Anti-smoking measures, adopted by local authorities before the guideline on the ban of cigarette advertisement and anti-smoking campaign launched by the Government, are limited in scope and area. The activity is limited mainly to a ban on cigarette advertisements in theatres. Legislative measures are instituted only in the City Council, Municipal Councils and 2 ofthe 20 district councils surveyed. There is an awareness among several local authorities on the need for an increase in anti-smoking activities but action. is lacking. A population of 7.4 million. people lioe in areas controlled by the local authorities. The local authorities are expected to play a more active role along with other Government departments following a directive in August 1982 from the Chief Secretary to the Government.
The early Malaysian experience of laparoscopic sterilisation with the Fallope tubal rings, as undertaken at the Obstetrical and Gynaecological Unit of the University Hospital, University of Malaya in Kuala Lumpur, Malaysia is reported in a study of 291 consecutive females that had had the procedure undertaken during the one year period, May 1975 to April 1976. Of the 291 cases, 247 women were sterilised in the "interval" period, 43 after "menstrual regulation" procedure and one after a spontaneous abortion. General anaesthesia was used in all except one case. The salient socio-demographic, contraceptive and reproductive characteristics of study cases are presented and discussed. The technical problems, the early complications and morbidity encountered in this study are presented and discussed in the light of other similar studies, and in relation to sterilisation by laparoscopic tubal electrocoagulation. The overall impression is that laparoscopic sterilisation with the Fallope tubal rings is preferred to that by tubal electrocoagulation, in view of the possible inadvertent serious electrical burns of other structures during the use of the latter procedure.
From January 1980 to December 1982, there were 222 MEDEVAC patients admitted to Mid Hospital, out of whom 206 had their case notes available for this study. The median age of the 206 patients MEDEVAC was 24.5 years and the male to female ratio was 1.2 : 1. The Kenyah, Iban, Punans, Kelabit, Kayan and Murut ethnic groups contributed most of the cases. There was some seasonal variation in the number of MEDEVAC done, the high months being July and December and the low periods in May/June and October/November. Most of the MEDEVAC were requested by ground staff at the remote rural clinics and also district hospitals. The median duration of stay of the patients was 9.7 days. The top five causes for MEDEVAC were: bronchopneumonia; accidental falls; gastroenteritis; peptic ulcers; and appendicitis. 7.8% of the MEDEVAC died in hospital. The management of cases ranged from conservative management to blood transfusions to surgical interventions. Based on the criteria set, 63.6% of the MEDEVAC were considered justified.
A preliminary survey of Aedes aegypti was carried out in 6 areas in the state of Selangor, Malaysia. The densities of Ae. aegypti and Ae. albopictus in the areas were discussed. Results indicated that the distribution of larval habitats varied with the housing type. The most ommon indoor larval habitat in urban areas is the bathroom tank. In both urban and rural areas, outdoor preference is for the earthenware jars. Anttraps have decreased in importance as larvae breeding habitats. The accuracy of house searches can be increased by increasing the number of larvae examined per container to 5 or more. Further study is required to determine whether the findings of this survey is peculiar to the areas surveyed or is representative of the whole country, and whether there is a seasonal fluctuation in the types of preferred larval habitats.
This paper attempts to analyse professional rivalry and dissonance amongst traditional Malay midwives (bidan kampung) in the Northwest areas of Peninsular Malaysia. It elucidates how techniques of symbolic and ritual communication are carefully monitored by these female specialists, to develop regular clientele and professional credibility over time. However, since an integral element of Malay midwifery is protection from and mastery over mystical forces in nature and evil spirits harboured by witches, a midwife is also an exorcist with skills rather similar to the Malay bomoh (traditional medical practitioner, usually male) except that her range of knowledge of witchcraft is limited to diagnostic and curative rituals of spirit-possession, in infants and children, young unmarried women and pregnant mothers. Within a restricted population area, professional rivalries and competition amongst midwives regularly surface in oblique attacks of witchcraft accusations where the accused strives to maintain her credibility while her accuser gradually wins over her clientele. Significantly, codes of professionalism in traditional Malay midwifery are not only determined by skill and experience, but also religiousness (faith in Islam), benevolence, virtue, diligence and a sense of equality and fair-play in the practice of the trade. These qualities are seemingly lacking in witches who are conceived to be anti-Islamic, uncompromising, manevolent and destructive. Thus, government midwives who threaten the popularity of traditional midwives by being particularly active in their work or supervising and controlling midwives in an authoritarian way, are also labelled as witches. Generally, while midwifery and witchcraft reflect two forms of knowledge that are structurally opposed, in ideology and morality, they exist within the same sphere of ritual and symbolic communication where the practitioners aided by their clients, shift from one state of dissonance to another in an attempt to regulate behaviour.
Maternal deaths in Kerian district during a 5 year period (1976-1980) is described. There were 35 maternal deaths in all and Malays constituted the majority 32 (91.4 percent). Most of the women were of low socio-economic status and only 20 percent had some formal education. The women were mainly multigravida and majority of them 20 (57.2 percent) were between 31-40 years of age. The main cause of death being PPH and PPH with retained placenta. Most of them died at home and were attended to by TBAs. The need to identify, train and utilise TBAs has been realised as they delivered about 41.4 percent of the deliveries in Kerian in 1976.
The multidiscipline laboratories (MDLs) of University of Malaya are a significant feature in the Faculty of Medicine. They provide facilities for a number of activities within the teaching curriculum. This is in contrast to the departmental type of laboratories. Being the first in the eastern hemisphere, they are gaining popularity among new medical schools in this part of the world. Since a number of visitors testify to a continued interest in the multidiscipline laboratories, an attempt is made to discuss our experience with these facilities in relation to tthe design, uses, organisation, staff requirement, student usage and space problems.
The summary of various studies done looking at size selection of the laryngeal mask airway (LMA) in adults is that, selection based on sex is appropriate, and that both sizes 4 or 5 are adequate for adult females. However, in our local population these sizes may be too large especially the size 5 for adult females.