Call for more dialysis centres

BY LOH FOON FONG

PETALING JAYA: Nephrologists are urging the Health Ministry not to stop issuing licences to NGOs to set up haemodialysis centres in rural areas as peritoneal dialysis (PD) services cannot meet demands there.

National Nephrology Services head Datuk Dr Ghazali Ahmad said there were more than enough haemodialysis centres in the west coast of the Peninsular Malaysia but they were most inadequate in states such as Terengganu, Sabah and Sarawak.

“Not all patients were able to use PD and the Ministry should be more balanced in its policy in providing haemodialysis besides PD,” he said.

PD is a treatment for patients with severe chronic kidney disease that makes use of the patient’s peritoneum in the abdomen as the membrane to filter out waste.

However, it needs a high degree of commitment and discipline from the patient as infections can still arise if things are not properly handled.

On Tuesday, The Star carried an exclusive report on the ministry announcing that it was not issuing any more license for haemodialysis centres, and is closing down in stages, centres that did not meet its requirements.

The following day, its deputy health director-general Datuk Dr S. Jeyaindran said that it would focus more on PD than haemodialysis.

According to the ministry, as many as 5,000 Malaysians suffer end-stage kidney failures each year due to poor lifestyle habits.

Dr Ghazali said that he welcomed the shutting down of non-compliant centres as they disrupt the services in established centres by taking away trained doctors and nurses who are currently in short supply nationwide.

However, Sabah Kidney Society nephrologist Dr Liew Boon said the ministry should make exceptions for non-profit organisations in less served states.

He said that PD is unsuitable for the remote communities in Sabah because many of them did not have clean water and electricity.

“They use water from wells and there is no guarantee that they can clean their hands properly for them to handle PD,” he said, adding that low levels of hygiene could lead to infections.

He also questioned whether the ministry had the capacity to send eight litres of dialysate (a liquid needed for PD) to homes that are only accessible by boats and four-wheel drives on a weekly basis.

Dr Liew added that the ministry should not only allow some NGO-run haemodialysis centres that did not comply with staffing requirement to continue operating in underserved areas, but to lend its staff to help these centres as they desperately sort out their manpower problems.

Related story:
Minister: We are not closing our doors

Higher risk at illegal centres

THE STAR

BY LOH FOON FONG
foonfong@thestar.com.my

PETALING JAYA: The survival rate of patients is less than 50% after one year of dialysing in some unlicensed haemodialysis centres.

This is much lower than the national average of more than 80%, said a senior nephrologist.

“We do not have details as to why this is happening but we are concerned,” said the nephrologist, who declined to be named. He was responding to a report in The Staron Tuesday of the Health Ministry’s plan to close down – in stages – haemodialysis centres which did not meet requirements.

The report quoted National Kidney Foundation chairman Datuk Dr Zaki Morad as urging the ministry to approve applications for haemodialysis centres in rural areas.

Consultant nephrologist Dr Ong Loke Meng, said he was not aware of any centre with a less than 50% survival rate but, he said, some centres with a high death rate might have taken older and very ill patients.

He said the Health Ministry had, in the past, temporarily suspended centres where the patients were found to have contracted Hepatitis C. Deputy Health director-general Datuk Dr S. Jeyaindran said that the ministry was clamping down hard on centres that did not meet the requirements.

He said to make it easy for patients to check the approval status of any centre, the ministry was coming up with certificates with serial numbers that will be displayed at haemodialysis centres.

He said currently, the centres were only issued letters of approval.

Dr Jeyaindran also said that the ministry would focus more on peritoneal dialysis (PD) treatment than setting up new haemodialysis centres to make treatment more accessible to patients, especially those in rural areas.

“We are not in favour of having more haemodialysis centres because we already have an excess of capacity and they are also more expensive to maintain,” he said.

Meanwhile, the Penang Welfare, Caring Society and Environment Committee chairman Phee Boon Poh said it had obtained all the necessary approvals for the state’s CAT Dialysis Centre at the Balik Pulau market complex.

The centre is said to be the first state-run dialysis centre in the country.

For enquiries, call 04-262 0860.

Ministry says no to new dialysis centres

the star

BY LOH FOON FONG

PUTRAJAYA: The Health Ministry has stopped issuing new licences for dialysis centres and will close down existing ones that do not meet requirements and endanger patients’ safety.

There are now 560 haemodialysis centres nationwide run by NGOs and private firms but only 326 have licences from the ministry.

Deputy Health director-general Datuk Dr S. Jeyaindran said the centres that failed to meet standards would be closed down in stages after being given enough time for compliance.

The ministry would also find suitable alternative centres to relocate patients.

“Two haemodialysis centres, one in Kuala Lumpur and the other in Penang, were closed down recently,” he said.

Health woes: A patient receiving haemodialysis treatment at the CAT Dialysis Centre in Balik Pulau, Penang. 

Out of the 234 unlicensed centres, 114 had structural problems, were run without proper policies and did not submit applications for approval.

The issuance of licences to 80 centres was deferred because the operators did not comply with requirements as promised while another 40 centres did not have trained staff.

The pinching of staff also meant that some centres, whose employees had left, were unable to meet the requirements.

Operating licences of haemodialysis centres are renewable every two years, subject to meeting the ministry’s criteria.

Last month, The Star highlighted the plight of haemodialysis patients whose approvals for a government subsidy of RM600 per month were delayed.

An estimated 5,000 new kidney patients were diagnosed with end-stage kidney failure each year over the last three years. About half the patients going to NGO-run centres need treatment subsidy from the Government.

Dr Jeyaindran said the ministry had given out almost RM45mil (RM2mil in subsidy for dialysis and RM21mil in subsidy for erythropoietin injections each year), not including aid given by other government agencies.

Erythropoietin is a hormone produced by the kidneys and controls red blood cell production.

Click on graphic for larger view. 

He said the ministry was looking for companies to donate dialysis machines to ensure that the lower income group also received haemodialysis treatment with patient safety adhered to, as done by Maybank and Tabung Haji.

“We have the capacity for 1,700 dialysis slots but we only have 1,500 machines and need 200 more,” he said.

He said sponsorship from non-government entities was in keeping with the Prime Minister’s call for a public-private partnership, which encouraged optimum utilisation of resources.

On the training of renal staff, he said the ministry and the Malaysian Society of Nephrology had started a 200-hour programme on dialysis management for 60 doctors and also increased the number of renal nurses being trained.

There will be three more programmes to ensure an adequate number of trained doctors and nurses by the end of next year.

Related story:

Group: Government should set up new kidney dialysis centres in rural areas

BY RAZAK AHMAD AND RUBEN SARIO

PETALING JAYA: The National Kidney Foundation chairman Datuk Dr Zaki Morad called upon the Health Ministry to approve applications to set up new kidney dialysis centres in rural areas

“In rural areas, patients need to travel long distances, up to three times a week, to the nearest dialysis centre and this is a burden for many.

“We need more centres in smaller populated rural locations, especially in Sabah and Sarawak,” said Dr Zaki.

He said investors would not be interested in setting up dialysis centres in many rural locations because it was not possible to turn in a profit with the sparse populations.

“We should consider setting up more centres via partnerships between the government and non-profit organisations,” said Dr Zaki, adding that the centres must also be run efficiently, using the machines to treat more people.

He said that although one machine could cater to six patients, many centres only served three to four patients per machine.

For three patients in Sabah, getting to haemodialysis treatment is a two-hour boat ride followed by another two hours on a four-wheel drive vehicle to the nearest district hospital.

The patients, including an 11-year-old child from the remote interior settlement of Pagalungan in the Pensiangan district undergo this process each time they need treatment.

State Assistant Minister of Agriculture and Food Industry Datuk Sairin Karno said they would have to take a boat to Sapulut before hopping on board a four-wheel drive vehicle to the Keningau district hospital, adding that the journey was only possible if the weather was fine.

Sairin, who is Liawan assemblyman, said the Keningau hospital had six haemodialysis machines but they were insufficient.

“We have asked the authorities to provide machines to smaller hospitals such as the one in Nabawan.

“This will make the treatment more accessible to rural folk,” he said.

He said the Welfare Department should also provide financial aid to kidney patients from remote areas who have to travel to towns to get haemodialysis treatment.

Blind entrepreneur receives recognition from Govt for providing jobs to the disabled

the star

BY LOH FOON FONG

Founder of Koko Minda Food Industries (M) Sdn Bhd Salim Salleh.

SERDANG: Blind entrepreneur Salim Salleh was all smiles when he received a trophy, certificate of appreciation and a bouquet of flowers from the Government for providing jobs to the disabled.

While most disabled persons beg for jobs, Salim, 56, decided to be an employer.

Salim, who became blind in 2008 because of diabetes went on early retirement from the Anti-drug Agency and started a business producing cocoa drink with added herbs and fruits the following year.

He started his company Koko Minda Food Industries (M) Sdn Bhd and began mixing the products manually and produce 1,000 boxes (15 powder sachets per box) of the drink a month but now with mixer provided by the Department, he could produce 1,000 boxes a day.

“I did not expect to receive this recognition on a National and International Day of People with Disability,” said the elated Salim after the National Day of People with Disability yesterday.

He said that those with disabilities could compete with able bodied people and he hoped that his achievement would motivate others with disabilities to use their talent for the country.

Being a diabetic, Salim wanted to create something healthy for people and liked the cocoa drink, which contains high anti-oxidants.

He decided to mix cocoa with ginkgo biloba and brought it to the Malaysian Agricultural Research and Development Institute (Mardi) and Sirim for advice.

Mardi then advised him to add in the pegaga leaves (pennywort), dates, raisins and honey.

“I took their advice and I made the concoction and fed it to my four-year-old son and was surprised that he began to be more attentive, learned quickly, talk more and even read,” he said.

That motivated him to start developing the business with assistance provided the Human Resource Department and the Small and Medium Enterprise Corporations.

He said that when he left the Government service, he was earning RM4,000 a month but now earns RM30,000 a month, something which he did not expect.

Salim said that the Department had offered assistance to him with the agreement that he would hire other disabled people and he agreed.

He said that he pays the workers RM900 as minimum wage and more if they could be as efficient or almost as efficient as a normal bodied person.

“We pay according to their abilities and the hours they want or is able to work,” he said.

He said that the Department would be helping him order another RM500,000 mixer to increase productivity and export the products to Singapore, Indonesia and the Philippines.

Salim said that customers had told him that the nutritious drink had helped them with their health in one way or another.

A recipient on academic excellence award, wheel-chair bound Loh Xin Yee, 13, who received 7As for her UPSR in 2012 said, “If we put our minds to the things we want to achieve, it can be done,” she said who received a trophy, certificate, a bouquet of flowers and RM300.

Her mother beautician Susan Ng, 33, said that her daughter was an intelligent and dertermine child and would work towards her goals.

In her speech, Women, Family and Community Development Minister Datuk Seri Rohani Abdul Karim urged employers to offer employment opportunities and provide suitable amenities to the disabled.

“People with disabilities should not be seen as a weak group or often expecting sympathy from people but as people with potentials that could be built and polished,” she said.

She said the Human Resource Department’s records in the Peninsular Malaysia showed that from 1990 to August 2013 as many as 13,973 people with disabilities had registered for job opportunities in the private sector through the People with Disabilities Job System.

From the numbers, 9,176 (66%) people with disabilities had managed to get jobs and were placed in various sectors.

The Public Services Department showed that there were 1,754 public servants with disabilities working in various ministries, departments and government agencies, she said.