Health Services - Where are we?
This article was emailed to me and almost immediately I sniggered. The article was published in NSTonline titled: Heart surgery: Solution lies in improving our own services
Well, regarding the article, it was well written and as usual I am afraid our health minister is again wrongly informed. Foreigners are charged in USD in India and the charges are far greater than for their locals obviously. The rates given appear to be rates meant for the locals of India nationality.
But what was more interesting is that the author managed to point out some interesting facts.
First and foremost: the lack of manpower.
Well, there are many reasons for this and it is just not the matter of doctors leaving the public service for private. Malaysia always had the idea that quantity is far more important than quality. Before the 90s’, there were only 3 university hospitals. Suddenly there was a boom of private universities and many academicians left. Then there was an issue of brain drain. Not only that private hospitals also sprouted and these made the issue even worse and even affected the public hospitals. But why? The renumeration and the promotions were difficult. So what is the issue now? Well, the health ministry started to built more hospitals (probably to garner more votes) despite the ever growing lack of manpower, rather than making the present hospitals better in staffing and better equipped. Almost every state now has a university(for such a small country like Malaysia - probably also to garner more votes) and uses the public hospitals for the universities teaching. This stresses the already dwindling workforce. The universities are also suffering as a result needing to take in younger doctors as their lecturers. This had an impact on the future of the medical students as many lecturers were too young and inexperienced and there were lack in role models. The government also decided to make the promotions more difficult in the public sector and worse made many other profession such as degree nurses, medical assistants, pharmacist, radiographers, dietician, physiotherapist to sit in the same pay grade with doctors worse specialist and some sub-specialist. Just today, I, a specialist with “memangku” U48 listened to a talk given by a U48 dietician!! I have no problems listening to a dietician as they are good at their field but to be of a lower rank despite my many years of service, time spent and studies - I just feel it is unfair. But maybe the government is trying to say ” Look, why work so hard!?” That takes me to the next point!
Second, training
This actually goes in hand with the lack of man power. Lack of manpower, unlike what most people and the government understands of it, is not the amount per se but the lack of senior and experienced specialist. So with the lack of these group of experienced professionals in public hospitals, the junior doctors were left abandoned and junior specialist were poorly supervised. The seniors or those in position nowadays, lack the lustre of a leader and have poor vision or interest to make the field of speciality grow. Why? Many times have I heard my bosses say that despite all the meetings and opinions the administrators ask of these senior specialist but none of their opinions are ever taken or listened to. In the universities, the same lack of seniors are also causing a slack in speciality training.
So where are we? At present, we are still able to give our best possible care and some government hospitals are doing very well. But the future as from how I see it, the health system is slowly but surely deteriorating and probably impending collapse if the government and especially the public decides to keep their silence and disinterest in the progress and future of health. The senior specialist especially should be attracted to come back to both public and universities to be role models and pass down their knowledge and experience.
So is the private any greater? Well, not really as money comes into the calculation of treating patients but that is not of great importance as there are still the good ones out there. But what is worrying is more and more junior specialist with minimal experience are leaving to the private too. So how great would it be anyway? For the private facility the more specialist, the more money.
