Malaysia, like many other countries faces major challenges in meeting increasing demands with limited resources. Changes in demography, life-style diseases, increasing consumer expectations, new medical technologies and rapid economic growth all fuel demand for more healthcare services. There are problems related to the distribution and delivery of healthcare services, and there is inadequate integration of healthcare delivery and continuity of care is a major concern. Resources tend to be concentrated in the very expensive hospital sector, although services would be cost-effectively and conveniently delivered at primary care level. There is no ideal healthcare system, and how healthcare is supported and organized for service delivery influences the country's social, economic and political well-being. Like many other countries, Malaysia is undergoing health reform in meeting these challenges, and is becoming more reliant on telemedicine and telehealth.
This case study of medical schools in Malaysia addresses their role in meeting the demands of a young nation. Throughout the growth and development of these medical schools, there have been efforts to coordinate and cooperate with providers of health care. The treatment of illness must mesh with the changing paradigm of health and wellness as an achievable and indeed desirable goal, not only for the individual but also for society. The scientific basis of medicine is being emphasized with the advent of evidence-based medicine and outcome measures. Innovations have been made to bring the schools in closer contact with the service providers. Malaysia has prepared farsighted plans to become a developed nation by the year 2020. Accordingly, its health services will use advances in information technology and will introduce telemedicine in various strategic applications to extend the reach of the health care team. It is incumbent on the medical schools to move in concert with the Ministry of Health to realize goals of the nation and the society.
The people of Malaysia generally enjoy a high standard of health. This is largely attributed to the comprehensive range of health services provided by the Government and the private sector at affordable costs. However, there are changing trends that now seriously challenge this status quo. The changing population structure, lifestyle, disease patterns and globalization are causing healthcare costs to rise. New and innovative ways will have to be devised to further improve the health status and at the same time contain costs. Information and Communication Technology (ICT) presents unprecedented opportunities to help the health sector in Malaysia reinvent itself and transform the way health and healthcare is managed and delivered in the future. Malaysia's Telehealth initiative under the Multimedia Super Corridor (MSC) project is designed to realize Malaysia's health vision and goals and meet future health challenges. Multimedia and Internet technology will be fully harnessed to deploy services that will shift the emphasis from episodic management of illness to proactive promotion of lifelong wellness and disease prevention. Health information content and interactive applications will engage the people to work as partners of health with healthcare professionals in maintaining their own health or managing their illnesses.
Haematuria is always a significant finding that requires proper evaluation, and investigations may need to be initiated based on an adequate history. A careful urine microscopy of the urine using phase contrast microscopy is essential, and may predict the source of the haematuria based on red cell morphology, and point the direction that appropriate investigation should take. Infection tumours, obstruction; and calculi account for most cases of gross haematuria in adults. In paediatric patients, the causes of gross haematuria are readily apparent in half of the cases, but further investigations are necessary in the other half. All cases of haematuria require prompt evaluation and appropriate investigations to ensure correct and early treatment.
Over a five year period, 184 patients were treated for acute renal failure. Uraemia was usually treated by peritoneal dialysis, and haemodialysis was reserved for post surgical and hypercatabolic patients. The overall mortality was 33.2% and was highest among surgical patients. These results were similar to previous reports. Peritoneal dialysis was usually effective in controlling uraemia. Uncontrolled sepsis remains a major problem, and septicaemia and gastrointestinal bleeding were adverse factors affecting the outcome. The combination of septicaemia and gastrointestinal bleeding commonly led to a fatal outcome.
The International Medical University, Kuala Lumpur (IMU) has just completed 20 years of success and had a series of events to celebrate its 20th anniversary as well as its achievements in 2012. As part of the 20th anniversary celebrations, IMU successfully co-hosted the Ottawa conference with the European Medical Education Association in Kuala Lumpur. This was the first time this conference was hosted in Asia and it was one of the biggest and most successful of the Ottawa Conference series ever held. This conference focuses on medical education with the major emphasis on assessment.
Healthcare investment is critically important for the health and well-being of the population, and different health systems are developed to meet the needs and priorities of each country. What has become clear has been that despite major advances in medicine, science and technology, there are major issues related to access and equity as well as quality and patient safety in healthcare services. The issue of patient safety was highlighted by the reports of the Institute of Medicine, USA1,2 and this had received worldwide attention. It is also an irony that despite being in an age of major advances in medicine, science and technology, with the acceptance of evidence-based medicine, so much of medicine and healthcare delivered is of little or no proven value. This poses a major challenge on health policy, and on how this can be addressed in any health reform process that focuses on improving access, equity, efficiency and effectiveness in healthcare services.
In ancient times, before Hippocrates, disease and illness were attributed as a sign of divine dismay, and the Gods needed to be appeased to achieve a cure. Hippocrates and his followers showed courage in breaking away from this paradigm. They moved away from the divine and supernatural, to focus on the biology of the body. In the process they put the patient at the centre of their focus. They collected detailed case histories, dismissed religious and supernatural explanations and developed remedies in the form of diets, exercise and mixed minerals and herbs based on their understanding of ill health.
Citation: Abu Bakar Suleiman. Seminar on Postgraduate Family Medicine Programme. Pusat Kesihatan Padang Serai, Kulim, Kedah, Malaysia. 28th September 1991.
Citation: Abu Bakar, Suleiman
Keynote Address. Bengkel “Program Perubatan Keluarga: Posting Pusat Kesihatan”. Pusat Kesihatan Padang Serai, Kulim, Kedah, Malaysia, 27 Mac 1995
One hundred and fifty two patients were treated for acute renal failure in 1976-1978. Overall mortality was 46 (30.3 percent) and was highest among the surgical patients 15 (51.7 percent) and lowest in patients with outflow tract obstruction 2 (8.7 percent) uncontrolled sepsis was the commonest cause of death.
A review of the home haemodialysis programme at the General Hospital, Kuala Lumpur between 1977 and 1984 revealed that out of 194 patients accepted into the programme, 187 completed home training and continued haemodialysis at home, seven died before having started on the training programme. The majority of patients required less than four months to be trained; 107 patients performed dialysis independently and 24 required assistance only for the insertion of needles. Patient survival was 93%, 80% and 69% at one, three and five years, respectively. Rehabilitation has been excellent and few social problems were encountered. Our experiences with home haemodialysis have shown that the majority of patients were able to assume responsibility for their own dialysis, and this has contributed to the good survival and excellent rehabilitation. Home haemodialysis was started in Boston in 1963, in Seattle and London in 1964 for the treatment of end stage renal disease (ESRD). It is now well-established as a therapy for patients with ESRD. Home haemodialysis has been practised in Malaysia since 1977. This report reviews the experiences of patients accepted for treatment between 1977 and 1984. All patients were treated by the Department of Nephrology, General Hospital, Kuala Lumpur, which supervises patients living all over the country.
Ten out of 237 patients who underwent renal transplantation between 1975 and October 1986 developed tuberculosis. Most patients presented with vague symptoms, and typical symptoms commonly associated with tuberculosis were not common. Six had positive urine cultures. One patient had positive sputum and urine cultures and one had positive sputum and cerebrospinal fluid cultures for tuberculosis. In this last patient cryptococcus was also cultured from the sputum and CSF. Nine of the 10 patients responded well to antituberculosis therapy and was cured of the infection. The patient with associated cryptococcal infection died 2 months after presentation. Side effects of antituberculous therapy was minimal and easily resolved on stopping the offending drug.
There are significant differences in the food consumption patterns of countries. In the lower income countries, most of the energy intake is derived from cereals and starchy roots. On the other hand, the intake of these carbohydrate foods is much lower in the economically developed countries and more of the energy is derived from added fats, alcohol, meat, dairy products and sweeteners. The contribution of energy from various food groups has changed markedly over the past three decades. With increasing national wealth there is a general tendency for the consumption of cereal foods to decline, whereas the consumption of added fats, alcohol, meat and dairy products has increased over the years. Similar changes have also been observed for Malaysia. These dietary alterations, as well as other lifestyle changes, have brought about a new nutrition scenario in many developing countries. These countries are now faced with the twin problems of malnutrition, that is, undernutrition among some segments of the population and diet-related chronic diseases in other groups; for example, obesity, hypertension, coronary heart disease, diabetes and various cancers. In Malaysia, deaths due to diseases of the circulatory system and neoplasms have been on the rise since the 1960s. The former has been the most important cause of death in the country for more than 15 years, with cancer ranking third for almost 10 years. Epidemiological data collected from different community groups showed increased prevalences of various risk factors amongst Malaysians. In view of the changed nutrition scenario in the country, intervention programmes have been reviewed accordingly. The Healthy Lifestyle (HLS) Programme was launched in 1991 as a comprehensive, long-term approach to combating the emerging diet-related chronic diseases. For six consecutive years one thematic campaign per year was carried out; namely, coronary heart disease (1991), sexually transmitted diseases (1992), food safety (1993), childhood diseases (1994), cancers (1995) and diabetes mellitus (1996). To further strengthen health promotion among the community, another series of activities to be carried out under the second phase of the HLS programme from 1997 to 2002 was launched within the framework of the National Plan of Action on Nutrition (NPAN) for Malaysia. In view of the importance of diet and nutrition in the causation and prevention of chronic diseases, the theme for the first year of this phase was Healthy Eating. It is clear that nutrition education for the community in order to inculcate a culture of healthy eating is the long-term solution. A series of guidelines have been prepared for dissemination to the public via a variety of media and approaches, and with the collaboration of various government and non-governmental organisations. The implementation of the programme is, however, a challenge to health and nutrition workers. There is a need to examine the strategies for nutrition education to ensure more effective dissemination of information. The challenge is to determine how best to promote healthy eating within the present scenerio of rapid urbanisation, 'western' dietary pattern influence, a whole barrage of convenience and 'health' foods, and nutrition misinformation. We would like to share our experiences in the approaches taken and our concerns with other countries in the region given that various opportunities exist for collaboration.