Monday, January 18, 2010

Malaysiakini: Ensure quality at 1Malaysia clinics by Chris Anthony

Ensure quality at 1Malaysia clinics
Chris Anthony
malaysiakini, Jan 18, 10, 3:36pm
The government's decision to set up 1Malaysia clinics to serve the urban poor is a laudable one that would be most welcome especially by those in the lower income group. Like in other countries, urban poverty has now become a major issue, which the government needs to address.

More planning and funds need to be channeled to provide for the basic needs of this group of citizens who are major contributors to the development of the nation. Neglecting them will only lead to many social ills in cities and major towns.

The 1Malaysia clinic concept is indeed a positive move in caring for the welfare of these urban poor. It comes at an appropriate time when the cost of basic health care is becoming beyond the reach of many wage earners in urban areas who are struggling to cope with the economic downturn.

However, are the 1Malaysia clinics really a priority and necessity now? Why the rush to establish them with much speed? We already have the hospitals and their satellite health clinics all in major towns.

In addition, the local city councils also run maternal and child clinics.

It would be more appropriate and economical to extend and improve these existing clinics instead of starting new 1Malaysia clinics to be manned by Medical Assistants (MA) and Staff Nurses (SN). The name itself gives it a political identity and it may well be the motive behind the move.

Meanwhile there are genuine concerns from the medical fraternity regarding the quality of care at these clinics particularly when paramedical staff and not qualified doctors man them.

Medical assistants and trained staff nurses may be able to carry out simple treatment like wound dressings, giving injections and screening tests for common diseases like diabetes and hypertension but are they competent enough to diagnose and treat minor diseases?
It must be borne in mind mesthat even treatment of minor ailments is not without major complications.

Furthermore there is no way one can stop major medical emergencies from being rushed into these clinics for immediate attention. What arrangements have been made to cater for these cases?

Are these clinics properly constructed and equipped according the stringent criteria as stipulated by the Health Ministry to handle such emergencies?

Otherwise, wouldn't an unnecessary delay at these clinics be detrimental to the prognosis of these dire emergencies?

The ministry must take into consideration all these factors as they also have medico-legal implications as well. Who is responsible for deaths in these clinics?

There are no doubts that many of our senior nurses and MAs are adequately trained, capable and experienced enough to treat simple ailments but can we say that of present day MA and nurses who are mainly trained in nursing care?

Today the training is very much different; the nurses and MAs are trained in nursing care and not so much in diagnosis and treatment of diseases as we have more than enough doctors to do that.
Entrusting the treatment of diseases however minor they may appear, will not be a wise move particularly when the people's expectations are high.

The Health Ministry must do its best to get medical officers to man these clinics as that would provide more reliable and acceptable treatment to the people today. It will be the only way to reduce the number of people going to the hospitals for minor ailments.

The Health Minister's contention that we are short of doctors is not acceptable with the incredibly large number of medical schools in the country that churn out about 4,000 doctors a year.
The reported shortage of doctors is only relative and with better management they can be distributed more evenly to cover these clinics.

At a time of rapid sub-specialisation in the various medical fields, it is unfortunate that we seem to be content with para-medical staff diagnosing and treating simple ailments.
Isn't it a retrograde step? Is it right to justify the move just because it involves the poor in urban areas?

The people are entitled to the best medical care from government facilities regardless of their affordability even for minor ailments. Its quality should not be compromised just because it is provided cheap for the urban poor.

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