Another Battle At Our Doorsteps..Literally
Now that there’s a temporary reprieve in Gaza, our attention should shift to a series of attacks by various viruses in the Far East. In China, a potential outbreak (again!) of bird-flu is in the making with the death of a 27 year-old woman in China. Caused by the H5N1 virus, the last outbreak was in Asia in 2003 where 247 died. Find out more about the avian influenza virus( the proper name).
A little-known virus, Chikungunya (pronounced chikoon-goon-nya) has already made its entrance with Malaysia reporting 100 cases per week instead of the usual 100 cases per year. This disease is usually confused with dengue as they have similar presentations, although it follows a more benign course. Read more about it in my recent posting “This Thing called Chikungunya”.
Of immediate concern is the recent outbreak of dengue fever(pronounced den-gie), where the incidence has doubled in recent months in tropical and subtropical areas. In Malaysia, 8 deaths have been reported this month alone. Here’s a good write-up about dengue but I would like to highlight a few pointers:
- While the typical symptoms are high fever with chills, rashes, headaches and severe bodyaches in the absence of a runny nose, the latest outbreak has produced unusual symptoms like fits, yellowing of the eyes (jaundice) and kidney failure, all of which require treatment in hospital.
- Both Chikungunya and Dengue viruses are carried by the same mosquitoes called Aedes Aegypti. They are the ones with black-and-white stripes on their bodies. Don’t ask me why, but the females are the culprits and they have adapted themselves so that they don’t fly in your face or make a loud humming sound, preferring to come in low and bite in the ankles. These mosquitoes are attracted to perfume and dark clothing, so party animals, beware!
Aedes aegypti: only the females bite
- Because the Aedes mosquito cannot travel far, it is generally accepted that the breeding ground is within the same compound or area, so one should get rid of pools of stagnant water which can collect in empty bottles, cans and plastic wrapping.
- You can confirm whether a fever is due to dengue via blood tests although they are not always accurate. Sometimes it is necessary to repeat the tests several times before they become positive. Nevertheless, diminishing numbers of a component of blood cells called platelets is suggestive of dengue.
- There is no treatment that can cure dengue. Like in most viruses, its up to one’s body resistance; and this can be enhanced by rest, adequate fluids and measures to reduce the fever.
At the end of the day, prevention is the mainstay. The way not to get dengue is to eliminate the Aedes mosquito if thats at all possible; failing which, to prevent the insect from biting you and passing you the virus..
Health Questions Too Embarrassing To Ask
This morning I had to see a male patient who had been put on cholesterol-lowering medications. After the mandatory checks were over, he seemed reluctant to leave and appeared to have a question over his head. After some coaxing, he admitted to having impotence after commencing the medications.
This problem was easily sorted out, but it got me thinking …were there other ailments that people wanted to ask their doctors but were too shy to ask? A look on AOL Search yielded the answers:
Top Searched Embarrassing Health Concerns on AOL Search:
1. Herpes
2. Irritable Bowel Syndrome (IBS)
3. Yeast Infection
4. Psoriasis
5. Urinary Tract Infection
6. Genital Warts
7. Hemorrhoids
8. Impotence
9. Hyperhidrosis
10. Incontinence
Herpes Simplex Tops the List of Embarrassing Ailments -To Ask or Not to Ask?
Why, impotence wasn’t even in the top 5! I guess its hard bringing up health issues which are deemed private with a relative stranger on issues that make one blush just thinking of them. But the doctor is a trained professional and if you’re comfortable with yours, by all means bring it up. They’ve probably seen scores of patients with similar problems as yours anyway!
Healthcare Blooper of the Year – Malaysian edition
This blog was meant to be for an international audience, but by request from one of the blog’s avid followers, I am presenting the Malaysian equivalent of ‘blooper of the year’. Several candidates came to mind…the ex-Health Minister episode, the conviction and jail sentence of a doctor for noncompliance to the PHFS Act and the gaffe by the Deputy Minister in stating that doctors have a licence to kill.
But the winner is….the proposal to privatise the National Heart Institute by a Malaysian public-listed company.
The National Heart Institute of Malaysia - a model of corporatisation as a prelude for all public hospitals?
For international readers, a quick 101 : Malaysia has a unique healthcare system – public and private. The two entities are separate and distinct so that staff cannot work in both sectors. The public hospitals are almost totally subsidised by tax-payers and is accessible by all citizens at practically no charge. The private sector is profit-orientated with approximately two-thirds of its patients funded by third-party payors while the rest pay out-of-pocket.
So what makes this deal unique? After all, this sounds similar to the extensive NHS privatisation exercise carried out since 2006 in the UK which drew much fanfare. Well, the National Heart Institute in Malaysia (NHIM) started life in 1992 as a corporatised entity. In essence, the government retained the physical assets (the balance sheet) and parceled out the operations (P&L- profit & loss accounts) to a state-owned entity, MOF Inc. The P&L has remained healthy and it is believed to have over USD 70 million in cash assets. In short, the Institute seems profitable.
So what’s wrong with the deal? Plenty..
1. When the NHIM started in 1992, its vision and mission was to be a centre of excellence with equal time devoted towards training and research & development(R&D) as towards service to patients. As it is, due to the busy patient service workload, NHIM has strayed away from its original objectives. Today, R&D is almost non-existent. Can privatisation remedy this? It is doubtful, as R&D is hardly profitable in the near-term.
2. Transferring a corporatised entity to a privatised entity means, amongst other things, looking for an alternative source of funding for the 85% of its patients who are now almost completely subsidised by tax-payers. This will cut into the P&L like a hot knife into butter and melt away the profits, especially in the absence of a comprehensive national health insurance scheme. Who is going to finance these group of patients under privatisation? Surely not the tax-payers! Otherwise,why privatise at all?
3. Unknown to many, NHIM is already classified as a private hospital under the 1998 Private Hospital Facilities and Services Act. This adds to the confusion as, in many ways, it works and runs like a public hospital despite its categorisation as a private hospital.
4. Despite the above misgivings, NHIM has been operationally viable and relatively successful. The privatisation proposers have not given solid reasons as to how the Institute will benefit should it be privatised.
5. It is clear that the views of all stakeholders were not obtained prior to the somewhat premature announcement of the takeover. I am given to understand that even top management were left in the dark.
The privatisation team
The decision-makers in government have since sidelined the proposal; but there are many other ways that a public-listed company can work together with the Institute. One is to form a strategic partnership instead of a takeover. For instance, by establishing heart units country-wide funded by the public-listed company and using IJN technical expertise and training, the service workload can be minimised and the company hopefully achieve a decent profit in the medium term.
For The Most Honest and Ethical Job, the Winner is….
In its Annual Honesty & Ethics of Professions Survey this year, Gallup has placed the winner as, for the seventh straight year, nursing. In its latest results released Nov 24th, 84% of Americans surveyed gave a high or very high rating for nurses as the most honest and ethical profession.
This shouldn’t come as a surprise, for all the reasons I mentioned in my earlier posting- “Nursing – the ‘In’ Profession”. Long derided by medical doctors as ‘glorified hand-maidens’ and the subject of countless bawdy humour, the nursing profession has lately regained a lot of prestige and has been hailed as one of the ‘in’ professions, what with the acute shortage worldwide and a more-defined career pathway which can lead one up to becoming a hospital CEO even.
And who are at the bottom of the list? Car salesmen. 55% said they have low or very low ethics. No other profession comes close to this level of disparagement. This is not a new finding; car salesmen have been at the bottom every year they have been included in the list, except for the three occasions when telemarketers were included and essentially tied car salesmen for that unwelcome distinction. How many times have you heard this : “Hey,buddy, you look like a nice guy. I’m here as your partner in making this important decision!”
Here’s the ranking of the other professions:
|
2006 Honesty and Ethical Ratings Summary |
||||
|
Very high/High |
Average |
Very low/Low |
NET HIGH |
|
|
% |
% |
% |
||
| Nurses |
84 |
14 |
2 |
82 |
| Druggists or pharmacists |
73 |
23 |
4 |
69 |
| Veterinarians |
71 |
23 |
2 |
69 |
| Medical doctors |
69 |
26 |
6 |
63 |
| Dentists |
62 |
34 |
4 |
58 |
| Engineers |
61 |
33 |
3 |
58 |
| College teachers |
58 |
32 |
7 |
51 |
| Clergy |
58 |
29 |
9 |
49 |
| Policemen |
54 |
34 |
11 |
43 |
| Psychiatrists |
38 |
42 |
12 |
26 |
| Bankers |
37 |
52 |
10 |
27 |
| Chiropractors |
36 |
48 |
10 |
26 |
| Journalists |
26 |
48 |
25 |
1 |
| State governors |
22 |
52 |
26 |
-4 |
| Business executives |
18 |
53 |
27 |
-9 |
| Lawyers |
18 |
42 |
38 |
-20 |
| Stockbrokers |
17 |
56 |
23 |
-6 |
| Senators |
15 |
49 |
35 |
-20 |
| Congressmen |
14 |
45 |
40 |
-26 |
| Insurance salesmen |
13 |
51 |
34 |
-21 |
| HMO managers |
12 |
45 |
37 |
-25 |
| Advertising practitioners |
11 |
49 |
35 |
-24 |
| Car salesmen |
7 |
36 |
55 |
-48 |
Doctors play God, or don’t they?
Many years ago, as a junior resident in a large overcrowded public hospital, I chanced upon an elderly man lying in bed looking very pale and ill and surrounded by two younger men looking at their friend(the patient) as if he was in death’s throes. As I breezed past on the way home after a rather tough stint, the younger man stopped me in my tracks and said if we could do something to help the elderly man as they had been told earlier by another doctor that the patient was terminally ill, nothing could be done and that the best thing would be to take him home to spend his last days comfortably in his own bed.
It was already late night but as there was a bit of extra time left before the call-duty was over, I took a brief look at his case-notes and summarised that the working diagnosis was that of advanced cancer of the lungs.
Having promised the patient’s friends that we would take a second look the next morning with the team, I headed off for home.
To cut a long story short, the diagnosis turned out to be a lung infection called aspergillosis and in next to no time, the patient was cured and able to walk home quite well.
I was constantly reminded of this gentleman as he would faithfully turn up once a year outside my office during the main festivity season bringing a celebratory gift. Although he did not speak English, the words, gestures and smile spoke volumes in terms of gratitude. These visits went on for several years till my staff took his visits almost for granted.
One fine day, we all realised that his visit had stopped coming for some time and it wasn’t till much later that word got to us that this fine old man had finally succumbed at home to what was presumably old-age.
This whole episode really got me thinking whether we as doctors do actually determine the fate of fellow human-beings. Much as the Hippocrates Oath or the Geneva Declaration on Health determine our behaviour towards patients, doctors are subjected to various constraints sometimes beyond their control. A missed diagnosis, inadequate review, insufficient resources are some of the factors which may hinder appropriate treatment and consequently lead to a different fate than what God probably intended…
