Malaysia has a large variety of traditional medical systems that are a direct reflection of the wide ethnic diversity of its population. These can be grouped into four basic varieties, namely, traditional “native”. traditional Chinese. traditional Indian, and modem medicine, examples of which are described. In spite of the great inroads made by modem medicine, the traditional systems are firmly established. Patients move from one system to another or use several systems simultaneously. The integration of the traditional Malay birth attendant into the health team is described. The forces influencing the development, acceptance, and integration of the medical systems are discussed.
The microbes that cause infectious diseases are complex, dynamic, and constantly evolving. They reproduce rapidly, mutate frequently, breach species barriers, adapt with relative ease to new hosts and new environments, and develop resistance to the drugs used to treat them. In their article "Meeting the challenge of epidemic infectious diseases outbreaks: an agenda for research", Kai-Lit Phua and Lai Kah Lee clearly demonstrate how social, behavioural and environmental factors, linked to a host of human activities, have accelerated and amplified these natural phenomena. By reviewing published and non-published information about outbreaks of Nipah virus in Malaysia, severe acute respiratory syndrome (SARS) and avian influenza in Asia, and the HIV pandemic, they provide a series of examples that demonstrate the various social, behavioural and environmental factors of these recent infectious disease outbreaks. They then analyse some of these same determinants in important historical epidemics and pandemics such as plague in medieval Europe, and conclude that it is important to better understand the social conditions that facilitate the appearance of diseases outbreaks in order to determine why and how societies react to outbreaks and their impact on different population groups.
The growing trade in patients seeking health care in other countries, or medical travel, is changing the forms and experiences of health care seeking and producing changes to hospitals in terms of their design, organization and spaces. What is termed in marketing parlance in Thailand as an 'international hospital' oriented to attracting foreign patients, is a hotel-hospital hybrid that is locally produced through the inflexion of local practices to make a therapeutic space for international patients. The paper reports on work undertaken within a Thai hospital in 2012 which included observations and interviews with thirty foreign in-patients and nine informal interviews with hospital staff. Although theorized as a culturally neutral transnational 'space of connectivity', we show how cross-cultural tensions affect the experience of the hospital with implications for the organization of the hospital and notions of 'cultural competence' in care. There is no single universal experience of this space, instead, there are multiple experiences of the 'international hospital', depending on who patients are, where they are from, their expectations and relationships. Such hospitals straddle the expectations of both local patients and international clientele and present highly complex cross-cultural interactions between staff and patients but also between patients and other patients. Spatial organisation within such settings may either highlight cultural difference or help create culturally safe spaces.
Challenges arising from epidemic infectious disease outbreaks can be more effectively met if traditional public health is enhanced by sociology. The focus is normally on biomedical aspects, the surveillance and sentinel systems for infectious diseases, and what needs to be done to bring outbreaks under control quickly. Social factors associated with infectious disease outbreaks are often neglected and the aftermath is ignored. These factors can affect outbreak severity, its rate and extent of spread, influencing the welfare of victims, their families, and their communities. We propose an agenda for research to meet the challenges of infectious disease outbreaks. What social factors led to the outbreak? What social factors affected its severity and rate and extent of spread? How did individuals, social groups, and the state react to it? What are the short- and long-term effects on individuals, social groups, and the larger society? What programs can be put in place to help victims, their families, and affected communities to cope with the consequences--impaired mental and physical health, economic losses, and disrupted communities? Although current research on infectious disease outbreaks pays attention to social factors related to causation, severity, rate and extent of spread, those dealing with the "social chaos" arising from outbreaks are usually neglected. Inclusion, by combining traditional public health with sociological analysis, will enrich public health theory and understanding of infectious disease outbreaks. Our approach will help develop better programs to combat outbreaks and equally important, to help survivors, their families, and their communities cope better with the aftermath.
Globally, more patients are intentionally travelling abroad as consumers for medical care. However, while scholars have begun to examine international medical travel's (IMT) impacts on the people and places that receive medical travellers, study of its impacts on medical travellers' home contexts has been negligible and largely speculative. While proponents praise IMT's potential to make home health systems more responsive to the needs of market-savvy healthcare consumers, critics identify it as a way to further de-politicise the satisfaction of healthcare needs. This article draws from work on political consumerism, health advocacy and social movements to argue for a reframing of IMT not as a 'one-off' statement about or an event external to struggles over access, rights and recognition within medical travellers' home health systems but rather as one of a range of critical forms of on-going engagement embedded within these struggles. To do this, the limited extant empirical work addressing domestic impacts of IMT is reviewed and a case study of Indonesian medical travel to Malaysia is presented. The case study material draws from 85 interviews undertaken in 2007-08 and 2012 with Indonesian and Malaysian respondents involved in IMT as care recipients, formal and informal care-providers, intermediaries, promoters and policy-makers. Evidence from the review and case study suggests that IMT may effect political and social change within medical travellers' home contexts at micro and macro levels by altering the perspectives, habits, expectations and accountability of, and complicity among, medical travellers, their families, communities, formal and informal intermediaries, and medical providers both within and beyond the container of the nation-state. Impacts are conditioned by the ideological foundations underpinning home political and social systems, the status of a medical traveller's ailment or therapy, and the existence of organised support for recognition and management of these in the home context.
With globalization education has become a tradable service governed by the rules and regulations of GATS and worth trillions of dollars. International standards are rapidly being developed to facilitate cross border supply of services. In medical education, the WFME has produced International Guidelines on Quality in Medical Education which has a regional equivalent in the WHO Western Pacific Region, and the IIME has defined the minimum essential requirements of standards in medical education in seven core competences. Malaysia, having an explicit policy of making education a sector for revenue generation, has put in place regulatory frameworks and incentives to make the country a centre of educational excellence. Within the ambit of this national aspiration, medical education has grown phenomenally in the last decade. Standards and procedures for accreditation of medical schools in line with the world standards have been developed and implemented and policies are enforced to facilitate compliance to the standards. The ultimate goal is for medical schools to be self-accredited. In striving towards self-accreditation medical schools should be innovative in making changes in the three requirements of medical education. These are the intellectual and social imperatives and strategies for effective implementation.