The Malaysian Insight

GOVERNMENT doctors – for all the time they spend saving Malaysians from sickness and death – are themselves facing serious health issues caused by severe sleep deprivation and lack of a balanced diet.

Myelone Tharmaseelan, a doctor at a government clinic in Shah Alam, said he sometimes worked up to 13 hours in the clinic because of the overwhelming number of patients.

According to Myelone, the number of patients over the years had increased, as the increasing cost of living and slow economy resulted in more Malaysians opting for government healthcare facilities for affordable treatment.

He said doctors sometimes did not even have time to eat or talk because of the workload that they faced each day, and this had caused many to lose focus towards the end of their shifts.

“Every doctor must take the full history of the patient, then conduct the diagnosis, then prepare the proper treatment.

“If this process is interrupted in any way, the next doctor has to repeat the whole process again, so you can’t just say ‘I’ll get back to you tomorrow’.”

Myelone said he suffered from sleep deprivation, a condition that almost cost the life of his friend, Ganesh Palaniappan, who is a doctor in Sarawak.

Ganesh, who works in a government hospital in Serian, Kuching, Sarawak, said he crashed his car while driving home from hospital one day after a gruelling 18 hours of work without rest.

“It was dark, I was already tired from the long day…  I must have blacked out,” he told The Malaysian Insight.

“We have a lack of specialist doctors at government hopsitals, that is why doctors are overworked,” he said.

Too few doctors in the field

The Health Ministry aims to have a doctor-to-patient ratio of 1:400 by the year 2020, but having the numbers is just part of the equation, said President of the Malaysian Medical Association Dr Ravindran R. Naidu.

“We have a lot of doctors in training, but we fall short in the number medical doctors and training hospitals.

“Currently we have a doctor to patient ratio of around 1:600, so we still have a long way to go to achieve that target,” he told The Malaysian Insight.

The World Health Organisation recommends at least 23 healthcare workers per 10,000 population,  which is roughly a ratio of 1:435.

Ravindran also stressed that doctors who were completing their housemanship were not yet qualified as doctors.

According to the ministry’s 2016 figures, Malaysia now has 46,491 qualified doctors, with a patient ratio of 1:656.  This means Malaysia needs 5,950 more doctors per year, assuming that the Malaysian population does not increase, to achieve the 1:400 doctor-to-patient ratio by 2020.

To make things worse, in September 2014, it was reported that the Malaysian Medical Council (MMC) is reviewing the accreditation of foreign medical schools. Since 2013, MMC had suspended the setting up of new private medical colleges and universities.

Fast forward three years later, it was reported in April 6 this year that Malaysian graduates of medical schools in Indonesia, Russia and Egypt were less than capable of passing their housemanship in Malaysia, as they were not properly trained to handle patients during their studies.

This shortfall in numbers is causing the qualified doctors who are holding the fort now to feel the strain.

Ravindran said in addition to the lack of training hospitals, the system of training medical graduates to become qualified doctors can be a hassle, and that can be the reason why there is a lack of physicians in practice.

“A houseman will be given a provisional registration with the Malaysian Medical Council (MMC) for the two years that he or her will be in training.

“Then you are given a permanent registration with the MMC when you become a medical doctor, but you cannot leave the government service because it is compulsory for you to work two years with the government.

“This whole process may take a long time, and the doctors in training might just call it quits,” he said.

Ravindran said a houseman must go through at least six rotations at different departments in a hospital. Each rotation will be four months.

“This is why we are short of medical doctors. When there is a shortage, doctors will have to work longer hours resulting in sleep deprivation which will indirectly endanger their lives,” he said.

On May 31, 2017 the Director-General of Health Noor Hisham Abdullah said there were 554 road accidents involving government healthcare workers during the 2014-2016 period. Sixty-nine of those involved were returning home after extended working hours.

“Sometimes, we can work up to 36 hours. If you want to talk about labour laws, it doesn’t apply here as you can’t save someone’s life halfway and put it on hold,” Ravindran said. – July 1, 2017.