Berita MMA February 2016

February 2016
Berita MMA Vol. 46 No. 2

(For Members Only)
PP 1285/02/2013 (031328)
P E R S A T U A N
P E R U B A T A N
M A L A Y S I A
MALAYSIAN
MEDICAL
ASSOCIATION
MMA EXECUTIVE COMMITTEE

2015 2016
President
Dr Ashok Zachariah Philip
president@mma.org.my
Immediate Past President
Dr H. Krishna Kumar
pastpresident@mma.org.my
PresidentElect
Dr John Chew Chee Ming
president_elect@mma.org.my
Honorary General Secretary
Dr Ravindran R. Naidu
secretary@mma.org.my
Contents
ExCo
4
Editorial
Presidents Message
From the Desk of the Hon. General Secretary
12
Branches & Societies: Annual Report
13
Elections Committee
SCHOMOS
14
Towards Excellence
PPSMMA
Honorary General Treasurer

Dr Gunasagaran Ramanathan
treasurer@mma.org.my
16
Honorary Deputy Secretaries

Dr Ganabaskaran Nadason
dr.ganabaskarn@gmail.com
18
Child Abuse and Neglect A Conference Experience
19
Elective Posting Down Under
Dr Rajan John
drrajan09@yahoo.com
Surveys & Reports by PPSMMA
SMMAMS
General
21
2016 AGM Registration Form
22
2016 AGM Payment Form
23
The Pursuit of World Class Primary Care: Are We There Yet?
25
Engaging Cancer Patients: The Role of Cancer Groups
28
Vaping: A Public Health Perspective
Editorial Board 2015 2016
30
Armed Forces Medical Veterans
Editor
Dato Pahlawan Dr R. Mohanadas
genmohan@gmail.com
31
Diari Doktor Desa
34
Seminar: Future of Medical Education and House Officer Training
Ex-Officio
secretary@mma.org.my
35
Humour
Editorial Board Members

Assoc Prof Dr Jayakumar Gurusamy
drjkumar6@gmail.com
36
MMA: Doc Who Stayed to Help Did the Right Thing
36
A Cold Line Between Life and Death
37
Not All That is Natural is Good
SCHOMOS Chairman
Mr Vasu Pillai Letchumanan
schomos@mma.org.my
PPS Chairman
Dr Muruga Raj Rajathurai
pps@mma.org.my
Dr Gayathri K. Kumarasuriar
gsuriar@yahoo.com.sg
Dr Juliet Mathew
drjuliem@hotmail.com
Prof Dr M. Nachiappan
drnachi611@gmail.com
Publication Assistant
Ms Malar
publications@mma.org.my
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(MMA News) do not necessarily reflect those of the Editorial Board, MMA
Council, MMA President nor VersaComm, unless expressly stated. No
part of this publication may be reproduced without the permission of the
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be true as of the date that it is published. All content, materials, and
intellectual property rights are owned and provided for by Malaysian
Medical Association and its members.
VersaComm makes no guarantees or representations whatsoever
regarding the information contained herewith including the truth of
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Published by
Malaysian Medical Association
4th Floor, MMA House, 124, Jalan Pahang, 53000 Kuala Lumpur
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ISSN 0216-7140 PP 1285/02/2013 (031328) MITA (P) 123/1/91
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MMA in the Press
Book Review
38
Battling Adversity
Personality
39
Datuk Dr A. Puraviappan: The Changing Face of Obstetrics
41
Poem: A Reflection of My Life
Memoriam
42
Dr RV Pillay
Branch News
43
MMA Pahang 5th Annual Scientific Meeting and Installation

Dinner 2015
44
12th Rights & Responsibilities Seminar, Sabah 2016
46
Mark Your Diary
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Nothing in this disclaimer will exclude or limit any warranty implied by law that it would be
unlawful to exclude or limit.
beritaMMA Vol.46 February 2016
exco editorial
Dato P
Pahlawan
hl
D
Dr R
R. M
Mohanadas
h
genmohan@gmail.com
Editor
Editorial
Parenting is challenging these days.
The why not syndrome has become
so infectious that the first answer most
parents receive from their teenage
children is why not. At a time when
parents find it difficult to get their teens
to stop fiddling with their smartphones
at the dinner table, or put off the
phones and chat with visitors at home
or advise they come home by 10pm or
so, I find it so difficult to believe young
doctors who are not performing well
in their clinical duties blaming their
parents for their choice of career. Is
this still true at current times, when a
career in medicine is not that much a
glamor and where a medical course
could cost anything from about RM
300,000 to RM 600,000 in a local
private medical school. Would children
these days agree on this five-year
gruelling course just because their
parents wish their children should be
doctors? I met two doctors recently
who are administrators in private
colleges and another who is a pilot
in a local low cost carrier, all from
recognised medical schools. They
are happy they made that switch
early, but do fault their parents on the
sidelines! I guess the disappointment
in these parents would be far greater
when the young doctor decides not
to practise medicine after graduation,
compared to an outright refusal before
entering the programme.
Advertising Institutions of Higher

Education is big money. I visited the
popular Star Education Fair held
earlier this month at the Kuala Lumpur
Convention Centre. All the five halls
were taken up by exhibitors and it
was estimated that some 60,000 odd
people visited over the two days. There
were many parents accompanying their
children, some even entire families.
That is the anxiety and commitment in
parents to higher education, with the

hope of a brighter future for the next
generation. Almost all local private
medical schools participated, and
a few overseas ones, and I noticed
queries for medical programmes are
still very positive! The career talks,
especially those like Pursuing a Career
in Medicine and Health Sciences had
almost no standing space. My advice
to students and their parents was
straight and simple, five questions:
Do you have good results, better
than the minimum req uirement? Are
you definitely interested in a medical
career, and have a passion for it? Are
you a caring person, if so give some
examples (incidents)? Two questions
for the parents: Can you afford this
tuition fee, which excludes all living
expenses? What do you expect from
your child after they graduate? When
students say yes to all and the
parents say I expect nothing from
20 gantry advertisements of private

institutions including medical schools.
But what disheartened me most was
seeing advertisements of medical
schools on tree trunks, competing with
air-con repair shops on the same tree
in Petaling Jaya.
What sad state of affairs for the medical
profession!
Whatever the mode of advertising, it is
important that some of us, as providers
of medical education are honest in
our claims and provide the best of
education and training possible.
~~~
It is important that some

of us, as providers of
medical education are
honest in our claims
and provide the best of
education and training
possible
~~~
them when they graduate, then I

would say please fill the forms for
registration and interview. It is amazing
despite all the negativities in the media
of oversupply, housemanship woes,
dropouts after graduation, difficulty
in coping, stress and the list goes
on; yet medicine seems still the first
choice of high achievers. Lets hope
the profession remains noble.
Advertisements for programmes in
higher education require no vetting
or approval from authorities unlike our
own Lembaga Iklan Ubat in healthcare.
The onus is on the Institution to
substantiate their claims. On a recent
trip to Kedah, I counted no less than
In my visits to these Fairs at KLCC, I

will not miss the curry mee sold just
along the corridor of the exhibition
halls, tasty indeed, you have to try it!
This short period of rest after visiting
the booths, allows me to think and
analyse, observing the types of visitors,
from the promo bags they carry, the
way they dress, the enthusiasm on
their faces etc etc but this time what
struck me as I was enjoying the curry
mee was the huge numbers of people
coming down the escalators from the
upper floors, definitely more than a
thousand, more than all the visitors
in the exhibition halls at that time. I
thought, it cannot be a film show, free
makan or what? I was too curious,
called a lady from the crowd and
asked, where are you coming from?
The answer a talk on Feng Shui for
the Year of the Monkey. That got me
anxious, such a big crowd, a difficult
year ahead must be, so too for all the
exhibitors, including me!
Well, Gong Xi Fa Cai to all our Chinese
Members and their families and
friends, and let us all hope the kind
Monkey will give us some leads into
the New Year!
exco presidents message
D A
Dr
Ashok
h kZ
Zachariah
h i h Philip
Ph
president@mma.org.my
ashokphilip17@gmail.com
President
~~~
Gone are the

days of producing
idealistic,
passionate
practitioners. Now,
what is in demand
is a homogenised,
pre-packaged
generic doctor
~~~
Medical Education
in Malaysia
attended the 13th Asia Pacific Medical Education Conference on the 15th and
16th of January 2016 in Singapore. It was organised by the National University of
Singapore and took place at the University Cultural Centre, which has a large, wellequipped hall where the main talks were held, as well as a number of smaller rooms
for concurrent sessions. I had only learned of this conference when I met Professor
David Gordon, President of the World Federation for Medical Education, at the World
Medical Association meeting in Moscow last year.
The World Federation for Medical Education (WFME) is based in France and is a
non-governmental organisation for medical education. Its role in this field is officially
recognised by the World Health Organisation (WHO). It is a partnership organisation
for the worlds regional associations for medical education. WFME does not
concern itself with the details of how medicine is taught, but more with the quality,
management, organisation, support and delivery of medical education.
Over the past 15 years, WFME has had three main initiatives, namely setting standards
for medical education, accrediting and recognising the accrediting agencies and
compiling a directory of the worlds medical schools. Their website address is
http://wfme.org.
Before I get
g back to whyy WFME may be important to us, let me digress to the state of
Malaysian Medical Education. One
O of the sessions at the APMEC meeting concerned
medical education. Broadly speaking, this means taking
the commodification of medica
something
have no commercial value and making it into something
g that is thought
g to hav
that is a commodity that is, something that does have commercial value.
Traditionally, medical training was treated as more of a calling than a commodity.
The experienced and skilled doctors took the students under their wings and
became full-fledged doctors. Of course, things were never
guided them till they becam
quite that ideal, but of late it can be seen that business is intruding into the
field of medical education an
and with it all the metrics and outcome measures that
hard-headed business people demand. Gone are the days of producing idealistic,
passionate practitioners. Now, what is in demand is a homogenised, pre-packaged
generic doctor.
beneficiary of what seems to me a particularly virulent
Malaysia has been the be
form of medical course ccommodification. In a decade or so the number of
has far outnumbered the public courses, and
private medical programmes
program
many of them are now ccompeting frenziedly for students. Apparently the
is (finally!) declining, and we can anticipate
demand for medical courses
co
that competition will
wil become more acute, and more colleges will fail or
merge. While such natural selection might be good for the system as a
whole, it will of ccourse cause major problems for enrolled students of
schools. One way forward, which I believe some schools
troubled scho
is to attract international students.
are already exploring,
ex
students to study medicine in Malaysia
Attracting international
in
will not be easy. While the relatively safe environment, good
infrastructure and excellent food might be pull factors, the
infrastructur
element will be whether these students will be able to
deciding ele
anywhere else but in Malaysia with their degrees. If the
practise anyw
degrees are recognised by foreign medical councils, then
exco presidents message
there is no problem, but the vast majority do not get

automatic recognition usually there is some sort of
examination to pass.
One such examination, which many Malaysians are
familiar with, is the Educational Commission for
Foreign Medical Graduates (ECFMG) examination. This
examination has to be passed by anyone with a foreign
medical degree who wants to work in the United States.
Thus, a foreign student who gets a Malaysian degree
would have to sit for and pass the ECFMG examination
in order to be eligible to work in the United States.
However, the ECFMG recently announced a rather
momentous change. From 2023 onwards, only those
doctors with degrees from an appropriately accredited
medical school will be allowed to sit for the examination.
What does appropriately accredited mean? Basically,
it means that the medical school must be accredited
through a formal process that uses criteria comparable to
those established for US medical schools by the Liaison
Committee on Medical Education or that uses other
globally accepted criteria. The question then arises, of
course, as to what globally accepted criteria might be.
This is where we come back to the WFME.
In March 2013, the ECFMG announced that the WFME, in
collaboration with the Foundation for the Advancement
of International Medical Education and Research
(FAIMER), had developed a Programme for Recognition

of Accrediting Agencies. If the accrediting agency
goes through this programme successfully and gets
recognition, then the graduates of any medical schools it
accredits will be able to sit for the ECFMG examination.
At present, only four accrediting agencies have gone
through the WFME-FAIMER process. Malaysias
accrediting agency is not one of them. I am well aware
of issues of national pride, but in an increasingly
globalised economy with a mobile workforce, it may
be counterproductive. It is easy to say that we should
be the judges of what are acceptable standards for
medical schools in our country, but in the interests of
our students and in the cause of greater transparency,
our accrediting agency should consider obtaining
international accreditation for itself walk the talk, as it
were. The national accrediting agency will still set national
standards, but by having international recognition, it will
bring added value to its clients.
The private medical education sector in Malaysia is
headed for tough times and restructuring. Active
collaboration at national and international levels on
accreditation and standards setting is urgently needed
to maintain our standing and credibility. Let us all
work together towards establishing ourselves on the
world stage, without letting false pride and excessive
nationalism hold us back.
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exco hgs
From the Desk of the
Hon. General
Secretary
flynaidumma@gmail.com
Hon. General Secretary
Meeting with Bahagian Amalan Perubatan, Ministry of Health (MoH)

27 November 2015
This is the final part of the balance regulations which was discussed on 15 October 2015. We have strongly objected
to all jail sentences. If members have any queries or recommendations, please feel free to email.
A) SECOND SCHEDULE
Schedule Fees
[Regulations 3, 4, 5, 6 and 19]
No.
1.
Type Of
Application
Registration
(processing fee)
(a) Private medical

clinic
(b) Private dental

clinic
Regulation
Proposal from MMA
Fee
(RM)
3(1)
1.
500
500
Type Of
Application
No.
Registration
(Processing fee)
Regulation
Fee
(RM)
3(1)
Remarks
MMA proposed
to reduce the
Relocation fee from
RM1,000 to RM500
in cases where there
are no changes to
the clinic.
(a) Private medical

clinic
New
registration
500
Relocation
(b) Private dental

clinic
New
registration
500
Relocation
10
exco hgs
Schedule Fees
[Regulations 3, 4, 5, 6 and 19]
No.
2.
Type Of
Application
Registration
(Issuance of
certificate of
registration)
Regulation
Proposal from MMA

Fee
(RM)
3(3)
(a) Private medical
2.
1,000
3.
Transfer, assignment
or otherwise
disposal
1,000
4(1)(b)
300
Registration
(Issuance of
certificate of
registration)
Regulation
Fee
(RM)
3(3)
(a) Private medical

clinic
clinic
(b) Private dental

clinic
Type Of
Application
No.
New
registration
1,000
Relocation
(b) Private dental

clinic
New
registration
1,000
Relocation
3.
Transfer or
assignment of
certificate of
registration
4(1)(b)
300
3A
Disposal of
certificate of
registration
4(1)(b)
4.
Variation of terms
or conditions
of registration
or amendment
to certificate of
registration
5(1)
150
4.
Variation of terms
or conditions
of registration
or amendment
to certificate of
registration
5(1)
150
5.
Duplicate copy
6(c)
200
5.
Duplicate copy
of certificate of
registration
6(c)
200
19(5)
50
6.
Search on or
extracts from the
Clinics Register
6.
Search on or
extracts from the
Clinics Register
19(5)
(a) less than 10

clinics
100
(b) 10-50 clinics
500
(c) more than 50

clinics
1,000
plus
10
per
clinic
Remarks
D) FIFTH SCHEDULE
Fifth Schedule
Basic Emergency
Services,
Equipment,
Apparatus,
Materials, and
Pharmaceuticals
Fifth Schedule
[Subregulation 75(9)]
Fifth Schedule
[Subregulation 75(9)]
1. Private Medical Clinic
1. Private Medical Clinic
Each private medical clinic shall unless

otherwise specified by standards set for that
private medical clinic, provide at a minimum
the following services and equipment, both
adult and paediatric, to provide emergency
care:
(a) an emergency call system;
(b) oxygen;
(c) ventilation assistance equipment,
including airways and manual breathing
bag;
(d) intravenous therapy supplies necessary
for the level of services to stabilise the
patient as specified by the person in
charge;
(e) electrocardiogram;
(f) laryngoscope and endotracheal tubes, if
possible;
(g) suction equipment;
(h) indwelling urinary catheters; and
(i) drugs and other emergency medical
equipment and supplies necessary for
the level of services to stabilise the
charge.
Each private medical clinic shall unless

private medical clinic, provide at a minimum
care:
(a) deleted
(b) oxygen;
(c) airway maintenance apparatus;
(d) intravenous therapy supplies necessary
charge;
(e) electrocardiogram;
(f) laryngoscope and endotracheal tubes, if
possible;
(g) suction equipment if possible;
(h) urinary catheters; and
(i) drugs and other emergency medical
equipment and supplies necessary for
the level of services to stabilise the
charge.
2. Private Dental Clinic
2. Private Dental Clinic
Each private dental clinic shall unless

private dental clinic, provide at a minimum
care:
(a) an emergency call system;
(b) ventilation assistance equipment;
(c) suction equipment; and
(d) drugs and other emergency medical
equipment and supplies, necessary
charge.
Each private dental clinic shall unless

private dental clinic, provide at a minimum
care:
(a) ventilation assistance equipment;
(b) airway maintenance apprentice;
(c) suction equipment; and
(d) drugs and other emergency medical
equipment and supplies, necessary
charge.
(Dental will send to MDA the equipment to
be specified and also a copy to BAP)
Wishing all my Chinese

friends and colleagues
GONG XI FA CAI
12
exco hgs
56th MMA AGM

BRANCHES AND SOCIETIES AGM
SUBMISSION OF ANNUAL REPORT 2015/2016
The Organising Committee of the MMA has finalised the dates for the 56th MMA AGM to be
held in Meritz Hotel, Miri, Sarawak between 26 to 29 May 2016.
1. COMPLIANCE OF CLAUSE 7 (1) (ii)
(iii) AND (iv): THE ANNUAL GENERAL
MEETING
In accordance with the above Article, the
Secretariat has set the following target dates
and notices will be sent out accordingly.
a. Notice of AGM by 29 February
2016 (12 weeks before AGM)
b. Last date for submission of resolutions
by 5.00pm on 25 March 2016
(8 weeks before AGM)
c. Members to receive Annual Report
2015/2016 by 12 May 2016 (2 weeks
before AGM)
2. PREPARATION OF ANNUAL REPORT
All Branches, Sections, Societies, Committees,
Representatives to external organisations
should submit their Annual Reports by
14 March 2016.
3. DUTIES OF BRANCHES
In accordance with Clause 15 (1) the Branch
AGM should be held 2 months prior to
the National AGM, that is not later than
26 March 2016.
Notice of the Branch AGM should be sent out
at least 4 weeks before the date of the AGM.
d. All Resolutions submitted by members.

e. Annual Reports of the Branch
SCHOMOS and PPSMMA sections.
3.1 Post Branch AGM
Minutes of the Branch AGM should be
prepared, and after being approved by the
Branch Chairman should be circulated to all
Branch members.
3.2 Submission to MMA Secretariat
within 30 days
The following should be submitted to the
MMA Secretariat within 30 days of the MMA
Branch AGM:
1. 2 copies of the Minutes of the Branch
AGM.
2. 3 copies of the list of newly elected
office bearers in the prescribed format.
3. 2 copies of the Branch Audited
Accounts.
3.3 Election of Delegates
All Branches should submit the list of
delegates attending the National AGM to
the MMA Secretariat by 4 April 2016. This
will then be forwarded to the Organising
Committee of the MMA AGM. (Please note
Clause 15 (5) (i), (ii) & (iii).
4. DUTIES OF SOCIETIES WITHIN MMA
All resolutions to be tabled by members at

the Branch AGM should reach the Branch
Secretary at least 21 days before the Branch
AGM.
In accordance to the terms of reference of

Societies within MMA, all Societies should
hold their AGM by 14 March 2016.
At least 14 days before the Branch AGM, the

Branch Secretary should notify members of
the Agenda and also circulate the following:
Societies should adhere to Clause 7 (1) (ii) to 7

(1) (v) of the MMA Constitution in preparation
of the Annual General Meeting of the Society.
a. Annual Report
b. Audited Statement of Accounts and
Budget of the Branch.
c. Minutes of the previous AGM of the
Branch.
Dr Ravindran Naidu
Honorary General Secretary
Malaysian Medical Association
elections committee
13
14
schomos
Towards
Excellence
Mr Vasu Pillai Letchumanan

schomos@mma.org.my
drvasushan@yahoo.com
Chairman
National SCHOMOS
or the first time in history, by taking a bold step in organising three different events, SCHOMOS and PPS with some
contribution from SMMAMS are working together to bring you the Towards Excellence Series on 20 February 2016
at the Sheraton Imperial, Kuala Lumpur. The idea to combine both effort and resources was borne as a result of the
current economic plague. Apart from fostering goodwill amongst doctors, an event like this is a potential hub for networking
amongst doctors.
Women Empowerment
Seminar
A woman today wears many hats,
juggling her duties against time,
catering to the needs of everyone
under her care except for herself.
All this is done at the expense of
her health and peace of mind. Yet
she does not realise her worth.
Recognising this, SCHOMOS has
organised a seminar to empower
women to step up as leaders and
promote gender equality.
Tan Sri Rafidah Aziz, Prof Dr Kyung Ah
Park, President of Medical Womens
International Association (MWIA), Dr
Mary Suma Cardosa, Past President
MMA, are prominent ladies in their
own right and will be speaking on
topics that we hope would help to
bring about a positive change in the
lives amongst the participants. For
those who are already empowered,
we hope these talks will help motivate
you further.
It will be interesting to meet and
exchange notes with these successful
women leaders as well. Please spread
the message around. This seminar is
open to the public too.
ABC of Housemanship in Malaysia

SCHOMOS with SMMAMS have come together to organise this seminar. This proactive measure was
undertaken to expose our future doctors to the work culture in our hospitals. Those who will benefit from
this seminar are medical graduates awaiting their housemanship posting, especially foreign graduates.
The other group that would benefit would be the final year medical students.
We have invited senior consultants from different departments who have vast experience in housemen
training. They will guide our future doctors on how to cope with the stress of housemanship. The
participants will also be enlightened on the potential problems that junior doctors could face as well as
what is expected of them when they are posted in each department. They will also be exposed to the art
of effective communication and be given the opportunity to have some hands-on experience on common
procedures.
Included in this seminar is a session where Medical Officers and Housemen will share their experience with
the participants. Definitely, not a seminar to be missed.
GP Seminar and
Scientific Meeting
This annual event is organised by
PPS. There are many issues affecting
the General Practitioners and Private
Specialists, currently putting them
in a quandary. This Seminar would
be an ideal platform to discuss the
predicaments faced by them. Topics
like Managed Care Organisations/
Third Party Administrators, Antibiotic
Usage in GP Practice, Rang UndangUndang Farmasi (RUUF) and the
current tax issues will be covered.
An interesting topic not to be missed
would be Tidying Your Taxes, an
Insight by LHDN.
We are counting on all of you to make
these events successful. So please help
us spread the word. See you there!
16
ppsmma
Surveys & Reports

by PPSMMA
Dr Thirunavukarasu Rajoo
o
drarasu@cahayaclinics.com
m
y
Honorary Secretary
National PPS
S
MA engaged a consultant to undertake two

contentious studies regarding issues faced by
the General Practitioners (GP) which are, The
Perceptual Study on Managed Care Organisations (MCOs)
in Malaysia and A Study on Challenges Faced with
FOMEMA & Growarisan in Malaysia
The above reports can be downloaded at the MMA website,
http://www.mma.org.my/614-private-practitioners-section-pps
Managed Care Organisation (MCO)/

Third Party Administrator (TPA)
The term managed care or managed healthcare is used
in the United States to describe a variety of techniques
intended to reduce the cost of providing health benefits and
improve the quality of care (managed care techniques),
for organisations that use those techniques or provide
them as services to other organisations (managed care
organisation or MCO), or to describe systems of
financing and delivering healthcare to enrollees organised
around managed care techniques and concepts (managed
care delivery systems). Wikipedia.
Anything that comes from United States; does it have to be
good for our system? MCOs or TPAs are just middlemen who
facilitate the services between Healthcare Providers like GPs
and employers. For any system to work, it has to have a winwin sustainable model for all the concerned parties without
compromising the quality care of the patients, because of
whom all these healthcare systems exist.
GPs encounter various issues with MCOs/TPAs. These issues
are not favouring us, proven by the lopsided agreements
which can also be known as Corporate Bullying. We can
divide these unfavourable issues into three major parts
comprising of registration, submission and collection. The
consultation fee should not be a fixed amount, but instead
should be based on the diagnosis keeping within the 13th
Fee Schedule. Being so caught up in providing quality patient
care, we have failed to read the MCO/TPA agreements
before signing them. We have had two meetings with the
MCO/TPA representatives and the third meeting was due
in January 2016. We hope we can conclude and come to an
understanding in the near future.
The guiding principles in our engagements with the TPA/
MCO in resolving these longstanding issues are based on
patients interests, MMC Code of Medical Ethics, MCO
Guidelines, Private Healthcare Facilities and Services Act
(PHFSA) 1998 and its Regulations 2006, Good Medical
Practice, and Good Business Practice.
Foreign Workers Medical Examination

Monitoring Agency (FOMEMA)
We have approximately 4,000 registered clinics providing
services for FOMEMA, with about 800 clinics who have
invested into acquiring X-ray facilities. Not forgetting
approximately another 300 clinics who have invested by
upgrading their X-ray facilities with CR Machine. We have

another middle-man company who is charging RM4 for
each X-ray transmission with an additional software cost
of RM5,500. While the Government is working very hard
towards a developed status, we wonder why the private
sector is not keen for competition. GPs do welcome
innovative ideas or business models that can help to ease
the work process but we are totally against monopoly. It is a
known fact that competition will reduce the cost of a product
and services, while ensuring high quality. The main issue with
FOMEMA is the fee structure which has been unchanged
since its inception. What is puzzling is that while the cost
of hiring a maid has tripled from RM5,000 in 2005, and to
RM15,000 currently, our request to increase the fees as per
current market has fallen on deaf ears. With the ongoing
blame game, where fingers are being pointed at the Public
Private Partnership Unit of the Prime Ministers Department,
the issue of the unchanged FOMEMA Fee Structure remains.
Even the memorandum which had been signed by the four
major medical associations representing more than 5,000
GPs, was not acknowledged. We are being paid RM25 per
X-ray taken, whilst the operating cost is more than RM35 per
X-ray and this is not including the new software system with
transmission cost. This clearly indicates that the GPs have
always been taken for a ride, while, we continue subsidising
the huge profit-making corporate companies.
We hope that with these two reports, which we have sent to
all the relevant authorities; due consideration will be given
and these issues will be seriously addressed once and for all.
These reports have been submitted to Asia Pacific Journal of
Public Health for review and publishing.
GP Seminar & Scientific Meeting

PPSMMA in collaboration with SCHOMOS will be organising
Towards Excellence Series on 20 Feb 2016 at Sheraton
Imperial, Kuala Lumpur. Apart from the two scientific talks,
three major issues will be covered.
1. MCO/TPA: Are They Complying to MCO Guidelines?
by Dr Ahmad Razid, Pengarah Bahagian Amalan
Kesihatan Swasta, KKM.
2. What is RUUF & How Will it Affect GP Practice? by
Tuan Hj Ghazali Bin Mansor, Timb Pengarah (Perundangan
& Setiausaha Lembaga Racun) Bahagian Perkhidmatan
Farmasi, KKM.
3. Tidying Your Taxes, an Insight by LHDN by Ms Chong
Yin Yee, Pegawai Eksekutif (Penaksiran), Bahagian
Pendidikan Cukai, LHDN.
All the above sessions will be followed by a Questions &
Answers session. We have also invited representatives from
TPAs/MCOs as panellists.
PPSMMA has been working and finding ways on how many
of the contentious issues can be resolved via a series of
engagements! Registration forms are available at MMAs
website or http://goo.gl/forms/WEYryNrWbf.
18
smmams
Child Abuse and Neglect

A Conference Experience
By
Shabbitha Gobee
dr.shabz91@gmail.com
Committee Member
SMMAMS
&
Thum Chern Choong
seanthum@yahoo.com
Honorary Assistant
Secretary
SMMAMS
he Federation of Family Planning Association

of Malaysia recently held the 10th Asia Pacific
Conference on Child Abuse and Neglect at the Raja
Chulan Hotel, Kuala Lumpur. I was extremely fortunate to
be able to attend this event, along with 12 of my colleagues
from Melaka Manipal Medical College.
The programme began with a slide presentation on child
abuse. Like any good presentation, it started by painting a
gloomy picture of the epidemic of child maltreatment with
statistics, causes, and features of abuse.
Child abuse is the maltreatment by the caretaker or parent
to individuals under the age of 18, leading to serious harm
to them. There are various types of abuse, among them
physical, emotional, sexual, and neglect. While it was
illuminating listening to the talks given by experts in this
field, we were absolutely horrified by the things one could
do to an innocent and defenceless child.
A multinational discussion of Child Sex Tourism (CST)
was set up via Skype. We had the opportunity to speak
to students and community leaders from the Philippines,
Indonesia, Russia, and Bangladesh, with the Malaysian
presence led by members of the National Child Exploitation
Committee. The participants traded information and
shared the advances in the war against CST in their
respective countries.
The non-governmental international organisation ECPAT
(End Child Prostitution, Child Pornography, and Trafficking
of Children for Sexual Purposes) defines CST as a sexual
exploitation of children by a person or persons who travel
from their home district, home geographical region,
or home country in order to have sexual contract with
children. It is a form of child abuse.
Unbeknownst to many, Malaysia is deemed as one of the
source countries of CST in ASEAN, and this is alarming.
Our children are being targeted for commercial sexual
exploitation, and existing efforts are slow in responding to
this threat! Hence the staging of this event is an effort to
address this issue.
Involving the input of all the participants, including
recounting of past experiences by victims of the trade;
Prabakran Ramachandran (left) and Shabbitha Gobee
this discussion was a breakthrough in our fight against

CST. Most of us present were exposed to this disease that
has been growing silently in the Malaysian system (and
worldwide) throughout the years, and many of us resolved
to play a part in arresting its development.
Raising public awareness is the first step in winning this war,
and various sectors have to work hand in hand to achieve
this. The Government, through its influence, can make a
significant difference by taking the initiative. The media,
whether mainstream or social, has an integral role to play
in propagating the message to Malaysians of all colour and
creed. And the tourism industry, being in the eye of the
storm, has to pull out all stops to redeem its reputation of
the country being a source country of the CST epidemic.
While this event may not lead to an immediate
elimination of child abuse, it is a small step in the right
direction. Awareness and education are the first steps in
understanding an existing issue, and therefore precursors
of subsequent actions in combating the issue. I am grateful
to be given the opportunity to participate in this event; I
hope more medical personnel will pick up the baton in the
war against Child Abuse.
smmams
Elective Posting
Down Under
Introduction
Our elective placement took place at the Box Hill

Hospital which is a teaching hospital affiliated with
Monash, La Trobe and Deakin Universities in the city
of Melbourne, Victoria. It is one of the seven hospitals
that are governed within the Eastern Health network
which provides healthcare services across the Eastern
metropolitan area of Victoria. The Box Hill Hospital
provides the following services; emergency care,
general and specialist medicine, intensive care, mental
health services for children, adolescents and adults,
maternity services, post-acute care programmes
and specialist surgery. Established in 1956, Box
Hill Hospital is the largest of Eastern Healths acute
hospitals, admitting more than 48,000 patients
each year.
Elective Placement
We applied for our elective placement through
Monash University, whereby we were placed at the
Box Hill Hospital. During the elective period, we spent
four weeks in the plastic surgery department. We
joined the plastics team of consultants and registrars,
and shadowed Paul di Giovine (Registrar) as well as
Bruce Wilkie (Resident).
We met a final year medical student from Monash
University, and learnt about the culture in Australia
19
By
Shalini Nair and Hanisha Kaur
shalininair_91@hotmail.com
5th Year Medical Students
UCSI University
Members SMMAMS
as well as how the medical education differs. Elective

students were expected to attend clinic sessions, ward
rounds and observe the procedures in the operation
theatre from 9.00am to 5.00pm daily. Outside of
working hours, we also spent time together exploring
Melbourne and visiting all the famous tourist spots.
The system of medical education at Monash University
is slightly different to that of our home university
(UCSI). Fifth year students have very minimal classes
in the university and are instead expected to attend
the wards each morning and visit the patients that
are assigned to them, write follow-up notes and
find investigation results from the previous day. The
registrar then conducts a daily ward round. If any further
investigations are ordered, it is the responsibility of
the student to ensure these were carried out and the
results are delivered to the patients file in a timely
manner.
Being responsible for our own patients is something
which we had never fully experienced in Malaysia
before. We found it very rewarding and captivating
as the students are truly involved in the care that
the patients receive. Consultant ward rounds took
place weekly and after each on-call session. These
ward rounds were very lengthy as each patient was
discussed in detail. The emphasis was on education of
students and junior doctors and these sessions taught
us a great deal.
~~~
During this elective

posting, the registrars
were kind enough to
allow us to scrub in
during a procedure as
well as explain the steps
involved while they were
operating
~~~
Hanisha
Shalini
20
smmams
Clinical presentation of patients during

clinic sessions
Medical students in Melbourne are well integrated
with the clinical firm and actively participate in patient
care. We were given many opportunities to present
cases during the clinic sessions in front of consultants
and registrars and we found this worth the choice of
coming to this placement.
This experience enhanced our confidence and now we
feel that we are able to present and make valuable
contributions during ward rounds and clinic sessions
while back here in Malaysia and partake in the overall
care of the patients.
Observe procedures in the operation

theatre
In Malaysia, we have had limited opportunities to
scrub in during an operation or observe procedures
in the operation theatre. Even if we are allowed in,
we were instructed to observe from a certain distance.
However, during this elective posting, the registrars
were kind enough to allow us to scrub in during a
procedure as well as explain the steps involved while
they were operating. This allowed us to gain a more in
depth understanding of plastic surgery.
Experience working in an environment

where there is no hierarchy system
We noticed a major difference in the healthcare
working life, whereby there were no segregations
between nurses, residents, registrars and consultants.
All of them worked in a peaceful environment and
are treated equally regardless of their post in the
healthcare hierarchy which is in contrast to our local
settings. In Malaysia, there seems to be a hierarchical
Shalini (left), Dr Paul di Giovine (Registrar) and

Hanisha (right) in the OT
gap between the specialists, the junior doctors and

medical students. Setting up a meeting with the
specialists would usually require a lot of preparation
and appointment ahead of time.
Conclusion
Our elective was an extremely enjoyable and
educational experience. We feel that we have learnt
a lot, not only about plastic surgery, but medicine as
a whole. We have experienced a different healthcare
system, different culture and way of life. We feel that
this has broadened our horizons and made us more
knowledgeable about the world. As doctors, we
will meet people from all over the world, and the
experiences during this elective posting certainly met
our expectations and had given us insight into how we
should prepare ourselves for a medical career.
56h mma agm
21
56th MMA NATIONAL AGM AND SCIENTIFIC MEETING

Meritz Hotel Miri 26 29 May 2016
Pre-AGM Oncology & Palliave Medicine Conference

Meritz Hotel Miri 25 May 2016 (separate registration required)
REGISTRATION FORM
Name: _______________________________________________________________________ Age: ______________
IC Number: _____________________________________________ MMA Membership Number: _________________
Address: __________________________________________________________ Postcode: ______________________
State: ________________________________________________________________ Ocial Delegate:
Yes
No
Contact Number: (O) __________________________ (H) _________________________ (HP) ____________________

Email: ___________________________________________________________________________________________
Vegetarian:
Yes
No
Aending Naonal Banquet:
Yes
No
Aending State Dinner:
Yes
No
Spouses Name: ___________________________________________________________________________________

IC Number: _______________________________________________ Ocial Delegate (If applicable):
Yes
No
State: ________________________________ MMA Membership Number (If applicable): _______________________

Contact Number: (O) __________________________ (H) _________________________ (HP) ____________________
Email: ___________________________________________________________________________________________
Vegetarian:
Yes
No
Aending Naonal Banquet:
Yes
No
Aending State Dinner:
Yes
No
(Meals are included for registered members and registered spouses)
ACCOMPANYING CHILDREN AND GUEST(s):
Gender:
Vegetarian:
Name: _______________________________________ IC: _____________________
Yes
No
Name: _______________________________________ IC: _____________________
Yes
No
Name: _______________________________________ IC: _____________________
Yes
No
MEALS (Excluding member and spouse):

t
Extra meals chargeable at Lunch RM45 ne / Dinner RM60 ne per adult.
t
Child at Lunch RM35 ne / Dinner RM 45 ne per child (child 4 to 12 years old).
t
Annual Banquet and State Dinner chargeable at RM110 per guest (children below 12 are not allowed)
t Fellowship Night chargeable at RM80 per guest.
SPOUSES PROGRAMMES (please indicate number of PAX aending)

26 May 2016 PM
Bachata Line Dance Spouse (free)
Colouring Contest Children (free)
27 May 2016
7.00 am 8.00 am Piloxing (free)
5.00 pm 6.00 pm Kizomba Line Dance (free)
Miri City Tour (Packages by Transworld Travel Services Sdn Bhd) fees payable to Transworld Travel Services Sdn Bhd
28 May 2016
7.00 am 8.00 am Zumba Fitness (free)
5.00 pm 6.00 pm Salsa Fun Dancing (free)
Explore Your Imaginaon Contest (free)
Niah Cave Excursion (Packages by Transworld Travel Services Sdn Bhd) fees payable to Transworld Travel Services Sdn Bhd
*TransWorld Travel Services Sdn Bhd (TWT) will have a booth for delegates/family who want to arrange for other tours.
22
56th mma agm

56th MMA NATIONAL AGM AND SCIENTIFIC MEETING
Meritz Hotel Miri 26 29 May 2016
Pre-AGM Oncology & Palliave Medicine Conference

Meritz Hotel Miri 25 May 2016 (separate registration required)
AGM PAYMENT FORM

REGISTRATION FEES
Delegate @ RM100
Spouse @ RM100
EXTRA MEALS (please indicate number of PAX)

26 May 2016
Dinner @ RM 65: Adult
x ________ Child RM 45:
State Dinner @ RM 100 x ________________
27 May 2016
Lunch @ RM 45: Adult
x ________ Child RM 35:
x ________ Child RM 45:
Naonal Banquet @ RM 100 x ___________
RM ______________________
x ________
RM ______________________
x ________
x ________
28 May 2016
Lunch @ RM 45: Adult
x ________ Child RM 35:
x ________
x ________ Child RM 45:
x ________
Fellowship Night @ RM 85, Adult/Guest x _____________
@ RM 50, Child
x _____________
SPORTS PROGRAMMES (26 May 2016, Morning)
GOLF @ RM 100
BADMINTON @ RM 20
TENNIS @ RM 20
SQUASH @ RM 20
GRAND TOTAL: ______________________
RM ______________________
RM ______________________
RM ______________________
RM ______________________
Tours by TransWorld Travel Services Sdn Bhd

Accommodaon at MERITZ Hotel Miri, hp://www.meritzhotel.com/
Instrucons:
- Rates & Reservaon Form aached.
- Credit Card Authorisaon Leer aached.
- Limited Family Suites Rates on applicaon, depend on the availability
*Many hotels within 5 10 minutes walking. Please lookup at www.agoda.com or www.trivago.com.my
Payment
1)
2)
3)
Conference Registration/Meals/Sports Programmes

Malaysian Medical Association (Sarawak Branch 56th AGM)
Public Bank (PBB) Account Number: 319 687 5134
Tel/Fax: 082-507 330 (Office Hour)
H/P
: 013-862 6383 (Office Hour)
For enquiries/assistance Ms Melanie Kho
Kindly email payment slips to agmmiri@gmail.com
Hotel Accommodation
Kindly fill up attached forms & email to agmmiri@gmail.com
Secretariat will forward to Meritz Hotel for processing. Confirmation will be sent by email.
Tours (for all tours)
Kindly contact: TWT
TransWorld Travel Services Sdn Bhd
Tel: 085-422277, Fax: 085-415277, Website: www.twtmiri.com.my , Email: twtmiri@hotmail.com
Please quote 56th MMA AGM
*Note: The hotel booking form and credit card authorisation form can be downloaded from the MMA website.
general
The Pursuit of
World-Class
Primary Care:
Are We There Yet?
23
Dr Sheamini Sivasampu
Sivasamp
sheamini@crc.gov.my
Head of Healthcare Statistics Unit
National Clinical Research Centre
Life Member MMA
irst and foremost, our heartfelt thanks goes to the Berita MMA Editorial Board for featuring our National Medical Case
Statistics (NMCS) 2012 findings in the Malaysian Primary Care: Do We Know Enough? Series (Berita MMA October 2013
March 2014 Issues). Subsequent to our last report, we conducted the second cycle of the NMCS survey in 2014, which
yielded findings similar to those we reported for NMCS 2012.1,2
With the questions on morbidity and utilisation patterns as well as healthcare resources and services answered, it is time that we
evaluate the quality of care delivered in primary care settings in an effort to steer the health system towards better outcomes. The
pursuit of world-class primary care has brought us to launch the QUALICO-PC (Quality and Costs of Primary Care) study last year
to evaluate the Malaysian primary care system in terms of quality, equity, and costs of care.
What is QUALICO-PC?
The QUALICO-PC project is the single largest multinational study
of primary care in the world.
At present, the international QUALICO-PC database harbours
data for 7,007 general practitioners and 69,201 patients from
34 countries.3
The participating countries include 31 European countries
(26 European Union member states and Iceland, Norway, Turkey,
Switzerland, and Macedonia) and 3 non-European countries
(Australia, Canada, and New Zealand).3
QUALICO-PC Malaysia is the latest addition and the first in Asia!
What are the overarching goals of QUALICO-PC Malaysia?

To comprehensively evaluate the quality of primary care in Malaysia, with focus
on the four core dimensions of primary care (access, comprehensiveness,
continuity, and coordination of care).
To benchmark the quality of Malaysian primary care against other countries.
How is the quality of primary care measured and evaluated in QUALICO-PC?

Four questionnaires are used to assess the structure, process, and outcome of primary care:
The Practice Questionnaire collects information on organisational features (e.g. design and delivery of primary care) for
assessment at the system level of care.
The Doctor Questionnaire collects information on the type of tasks and services delivered (e.g. first contact care, prevention,
continuity of care, and integrated service provision) to allow for assessment at the provision level of care.
The Patient Experiences Questionnaire collects information on patients experiences with regards to coordination, continuity,
quality of care, and equity in treatment in primary care.
The Patient Values Questionnaire evaluates the importance of access, quality of care, and services delivered in primary care
from the patients perspectives.
24
general
How do we approach the conduct of QUALICO-PC in Malaysia?

Five states (Selangor, Federal Territory of Kuala Lumpur, Kelantan, Sabah, and Sarawak) are chosen to represent the general
population of the country.
Sample size: 222 public clinics and 220 private clinics (selected via stratified random sampling).
Respondents: one doctor from each clinic and ten eligible patients seen by the participating doctor on the survey day.
Two phases: Phase I for the public sector and Phase II for the private sector.
QUALICO-PC Phase I
Data collection for Phase I lasted for three
months and was completed in October 2015.
221 public clinics/doctors (response rate =
99.5%) and 2,148 patients (response rate =
90.8%) participated in the survey.
QUALICO-PC Phase II
With the support from the MMA, Pertubuhan Doktor-Doktor Islam Malaysia (PERDIM), Federation of Private Medical
Practitioners Associations Malaysia (FPMPAM), Primary Care Doctors Organisation Malaysia (PCDOM), and Medical
Practitioners Coalition Association Malaysia (MPCAM), we are set to launch the Phase II study in private clinics in midFebruary 2016.
Cooperation and support from all parties will be a key factor in the success of this survey.
We hope that this introductory overview of the QUALICO-PC study would kindle the readers interest in primary care
performance and quality improvement initiatives. Join us in our mission to build better healthcare for Malaysians by
being part of the QUALICO-PC Phase II study!
References
1. Sivasampu S, Wahab YF, Ong SM, Goh PP, Jeyaindran S. National Medical Care Statistics (NMCS) 2014. Kuala Lumpur: National Clinical Research Centre;
2016.
2. Sivasampu S, Yvonne L, Norazida AR, Hwong WY, Goh PP, Hisham AN. National Medical Care Statistics (NMCS) 2012. Kuala Lumpur: National Clinical Research
Centre; 2014.
3. Schfer WL, Boerma WG, Murante AM, Sixma HJ, Schellevis FG, Groenewegen PP. Assessing the potential for improvement of primary care in 34 countries:
a cross-sectional survey. Bull World Health Organ. 2015 Mar 1;93(3):161-8.
For more information, please do not hesitate to contact us. We are just a call away!
Healthcare Statistics Unit
National Clinical Research Centre
3rd Floor, MMA Building
124, Jalan Pahang,
53000 Kuala Lumpur
Tel No: 03-4043 9300/9400
Fax No: 03-4043 9500
www.crc.gov.my/nhsi/
Better Use of Better Statistics for Better Policies and Health Outcomes
We would like to thank the Director General of Health, Ministry of Health Malaysia for the permission to publish this
article.
general
Engaging Cancer
Patients:
The Role of Cancer Groups
25
Dr H
Hardip
ardi
dip Si
Singh
ngh
hG
Gendeh
end
hardip88@gmail.com
Member MMA, Wilayah
A Malaysian doctor previously served abroad, details his experience in engaging a cancer
support team with his patients.
Growing in numbers: Malaysian Laryngectomee Support Group by Department of Otorhinolaryngology, Head & Neck Surgery, Hospital
Cancelor Tuanku Muhriz, UKMMC. Gratitude to Associate Professor Dr Marina Mat Baki as Group Chairperson (front right), Professor Dato
Dr Abdullah Sani as Group Advisor (centre) and Associate Professor Dr Mohd Razif as the Head of Department
was struck by the great need for information that

both patients and their families had Dr Vicky
Clement-Jones1. These were the words that led
to the formation of CANCERBACKUP on 31 October
1985, marking a new era of cancer management that
changed the lives of many patients in the United
Kingdom (UK). The journey to patient engagement to
cancer background and treatment can be challenging
and demanding on healthcare professionals. This
article aims to enlighten healthcare professionals on
the role, benefits and functions of a non-profitable
cancer support service available to patients citing
Cancerbackup as an example.
GLOBOCAN indicates that there are 14.1 million newly

diagnosed cancer cases with 8.2 million cancer deaths
in 2012. Thirty two (32) million of the worlds population

are living with cancer in 201212. The Malaysian Cancer
Index reports that in the year 2012, 37,400 people were
newly diagnosed with cancer among the population
of 29.3 million. Approximately 21,000 Malaysians
succumb to cancer yearly13. Although these figures
are small in percentage compared to its denominator,
the value of numbers is large. Therefore, there are a
significant number of Malaysians who are in need of
cancer information and support.
Cancerbackup, a non-profitable charity organisation
provides up-to-date cancer information, practical
advice and support for cancer patients, family and
public, in accordance with its theme of informing,
understanding and supporting cancer patients2. In
26
general
order to achieve its aims, Cancerbackup provides a

wide range of services such as free drop-in sessions for
consultations with patients, family and friends at specific
local centres, located at cancer hospitals throughout
the country. There is a total of eight centres, three
of which are in London and the rest are in Coventry,
Ipswich, Jersey, Manchester and Nottingham. Other
forms of support include
a free phone helpline
providing
information,
advice and support from
specialist cancer nurses and
many more which will be
elaborated later. Moreover,
it is the start of a new,
revolutionary and diversified
form of cancer management,
which was at once only
managed by clinicians.
Cancer Support Team (CST)
provides a solution to the
lack of psychosocial support
in cancer management3.
a cancer patient said, Its wonderful to speak freely

without alienating the listener6. This is vital as many
find it difficult to discuss their condition with family
and friends and vice-versa, in the fear of upsetting
them. Discussions are kept confidential. Nurses
may also recommend after-care support including
support groups and therapies which might ease the
From the patients point of

view, CST is the source of
reliable, concise, updated
and
non-frightening
information. This is made
possible by the distribution
of free booklets, fact sheets Members of the Malaysian Laryngectomee Support Group sharing their experience with others
and audiotapes. Booklets
contain information on
the diagnosis, symptoms, signs, effects, treatment,
recuperating process7.
clinical trials, etc. In laymans language, thus
facilitating understanding for those without a scientific
Looking from a different perspective, CSTs help in
background4. They are available for more than 50
reducing the workload on the healthcare providers
various cancers in five different languages. Audio
shoulders. As a result, patient care in National Health
tapes cater for the illiterate and blind, contain the
Service (NHS) hospitals is now more satisfying. In the
same amount of information as in booklets. Often,
UK, Cancerbackup also acts as a middle body between
patients find it difficult to comprehend large doses
the patient and the service provider, the NHS. It aids
of information provided by clinicians during short
clinicians by passing information down to patients.
consultations. Hence, these sources allow patients
The birth of a CST is an economical investment,
to absorb information of their condition at their own
requiring only space from the hospital as other matters
pace, allowing future references as patients often
are arranged by the charity.
misremember information. Well-informed patients
On a larger scale, CSTs help in increasing cancer
also find it easier to make treatment decisions5.
awareness among the public. Everyone is granted
Besides, CSTs provide emotional support to patients,
access to cancer information. This is especially
family and friends. They are welcomed to drop in any
important in educating the public about signs and
of the centres or simply dial the call centre at any
misconceptions of cancer, which is in a worrying
time of convenience to discuss their condition with
state among the lower income group8,9. Besides,
cancer specialist nurses. Some CSTs have call centres
health professionals, patients and the public may
operating in various languages, catering for various
benefit from grants provided for cancer research
ethnicities. This allows patients to pour out their hearts
and clinical trials, supported by CSTs. In educating
content by expressing their mixed feelings as the
the community, the least CSTs could do is to send
diagnosis of cancer is always a shocking and daunting
speakers to other charitable organisations. Being a
experience. Milton (name changed for confidentiality),
charitable organisation itself, services provided by
Cancerbackup to the public is free, saving tax and

decreasing expenditure on healthcare information.
Clinicians are not to be blamed for not providing
enough emotional support to cancer patients. This
is because, clinicians often have their hands tied as
consultation times are restricted due to large numbers
of appointments. They often act in the best interest of
the patient, with beneficence in mind to provide the
best treatment in order to do what they are best at
that is saving lives. Consultations are often maximised
to obtain as much information as possible from the
patient, to decide on the best treatment options.
This gives little time to clinicians to comfort patients.
However, consultations nowadays are becoming more
patient-centred, allowing clinicians to offer emotional
support which increases patients satisfaction10,11.
Cancerbackup has since merged with the Macmillan
Cancer Support in April 2008 and are now one of the
UKs leading cancer healthcare services. The National
Cancer Council Malaysia (MAKNA) is the Malaysian
equivalent and shares a similar concept to the
Macmillan Cancer Support. MAKNA with its theme of
putting patients first serves more than 10,000 cancer
patients yearly14.
Clinicians and cancer organisations have been working

together to provide medical treatment and emotional
support respectively, hence bringing a paradigm shift
to cancer management towards achieving greater
comfort, fulfilment and satisfaction among patients.
Therefore, cancer organisations are invaluably filling in
the information gaps in the understanding of cancer,
at the same time acting as a backbone for support that
allows cancer patients to rely on when they are at their
most vulnerable state, which is after being diagnosed.
Healthcare professionals may consider engaging
or pointing their patients towards these cancer
organisations to fulfil the road of patient understanding
of their illness. More centres should be encouraged at
our local arena to provide equal access to the people
across the nation. In order to fight cancer, one must be
able to understand it and cancer organisations such as
Macmillan Cancer Support in the UK and MAKNA in
Malaysia have been helping many to achieve it.
(Endnotes)
1
Vicky Clement-Jones. Cancer & Beyond: The Formation of BACUP.

British Medical Journal, 12th October 1985, vol. 291, 1021-1023.
CANCERBACKUP available at: http://www.cancerbackup.org.uk/

Home (16th February 2008)
S. Steginga et al. Socio-demographic, psychosocial and attitudinal

predictors of help seeking after cancer diagnosis. Psycho-Oncology,
2008. Available at: http://www3.interscience.wiley.com/cgi-bin/
fulltext/117883568/PDFSTART (17th February 2008)
Debbie Coats. Understanding Cancer of the Ovary. England:

Stephen Austin, 2006.
A. Coulter, V. Entwistle & D. Gilbert. Informing Patients, an

assessment of the quality of patient information materials. London:
Kings Fund Publishing, 1998, page 30.
CANCERBACKUP Annual Report 2005- 2006 information booklet.
Interview with a specialist nurse at the Cancerbackup Information

Centre, Oncology Block, City Campus, Nottingham University
Hospitals NHS Trust, Hucknall Road, Nottingham NG5 1PB. (11th
February 2008)
N. Brunswick, J. Wardle & M.J. Jarvis. Public Awareness of

Warning Signs of Cancer in Britain. Cancer Causes & Control, 2001,
12, 33-37.
Digital Mobile Mammogram for early detection of

breast cancer.
Neera Deepak. Beyond the barriers, providing cancer information

and support for black and minority ethnic communities. Great
Britain: Dexter, 2004.
Many healthcare providers have been echoing the

spirits and concept of large CSTs by initiating their
very own support group for highly specialised cancer
treatment and management. An apparent example
would be the Malaysian Laryngectomee Support Group
initiated by the Department of Otorhinolaryngology,
Head & Neck Surgery, Hospital Canselor Tuanku
Muhriz, Universiti Kebangsaan Malaysia Medical
Centre (UKMMC). Laryngeal cancer patients post
laryngectomy at various stages and devices of voice
are able to share a table and encourage other patients
on the road to recovery and recuperation. Visit them
at https://www.facebook.com/LSG.MY/.
10 L. Zandbelt et al. Medical specialists patient-centered

communication and patient-reported outcomes. Medical Care,
April 2007, 45(4), 330-339.
Among the many services provided by MAKNA are14

MAKNAs Bursary Assistance Programme; providing
financial aid to the needy.
Provision of cancer-related medication and
treatment at the Universiti Kebangsaan Malaysia
Medical Centre (UKMMC) MAKNA Cancer Centre.
MAKNA Cancer Helpline is available at
1-800-8862562; from 9.00am to 5.00pm, Mondays
to Fridays.
Cancer Patient Survivors Gathering Event (WIRA
Kanser); a platform for cancer survivors to share and
exchange experiences.
11 E. Moja and E. Vegni. Patient-centered medicine. Annali Italiani di

Medicina Interna, Jan-March 1998, 13(1), 56-64.
12 GLOBOCAN 2012: Estimated cancer incidence, mortality and
prevalence worldwide in 2012. Available at: http://globocan.iarc.fr/
Pages/fact_sheets_cancer.aspx. [Accessed on 1st November 2015]
13 Cancer Index. Cancer Statistics. Available at http://www.cancerindex.
org/Malaysia. [Accessed 1st November 2015]
14 MAKNA-National Cancer Council Malaysia. Available at:
http://makna.org.my/ [Accessed 1st November 2015]
28
general
Vaping: A Public
Health Perspective
Dr Saraswathi Bina Rai
binarai@yahoo.com
Public Health Physician
Life Member MMA,
Penang
y introduction to vape
happened a while ago
watching a man vaping in
his van. From a distance it looked
like he was on fire frightening as
it appeared, the smoke or vapour
he created dissipated as quickly as it
was formed. Vape: a four letter word,
an issue that is now hotly debated
by both advocators and champions
against vaping.
Definition
So what exactly is vaping?
According to the Cambridge
Dictionary, vaping is the use of
E-cigarettes or other devices that
let you breathe in nicotine or other
drugs as vapour rather than smoke.
It is an electronic nicotine delivery
system (ENDS). Often the two terms:
Vape and E-cigarettes are used
interchangeably. However, there
can be slight differences between
the two.
E-cigarettes are electronic devices
that look like a regular cigarette.
They include a heating element,
battery and a disposable liquid
nicotine cartridge (available in a
variety of flavours) that produces a
smokeless and low-odour vapour.
Vapourisers, or vape pens, are
battery or USB-charged devices
that are often the size of a fountain
pen and use a different filter to
generate the vapour from liquid
nicotine that can be refilled within
the device. Vape pens produce large,
puffy clouds of vapour, whereas
E-cigarettes give off a smaller
amount of vapour, looking more like
an actual cigarette exhale. Therefore
an electronicc cigarett
cigarette
personal
te is a per
rso
onal
vapouriser but a personal vapouriser
is not necessarily an electronic
cigarette. Similar, but different.
Vaping
Vaping in many different forms and
method have been amply described
since time immemorial but the
modern day credit for E-cigarette
goes to Hon Lik in China in 2003.
He developed E-cigarettes as
an alternate means of delivering
nicotine for his own use in hopes of
giving up smoking. He got his first
patent in 2003 and introduced it to
the Chinese market the following
year. The company that he was
working for at that time was Golden
Dragon Holdings who purportedly
was so inspired that they changed
their name to Ruyan (literally
translated like smoke) and they
then marketed this product abroad.
Business was so good that in 2008
Ruyan sold 300,000 E-cigarettes.
Basically an E-cigarette is a cigaretteshaped canister filled with liquid
nicotine in various potencies. It
comes in many shapes and sizes but
basically all function similarly:
A mouthpiece through which one
inhales and starts an air flow.
The air flow triggers a sensor that
activates a small battery operated
heater.
This heater vapourises the liquid
nicotine and propylene glycol
held in a small cartridge.
The user gets a puff of hot gas
with a sensation and satisfaction
similar to tobacco smoke.
The heat also makes the tip of
the E-cigarette glow red, white or
blue depending on the brand.
The vapour quickly dissipates.
This is not a cheap habit to acquire.
To understand the attraction that it
holds for the vapers, as a medical
professional we need to know the
mechanism behind the process of
vaping.
needs
vapi
ping
ng T
To start
rt vaping
i one n
eeds
d to
first purchase a starter kit. A starter
kit consists of a battery, charger and
atomiser. There is a wide range of
starter kits available in the market
and once a person has decided on
starter kit to purchase, he will need
E-liquid. Usually the atomisers and
tanks are refillable with E-liquid. If
you search in the market, you will
note that the supplier will suggest
that one should purchase about two
to three bottles of E-liquid to find the
most suitable one. Added expense
is that an atomiser is expected to last
only two to three weeks, therefore
backup atomisers are required. This
is an expensive habit.
E-Cigarettes, Vaping and

Youth
Unfortunately E-cigarettes are
increasingly popular among youths
and adolescents. Although they
contain nicotine derived from
tobacco, they are not yet subjected
to the regulation as tobacco
products. Even with the requirements
that purchasers need to be a certain
age, or even if it is banned in a state,
some adolescent buyers get past
that by buying online. There are
many such sites in Malaysia. Their
easy availability and the plethora
of cartridge flavours (coffee, mint,
bubble gum, and strawberry) may
make them particularly appealing to
the adolescent.
Unfortunately, we do not have proof
on the long-term effects of vaping.
We do not know what the health
effects of vaping are. But early
evidence suggests that this may
serve as an introductory product
and adolescents then move on to
other tobacco-related products.
A study done by Rigotti in 2015
and published in the August issue
of JAMA showed that students
who have used E-cigarettes by
the time they start 9th Grade
are more like than others to start
traditional cigarettes and other
smokable tobacco products within

the following year. But if we do our
research we would find for every
article that discourages vaping,
another ten would be put online
extolling the virtues of vaping. This
is an uphill battle for advocators of
public health.
Nicotine Levels
A regular pack of cigarettes
contains 8 20 milligrammes (mg)
of nicotine and from that about 1
mg is absorbed when smoked. That
means from every cigarette stub
containing approximately 1.2 mg of
nicotine, the smoker will absorb 0.1
mg of nicotine. Some brands market
them with less nicotine.
In contrast, for an E-liquid, the
nicotine density is the number
of milligrammes of nicotine per
millilitre (ml). Therefore a 10 ml
bottle of 24 mg nicotine E-liquid
would contain 240 mg of nicotine. A
30 ml bottle of 24 mg E-liquid would
have 720 mg of nicotine in it. There
are roughly 20 drops of E-liquid per
millilitre. Doing our maths, there
would be 1.2mg of nicotine per
drop. Assuming one puts 3 drops of
E-liquid into the cartridge (or directly
into the atomiser), one would be
taking in 3.6 mg of nicotine from the
start of vaping until refilling. Homegrown solutions have no control on
the amount of nicotine put in.
Public Health Concerns

Our main concerns are public health
related.
It is worrisome that vaping may
normalise cigarette use if they
are permitted in areas where
cigarettes are banned.
At this point it is unclear whether
E-cigarettes are an effective
smoking-cessation aid. Instead
there is the possibility that they
could perpetuate the nicotine
addiction and therefore interfere
with quitting.
In addition, it has a potential
appeal to non-smokers especially
to children and adolescents.
The argument that its main aim
is to help tobacco users give-up
smoking just does not hold water
as the E-liquids are marketed
with enough and varied flavours
to appeal to young children, to
~~~
Even with the

requirements that
purchasers need to be a
certain age, or even if it is
banned in a state,
some adolescent buyers
get past that by
buying online
~~~
adolescent girls and right up to

adults.
There are also the possible
health risks such as the users
exposure to the E-cigarette
constituents such as flavouring
or propylene glycol and to
E-cigarette contaminants. In the
United States, law enforcement
has discovered new synthetic
drugs hitting the streets and these
drugs are being ingested by using
E-cigarettes. This method of
ingesting drugs may be the next
wave in popularity when it comes
to drug use, as it is easy to hide
what one is smoking.
The high cost of the E-liquid may
spur some to create their own
with any concoction and cocktail.
There is no control on what
products or additives are put into
this home-grown E-liquid
The way this is marketed it
describes the experience as one
would describe the experience of
climbing a mountain or surfing
a wave. The new trend is for
adolescents and youths to find
new experiences in life and this is
described as one such experience
as nicotine can produce the
dopamine effect. There is nothing
in this that facilitates or even
encourages one to stop smoking.
These products have not been
thoroughly evaluated in scientific
studies. This may change in the
near future, but for now we have
very little data on neither its safety
nor its therapeutic benefits.
What we are mostly looking at
now with concern is the penlike portable vapouriser that has
taken the industry by storm. In
addition there are also tabletop models like the Volcano and
this has been described as the
porsche of vapourisers that
delivers a larger effect to the user.
Companies are giving vapourers
a stylish makeover and elevating
its public profile of the entire
industry, making our task even
more difficult.
The level of nicotine is higher
and there is no control over the
amount or to the additives put
in especially the home-grown
version.
We have safety concerns as the
contraptions have been known to
explode and cause severe injury if
not used or handled properly.
What spurs one to vape? Maybe this
is where we should now focus our
efforts on. As long as we are not sure
what makes this habit so appealing
to the adolescent and new smoker
(or vaper), we may not really know
where to target our efforts to
curtail this disturbing but very fast
expanding habit. We can hope that
like the Tamagotchi (virtual pets)
that surfaced in the 90s as a fad
attracting millions of young children
and adolescents worldwide, vaping
would just be a fad and would
die a natural death. But with such
aggressive marketing and looking at
the profits reaped by those involved
in this business, it appears that as
public health professionals it is an
uphill battle. In our country of 29
million people, it is estimated that
there are 1 million smokers, a very
dismal statistic for public health.
As health professionals we need to
understand what vaping is all about
and the processes involved. Some
states have taken the bold move
of banning vaping and all vaperelated products. We should follow
the numerous countries that have
already banned it and advocate
banning it here completely. At
present it appears that we have
to scientifically prove that it is
dangerous or injurious to ones
health before it can be taken off the
market. Let the tables turn and let
the companies prove scientifically
and without a shadow of doubt that
vaping is safe and healthy before we
should even consider legalising it.
30
general
Armed Forces Medical

Veterans
he services of the medical and dental officers

who served in the Malaysian Armed Forces have
been duly recognised and rewarded. All medical
and dental officers who served in the
Armed Forces are now considered
Veterans irrespective of the length
of service or the type of commission.
They will be issued a KAD BEKAS
TENTERA which entitles them to
full medical benefits and other perks
enjoyed by the Short Service Officers
and Regular Commissioned Officers.
This good news was announced by
Maj Gen Dato Wira Haji Mohd Noor
Bin Haji Daud, the Director General
of Veterans Affairs during the Pingat
Jasa Malaysia Medal presentation in
January 2016.
Forty (40) medical and dental officers
were awarded the PJM Medal. This
award is given to Armed Forces
Personnel who served during the
following operations:
Operations during the confrontation
against Indonesia (Jan 1963
Dec 1965)
(L to R) Lt Col Dr Jaswant Singh (Rtd), Maj Gen Dato Wira Haji Mohd Noor
bin Haji Daud, Maj Gen Dato Pahlawan Dr R. Mohanadas (Rtd) and
Capt Dato Dr Amarjit Singh (Rtd)
Operations against the Communist Party of Malaya

(1969-1989)
Operations against the North Kalimantan
Communist Party (1969-1990)
These doctors were called to serve as National
Service Officers and later under Compulsory Service.
Most of these officers were young doctors fresh after
Housemanship and were literally thrown into the deep
end. They suffered hardships and injuries.
Two doctors lost their lives:
Dr John Ramanathan in a plane crash near Tawau
in 1970
Dr Surinder Singh in a drowning mishap in the
Rejang River in the mid-1970s
It was a sad loss of young and bright officers.
The recent PJM Medal presentation ceremony was
organised by the Persatuan Pegawai Veteran Kor
By,
Lt Col Dr Jaswant Singh (Rtd)
jaswanttexansidhu@gmail.com
Member MMA, Wilayah
Kesihatan (PPVKK). One of the objectives of our

association is to look into the welfare of our members
and their dependents. The recent medal presentation
was attended by Maj Gen Dato Pahlawan R.
Mohanadas (Rtd), senior members of the MMA and
Armed Forces Medical Corps.
For further information please contact:
Lt Col Dr Victor Feizal Abd Shatar (Rtd)
Secretary of PPVKK
Tel: +6012-399 5912 or
Email:victorfeizal@gmail.com
Col Dr V S Singam (Rtd), Vice President PPVKK
Tel: +6016-221 8894
Email:satkunasingam@hotmail.com
Lt Col Dr Jaswant Singh (Rtd), President PPVKK
Tel: +6016-313 0127
Email: jaswanttexansidhu@gmail.com
general
31
Diari Doktor Desa

(Diary of a Rural Doc)
A Song in My Heart
Dr JJean-Li
D
Li Li
Lim
jeanmd@gmail.com
Family Medicine Specialist,
Life Member MMA, N. Sembilan
The Batang Rajang at dusk from Kg Gelam, Song
~~~
To get an idea of
how tiny Song is,
a walk from one
end of town to the
other will take less
than five minutes.
If you take a
leisurely stroll,
eight minutes tops
~~~
Based on the collection of virtual diary entries I recorded for posterity, during my
stint as a Family Medicine Specialist in the hinterlands of Sarawak.
had little doubt I would be posted to East Malaysia for my gazettment as a Family
Medicine Specialist (FMS) after the completion of my Masters. Everyone in my
cohort was abuzz with anticipation as we made our posting choices from a list
given to us. I still recall some of the options available Keningau and Kota Marudu in
Sabah, Kapit, Limbang and Julau in Sarawak. However, when I received my posting
order, I was in for a surprise.
Anda dikehendaki melapor diri di penempatan anda di Klinik Kesihatan Song,
Sarawak. My heart did a deep dive... downwards. Most people I know have never
even heard of this place, let alone know where it is located. For me, Song was
not some new exotic destination. In fact, I first set foot there in 1999 as a medical
student while on transit to Kapit. The lure at that time was the vestiges of the Dayak
headhunting tradition as well as the renowned Iban tattoo artist, Robert Mayau. He
still tattoos the way his ancestors did, using the traditional hand-tapping method.
What I remembered from that sojourn was that Song was nothing more than a row of
wooden shophouses flanking a narrow set of stairs that functioned as the communitys
jetty. Perhaps, nothing more than a stop-over for those heading even deeper up into
the Dayak hinterlands. Fast-forward 13 years later, nothing has changed much. Song
is still pretty much a sleepy hollow. So then, where in the world is this little town
where time has forgotten, located?
32
general
Song is one of the districts in the Kapit division of

Sarawak. Although Song is only 85 kilometres away
from the nearest city, Sibu, it takes between two to
three hours to get there. The only way at the moment
is via the Mighty Rejang, Malaysias longest river.
The Rejang starts its life in the Iran Mountains, at the
borders of Sarawak and Indonesia and makes its way
into the South China Sea. To the locals, this murky
640-kilometre serpentine is known as Batang Rejang.
Express boats frequently ply the riverine towns and
villages by its banks. Access by land only goes as far
as Kanowit. From there it is still another hour by boat
to Song. At this point in time, there is ongoing work
to connect Song with Kanowit downriver and Kapit
upriver by land. The Song district itself is 3,935.2 square
kilometres (thanks Wikipedia!) and according to the
latest head count in 2010, has a population of around
20,046 (thanks once again Wikipedia!). The Iban form
the major ethnic group in Song, followed by the Orang
Ulu, Chinese, Malay, Melanau, and Bidayuh. Song is an
important stopover for river traffic going up the Batang
Rejang and if you are bound for Kapit, your ferry might
just linger for a while at the Song Jetty.
happens to be the only one I know that operates

office hours! Beware though; the price of petrol here is
expensive. When I was there, RON 95 was RM2.65 per
litre, while it was going at RM2.30 per litre elsewhere,
thanks to the transportation cost involved! Everything
comes in via riverine transport, including construction
material for the proposed connector road to Sibu. In
fact, most things are priced higher here. An egg costs
RM0.50 and my favourite brand of 3-in-1 instant coffee
is a whooping RM22! This is when the monthly grocery
runs to Sibu, the nearest city helps me stretch my
budget!
Floating petrol station
Song Market
Express boats plying Batang Rejang
As in most rural
Sarawakian towns,
To get an idea of how tiny
life in Song is centred
Song is, a walk from one
a ro und t he l o c a l
end of town to the other will
market or tamu. In the
take less than five minutes.
m o r ni ng , t he ta m u
If you take a leisurely stroll,
is a hive of activity
eight minutes tops. Most
as villagers from the
of these shops are either
different longhouses
Mom & Pop type kopitiams
make their way down
or our distinctly Malaysian
the Rejang tributaries
kedai runcits. The unique thing
to trade or catch-up
about these provision shops is
on the latest village
Sleepy Song Town with its pre-war wooden shophouses
that they sell everything from
gossips! The tamu
hardware, domestic goods to
is probably the best
fertilisers. As a result, they are crammed full to the
place to get local vegetables and exotic protein sources.
rafters with goods and only the proprietor knows
Many of the little old ladies there also sell meticulously
exactly where things are!
crafted beaded products, baskets and local fish traps
called bubu. By noon, calm descends once more on
If you decide to bring your vehicle upriver, do not fret
Song as the villagers catch the perahu tambang and
as there is a small Shell station here for refuelling. It
head back upriver to their respective longhouses.
One of the sign of the times here in Song is the ATM.

Prior to that, cash had to be withdrawn manually at
the post office. Our one and only ATM sees the most
action on pay day. During pay day, there is a queue of
15 to 20 people, as nearly every Government Servant
in Song (predominant from the teaching and medical
profession) will be in line to get their hard-earned
cash for the grocery run or what I call the Pay Day
Weekends in Sibu.
Kesihatan Song also happens to be the only clinic I know

with a resuscitaire and incubator! The postnatal ward is
equipped with phototherapy facilities for cases of lowrisk neonatal jaundice, as this will save the mother and
child a hour-long boat trip to the nearest hospital. As it
is, Klinik Kesihatan Song is the only available medical
facility between Kanowit and Kapit. High time some
enterprising General Practitioner comes over to open
a practice in the middle of the jungle!
Aside from the facilities mentioned
earlier, Klinik Kesihatan Song is home to
a busy Outpatient Department, Maternal
and Child Health Clinic and Dental
services. There are also special monthly
Paediatric Clinics run by the visiting
Paediatrician and Early Childhood
Intervention team from Kapit Hospital.
Believe it or not, there were only two
doctors manning this full-fledged clinic,
my medical officer and myself. We took
turns to be on-call alternate days. The
only other time I remembered having
to do calls every other day was during
the seriously short staffed surgical
posting of my housemanship. Despite
the demanding responsibilities and
Klinik Kesihatan Song
Although Song may lack the trappings of an urban city, I

must say I was pleasantly surprised by the infrastructure
at the Government Health Clinic, my home for nearly
two years. Klinik Kesihatan Song is a comprehensive
medical complex located about 1.2 kilometres away
from the jetty. If you are coming by foot, it only takes
a leisurely 15 to 20 minutes stroll to reach. Many of
the patients have no choice but to walk here. After
spending a tidy sum on the perahu tambang down
the Katibas or Ijau tributaries to get to Song Town, it
leaves them little to pay for the fare here by van sapu.
Due to the timings of the perahu tambangs, patients
are already camped outside the clinic doors before
it opens at 8.00am. By 12.00pm, the patients would
have already dwindled to a handful, as this is when
the perahu tambangs make the journey back up the
river. Those who come in the evenings are mainly local
town folk or those with their own perahus.
For a rural clinic, Klinik Kesihatan Song functions
almost like a hospital. There is the X-ray department
plus biochemical and haematological laboratory,
essentials when you have a round-the-clock Accident
& Emergency (A&E) Department. A four-bed ward
complements the A&E. Usually, this is where we
observe patients or keep them overnight till it is safe to
transfer them by boat to the nearest hospital, usually
as dawn breaks the next morning. There is also an ABC
or Alternative Birthing Centre for low-risk mothers plus
the occasional mother who comes fully in labour! Klinik
Calm before the storm at the starting of a clinic day in Song
workload, I must say I was truly blessed to have capable

medical officers (four different ones during my stint),
medical assistants and nurses who were committed
to providing the best healthcare possible to the rural
folk, despite the limited resources available. They were
a great team! Their passion was one of the reasons I
decided to stay longer than the official six months
period for gazzettment. Thank you for your sacrifices
and dedication in promoting and improving health
along Batang Rejang.
Stay tuned for the second installment of Diari
Doktor Desa!
34
general
Seminar: Future
of Medical
Education and
House Officer Training
M
MA Committee on Medical Education looks into and addresses

issues involving medical education in the country. The Committee, in
addition to giving input on medical education to the President and
the Council of MMA, has been organising seminars on medical education
annually.
Prof D
Dr K
Krishna
i h G
Gopall R
Rampal
drkgrampal@perdanauniversity.edu.my
Secretary
MMA Committee on Medical Education
The Committee Members for 2015-2016 are as follows:

Datuk Dr N. Athimulam
Prof Dato Dr N.K.S. Tharmaseelan
(Chairman)
Associate Professor Dr Jayakumar
Prof Dr Krishna Gopal Rampal
(Secretary)
Dato Dr P. Vijaya Singham
(Treasurer)
Gurusamy
Dr Chandran Rajagopal
Dr H. Krishna Kumar
Dr Tharmalingam Palanivelu
The seminar this year is on Future of Medical Education and House Officer
Training Program. It will be held at the Grand Seasons Hotel, Kuala Lumpur
on 16 April 2016. The topics being presented on training of medical students
include the current situation of medical colleges, graduate entry medical
education, school leaver medical education, problems and issues faced by
public and private medical schools, and accreditation of medical degree
programmes. Topics related to housemanship include problems faced by
the Ministry of Health related to housemanship, fast track housemanship,
attrition among housemen, and monitoring of housemen.
The seminar will be officially launched by the Minister of Health Malaysia,
Datuk Seri Dr S. Subramaniam. The topics will be delivered by prominent
academicians, policymakers and administrators involved in the delivery of
medical student and houseman training. They include Datuk Dr S. Jeyaindran,
Prof Awang Bulgiba Mahmud, Prof Dato Dr Raymond Azman Ali, Prof Datuk
Dr Abdul Razzak bin Mohd Said, Prof Dr Krishna Gopal Rampal, Prof Dato Dr
Ravindran Jegasothy, Prof Dr Nabishah Binti Mohamad, Datuk Dr Jayaram
Menon, and Datuk Dr Haji Rohaizat Bin Haji Yon. The seminar will conclude
with a panel discussion on the theme of the seminar. The committee
anticipates the seminar to be well-attended and participants to benefit from
the useful information and interesting discussion on the topics presented.
general
Humour
In a Psychiatry Clinic:
Charles: Doctor, whenever I go to bed, I

think there is somebody under the bed. I
am scared. I keep looking under the bed so
often. I cant sleep. So, I cant concentrate
on my work.
Psychiatrist: Oh I can handle this. See me
once a week for the next six months. You
will be alright.
Charles: Every week will be difficult,
expensive. I will buy the medicine instead.
Psychiatrist: No medicines for this. Only
counselling sessions.
Charles: How much do I pay for each
session?
Psychiatrist: Depends. Short sessions,
RM150. Long sessions, RM250.
Charles: Let me think about it, I will come
back.
35
Compiled by,
Dato Wira Dr LR Chandran
and his team of jokellectuals,
Alor Setar
Alex walked into a bar and loudly shouted his order:

Barman, please give me a bottle of champagne and
everybody else a bottle of Black Label, because when I drink
I want everybody else to drink.
He toasted, Cheers, mates! Everybody was happy.
After a while, he called out loud again: Barman, give me a
steak and everybody else a steak as well, because when I
eat, I want everyone to eat.
Everyone was happy again and sang, For hes a jolly good
fella!
After his drink, he shouted at the Barman again: Please
give me my bill and everyone else his own bill, because
when I pay I want everyone to pay!
Alex has not been seen since!
Three months later, the Psychiatrist meets

Charles in town.
Psychiatrist: Oh Charles, how are you, you
have not come back?
Being airborne approximately 30 minutes in an Aer Lingus

flight, the flight steward made this announcement:
Charles: Your charges are expensive

Doctor. Anyway I am cured now.
Ladies & Gentlemen, firstly our apologies. There has been a

mix-up. We have 100 passengers on board but we received
only 50 meals. We are extremely sorry for this mix-up.
Psychiatrist (surprised): How? ... and

what do you mean?
Charles: The barman near my flats, advised
me to cut off the legs from
my bed. I did just that, and
now, nobody sleeps below
my bed. I visit the bar once
a week now. I am happy,
Doc.
If anyone is kind enough to give away his meal to other

passengers, we will be glad to provide you with free drinks,
unlimited, throughout the four-hour flight.
The flight attendants were seen to be busy from then on.
The flight steward came up again two hours later with
another announcement:
Ladies & Gentlemen: If anyone would like to change their
minds again. It is fine with us. We still have 45 meals
available!
36
xx
smma
erutin
aethe
f press
The Star 7 January 2016
MMA: Doc Who Stayed to Help

Did the Right Thing
PETALING JAYA: A
doctor who stayed with
an accident victim even
though her help was refused
h a s s h ow n e xe m pl a r y
professionalism in the face
of racism, said the Malaysian
Medical Association.
Its President Dr Ashok
Zachariah Phillip said Dr
Shalini Paramaswaran did
what was best in a difficult
situation by not forcing
anything that the patient did
not want.
At the same time, she
did not let him die on the
roadside. She made sure she
was there.
I think that is the best.
If they (patients) do not want
you to touch them, then you
dont touch them. You need
their consent.
B u t yo u a l s o d o nt
want him to suffer the

c o n s e q u e n c e s of s u ch
behaviour, he said in an
interview here yesterday.
Dr Shalini had posted
on Facebook about her
experience when trying to
help the motorcyclist whom
she claimed had called her by
a derogatory racial term and
did not want her to get close
to him.
The posting had since
been shared over 3,700 times
with more than 8,300 likes.
D r A s h ok s a id D r
Shalini was very humane
and understanding of the
situation by not getting
angry.
When you are involved
in an accident, patients can
be in shock, especially with
a fracture like that.
They might not be
behaving as they normally

do, he said.
Dr Ashok said although
he had never come across
racism in his career, he
acknowledged how patients
could be difficult in any
setting.
Its not only by the
roadside. People in the
emergency room can be
quite aggressive towards the
doctors as well.
Many of us learn quite
early in our careers not to
take it personally, he said.
Asked on his advice for
doctors facing racism in the
line of duty, Dr Ashok said
patients came fi rst.
If its a social or random
situation, then I suppose
you would behave like any
normal human being. You
may get upset. But if its a
professional situation, you

make sure the patient is all
right, he added.
Netizens have rallied
behind Dr Shalini, expressing
admiration towards her
professionalism and even
offering their apologies on
behalf of the motorcyclist.
Semoga kejadian
i n i t id a k mele m a h k a n
perpaduan antara kita yang
lain (May this incident
does not weaken our unity
with one another, wrote
Facebook user Asrul Nur.
Hadi Hambali wrote:
Keep helping people doc,
were sorry for the racist
pakcik.
D u r i n g t h e D e c 29
incident, the motorcyclist
was later apologetic when he
found out that the lady who
tried to help was a doctor.
The Star Online 8 January 2016
A Cold Line Between Life and Death

PETALING JAYA: In an
environment where bacterial
growth and infections can
spell the difference between
survival and death, airconditioning plays a vital
role, say doctors.
M a l ay si a n Me d ic a l
Association President Dr
Ashok Philip said that in
general, i ntensive care
units (ICUs) should be kept
as clean as possible since
patients there were seriously
ill and could easily get
infections.
He said he could not
comment on the specifics of

the problems at Kuantans
Hospital Tengku Ampuan
Afzan as he was not aware
of the situation there, but
added that infection was a
major concern when airconditioning was affected.
If windows are open,
this may allow flies to enter,
which can lead to infections,
he said following complaints
from visitors that the airconditioning system at the
hospital in Kuantan had
failed and had even affected
the ICUs.
Mo r e ove r, h e s a id ,
doctors and nurses had to
wear gowns when carrying
out procedures in the ICU.
Imagine the sweat
dripping on to a patient
while a doctor is performing
a procedure this can also
cause infections, he said.
D r A s h ok s a id t h a t
although the problem was
manageable, fragile patients
might face unnecessary
problems.
T hu s , r e p a i r wo r k
should be done as soon as
possible, he said.
Consultant interventional
radiologist Dr Alex Tang
said air-conditioning was
very important, especially
in several critical areas in
a hospital such as the ICU
operation theatres.
It helps in controlling
the temperature, humidity
and sterile filtration, as well
as facilitating a clean and
hygienic environment.
Besides the discomfort,
f a u lt y a i r- c o n d it io n i n g
could also give rise to issues
relating to infection control,
he added.
mma in the
features
press
37
xx
News Straits Times 17 January 2016
Not All That is Natural is Good

S o m e p e o ple s hu n
modern medicine because
they feel it is not natural
and they worry about the
side effects.
There is a false
perception that natural
treatments are free of side
effects, said Malaysian
Medical Association
President Dr Ashok
Zachariah Phillip.
However, most doctors
can tell you about severe
skin allergies, liver failure
and kidney failure due to
herbal treatment. My own
belief is that anything that
has any effects at all is also
likely to have side effects.
Alternative therapies
d o n o t wo r k . Ple a s e
consider this. Doctors are
pragmatic. If something
appears to work, scientists
will study it. If it does
work, doctors will use
it and it will no longer
be alternative therapy. If
something stays alternative
it is because there are no
studies showing it to be safe
and effective.
He stressed that
universal vaccination was
extremely important in an
increasingly crowded and
connected world.
If the great majority of
us are immune to a disease
because of vaccination, then
the disease cannot spread
easily, thus protecting the
unvaccinated.
Some people cannot
be vaccinated because
of severe allergies or
immune deficiencies and
rely on this herd immunity.
So, a parents refusal to
vaccinate his child is not
purely a personal choice.
It could end up killing an
immunosuppressed child.
An immunosuppressed
individual is one whose
immune system is not
strong. Sometimes this
is due to inborn diseases
and sometimes due to
treatments such as cancer
drugs.
He cited poor science
e d u c a t io n a n d s c a r e mongering by irresponsible
people as the main reasons
for the rise of the antivaccine movement.
St u d y a f t e r s t u d y
has shown vaccines to
be safe, with no longterm detrimental effects.
In particular, no study
has shown evidence to
connect vaccines to autism.

However, for some reason
or other, parents fear these
debunked effects rather
than the very real dangers
of polio, diphtheria and
measles.
Perhaps this is actually
due to the success of earlier
vaccination campaigns. We
rarely see measles anymore,
and think of it as trivial,
whereas in a significant
number of patients it can

cause severe disability and
even death.
However, Dr Phillip
added that vaccine refusal
was not the only reason
for the observed rise in
infectious diseases in
Malaysia.
The rise in TB and the
recent outbreak of typhoid
may be related to migration
or poor hygiene.
+603 8322 8933
38
book review
Battling Adversity
By Associate Professor Dato Dr Andrew
Mohanraj Chandrasekaran
Andrew Mohanraj Chandrasekaran, ed. Battling Adversity,
Kuala Lumpur, Tun Suffian Foundation Incorporated: 2015
132 Pages
ISBN 978-983-43530-3-2
Reviewed by,
Associate Professor Dr Jayakumar Gurusamy
djkumar6@gmail.com
Perdana University Graduate School of Medicine, Perdana University
Berita MMA Editorial Board Member
Available for purchase from Pacifica Publications, E2015,
Kelana Parkview, Jalan SS6/2, 47301 Kelana Jaya,
Selangor Darul Ehsan.
Tel: +603-7806 3151 Fax: +603-7806 4151
Email: pacificapublications@gmail.com
Price: RM 29.90 (West Malaysia); RM39.90 (East Malaysia)
inclusive of postage.
attling Adversity is a collection of 41 essays on

society and mental health. The first chapter, The
Risky Side of Beauty with the opening line Defying
aging and to look younger and better is an age old
practice in all cultures to the final chapter Merdeka 2015
A wish list for improved mental health services provide
an excellent easy-to-read account of various traditional
as well as contemporary mental health issues affecting
society locally and globally. The author has given a good
flavour to this concise book with contemporary topics like
technology and pornography, selfitis, sex jihadists and
Gigolo-What love got to do with him!
Dr Andrew has vast exposure in the international arena
particularly so in tackling mental health issues post
disasters especially with his immense involvement in
the aftermath of the Asian Tsunami of 2004. In addition,
he has personal experience in handling refugee
mental health. He added another feather to his cap in
his academic portfolio by obtaining a Fellowship in
Community Psychiatry from Melbourne.
book cover
photo speaks
vol u me of
the authors concern
ncern and
empathy towards
ds the family and friends
of the crew and passengers of MH370. Dr Andrew
succinctly covered the stages of grief namely denial,
anger, bargaining, depression and finally acceptance.
Aviation mental health as well as fear of flying are the
other two aviation related topics dealt well.
It is refreshing to note stigma and discrimination in
mental health has been highlighted. The ability of the
book to keep an array of readers immersed and able to
easily comprehend the book has to be lauded. Many
people come face-to-face with life-altering adversities
in their daily hustle and bustle lifestyle. One has to
arm oneself with this practical and concise book that
provides readers simple tips and solutions to overcome
adversities. The basic theoretical knowledge in the book
is further enhanced by simple and short case scenarios
shared by the author. His personal experience in the real
world of mental health locally and abroad provides a
different twist with the manner he advises patients while
battling adversities.
As for points of enhancement to the book, the contents
could have been divided into broader three to four
sub-headings. Another aspect to refine the book is
incorporating references at the end of each chapter and
including the traditional back-of-the-book index.
He has candidly covered significant mental health

areas after disasters in the chapter Diary of a Disaster
Psychiatrist. Refuge mental health is also rightly covered
at this moment where refugee crisis has reached a
mammoth human nightmare and tragedy for numerous
western governments.
Increasing societal affluence, rat-race, the demands of

material gains over family, the technology overload and
the excessive usage of social media platforms have been
more of a bane than a boon for mankind in terms of facing
up to adversities and the related mental health issues.
Malaysia faced two aviation mishaps in recent years; one

aircraft which seemingly vanished into thin air till today.
Tears of MH 370 is another chapter no-no to miss! The
I cannot resist to take a leaf from this book with a quote

by Aristotle Education is an ornament in prosperity and
a refuge in adversity. It makes sense to grab a copy of
this book to gain some insight to battle adversity!
personality
39
Datuk Dr A. Puraviappan:
The Changing Face

of Obstetrics
Interviewed and written by,
Dr M. Nachiappan
drnachi611@gmail.com
Editorial Board Member
was now elegantly and completely bald! He is happily

married with three children. The eldest, a son who is a
Surgeon is a trainee Urologist at the General Hospital
Kuala Lumpur. The second child, a daughter, is a
medical doctor, married to Dr Amarash Dayanandan, a
Radiologist in Perth, Australia. She is now a housewife
and they are blessed with two children. The youngest,
a son, an Engineer with Postgraduate degrees in
Business and Commerce is now in Kuala Lumpur.
The Early Years & Trodden Path
Datuk Puraviappan
t was a clear and bright afternoon on 10 January

2016, when I drove down to the quaint royal town
of Klang to meet Datuk Dr Puraviappan. As I entered
the town, I was reminiscing about an old and vague
memory of him in the only casual meeting with him
and some friends in a coffee shop in Klang, some
three decades back. I had found him then as a bubbly
and charismatic doctor with grand dreams, and who
was in a hurry to realise all of them.
I made my way to the foyer of The Royal Klang Club,
and Datuk Puraviappan walked in at about the same
time. It was hard not to notice the brisk pace and
spring in his walk, which defied his age of 75 years.
We greeted each other and settled against the sofa
in the hallway of the club. His smile was warm and
spontaneous as he ordered some drinks and bites. He
had not lost any of his bubbly charm and enthusiasm
over the years. The only notable difference is that he
Datuk Puraviappan was born in Telok Intan, another

quaint and rustic town, in Perak on 16 November
1941. After his schooling he went to India and did his
MBBS in Thanjavur Medical College. As it was also
my alma mater we tried to recall some of our former
teachers, but alas, the teachers whom he fondly
remembered were not there about a decade later. He
had been a diligent student and was a Gold Medallist
in Anatomy and had won a merit prize in Obstetrics
and Gynaecology as an undergraduate.
He did his housemanship in Seremban Hospital,
and thereafter, at the age of 27 he was posted as a
Medical Officer in charge at Kuala Lipis. Later, he was
specifically posted to Raub to revamp and reorganise
the services at the hospital.
In his surgery posting he was under the late and
legendary Dato Prof Dr M. Balasegaram. He recalled
that he had to be in the wards from dawn to dusk, or
else he would be taken to task! At this period of time,
Datuk Puraviappan had wanted to do cardiothoracic
surgery, allured by the pioneering feats of the famous
Cardiac Surgeons, Dr Denton Cooley and Dr Michael
DeBacky. However it was not to be.
He left the shores of Malaysia for England in 1970 and
did his MRCOG while at St Asaph Hospital, and later
in Westminster Hospital in London. He had also done
his FRCS in Obstetrics and Gynaecology. On his return
in December 1972, he was appointed as a Lecturer at
the University of Malaya, and as an Obstetrician and
40
personality
Gynaecologist at the University Hospital. In the three

years that he was at University Hospital, he introduced
laparoscopy surgery for infertility.
He is rightfully proud that for the first time, more than

one million school children throughout Malaysia had
their eyes screened during his term of office.
In 1975 he left the University of Malaya to open a solo

private practice in Obstetrics and Gynaecology in
Klang. In 1995, he opened the Arunamari Specialist
Medical Centre, of which he was the Managing Director
and CEO, till the year 2013, when it was acquired by
the Manipal Hospital Group.
He had organised many national and regional

congresses and workshops in the field of Obstetrics
and Gynaecology. He has more than 20 papers
published in both the local and international journals.
The Obstetric Practice & Beyond

During the years of 1984 to 2007, he also held the
post of Honorary Consultant Obstetrician and
Gynaecologist at the University of Malaya Medical
Centre and was actively involved in teaching the
students. He had obtained his FRCOG in 1985 and
has been a Fellow of Academy of Medicine, Malaysia
since 1977. He is also a Fellow of Indian Academy of
Medicine since 1997.
Apart from his professional activities, he had also

established his name in the corporate world. He had
been the CEO and Managing Director of several large
plantation and development companies.
He had held top positions in many community and
service organisations, including Rotary Club. He had
been a Trustee of Sri Murugan Nilayam, an educational
organisation for Indians established by Tan Sri Dr
Thambirajah in 1982.
He had been active in sports too, especially cricket
and hockey. He had represented his school in both
these games, had been a college Cricket Captain. He
had also represented the states of Negri Sembilan and
Pahang.
He was awarded the royal title of Setia Sharafuddin
Idris Shah (S.I.S.) from DYMM Sultan of Selangor in
2004, and the Panglima Jasa Negara (P.J.N.) from the
King in 2006.
He admitted that almost every aspect of the practice of
Obstetrics and Gynaecology has changed, and yet it is
still evolving. Unassisted home deliveries and midwife
deliveries have come down substantially compared to
the 70s and 80s.
Although allowing the husbands to be with their wives
during delivery is a relatively a newer phenomenon
in Malaysia especially in public hospitals, Datuk Dr
Puraviappan had allowed the husbands into the labour
room from the early days of his practice.
Datuk Puraviappan with his wife, Datin Sakunthala
He has been active in several professional bodies over

the years. He had been the President of Obstetrics &
Gynaecology Society of Malaysia from 1983 to 1984.
From 1990 to 1991, he had been a Member of The
Council of Academy of Medicine. In 1999, he became
a Member of The Malaysian Council for Maternal
Mortality in the Ministry of Health.
He had been the Past Chairman of MMA Selangor and
a Council Member of MMA. While he was a member
of the MMA Foundation between 1988 to 1991, he
had served as the Chairman of Eye Fund of MMA
Foundation.
Solo practices for Obstetricians are becoming a rarity.

Even in large private medical facilities, the specialists
are opting to do more gynaecological work than
obstetric practice for several reasons: the number
of malpractice claims have been increasing with the
increasing awareness of the rights and expectations
of the patient; the subscription rates for professional
indemnity insurance have skyrocketed in tandem with
increasing quantum awarded in malpractice cases.
The one-man obstetric practice with ancillary support
services available in the facility may be less than ideal.
This may result in increased morbidity and mortality in
high-risk deliveries.
The art of External Cephalic Versions for Breech or
transverse lie has been largely lost. Forceps deliveries
poem
have become extremely uncommon and may be
limited to an occasional use of outlet forceps, the
mainstay of assisted vaginal delivery being vacuum
extraction.
The Caesarean Section (c-section) rate has been
steadily increasing in Malaysia and there are several
possible reasons: routine use of the partogram in
labour, the loss of skill for instrumental deliveries,
change in the practise of the management in breech
presentations, medico-legal concerns and the rise
in patient-requested c-sections. When asked about
maternal-requested c-section deliveries which include
horoscope caesarean sections, he admitted that
most Obstetricians would comply if there were no
contraindications. The reason behind this is, there is a
higher chance of being sued if the request was denied
and complications were to occur during vaginal
deliveries.
Datuk Puraviappan elaborated on the advances made
in the early detection of chromosomal abnormalities
by taking maternal blood for Foetal DNA between 11
and 13 weeks of gestation and chromosomal analysis
of Foetal embryos before embro transfer. This can also
be used to determine the sex of the child whereas by
an ultrasound it may be possible to tell the sex only
after 20 weeks.
There has been a reduction in morbidity and mortality
of Dilation & Curettage (D&C), especially as the result
of earlier diagnosis of chromosomal abnormalities in
the first trimester, and with increased usage of medical
abortions by antiprogesterone and prostaglandins
like misoprostol.
He commented on the recent positive advances made
in the treatment of infertility and in-vitro fertilisation.
There have been strides of improvement made in
reproductive laparoscopic surgery techniques for
diagnosis and management of infertility. Single
embryo implantation of embryo and increased
viable pregnancy rates due to better selection by
chromosomal screening has become an exciting
possibility, Datuk Puraviappan elaborated.
I asked Datuk Puraviappan for a message that he
would like to give the young and aspiring doctors in
his field, and he had this to say Dont lose sight of
your focus, be fully committed and embark on a subspecialty.
As I looked into his eyes and shook hands to take
leave, I felt the hands that had delivered more than
20,000 babies, and I saw a man who has travelled
through so much of obstetric history, and a man of
storks and stocks.
41
A reflection of
my life...
Look at me,
My mane my crowning glory,
Is wiry silvery tufty.
The charm the dimple,
Has lost its wrinkle, no twinkle.
The eyes which sparkled,
Is cataractic and arched.
The neck so supple,
Has lost its elasticity.
The breasts so springy and proud,
Shows its parturient sag.
The female chest so proud,
Kyphotic and osteoporotic.
The naval midriff to exhibit,
Left with striae, protuberant
and scarred over.
Posterior an asset to pride,
Is adiposed with deposition by the side.
The thigh the thunder,
Is flabby without tone no wonder.
The feet so petit,
Shoe size big fit.
They say its worth it,
To see one in your own mould.
To share, to care,
I shudder to disagree.
As I count my days,
In the old folks home.
Just look at me!
Dr Asokan Shamuganathan
Member MMA Wilayah
42
memoriam
In Memoriam:
Dr RV Pillay
n 2 December 2015, Kedah lost one of its

most prominent sons, and Sungai Petani,
its longest serving Family Practitioner, Dr
RV Pillay, at the age of 80. Dr Pillay passed away
following a short illness at Hospital Sultan Abdul
Halim, in Sungai Petani. In Private Practice for 48
years at the very same clinic he began, Dr Pillay
had a huge following of patients, some spanning
three generations. Many of them he considered as
friends, and they would often come by at his clinic
for advice and counselling, and not necessarily
when in ill health.
~~~
A well-known and
likeable personality in
the town of Sungai
Petani, he maintained
his solo practice
without
any fanfare
~~~
A well-known and likeable personality in the town

of Sungai Petani, he maintained his solo practice
without any fanfare, a simple clinic, but as a
Family Practitioner, always kept himself current.
He started CME programmes in Sungai Petani
in the 60s and headed the Chapter of the then
College of General Practitioners. Until recently he
would find the time to attend CME meetings at
the Hospital, except that car parking was getting
difficult, he said at an interview with the Berita
MMA a year ago.
Dr Pillay leaves behind his wife Yvonne, and three
daughters, but his loss will be felt by many of his
friends in Sungai Petani.
May His Soul Rest in Peace
Dato Pahlawan Dr R. Mohanadas
Editor
branch news pahang
43
MMA Pahang
5th Annual Scientific Meeting

and Installation Dinner 2015
Dr Chan Chee Eng

scenic0@yahoo.com
Member MMA, Pahang
Committee members with the Menteri Besar and the MMA President
he 5th MMA Pahang Annual Scientific Meeting was held from

15-16 August 2015 at the Vistana Hotel, Kuantan.
A wide variety of topics was delivered in the meeting such as

womens health, psychiatric disorders in the geriatric population,
dermatology, occupational health, and ENT.
A dialogue session with the PPS and SCHOMOS was conducted
on the first day of the meeting. The session was led by the
National SCHOMOS Chairman, Mr Vasu Pillai and the Hon.
General Secretary, Dr Ravindran R. Naidu.
In the afternoon on the first day, we had three concurrent
workshops which included the basic abdominal ultrasound
workshop, fetal ultrasound workshop and an interactive session
with Dr Richard Lim Boon Leong on pain management in palliative
care. The workshops enable the participants to have a hands-on
experience as well as more interactive sessions with the speakers.
The Menteri Besar of Pahang delivering his speech
Department of internal medicine of Hospital Tengku Ampuan

Afzan and International Islamic University of Malaysia also jointly
organised the meetings with MMA Pahang. The second day of
meetings mainly covered medical sub-specialty topics such as
haematology, endocrinology, cardiology, and hepatology.
Installation dinner was held on 15 August 2015 at the same venue.
This year dinner was graced by the presence of the state Menteri
Besar, YAB Dato Sri Diraja Haji Adnan Bin Haji Yaakob and MMA
President, Dr Ashok Zachariah Philip.
The tentative date for our next annual scientific meeting will be
on 13-14 August 2016. We have gathered the feedback and
requested topics from the previous participants and hopefully
in the next meeting we will able to deliver a fruitful and better
learning opportunity.
Dr Iskandar Firzada delivering a talk on contraception
44
branch news sabah
12th Rights &

Responsibilities Seminar,
Sabah 2016
T
D V
Dr
Vasanthi
hi Bi
Bintii S
Selvaraju
l
vbm_selvaraju@yahoo.com
Honorary Treasurer
National SCHOMOS
Life Member MMA, Sabah
he 12th SCHOMOS seminar on Rights and Responsibilities (R&R)

of Government Doctors, jointly organised by the Malaysian Medical
Association (MMA) and the Ministry of Health (MoH) was held at Hospital
Queen Elizabeths Auditorium Sabah on 15 January 2016 and officiated by Dr
Irene Chau, Deputy Director (Clinical II) of Hospital Queen Elizabeth (HQE) who
represented our Director General (DG) of Health, YBhg Datuk Dr Noor Hisham
Abdullah, and delivered his keynote address on Future of Doctors in Malaysia.
Our DG has been very concerned with Government Doctors issues and has been
very supportive of SCHOMOS, MMA. A welcoming speech was given by our
beloved MMA Hon. General Secretary, Dr Ravindran R. Naidu, who represented
our beloved MMA President Dr Ashok Philip Zachariah.
This event is the twelth one organised by the MMA and MoH. The first was held
at Institute for Medical Research (IMR), Kuala Lumpur, the second was held in
Penang in 2009, third was held at Sabah on 13 November 2010, fourth was held
at Kelantan on 25 February 2012, fifth was held at Johor on 3 November 2012,
sixth was held at Pahang in February 2013, seventh was held at Sarawak on
20 21 April 2013, eighth was held at Perlis in November 2013, ninth was held
at Alor Setar, Kedah on 12 April 2014, tenth was held at Kelantan for the second
time on 15 November 2014, and eleventh was held at Johor for second time
in December 2015. Sabah has taken the responsibility and task to organise this
event for the second time since 2010. We all know that
the medical profession is facing significant challenges
as we move forward towards attaining the status of a
developed nation. How do we maintain societys trust
in the medical profession? How do we ensure that we
still have the respect of the society at large? How do
we guarantee that our doctors of today and tomorrow
are competent, proficient and trustworthy? It is not just
a question of enjoying the privileges and high social
standing that has been bestowed upon us.
The objectives of this SCHOMOS seminar are:
1. To convey important information about the needs
and welfare services of the doctors.
2. To communicate the roles and responsibilities of
doctors working in the Government.
3. To support the efforts of the MoH to increase the
level of healthcare in this country.
The total number of registered participants for the
seminar was about 81, though Universiti Malaysia
Sabah initially confirmed that there would be 100
Year 4 and Year 5 clinical students joining the seminar;
due to unforeseen circumstances the medicos were
not able to attend. However, we have succeeded in
recruiting about 15 new Ordinary Members on that
day and 2 Life Members. Fifty (50) forms were filled-up
and sent to the MMA Sabah Secretariat for payment
processing. A special gratitude for the hard work
by our secretariat staff, namely Ms Rafikah Nordin
(SCHOMOS Secretariat HQ), Madam Elsie Johnson
Jinatin and Madam Floritta (MMA Sabah Executive
Secretary).
2. Requirements for Masters Programme by Prof

Dr Abdul Razak Sulaiman, Deputy Dean, Universiti
Sains Malaysia
3. Specialty and Sub-specialty Training Some
Current Developments by Dr Mohd Fikri Bin
Ujang, Senior Principal Assistant Director, Medical
Development Division, Medical Professional
Development Section
4. Promotion for Doctors by Puan Mazlina Bt
Munawar, Principal Assistant Secretary, Promotion
& Professional Unit, Human Resources, Ministry of
Health Malaysia
5. Avoiding or Minimising Medical Litigation by
Dr Mohamed Faruqi Uzair Bin Mohamed Sidek,
Assistant Director, Medico Legal Branch, Medical
Practice Division
6. Financial Aids for Government Doctors by Mr
Norali @ Awang Norali Bin Awang Damit, Principal
Assistant Director, Management Department, State
Health Department
7. Private Health Care by our HGS, Dr Ravindran R.
Naidu
8. Why is it Important to Join MMA and the Role of
SCHOMOS by Mr Vasu Pillai A/L Letchumanan,
National SCHOMOS Chairman
The seminar ended around 5.00pm and submission
of the MMA membership forms and certificates of
participation were presented to all the registered
delegates. The smooth-running of the seminar
would not have been possible if not for the untiring
and continuous support from the MMA ExCo, MMA
Sabah Council, Jabatan Kesihatan Negeri Sabah, and
Hospital Queen Elizabeth.
The upcoming 13th Rights and Responsibilities of
Government Doctors will be held at Malacca on
5 March 2016.
With the great MMA Secretariat staff and Dr N. Ganabaskaran

(MMA Hon. Deputy Secretary)
Various important topics were presented by imminent

speakers from the MoH and universities. The topics
covered were:
1. Full Registration and Service Confirmation by
Dato Dr Hj Azmi Bin Shapie, Secretary of Malaysian
Medical Council
Official launch of the 12th R&R Seminar by the Guest of Honour, Dr

Irene Chau , Deputy Director from HQE
46
mark your diary
YEAR 2016
FEBRUARY
WOMEN EMPOWERMENT SEMINAR
Date
: 20 February 2016
Venue
: Sheraton Imperial Kuala Lumpur
Contact
: Ms Rafikah Nordin
Tel
: +603-4041 1375
Fax No
: +603-4041 8187/+603-4041 9929
Email
: schomos@mma.org.my / pps@mma.org.my
Website
: Women Empowerment Seminar
ABC OF HOUSEMANSHIP IN MALAYSIA
Date
: 20 February 2016
Venue
Contact
: Ms Rafikah Nordin
Tel
: +603-4041 1375
Fax No
: +603-4041 8187/ +603-4041 9929
Email
: schomos@mma.org.my / pps@mma.org.my
Website
: ABCs of Housemanship in Malaysia
GP SEMINAR & SCIENTIFIC MEETING
Date
: 20 February 2016
Venue
Contact
: Ms Raviga
Tel
: +603-4041 1375
Fax No
: +603-4041 8187/ +603-4041 9929
Email
: pps@mma.org.my / ppsmma1@gmail.com
Website
: GP Seminar & Scientific Meeting
AOEMM MEDICAL REVIEW OFFICER COURSE (MRO) 2016
Date
: 27 28 February 2016
Venue
: Vistana Hotel, Kuala Lumpur
Organiser : Academy of Occupational & Environmental Medicine
Malaysia
Contact
: Ms Hema
Tel
: +603-4050 8211/+6012-602 0778 (9am-5pm)
Fax No
: +603-4050 8211
Email
: malaysia.aoem@gmail.com
MARCH
MAHSA INAUGURAL MEDICAL AND HEALTH EDUCATION
CONFERENCE 2016
Date
: Pre-conference workshops on 2 March 2016
: Conference 3 March 2016
Venue
: MAHSA University Kuala Lumpur
Contact
: Mrs Susan Miller & Mr Calvin Leong K.W.
Tel
: +603-7965 2555 Ext 998
Fax
: +603-7931 7118
Email
: susanmiller@mahsa.edu.my
: Calvin@mahsa.edu.my
Website
: http://www.mahsa.edu.my
AOEMM ASSISTANT MEDICAL REVIEW OFFICER (AMRO)
COURSE 2016
Date
: 5 6 March 2016
Venue
: Vistana Hotel, Kuala Lumpur
Organiser : Academy of Occupational & Environmental Medicine
Malaysia
Contact
: Ms Hema
Tel
: +603-4050 8211/+6012-602 0778 (9am-5pm)
Fax No
: +603-4050 8211
Email
: malaysia.aoem@gmail.com
8TH MALAYSIAN CONFERENCE ON HEALTHY AGEING
Theme
: Making Mental Health a Priority for
Healthy Ageing
Date
: 31 March 2 April 2016
Venue
: The Royale Bintang Kuala Lumpur, Malaysia
Tel
: +603-2070 5600 / +6012-364 6109
Fax No
: +603-2072 5600
Email
: info@healthyageing.org
Website
: http://8mhas2016.wix.com/mhas2016
APRIL
CERTIFICATE IN CLINICAL HYPNOSIS (UK UNIVERSITY
ACCREDITATION) APRIL 2016 INTAKE
Date
: 2 April 2016
Venue
: University of Malaya, Kuala Lumpur
Phone
: +603-7960 6449 / +6011-2662 4623
Email
: info@hypnosis-malaysia.com
Website
: www.lcch-asia
12TH NATIONAL SYMPOSIUM ON ADOLESCENT HEALTH
(12TH NSOAH)
Theme
: E-Teens: Empowering Teens in the Digital Age
Date
: 1 3 April 2016
Venue
: M Suites Hotel, Johor Bahru
Contact
: Ms Laila/Ms Ria
Tel
: +6013-266 5911/+6013-353 2561
Fax
: +603-4050 2422
Email
: maah.secretary@gmail.com
Website
: maah.org.my
FUTURE OF MEDICAL EDUCATION AND HOUSE OFFICER
TRAINING SEMINAR
Theme
: Moving Towards Professionalism
Date
: 16 April 2016
Venue
: Grand Seasons Hotel, Kuala Lumpur
Time
: 8.00 am 5.00 pm
Contact
: Ms Raviga
Tel
: +603-4041 1375
Fax
: +603-4041 9929
Email
: medic_edu@mma.org.my
8TH MMA SABAH PRIMARY CARE CONFERENCE
Date
: 15 17 April 2016
Venue
: Grand Ballroom, Pacific Sutera,
Kota Kinabalu, Sabah
Contact
: Elsie +6012-805 5009; Florita +6016-838 0769
Fax
: +6088-538 804
Email
: mmasbh8gpc@gmail.com
Facebook : www.facebook.com/sabahbranch.mma
MAY
56TH MMA NATIONAL ANNUAL GENERAL MEETING 2016
Date
: 26 29 May 2016
Venue
: Meritz Hotel Miri, Sarawak
Contact
: Ms Melanie Kho
Tel
: +6082-507 330 (Office Hour)
H/P
: +6013-862 6383 (Office Hour)
Fax
: +6082-507 330 (Office Hour)
Email
: agmmiri@gmail.com
JULY
MALAYSIAN THORACIC SOCIETY CONGRESS 2016
Date
: Conference workshops on 28 July 2016
: Conference 29 31 July 2016
Venue
: Hotel Equatorial, Bukit Jambul, Penang
Secretariat : Academy of Medicine
Email
: secretariat@mts.org.my
Tel
: +603-4023 4700
Enquiries : Malaysian Thoracic Society
Email
: m.thoracicsociety@gmail.com
Tel
: +603-2856 9539
Fax
: +604-229 2379
Website
: www.mts.org.my
SEPTEMBER
19TH PENANG TEACHING CONFERENCE FOR GENERAL
PRACTITIONERS ORGANISED BY MMA PENANG BRANCH
Date
: Pre-conference workshops on 15 September 2016
: Conference 16 18 September 2016
Venue
: Bayview Hotel Georgetown, Lebuh Farquhar, Penang
Contact
: Mr SP Palaniappan (Secretariat) +604-222 9188
Fax
: +604-222 9188 / +604-226 2994
Email
Enquiries
Email
Tel
:
:
:
:
19gpcourse@gmail.com
Dr Hooi Lai Ngoh
drhooi.hooi@gmail.com
+604-226 6699 & Fax: +604-229 2379

Berita MMA February 2016

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February 2016

Berita MMA Vol. 46 No. 2

MMA EXECUTIVE COMMITTEE

From the Desk of the Hon. General Secretary

Branches & Societies: Annual Report

Honorary General Treasurer

Honorary Deputy Secretaries

Child Abuse and Neglect A Conference Experience

Elective Posting Down Under

Surveys & Reports by PPSMMA

2016 AGM Registration Form

2016 AGM Payment Form

The Pursuit of World Class Primary Care: Are We There Yet?

Engaging Cancer Patients: The Role of Cancer Groups

Vaping: A Public Health Perspective

Editorial Board 2015 2016

Armed Forces Medical Veterans

Diari Doktor Desa

Seminar: Future of Medical Education and House Officer Training

Editorial Board Members

MMA: Doc Who Stayed to Help Did the Right Thing

A Cold Line Between Life and Death

Not All That is Natural is Good

12-A, Jalan PJS 8/4, Mentari Plaza, Bandar Sunway,

MMA in the Press

Datuk Dr A. Puraviappan: The Changing Face of Obstetrics

Poem: A Reflection of My Life

MMA Pahang 5th Annual Scientific Meeting and Installation

12th Rights & Responsibilities Seminar, Sabah 2016

Mark Your Diary

beritaMMA Vol.46 February 2016

Advertising Institutions of Higher

parents to higher education, with the

20 gantry advertisements of private

It is important that some

them when they graduate, then I

In my visits to these Fairs at KLCC, I

exco presidents message

Gone are the

beritaMMA Vol.46 February 2016

exco presidents message

there is no problem, but the vast majority do not get

(FAIMER), had developed a Programme for Recognition

H&A Medical Supply Sdn Bhd

From the Desk of the

Meeting with Bahagian Amalan Perubatan, Ministry of Health (MoH)

(a) Private medical

(b) Private dental

Proposal from MMA

(a) Private medical

(b) Private dental

beritaMMA Vol.46 February 2016

Proposal from MMA

(a) Private medical

(a) Private medical

(b) Private dental

(b) Private dental

beritaMMA Vol.46 February 2016

(a) less than 10

(b) 10-50 clinics

(c) more than 50

1. Private Medical Clinic

1. Private Medical Clinic

Each private medical clinic shall unless

Contact Number: (O) ______________ (H) _ (HP) ________

State: __________ MMA Membership Number (If applicable): _

Name: ___________________ IC: _

Name: ___________________ IC: _

Name: ___________________ IC: _