Medical Association
Co-founder and Director of Health Equity
Initiatives, Kuala Lumpur, and member of
the organizing committee of the National
Symposium on the Right to Health.
beritaMMA Vol.46 • April 2016
he Health and Human Rights Committee of the Malaysian Medical
Association will organise a National Symposium on the Right to
Health on 23 April 2016 in Kuala Lumpur. The symposium will
provide an opportunity to examine and deliberate on the Malaysian
experience of entitlements and freedoms and equality and nondiscrimination that afford the possibilities to enjoy the highest attainable
standard of health within a right to health approach. It will also broaden
the understanding of whether the current strategy and praxis of Universal
Health Coverage (UHC) warrants a conceptual expansion from a right to
health perspective to achieve its avowed goals.
Malaysia’s healthcare system has received international recognition
with primary healthcare services being at the helm of health services
in the country. The development of health infrastructure; increase in
the quantity, quality, and geographical distribution of skilled human
resources; strengthening of referral mechanisms; and expanded access
to multi-disciplinary and integrated care at the primary healthcare level
has contributed to progress in health outcomes such as reduction
in maternal mortality and morbidity rates and under-five mortality(1).
Additionally, life expectancy at birth is about 75 years(2). These health
outcomes are significant indicators of development, and the state of
health and human rights in any country.
Nevertheless, Malaysia faces substantial challenges in preserving
these health gains as it experiences several transitions. Demographic
and epidemiological transitions have contributed to an ageing
population and a dual burden of disease. The major causes of death
are shifting from communicable to non-communicable diseases while
many communicable diseases are witnessing an emergence and reemergence(3). At the same time, the health system has been gradually
transitioning into a dichotomous two-tiered system of public and private
healthcare, with the private sector catering largely to urban areas and
affluent patients and providing primary and secondary care, while the
public sector’s primary care services are largely utilised by poor and rural
populations(3). On the economic front, although income inequality has
been decreasing in absolute terms(4), it is still higher relative to many
developed countries(5). Simultaneously, there has been an increase in
the income gap between the richest and poorest states in the country(6)
and within some ethnic groups(7). The emerging paradox is amplified in
the health and healthcare experiences of the socially vulnerable. Three
of several possible examples are cited here.
For example, compared to the national average, the Orang Asli
experience higher crude death rates, higher burden of maternal and
infant morbidity and mortality and of infectious and non-communicable
diseases, relatively lower immunisation coverage, relatively lower
percentages of safe deliveries, and high rates of poverty(8, 9).
According to the Ministry of Health (MoH), Malaysia,
the Malaysian population is reported to be protected
against catastrophic health expenditures through
policies of universal coverage(10). Malaysia is frequently
cited as an example of having the lowest burden of
out-of-pocket payments for healthcare in Asia(11)
and of catastrophic medical expenditure risk(12).
This corresponds to the underlying principle of the
Malaysian healthcare system that accessibility to
healthcare should not be determined by the ability to
pay(13). Despite this, the World Health Survey Report
Malaysia 2003 (as cited in the 10th Malaysia Plan)(10),
reports that the lowest two deciles (poorest) incurred
higher out of pocket payments than the other eight
deciles in terms of proportion to income and about
4.0% of households were exposed to catastrophic
spending. This means that those who are already
economically and socially vulnerable could suffer
devastating impoverishment as a result of utilising
healthcare.
Alongside these developments, accessing public
healthcare has become increasingly challenging for
non-citizens like migrant workers. Although evidence
shows that migrant workers are integral to the
productivity of the country(14), contribute substantially
in taxes, and are required to contribute toward
mandatory health insurance, they encounter numerous
policy barriers in accessing healthcare. They pay high
and un-subsidised user fees in public hospitals and
are deported when they test positive for treatable
infectious diseases. Their ineligibility for more than
five days of prescription medicine in public hospitals
limits access to care for chronic illnesses. Immigration
counters in some hospitals have been known to arrest
undocumented migrants, including women who have
just delivered. Established principles of healthcare
financing are then challenged and concepts of UHC
are interrogated. How universal is universal health
coverage? Does UHC only include citizens? How does
the current practice of UHC link to its historical origins
of social protection which included migrant workers
who contributed to the economies and societies they
resided in?
The anomaly is in the paradox of the location of
health and healthcare disparities among the more
socially vulnerable. It underscores the lesson that
the elimination of discrimination and neglect which is
core to a right to health approach and the removal of
financial barriers that impede access to healthcare
under UHC are not substitute options. They are
complementary and concomitant. As Malaysia’s
healthcare system struggles with increasing costs
related to an ageing population and dual burden
of disease, low levels of Government spending on
healthcare relative to other countries, and paucities
and incoherencies in the distribution of healthcare
workers, right to health norms of equality, nondiscrimination, participation, and transparency could
support the realisation of imperatives of solidarity,
equitable risk pooling, and equitable access related
to UHC.
References
1.
Ekman B, Pathmanathan I, Liljestrand J. Integrating health interventions
for women, newborn babies, and children: a framework for action. The
Lancet. 2008;372(9642):990-1000.
2.
Department of Statistics Malaysia. Press release. Abridged life tables
Malaysia, 2012-2015: Government of Malaysia; 2015 [2016 March 9].
Available from: https://www.statistics.gov.my/index.php?r=column/
pdfPrev&id=cWxzRWcvMTZrWFp4UStqQmp3MG9QZz09.
3.
Jaafar S, Noh KM, Muttalib KA, Othman NH, Healy J, editors. Malaysia
health system review. Manila: World Health Organization; 2013.
4.
Economic Planning Unit. Household income and poverty. Jadual 6: Pekali
Gini mengikut kumpulan etnik, strata dan negeri, Malaysia, 1970-2014:
EPU, Prime Minister’s Department, Government of Malaysia; [2016 Feb
17]. Available from: http://www.epu.gov.my/en/household-incomepoverty.
5.
World Bank. Malaysia. Overview [2016 Feb 17]. Available from: http://
www.worldbank.org/en/country/malaysia/overview.
6.
Mahavera S. Income gap between rich and poor states went up in 2 years,
says think tank: Malaysian Insider; 2015 June 24 [2016 Feb 17]. Available
from: http://www.themalaysianinsider.com/malaysia/article/income-gapbetween-rich-and-poor-states-went-up-in-2-years-says-think-tank.
7.
Lee HA. Is Msia’s spectacular drop in income inequality for real? : Free
Malaysia Today; 2015 Oct 16 [2016 Feb 17]. Available from: http://
www.freemalaysiatoday.com/category/opinion/2015/10/16/is-msiasspectacular-drop-in-income-inequality-for-real/.
8.
Nicholas C. Orang Asli: rights, problems, solutions. Kuala Lumpur:
National Human Rights Comission of Malaysia (SUHAKAM), 2010.
9.
UNDP. Study and review of the socio-economic status of aboriginal
peoples (Orang Asli) in Peninsular Malaysia for the formulation of a
National Development Plan for the Orang Asli: UNDP Malaysia; [2016
March 9]. Available from: http://www.my.undp.org/content/malaysia/en/
home/operations/projects/poverty_reduction/75636_OrangAsli.html.
10. Ministry of Health Malaysia. Country health plan. 10th Malaysia Plan
2011-2015. 1 care for 1 Malaysia. Putra Jaya: MoH.
11. van Doorslaer E, O’Donnell O, Rannan-Eliya RP, Somanathan A, Adhikari
SR, Garg CC, et al. Effect of payments for health care on poverty
estimates in 11 countries in Asia: an analysis of household survey data.
The Lancet. 2006;368(9544):1357-64.
12. Flores G, O’Donnell O. Catastrophic medical expenditure risk. Tinbergen
Institute Discussion Paper 12-078/3 2012 July 13 [cited 2016 Feb 25].
Available from: http://ssrn.com/abstract=2116242 or http://dx.doi.
org/10.2139/ssrn.2116242.
13. Yu CP, Whynes DK, Sach TH. Equity in health care financing:
The case of Malaysia. International Journal for Equity in Health.
2008;7(15):doi:10.1186/475-9276-7-15.
14. World Bank. Immigration in Malaysia: Assessment of its economic
effects, and a review of the policy and system report completed in
collaboration with ILMIA—Ministry of Human Resources of Malaysia.
Human Development, Social Protection and Labor Unit, East Asia and
Pacific Region, World Bank, 2013.
The Health and Human Rights Committee of the
Malaysian Medical Association will be organising
a symposium on ‘The Right to Health’ on 23 April
2016 at Sunway Putra. The Minister of Health will
be the Guest of Honour at the symposium.
beritaMMA Vol.46 • April 2016
40
general
T&CM in Today’s Healthcare
T
quality. The practice of traditional
medicine in our country is not just a
skill that is handed from generation to
generation. It is very much a way of life
and is part of our culture. The strong
faith the public have in our traditional
healers is often more than they have for
modern practitioners of medicine like
us. Many a times it is upon the advice
of the traditional and complementary
practitioners that patients eventually
come to us for consultation. The
complexities of new diseases and
their lack of response to the western
medications and side-effects suffered
by patients when on these medications
are causing more and more people to
turn towards T&CM.
“Complementary medicine” or
“alternative medicine” are used
interchangeably with traditional
medicine in some countries. They refer
to a broad set of healthcare practices
that are not part of that country’s own
tradition and are not integrated into
the dominant healthcare system.
Sadly, taking advantage of these
factors, there are many quacks
and bogus healers who rampantly
advertise their services and products
to hoodwink the vulnerable public
in the name of traditional and
complementary medicine. It appears
that all one needs to do is put up a
poster, with no official approval, hang
it by a tree or paste it on the pillars
of a ‘teh tarik’ stall. We have all seen
colourful arrays of posters advertising
various interesting and sometimes
mystical promises of mind-boggling
cures.
The very phrase Traditional and
Complementary Medicine (T&CM)
raises many an eyebrow amongst
us, the allopathic practitioners for
it conjures images of shamans and
street vendors promoting medical
advice and products of questionable
T h e M i n istry o f H ea lth ( M o H )
established the T&CM division in 2004
with the aim of integrating traditional
and complementary medicine into
the modern medical system. This
was done to regulate, achieve a
balance and monitor the safety in the
Dr G
Gayathri
th i K
K. K
Kumarasuriar
[email protected]
T&CM and Editorial Board
Committee Member
Life Member MMA, Kedah
he World Health Organization
(W HO) d ef i n e s t r a d i t i o n a l
medicine as “the sum total of
the knowledge, skills, and practices
based on the theories, beliefs, and
experiences indigenous to different
cultures, whether explicable or not,
used in the maintenance of health as
well as in the prevention, diagnosis,
improvement or treatment of physical
and mental illness.”
beritaMMA Vol.46 • April 2016
integrated usage of both Western and
T&CM medicine.
Under the T&CM banner we have the
Malay, Indian and Chinese Traditional
Medicines, Homeopathy, Islamic
Medical practice and Complementary
Medicine. Despite the classification
of these services, their demarcation is
still vague in our country and it seems
that almost anyone can be a T&CM
health provider. Regulation is needed
.The MoH has passed the T&CM Act
in 2013 (Act 756). It is now in the
process of waiting to be gazetted by
the Parliament.
In the meanwhile, damage is being
done. Awareness has to be created.
On that note, come this 7 May 2016,
the Traditional & Complementary
Medicine (T&CM) Committee of MMA
will be conducting the 4th Evidence
Based Seminar. The theme this time
is, “Advances in Traditional and
Complementary Medicine in Asia” at
the Grand Seasons Hotel.
This seminar is packed with renowned
speakers, both local and from overseas.
They will deliver updates on integrated
medicine and the challenges faced,
latest evidence based research and
various attractive topics which will
surely hold the interest of even the
skeptics amongst us.
There is only one way to find out! Be
there and hear it for yourself, first hand.
You may browse MMA’s webpage for
more information or to register online.
general
OLD IS GOLD!
41
Humour
Robert, 85, married Jenny, a lovely 25-year-old.
Since her new husband is so old, Jenny decides that after their
wedding she and Robert should have separate bedrooms, because
she is concerned that her new but aged husband may over-exert
himself if they spend the entire night together.
On their wedding night, Jenny prepares herself for bed, and the
expected knock on the door. Sure enough, the knock comes, the
door opens and there is Robert, her 85-year-old groom, ready for
action. They unite as one, all goes well, and Robert takes leave of
his bride, and she prepares to go to sleep.
After a few minutes, Jenny hears another knock on her bedroom
door. It is Robert, again and he is ready for more ‘action’.
Somewhat surprised, Jenny consents for more coupling. When
the newlyweds are done, Robert kisses his bride, bids her a fond
good night and leaves.
She is set to go to sleep again, but then, you guessed it-there is
another knock on the door! Robert is back again, rapping on the
door and he is as fresh as a 25-year-old, ready for more ‘action’.
Once more they enjoy each other.
This time, as Robert gets set to leave again, his young bride, now
truly exhausted, says to him, ‘I am thoroughly impressed that at
your age you can perform so well and so often. I have been with
guys less than a third of your age who were only good once. You
are truly a great lover, Robert.’
Robert, somewhat embarrassed, turns to Jenny and says: ‘You
mean I was here already?’
The moral of the story:
Don’t be afraid of getting old, Alzheimer’s has its advantages!
Compiled by,
Dato’ Wira Dr LR
Chandran and his team
of jokellectuals,
Alor Setar
MARITAL BLISS
A newly married couple was walking
through a garden when suddenly a dog
runs towards them. They both knew
that it will bite them, so the husband
quickly lifts his wife and decides to let
the dog bite him instead, rather than
his sweetheart.
The dog, however, stopped before them,
barked for a while and then ran away.
The husband gently puts his wife down,
expecting a hug and a few kind words
in return for his heroic gesture.
He was shocked beyond words when
his wife shouted instead,” I have seen
people throwing stones and sticks at
dogs ..this is the first time I am seeing
someone trying to throw his wife at a
dog !”
Moral of the story: A wife is wife. No
one else can misunderstand a husband
better than his wife!
LIFE TRANSACTIONS
A man and his wife were in court to have a divorce. The problem in contention was who will
gain custody of their child, the man or the wife. The wife jumped up and said, “My Lord, I am
the rightful owner of the child, I brought her into this world, with pain and labour alone.” The
judge then turned to the man, and gave him the chance to defend himself.
The man said slowly, “My lord, mine is a question: when you insert your ATM card into the
ATM machine and the money comes out, does the money belong to you or the machine?
Court took a long recess after that as much time was needed to control the outraged wife!
beritaMMA Vol.46 • April 2016
42
xx
smma
erutin
aethe
f press
The Sun Daily - 1 March 2016
MOHE Must Resolve Trainee
Doctors Issue, says MMA
PETALING
JAYA:
The long term solution
to the issue of too many
housemen doctors lies
with the Higher Education
Ministry (MOHE), says
Malaysian
Medical
Association (MMA).
Its President Dr Ashok
Zachariah Philip says that
there are too many medical
programmes in the country
producing a large number
of trainee doctors.
“MMA has informed
the Health Ministry that
there are too many medical
programmes in the country.
We feel there should be
more stringent screening
of students before they join
medical courses, and more
stringent procedures for
beritaMMA Vol.46 • April 2016
accrediting the courses.
However,
there
is
considerable
reluctance
by the ministry to address
the problems,” said Ashok
when contacted.
The Health Ministry
is looking to extend the
five-year
moratorium
imposed by the government
in 2011 on new medical
programmes in the country
due to the influx of trainee
doctors in the country.
Instead of producing
new
doctors,
existing
medical
colleges
are
encouraged to emphasise on
quality, Health Ministry’s
director-general Datuk Dr
Noor Hisham Abdullah
told theSun on Monday.
Ashok said there are
about 10,000 posts in
hospitals for housemen
which would be equivalent
to 5,000 a year, as
housemanship is for two
years.
“The number of new
doctors seems to have
stabilised at this number,
about 5,000 a year. Thus,
in theory, every new doctor
should be able to get a post
as a houseman.
“Under current laws,
the government is obliged
to
provide
housemen
training to every Malaysian
with a recognised medical
qualification,” he added.
However, he said that
problems arise as many
housemen take longer
than the stipulated two
years to complete their
housemanship,
either
because they are extended
or because of prolonged
sick leave.
“A small number also
disappear without giving
notice, but their posts
remain filled until they can
be terminated. This causes
a delay in accommodating
all the new doctors. When
there
are
vacancies,
only then can we call for
interviews.
“The duration of the
waiting period can vary. If
you are lucky, perhaps two
to three months. If not so
lucky, maybe six to eight
months. However, they will
all get jobs eventually,” said
Ashok.
beritaMMA Vol.46 • April 2016
46
mark your diary
YEAR 2016
APRIL
FUTURE OF MEDICAL EDUCATION AND HOUSE OFFICER
TRAINING SEMINAR
Theme
: Moving Towards Professionalism
Dates
: 16 April 2016
Venue
: Grand Seasons Hotel, Kuala Lumpur
Time
: 8.00 am – 5.00 pm
Contact : Ms Moon
Tel
: +603-4041 1375
Fax
: +603-4041 9929
Emai
: [email protected]
8TH MMA SABAH PRIMARY CARE CONFERENCE
Date
: 15 –17 April 2016
Venue
: Grand Ballroom, Pacific Sutera, Kota Kinabalu, Sabah
Contact : Ms Elsie (+6012-805 5009); Ms Florita (+6016-838 0769)
Fax
: +6088-538 804
Email
: [email protected]
Facebook : www.facebook.com/sabahbranch.mma
SOLUTION FOCUSED SYMPOSIUM
Date
: 18 – 19 April 2016
Venue
: International Medical University, Bukit Jalil,
Kuala Lumpur, Malaysia
Contact : Ms Liong Siao Lin / Ms Janet Foo
Tel
: +603 2731 7669 / 7072
Fax
: +603-8656 8018
Email
: [email protected]/
Website : http://www.imu.edu.my/icl
NATIONAL SYMPOSIUM ON THE RIGHT TO HEALTH
Date
: 23 April 2016 (Saturday)
Time
: 8.00 am – 5.00 pm
Venue
: Sunway Putra Hotel, Kuala Lumpur
Contact : Ms Jalina
Tel
: +603-4041 1375
Fax
: +603-4041 8187 / 4041 9929
Email
: [email protected]
12TH MALAYSIAN HOSPICE CONGRESS
Date
: 22 – 24 April 2016
Venue
: SWAN Convention Centre, Sunway Medical Centre, Bandar
Sunway, Selangor
Organiser : Malaysian Hospice Council
Contact : Dr Michael Yoong
Tel
: +603-3324 4740
Fax No : +603-3324 3125
Email
: [email protected]
Website : http://mhc201416.wix.com/mhc-congress-2016
XIII MALAYSIAN CONFERENCE AND EXHIBITION AND VI
INTERNATIONAL CONGRESS AND EXHIBITION OF ANTI-AGING,
AESTHETIC AND REGENERATIVE MEDICINE
Date
: 29 April – 1 May 2016
Venue
: Sheraton Imperial Kuala Lumpur
Secretariat : SAAARMM Secretariat
Address : 142, Jalan Ipoh, 3rd Floor, UMNO Selangor Building
51200 Kuala Lumpur
Tel
: +603-4041 0092 / 4041 6336
Fax
: +603-4042 6970 / 4042 4990
E-mail
: [email protected]
Web site : www.allergymsai.org
MAY
ADVANCED LEVEL OBSTETRICS AND GYNECOLOGY
ULTRASOUND COURSE
Theme
: Scanning to save lives
Date
: 6 – 8 May 2016
Venue
: Kompleks Rawatan Harian,
Hospital Raja Permaisuri Bainun Ipoh
Contact : Dr Japaraj
H/P
: +6019-399 4795
Fax
: +605-243 7389
Email
: [email protected]
beritaMMA Vol.46 • April 2016
4TH EVIDENCE BASED SEMINAR ON TRADITIONAL &
COMPLEMENTARY MEDICINE
Theme
: Advances in Traditional and Complementary Medicine
In Asia
Date
: 7 May 2016
Venue
: Grand Seasons Hotel, Kuala Lumpur
Contact : Ms Muthu / Ms Yulliz
Tel
: +603-4041 1375 (Ext: 200 or 218)
Fax
: +603-4041 8187 / 40419929
Email
: [email protected] / [email protected]
Website : www.mma.org.my
INTERNATIONAL GERIATRIC ORTHOPAEDIC UPDATE FOR
PRIMARY CARE PHYSICIAN AND GENERAL PRACTITIONERS 2016
Date
: 7 May 2016
Venue
: Sunway Putra Hotel, Kuala Lumpur
Time
: 2.00 pm – 6.30 pm
Contact : Ms Muthu
Tel
: +603-4041 1375 (Ext: 200)
Fax
: +603-4041 8187 / 40419929
Email
: [email protected]
Website : www.mma.org.my
56TH MMA NATIONAL ANNUAL GENERAL MEETING 2016
Date
: 26 – 29 May 2016
Venue
: Meritz Hotel Miri, Sarawak
Contact : Ms Melanie Kho
Tel
: +6082-507 330 (Office Hour)
H/P
: +6013-862 6383 (Office Hour)
Fax
: +6082-507 330 (Office Hour)
Email
: [email protected]
JULY
MALAYSIAN THORACIC SOCIETY CONGRESS 2016
Date
: Conference workshops on 28 July 2016
: Conference 29 – 31 July 2016
Venue
: Hotel Equatorial, Bukit Jambul, Penang
Secretariat : Academy of Medicine
Email
: [email protected]
Tel
: +603-4023 4700
Enquiries : Malaysian Thoracic Society
Email
: [email protected]
Tel
: +603-2856 9539
Fax
: +604-229 2379
Website : www.mts.org.my
AUGUST
THE MMA PAHANG BRANCH 6TH ANNUAL SCIENTIFIC MEETING
& REGIONAL MEDICAL UPDATES 2016
Date
: 13 – 14 August 2016 (Saturday - Sunday)
Time
: 8:00 am – 5:00 pm
Venue
: The Vistana Kuantan, Pahang.
Contact : En Mohd Ariff Hazami Elliazir
Enquiries : [email protected]
Facebook : https://www.facebook.com/mmapahangbranch
SEPTEMBER
41ST ANNUAL DERMATOLOGY CONFERENCE
Theme
: New Horizons in Immunology and Dermatology
Date
: 5 – 18 September 2016
Venue
: Pullman Kuching Hotel, Kuching, Malaysia
Enquiries : Mr Eric Chan
Tel
: +6012-268 3163
Email
: [email protected]
Website : http://www.dermatology.org.my/annual%20meeting.html

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