RESULTS: Five repatriation missions performed was led by the National Agency for Disaster Management (NADMA) with the Ministry of Health providing technical expertise. A total of 432 citizens were repatriated from the missions. The operations were divided into four phases: the pre-boarding screening phase, the boarding and in-flight phase, the reception phase and the quarantine phase. The commercial aircraft used were from two different commercial airlines. Each mission had flight crew members between 10 and 17 people. There were 82 positive cases detected among the repatriated citizens. There was a single positive case of a healthcare worker involved in the mission, based on the sample taken on arrival of the flight. There were no infections involving flight team members.
CONCLUSION: Medical flight crew must be familiar with aircraft fittings that differ from one commercial airline to another as it influences infection control practices. A clear understanding of socio-political situation of a country, transmission routes of a pathogen, disease presentation, and knowledge of aviation procedures, aircraft engineering and design is of great importance in preparing for such missions. Our approach of multidiscipline team involvement managed to allow us to provide and execute the operations successfully.
OUTBREAK SITUATION: A stringent screening process at all airports in Malaysia was enforced after the first case outside China was reported in Thailand. Up to April 14, 2020, Malaysia had reported two waves of COVID-19 cases, with the first wave ending successfully within less than 2 months. In early March 2020, the second wave occurred, with worrying situations.
ACTIONS TAKEN: The Government of Malaysia enforced a Movement Control Order starting on March 18, 2020 to break the chain of COVID-19. The media actively spread the hashtag #stayhome. Non-governmental organizations, as well as prison inmates, started to produce personal protective equipment for frontliners. Various organizations hosted fundraising events to provide essentials mainly to hospitals. A provisional hospital was set up and collaborations with healthcare service providers were granted, while additional laboratories were assigned to enhance the capabilities of the Ministry of Health.
ECONOMIC DOWNTURN: An initial financial stimulus amounting to RM 20.0 billion was released in February 2020, before the highlighted PRIHATIN Package, amounting to RM 250 billion, was announced. The PRIHATIN Package has provided governmental support to society, covering people of various backgrounds from students and families to business owners.
METHODS: The OpERA tool was used to collect specific milestone data that identify time periods, review stages, and data points for new active substances and biosimilars approved by NPRA in 2017.
RESULTS: In 2017, 25 new active substances and 1 biosimilar were approved by NPRA in a median of 515 days, representing both agency and applicant time. The median time between dossier receipt and the initiation of NPRA scientific assessment was 135 days, but there was a wide variation in queuing time. The median total assessment time was 279 days (agency and applicant timing). NPRA took a median of 166 days; applicants took a median of 131 days to respond to deficiency questions, with up to 6 cycles of review required for approval and 65% of applications requiring 4-5 cycles to provide satisfactory responses.
CONCLUSIONS: As a result of these data, NPRA proposes three improvements: target start for scientific assessment 100 days after file acceptance, a maximum of 5 review cycles, and applicant response time limited to 6 months. These results will serve as a baseline for further assessment.
METHODS: This observational qualitative case study employed semi-structured key informant interviews to describe partnerships between the Malaysian Malaria Control Programme (MCP), and private palm oil, rubber and acacia plantations in the state of Sabah. Semi-structured interview guides were used to examine resource commitments, incentives, challenges, and successes of the collaborations.
RESULTS: Interviews with workers from private plantations and the state of Sabah MCP indicated that partnerships with the commercial sector had contributed to decreases in incidence at plantation sites since 1991. Several plantations contribute financial and human resources toward malaria control efforts and all plantations frequently communicate with the MCP to help monitor the malaria situation on-site. Management of partnerships between private corporations and government entities can be challenging, as prioritization of malaria control may change with annual profits or arrival of new management.
CONCLUSIONS: Partnering with the commercial sector has been an essential operational strategy to support malaria elimination in Sabah. The successes of these partnerships rely on a common understanding that elimination will be a mutually beneficial outcome for employers and the general public. Best practices included consistent communication, developing government-staffed subsector offices for malaria control on-site, engaging commercial plantations to provide financial and human resources for malaria control activities, and the development of new worker screening programmes. The successes and challenges associated with partnerships between the public and commercial sector can serve as an example for other malaria-eliminating countries with large plantation sectors, and may also be applied to other sectors that employ migrant workers or have commercial enterprises in hard to reach areas.
Methods: A multicentre cross-sectional study was conducted in 12 government hospitals accredited for housemanship training within the central zone of Malaysia. The study included a total of 1,074 house officers who had been working for at least 6 months in various housemanship rotations. The Negative Acts Questionnaire-Revised (NAQ-R) was used to examine workplace bullying.
Results: The 6-month prevalence of workplace bullying among study participants was 13%. Work-related bullying such as 'being ordered to do work below your level of competence', person-related bullying such as 'being humiliated or ridiculed in connection with your work', and physically intimidating bullying such as 'being shouted at or being the target of spontaneous anger' were commonly reported by study participants. Medical officers were reported to be the commonest perpetrators of negative actions at the workplace. Study participants who graduated from Eastern European medical schools (adjusted odds ratio [AOR] 2.27; 95% confidence interval [CI]: 1.27, 4.07) and worked in surgical-based rotation (AOR 1.83; 95% CI: 1.13, 2.97) had higher odds of bullying compared to those who graduated from local medical schools and worked in medical-based rotation, whereas study participants with good English proficiency (AOR 0.14; 95% CI: 0.02, 0.94) had lower odds of bullying compared to those with poor English proficiency.
Conclusion: The present study shows that workplace bullying is prevalent among Malaysian junior doctors. Considering the gravity of its consequences, impactful strategies should be developed and implemented promptly in order to tackle this serious occupational hazard.