Malaysia - Turn hygiene into a culture

A health worker fumigating a residential area in Penang. People must take the threat of dengue and Zika seriously. FILE PIC

25 February 2017

KUDOS to the Terengganu Health Department for its proactive approach in containing the spread of dengue and Zika virus by Aedes Aegypti mosquitoes.

But, the war is not over yet and it never will be until the public adopts hygiene as a way of life. The threat will remain, but will be kept at bay through the efforts of health officers who risk themselves being exposed to mosquito bites.

These workers need to react to any signs of the disease before it reaches an outbreak proportion. They have to continue reminding the people to keep themselves and their surroundings clean to maintain good health.

Starting this month, health officers will be mobilised to step up inspections in urban areas that have been identified as breeding grounds for Aedes Aegypti mosquitoes.

Although in the past 65 days, Terengganu had no cases of dengue and Zika infection, the change in climate conditions, from wet to warm, may trigger an explosion in the mosquito population in small pools of water in discarded containers or in stagnant rainwater.

The Aedes Aegypti mosquitoes have a lifespan of about eight days, but their proliferation may cause an outbreak. This disease is life-threatening and the only time control measures such as fumigation can be carried out is when there is a confirmed case of infection.

Terengganu recorded five deaths with 343 dengue cases in January last year (1,935 cases in 2016), which was a 290 per cent increase compared with 92 cases in the same period in 2015. Dengue fatalities in Terengganu continued to increase last year, and by November, the state had registered its 19th case following the death of a 49-year-old woman from Hiliran Binjai, a sub-urban area in Kuala Terengganu.

She was among four who died due to dengue haemorrhagic fever. With no outbreak in the past four months, it could mean that the eggs of the Aedes Aegypti mosquitoes could have been flushed away by the floods during the monsoon season, but some may survive desiccation in concealed containers for several months,

However, State Health Department director Dr Mohamad Omar said while the floods explained why there had been no dengue outbreak for a record period, this did not mean that the mosquito eggs were gone.

Some of the eggs could be trapped in containers and there was no way of controlling the hatching of the larvae, which take less than three days to grow into adult mosquitoes. The authorities will only know if there are dengue and Zika outbreaks when someone is hospitalised and diagnosed with the diseases.

Only then will the Health Department assemble a team to fumigate the area where the victim lives. But, all these costly manoeuvres in organising clean-up exercises and awareness programmes, which involve manpower from the various agencies, can be minimised if people take the threat of dengue and Zika seriously.

Community leaders, especially, can take the lead in organising fortnightly or monthly gotong-royong in areas under their jurisdiction and areas known to record high number of dengue cases with help from local authorities and health officers.

However, it was observed in several campaigns in Kuala Terengganu that some residents became onlookers of clean-up campaigns and “mandors”, while some even took the opportunity to request municipal council workers to clear their clogged drains.

It irked the municipal council workers and health officers who felt ridiculed by the residents, who were mostly from the working class and felt no shame or guilt about the mess they created for others to clean up.

This is the mindset that needs to be changed. It may take a few generations and more deaths before everyone gives priority to prevention than cure. The kindergarten is a good place to inculcate this habit and it must not stop until the child leaves school at 18. The Japanese have done it and they turned hygiene and cleanliness into a culture.

Rosli Zakaria

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Malaysia - When forgetfulness is a concern

Mild cognitive impairment could be the start of dementia, writes Nadia Badarudin.

HOUSEWIFE Irdina, 40, worries about her mother, Saadiah, 63 (not their real names). Irdina says after her father passed away 10 years ago, her mother was generally well, and living independently.

Lately however, this has changed; her mother has become more forgetful. She notices that her mother asks the same question over and over again during conversations and keeps losing things.

“My mother is very organised. So when she told me that she often misplaces her reading glasses and later finds them in strange places like in an empty pot in her garden, I merely thought age was catching up,” she says.

Her mother recently lost her way driving home after her religious class. This has occurred several times.

“I find it quite strange because my mother uses the same route every day. When it has happened more than once, I just don’t know how to react,” she says.

“Although she manages her daily responsibilities like she normally does, I think something is not right.”

NORMAL AGEING?

Going into a room and forgetting why you went there, or misplacing things, can happen to anyone, not only older people like Saadiah.

Forgetfulness is part and parcel of the normal ageing process. According to the National Institute of Ageing, changes occur in all parts of the body, including the brain, as people get older.

It says memory loss can be linked to health issues such as side effects of medication, chronic alcoholism, tumours or infections in the brain, and to some thyroid, kidney or liver disorders.

It can also be related to stress, depression, anxiety and other emotional issues such as coping with the death of a close family member.

However, consistent forgetfulness or memory loss can be a sign of something more serious in the elderly.

As Malaysia becomes an ageing nation by 2035 with 15 per cent of the population classified as senior citizens (aged 60 and above), this should be a concern because it will result in higher costs of acute and long-term medical and healthcare services.

MILD COGNITIVE IMPAIRMENT

When people are more forgetful than normal for their age but can still function and carry out their daily tasks, as in Saadiah’s case, the condition is called Mild Cognitive Impairment (MCI).

Experts believe that MCI “may be an early warning sign of memory disorders later in life”, according to Health After 50, an American online health portal for the elderly.

Psychology Today describes the syndrome as being in-between normal ageing and dementia, hence being “stuck in the middle”.

Beacon Hospital consultant physician and geriatrician Datuk Dr Rajbans Singh says MCI often presents as slight decline in cognitive abilities, including thinking and memory skills that are serious enough to be noticed by the individual or by others.

“The changes due to MCI are different from normal ageing but less severe than someone with dementia — a broad term for memory loss of which 60 per cent is due to Alzheimer’s disease. “Unlike Alzheimer’s, the changes do not interfere with daily life or independent function and patients can manage their daily responsibilities such as shopping or driving,” says Dr Rajbans, who is founder and past president of Malaysian Healthy Ageing Society, member of the Elderly Committee of the Malaysian Medical Association and member of the American Academy of Anti-Ageing Medicine and British Geriatrics Society.

In normal ageing, the memory loss is not consistent and the person can remember again what he has forgotten.

In Alzheimer’s the memory loss is persistent and progressive, especially short-term memory, he says. “Patients with MCI are usually able to manage themselves and are not a burden to their families.

However, 20 per cent of MCI cases progress into Alzheimer’s and these are the ones who will need extra care and support,” he adds.

AT RISK

The National Institute of Ageing says signs of MCI, which mainly affect men, include losing things often and struggling to come up with desired words. A person’s health and lifestyle can influence the chances of developing MCI as he grows older.

Dr Rajbans says the risk groups for MCI include people of advanced years, or with a family history and those with cardiovascular risk factors including diabetes, hypertension and high cholesterol.

“Those at risk tend to be overweight and lack exercise. Smokers and those who are under stress are also prone to the symptoms,” he says.

The symptoms can be caused by several factors, some treatable and some not. Studies show that although MCI increases a person’s risk of developing dementia, it does not always get worse and progress into dementia.

Thus, diagnosing the condition is crucial and this helps prevent onset of dementia. Dr Rajbans says a thorough diagnosis is done to ascertain the causes of memory loss.

“Some blood tests and even a CT scan of the brain would be done to exclude an organic cause of memory loss or to rule out underlying illness. Regular follow-ups are important so that early diagnosis of Alzheimer’s can be made and addressed.”

NO DRUGS

According to Alzheimer’s Society, UK, there are currently no drugs which have been approved to treat MCI. It says there is growing evidence that exercising the body and mind, socialising and doing leisure activities such as reading, playing card games or puzzles can help prevent or delay the onset of MCI and dementia.

 “There is no treatment for MCI. The drugs that work for Alzheimer’s do not seem to have any effect on it,” says Dr Rajbans. Apart from medical treatment for vascular risk factors, patients are normally advised to adopt a healthy lifestyle and be active (physically and socially) to lower their risk of developing dementia.

“Exercising and keeping the mind active may prevent the progression to Alzheimer’s. In Japan, the elderly are encouraged to play Sudoku, which seems to help. Studies show that people who have purpose in their lives and who are socially connected with their families and friends have a lower incidence of MCI and Alzheimer’s,” he adds.

CAREGIVERS’ RESPONSIBILITY

Being ignorant or dismissing forgetfulness as just a normal sign of ageing are not an option. Family members like Irdina have a huge responsibility. Dr Rajbans says: “Caregivers must monitor for signs of progression into dementia.

“Caregivers need to be well-informed and help the patient adopt and maintain a healthy lifestyle to reduce the risk of progression.” 

Nadia Badarudin

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Malaysia - Is water birth a boon or bane?

MORE women are opting for water birth over traditional delivery methods as they believe that it is a more relaxed and less painful experience that promotes a midwife-led model of care.

Proponents of water birth also believe that it offers babies a more peaceful journey from the uterus into their mothers’ arms.

However, the question of safety and comfort pops up when it comes to selecting the preferred method of delivery.

The Health Ministry and medical experts argue that the safety of water births has not been scientifically proven and there is no evidence to suggest that the method is beneficial to mothers.

With the safety of mothers and babies in mind, the ministry, on July 13, prohibited water births from being provided as an option at private hospitals nationwide.

The decision has upset water birth proponents and would-be mothers who had been looking forward to delivering their babies via the method.

Water birth, which gained interest in the 1990s, sees the mother spending the final stages of labour in a birthing pool, with the delivery taking place either in or out of the water.

Director-general of Health Datuk Dr Noor Hisham Abdullah had said the ministry would discuss matters relating to the safety and training requirements for water births, and come up with a standard guideline for water births at hospitals.

While acknowledging that the method has its benefits, former Malaysian Medical Association president Datuk Dr N.K.S. Tharmaseelan says there is a lack of scientific evidence showing that it is a better option compared with traditional delivery methods.

“Options are always good to have, provided that there are proven results. “Most reports that laud water births are anecdotal. “Would-be mothers should be aware of all the pros and cons before opting to have a water birth,” he tells the New Sunday Times.

He says the water immersion method, on the other hand, may provide similar advantages without the potential risks associated with water birth. Water immersion is when a woman in labour is immersed in a tub of warm water only in the first stage of labour, when she experiences labour pains.

The delivery is not performed in the water, but in the conventional way.

Dr Tharmaseelan says studies have shown that water birth is associated with shorter labour, less use of analgesics, and less severe vaginal and perineal lacerations.

“The warmth of the water may induce a sedative effect that counters labour pains. “The mother is also better able to assume a comfortable position,” says the consultant obstetrician and gynaecologist.

However, he expresses concern over the safety and efficacy of underwater births for newborns, saying they have yet to be established.

“There is no convincing evidence of the benefits (of a water birth) to the neonate, but there are concerns that it could cause serious harm. “Therefore, such an option should be considered an experimental procedure and should not be performed except within an appropriately designed randomised control trial.

“The disadvantages of water births are that the perineum cannot be protected, an episiotomy cannot be performed if needed and the risk of perineal laceration is high.” Dr Tharmaseelan says newborns delivered via water births might also swallow contaminated water.

He says this may increase the risk of neonatal aspiration syndrome and neonatal asphyxia (deprivation of oxygen to newborns that lasts long enough to cause physical harm, usually to the brain).

He says continuous fetal heart rate monitoring cannot be performed underwater, which is a major concern as signs of fetal distress may be missed.

“Additionally, if the water is too hot, there is the risk of dehydration and overheating to mother and child.” Dr Tharmaseelan says it is important for parents keen on water birth to consider several factors, such as ensuring that the doctor and midwife have adequate training in handling such births, and the indemnity insurance for the doctor and hospital in the case of any eventuality.

Centres that have water birth as a delivery option should also be accredited by the Health Ministry and be equipped to handle all kinds of emergencies.

Dr Tharmaseelan says women with uncomplicated pregnancies and who had no problems during previous pregnancies or deliveries could opt for water birth. However, those who suffer complications during their pregnancies, have had complicated deliveries, including caesarean sections, and have medical conditions, such as toxaemia, hypertension, diabetes and heart problems, should deliver their babies via conventional methods.

“Women who have bleeding, infections during pregnancy and herpes should consider traditional delivery methods. “This also applies to women who are expecting twins, and those whose babies’ position is not normal or are in distress.” Obstetrician and gynaecologist Dr Michael Samy concurs with Dr Tharmaseelan’s view.

He says water births remain very controversial and are not the way forward. “Yes, water births ease labour pains as the buoyancy experienced while being in the water helps the mother relax.

“However, there is no evidence-based advantages,” says the president of the College of Obstetrics and Gynaecology at the Academy of Medicine.

He says women keen on having a water birth should have low-risk pregnancies. “Intermittent monitoring of the baby’s wellbeing must be carried out and the mother must agree to call off the water birth if fetal compromises develop.”

Tharanya Arumugam

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Malaysia - Strict laws for Malaysia

E-CIGARETTES should be strictly regulated as a pharmaceutical product in Malaysia.

That’s the recommendation of the Health Ministry’s technical committee tasked with studying the health effects of e-cigs and shisha smoking, reveals its chairman, senior consultant chest physician Prof Datuk Dr Abdul Razak Muttalif, a former director of the Kuala Lumpur Hospital Institute of Respiratory Medicine.

The initial recommendation was to ban e-cigs all together, he shares in a recent interview in Kuala Lumpur. But because there were “a lot of issues”, which he declines to elaborate on, the committee decided on the next best thing: strict regulation.

Last year, Rural and Regional Development Minister Datuk Seri Ismail Sabri Yaakob said the Health Ministry’s ban on sales of vapes containing nicotine would kill the Malay-dominated industry. The minister made the comment after several bumiputra groups lodged a police report over the issue.

Dismissing the concerns of pro-vaping groups that legislating e-cigs as a pharmaceutical product will push up costs and make them inaccessible to smokers who want to quit, Dr Abdul Razak says that it’s the same as buying medicine.

“Is it difficult to buy medicine in Malaysia? There are many pharmacies nationwide,” he says.

“We recommended regulating it as a pharmaceutical product rather than a consumer product because we cannot have people selling e-cigs over the counter like cosmetics.

“Once you categorise them as consumer products, you lose control of them,” he says, adding that the Malaysian model will be similar to the EU’s Tobacco Products Directive but will also take into consideration what is happening globally.

The minimum age restriction for the sale of e-cigs, however, is still being debated. While he thinks having a global regulatory standard is ideal, it is not realistic as different countries have different local issues to contend with: “I’ll be very happy if it’s 21 but we are also looking at 18.”

He questions the reliability of Greek cardiologist Dr Konstantinos Farsalinos’ claim that a large number of Malaysians have quit smoking because of vaping. The researcher, who will release his findings on the country’s vapers later this week, told Sunday Star last month that the new survey shows a high cessation rate of smoking regular cigarettes among vapers here.

“Was the study done in a proper, ethical manner? Let me see it first. We know that e-cigs will lead to nicotine addiction.

“We don’t want e-cigs to be a gateway to something bad. The aim is to ‘de-normalise’ smoking by 2045. Asking someone to go for e-cigs is to normalise the whole thing again. To me, zero vaping is as much a goal as zero smoking.”

The Health Ministry will regulate vaping liquids containing nicotine while the Domestic Trade, Cooperatives and Consumerism Ministry will be responsible for liquids without nicotine, says Dr Abdul Razak.

The e-cig devices, he says, must comply with Malaysian Standard, a technical document that specifies the minimum requirements of quality and safety for voluntary use by the public. The committee is also seeking to review the Poisons Act 1952 to include e-cigs.

“We gave our recommendations to the relevant authorities involved in the regulatory framework two months ago. Now it’s for them to draft the law.”

Denying that the committee, which was set up in 2013, took too long in coming up with its report, Dr Abdul Razak explains that vaping and e-cigs are new and there aren’t many facts about the practice.

“We didn’t want any unnecessary lawsuits. It’s not easy coming up with a law. Many parties are involved. Cabinet must approve it. It’s a very long process.”

In May, Health Minister Datuk Seri Dr S. Subramaniam announced that laws to regulate the vaping industry will be ready before the end of the year. The laws will involve all aspects of vaping and its products and accessories as well as distribution.

Universiti Malaya associate professor, consultant psychiatrist, and nicotine addiction specialist Dr Amer Siddiq Amer Nordin is hopeful that whatever the Government decides will be in the best interest of Malaysians from a health perspective.

Our policies, he says, must protect all Malaysians from harm and should be in congruence with the National Strategic Plan 2015-2020. The Plan, he explains, aspires for a smoke-free nation by 2045. Our tobacco control policies, he insists, should be to reach that target – the sooner the better.

“We need legislation to tackle new nicotine products – like e-cigs – that will eventually make their way to Malaysia,” insists Dr Amer Siddiq, who is also the chief coordinator at the university’s Centre of Addiction Sciences.

The United States and the European Union seem to have taken a harder stand in regulating these products for their markets, he notes. Both, he feels, adopted a similar approach that they believe is in the best interest of their citizens.

“Although we’re aware of the decisions made by other countries globally, we must take their recommendations with a pinch of salt. What may work in the US and EU may not work for us due to various factors like the costs involved and their laws. So we take note of their regulations, review our situation, and take what’s suitable for us.”

He expects the Health Ministry to take a hard stand like the US and EU. All efforts, he feels, should be to reduce smoking prevalence by reinforcing existing laws.

thestar

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Malaysia - Responsibility to protect our kids

LAST week, news broke out that a 41-year-old in Negri Sembilan had contracted diphtheria.

Around the same time, a boy, 8, was also admitted to hospital for suspected diphtheria.

The latest development brings the total number of diphtheria cases nationwide to 15, five of which are fatal.

Diphtheria is supposed to have been eradicated by now. It can easily be prevented if one is vaccinated as recommended by healthcare experts.

Unfortunately, some parents choose to ignore the recommendations. They come up with various arguments, either from spiritual or health perspectives.

Some claim that the vaccines are not halal, hence they did not allow their children to be vaccinated.

Others cited conspiracy theories where vaccines are supposedly big business opportunities by unscrupulous pharmaceutical companies.

The debate has been going on, especially in the social media.

Those who are anti-vaccinations seem firm in their decisions. No amount of reasoning can influence them. I am fine with their decision if, and only if, it is for themselves. However, when it comes to protecting their children, I disagree with their stand.

The religious scholars had agreed that vaccines are allowed despite their questionable halal status. This is because bigger threats loom if one chooses otherwise.

The safety and health of individuals and the community at large are a bigger priority.

Secondly, parents who choose to not vaccinate their children are bordering on being irresponsible. It is their children who will unnecessarily suffer or even die from highly preventable diseases such as diphtheria.

Not only that, but they have also “helped revive” an otherwise eradicated disease.

Dr Nik Hisamuddin Nik Ab Rahman, associate professor at Universiti Sains Malaysia and head of Emergency Medicine Department at HUSM, stressed that our vaccination programme is among the best in the world.

The government has provided excellent support to the people for their health.

Many fatal diseases such as polio have been wiped out in Malaysia due to such vaccination programme. He added that the vaccine taken contains safe bacteria which had been deactivated.

These bacteria encourage our bodies to produce antibodies which can provide lifelong protection. Most are one-time doses except for a few vaccines which require boosters, such as hepatitis, meningococcal, influenza and tetanus.

Parents who are anti-vaccine probably think they are smarter than doctors. In doing so, they create unnecessary risks for their kids. So, let’s be more responsible and smarter parents. Let’s protect our kids today.

Zaid Mohamad

Zaid Mohamad coaches and trains parents to experience happier homes and more productive workplaces.

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Malaysia - Health Ministry mulls introducing government healthcare insurance scheme

PUTRAJAYA: The Health Ministry is seriously considering to introduce a healthcare insurance scheme which is run and supported by the government to address the weaknesses in the private healthcare system.

Health Minister Datuk Seri Dr S.Subramaniam said the government health insurance scheme would be voluntary and an alternative to the private healthcare system currently used by over 50 per cent of Malaysians. “There will be no private player and no profit motive.

The government health insurance scheme will evolve according to time.

“It is too early for me to give details such as the structure the scheme and so on. I am just throwing it as a concept and let the relevant party discuss it,” he told reporters here, today.

The move to introduce the government healthcare insurance scheme did not mean that the government plans to stop the current public healthcare delivery system.

“The government is still responsible to the public in providing the public healthcare system that everyone is utilising now. The public healthcare delivery will still continue and will not change.” Subramaniam said, the ministry has been studying the government healthcare insurance scheme concept for the past few months and analysing the challenges involve in implementing such a scheme.

“Once we are confident, we will offer it to the public,” he further said.

The ministry came up with the idea of introducing the government healthcare insurance scheme as it was aware that one of the challenges for Malaysians was paying for healthcare services.

“Such a situation can get people into financial catastrophe. The government healthcare insurance scheme may just be the answer.” He said Malaysia hosted delegates from 27 countries who attended the Joint Learning Network Global Meeting which is initiated by the World Bank.

Themed ‘Building Strong Health Systems to Achieve Universal Health Coverage’ the meeting held in Putrajaya began Wednesday and ended today.

The meeting is a platform for countries to share views, opinion, problems and challenges which they faced in delivering healthcare system.

Bernama

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Malaysia - It's time to increase drug options for patients

WHEN it comes to cancer, many healthcare professionals advocate early detection as this can greatly increase the chances of the treatment being successful.

Although there are no Malaysia-centric statistics on the number of patients whose cancer is diagnosed late, research has shown that almost 50 per cent of patients in the United Kingdom who get cancer are diagnosed late, making treatment less likely to succeed and reducing their chances of survival.

What this means is besides a greater need for education on early detection and screening, we need to ensure that patients with late diagnoses can access treatment and that their quality of life following diagnosis is not compromised. An example of a cancer that is often diagnosed late is renal cell carcinoma (RCC), also known as kidney cancer.

This is because the symptoms for RCC — such as loin pain, fever, weight loss and even bleeding in urine — are similar to that of other diseases and may surface only in the late stages of RCC. In fact, 49 per cent of patients in Malaysia are diagnosed with RCC when the cancer is at the final stage (Stage IV).

A study conducted at the University Malaya Medical Centre showed that the five-year survival rate of patients with Stage IV RCC was only 13 per cent. Kidney cancer is among the 10 most frequently occurring cancers in Western communities.

Globally, about 271,000 cases of kidney cancer are diagnosed yearly and 116,000 people die from it. According to the Malaysia National Cancer Registry Report published in 2007, the incidence of RCC is 0.6 per cent in Malaysian females and 1.7 per cent in males. RCC accounts for 43.8 per cent of new kidney cancers reported in Malaysia in 2007.

However, these statistics present limitations as it has been nine years since the data was collected for the registry. In addition, the actual statistics might be higher as data collection and reporting for RCC in rural areas can be challenging and lead to under-reporting.

Oncologists estimate that the incidence is most probably higher based on the increased number of RCC patients they have been consulting.

Despite the doom and gloom of cancer statistics, all is not lost. Advancements in medical research have led to new forms of treatment being developed for patients.

In the past, treatments with chemotherapy have not been effective and led to disappointing results. New treatment options, in the form of targeted therapy, emerged as a tool to fight cancer cells with more precision and potentially fewer side effects.

Revisions in healthcare policy should ideally be aligned with innovation in cancer treatment. Despite new targeted therapies being approved for use by the authorities in the United States and Europe, these are still limited in most parts of Southeast Asia, including Malaysia.

Even if they are available in the market, patients have to buy the drugs from private medical facilities as not all of them are funded by the government. This excludes a large number of Malaysians from accessing it in the public or government sector.

According to the National Health and Morbidity Survey 2015 (NHMS 2015), more than two-thirds of the adult population preferred government to private facilities when seeking healthcare services for major health problems, minor and major surgery, dental treatment and for child delivery.

Furthermore, a higher proportion of those in rural areas, the lower socio-economic groups and the aged population (above 75) preferred government healthcare facilities. When it comes to seeking treatment for major illnesses, the proportion of respondents preferring government hospitals increased to 75 per cent.

Thus, there is a pressing need for more drug options to be made available in public hospitals so that more patients benefit from the treatments. In the case of treatment for RCC or kidney cancer, there is only one drug approved and listed in the government formulary.

More options are needed by patients and clinicians because a single drug may not be suitable as every individual has different needs.

For patients who are not able to respond to this particular treatment, access to an alternative drug will allow them to continue treatment.

However, access to an alternative drug is often a lengthy and uncertain process. For some patients, the options that are available are so dismal that it is almost a case of no option at all. This is a grave injustice to patients because it is not available at the facility where they seek treatment. This can force patients to pick treatments that merely address the symptoms and not the cause of their condition or seek treatment at healthcare facilities that may be priced out of their reach (that is, private hospitals) just to obtain the right drug and treatment.

In Western or developed countries, the options to these drugs are fully funded by the government, leading to patients having equal access to treatment drugs that best suit them. However, in Malaysia, drug choices are limited and patients are left with limited or no options.

Patients may have to pay out-of-pocket expenses to access other treatment but this will put them in a difficult financial dilemma of cost versus survival. In fact, a recent study showed that five per cent of cancer patients and their families were pushed i nto poverty in Southeast Asia between March 2012 and September 2013. The study, which was published by Dr Nirmala Bhoo-Pathy from Universiti Malaya’s Faculty of Medicine, evaluated data collected in eight low- and middle-income Southeast Asian countries, including Malaysia.

The study also showed that cancer resulted in “financial catastrophe” for almost half of the patients who suffered from economic hardship at the time of diagnosis. The policy of approving new drugs is based on an analysis of the quality of life years patients gain versus the cost of the drug.

Unfortunately, drug affordability is determined by pharmaceutical companies based in developed countries such as the US and Europe. This leads to a mismatch in drug affordability in a country like Malaysia, where people have a diverse range of economic situations.

Therefore, no matter how clinically effective a drug is touted to be, due to a mismatch in affordability criteria, no drugs have been approved in the government formulary in recent years. In the foreseeable future, cancer is set to be a major burden worldwide and become the leading cause of morbidity and mortality.

Although the good news is that there are new innovative products being approved by health authorities, cost still remains a major issue. Patients are often tormented with the choice between survival and cost, something that patients in Western countries do not have to contemplate as their treatments are fully funded by their health authorities.

Thus, it is imperative for policy- makers to review and update the targeted cancer therapy treatments in the national formulary. The last time an innovative drug indicated for solid tumours was listed was in 2013. The formulary is updated and made available at least three times a year and we urge the health authorities to provide similar targeted treatments for kidney cancer patients.

These targeted treatments may have higher costs but they have been proven to be efficacious and improve survival rates of patients. For better treatment outcomes in patients, the Health Ministry should ensure that medicines with proven efficacies are accessible to the majority of the population.

We hope that more funding will be made available to assist patients in their treatment so that they can live longer with better quality of life without putting them at risk of financial catastrophe. Malaysia’s healthcare system has been recognised by the World Health Organisation as one of the best among the 37 member states.

While the public delivery system continues to undergo transformation to meet the needs of a growing and ageing population as well as alarming rate of non-communicable diseases, let us be aware of the imperative need for Malaysia to keep abreast of breakthrough therapies that impact patient survival and quality of life and to champion for these therapies to be accessible in public hospitals.

Cancer does not discriminate. Every patient, regardless of economic status or whether he or she is at the early or end stage, deserves access to treatment.

Datuk Dr Mohd Ibrahim Abdul Wahid

Datuk Dr Mohd Ibrahim Abdul Wahid, medical director, Beacon International Medical Centre, and vice-president, College of Radiology, Malaysia

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Malaysia - Government adopts cafe approach to check teen pregnancies, premarital sex

KUALA LUMPUR, July 17 — While initiatives implemented by the National Population and Family Development Board (LPPKN) to check immoral behaviour among young Malaysians have been successful to a certain extent, their sexual behaviour and lack of knowledge on matters related to reproductive health and sexuality continue to be worrying.

LPPKN Chairman Datuk Mariam Mas Yacob said studies carried out previously by various government agencies have revealed that social problems like premarital sex, rape, pregnancy out of wedlock, baby dumping, sexually-transmitted diseases and sexual abuse among adolescents and teenagers were on the rise.

She said in view of this, and having recognised that lack of sufficient knowledge on sexuality and reproduction was causing teenagers to go astray, LPPKN developed an intervention programme in 2006 that focused on the provision of youth-friendly health services through a network of kafe@TEEN centres.

These centres provide, among others, counselling services and advice on reproductive health, as well as health and social education, to adolescents and youths to enable them to make responsible choices on matters related to their sexuality.

According to statistics revealed by Deputy Health Minister Datuk Seri Dr Hilmi Yahaya last September, about 18,000 teenage pregnancies were recorded in 2014.

As for baby dumping or abandonment, an average of 90 cases was reported yearly between 2008 and 2013.

Health Ministry statistics on students diagnosed with HIV and AIDS between 2008 and 2012 reflected an upward trend — in 2008, 28 were infected with HIV while seven had contracted AIDS, and by 2012, the numbers had increased sharply to 170 HIV and 16 AIDS cases involving students.

While there are no statistics to quantify the effectiveness of the kafe@TEEN initiative in checking social ills among young people in Malaysia over the last decade, Mariam Mas nevertheless contended that it remained the best platform for youths aged between 13 and 24 to obtain information and knowledge on reproductive health and sexuality.

“It’s hard for them to get the information they want from their families because talking about sex or sexuality is taboo. Then there are those parents who are too busy with their work or business to even have the time to talk to their children about these matters.

“Our kafe@TEEN centres are, therefore, ideal places for youngsters to discuss such sensitive issues comfortably and get more information from health personnel,” she told Bernama.

The kafe@TEEN programme kicked off in 2006 with the establishment of two centres, one situated at the LPPKN headquarters in Kuala Lumpur and the other in Butterworth, Penang.

There are currently 15 centres, located in Kedah, Penang, Kuala Lumpur, Negeri Sembilan, Melaka, Johor, Pahang, Kelantan, Sabah and Sarawak. Seven of these centres are located at the Urban Transformation Centres (UTC) in Pudu and Keramat in Kuala Lumpur; and one each in Melaka, Kuantan, Alor Setar, Johor Bahru and Kota Kinabalu.

Two more kafe@TEEN centres are set to open soon in Tawau, Sabah and Putrajaya. Mariam Mas said the youth-friendly kafe@TEEN concept has made it easier for youths to seek medical help, counselling services, information on reproductive health and even nutritional advice from medical officers, LPPKN nurses and counsellors, nutritional experts, information officers and educators.

The centres also come complete with a mini library and Internet services.

 “Our main objective is to help mould our youths into healthy, resilient and responsible people who possess good moral values and are able to cope well with the challenges they may face in their lives,” said Mariam Mas.

She said by having access to accurate and vital information on matters like sexuality and reproductive health via the kafe@TEEN centres, adolescents and teenagers would find themselves in a better position to make more informed choices and stay away from premarital sex and other social problems.

“It also reduces the risk of them suffering from an identity crisis or having unnatural sexual orientations like lesbians, gays, bisexuals and transgenders (LGBT),” she said.

Mariam Mas said the kafe@TEEN centres also provide educational and skill-building programmes to enable youths to pick up personal development skills and also participate in recreational activities.

“The centres enable the youngsters to make new friends, which indirectly improves their social interaction skills. Their self-confidence also improves when they start communicating with their newly acquainted friends,” she said.

According to Mariam Mas, LPPKN also conducted kafe@TEEN outreach programmes at schools and has succeeded in reaching out to 476,193 students between 2006 and February 2016.

She said over the same period, some 6,064 youths had obtained social counselling services at the various kafe@TEEN centres, while another 20,353 had received reproductive health services.

A total of 317,657 youths had taken part in the educational and skill-building programmes conducted by the centres.

Describing youths as an important asset to the nation’s development agenda, Mariam Mas said kafe@TEEN also encouraged them to become the agents of change by getting involved in volunteer activities.

She said kafe@TEEN had in 2014 and 2015 collaborated with 1Malaysia For Youth or iM4U — Malaysia’s youth volunteerism platform to nurture and inculcate volunteerism into the hearts of the youth — to conduct workshops for iM4U volunteers to equip them with knowledge and skills related to reproductive health and social behaviour.

“These workshops will equip kafe@TEEN and iM4U volunteers with the relevant knowledge to act as peer counsellors, as well as facilitators of our programmes,” she added.

Meanwhile, youths who wish to use the kafe@TEEN facilities and services and participate in their programmes must first register themselves as members at the kafe@TEEN centre located closest to them.

To qualify as a member, they must be single and aged between 13 and 24. Registration is free. The kafe@TEEN centre at the LPPKN headquarters is open from Monday to Friday, between 8am and 5pm.

The kafe@TEEN centres located at the various UTCs are open seven days a week, from 8.30am to 10.30pm.

themalaymailonline

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