More family medicine specialists soon

The Star
BY LOH FOON FONG

PETALING JAYA: More family medicine specialists are being trained to beef up primary health care and reduce congestion in hospitals.

Health director-general Datuk Seri Dr Noor Hisham Abdullah said there were now 238 family medicine specialists in health clinics and 70 in university hospitals.

“We still don’t have enough of these specialists and we hope more doctors will pursue a course in family medicine,” he said after the launch of the Primary Care Mini Conference 2014 held in conjunction with World Family Doctors’ Day yesterday.

Dr Noor Hisham said with the small numbers of such specialists, their services were only available in 25% of the 900 health clinics nationwide.

Each year, the ministry offers 60 post-graduate scholarships for doctors in the government service to pursue a Master in Family Medicine specialisation, a four-year programme under local universities.

Dr Noor Hisham said the failure rate, however, was high due to the depth and wide spectrum of fields to cover.

“Half of them failed the course and had to re-sit,” he said, adding that the training of the specialists was part of the 1Care health care transformation efforts to provide better care in the community and reduce congestion in hospitals.

“The presence of family medicine specialists helps improve the quality of services in health clinics, with services such as laboratory services, diagnostic imaging and specialist-category drugs.

“Services in health clinics will also be broadened to include community mental health, community-based rehabilitation for children with special needs and methadone replacement therapy for recovering drug addicts.”

Prof Datuk Dr D.M. Thuraiappah, convenor of the World Organisation of Family Doctors’ Working Party in Quality and Safety in Family Medicine, said general practitioners sent too many cases deemed “normal” to specialists, resulting in patients making unnecessary visits to hospitals and incurring high costs.

Family medicine specialists function as family doctors like GPs and family physicians, but they have more in-depth knowledge and expertise.

Docs in govt hospitals stretched by private students

The Star

BY LOH FOON FONG

PETALING JAYA: Too many private medical programmes nationwide are over-taxing public teaching hospitals.

While the Education Ministry’s university hospital teaching staff taught mainly their students, the general hospitals under the Health Ministry doubled up as teaching hospitals for private university students, resulting in a heavy workload, said a source.

“The doctors are overstretched. They have to divide time to attend to their patients, teach students from private universities and guide house officers,” said the source.

The source was concerned this would lead to students receiving little attention.

Private hospitals in Malaysia were not used as teaching hospitals as they did not have the needed case-mix (various types of patients) and high bed capacity to provide the needed training and exposure to students.

The source said the Cabinet needed to reduce the number of programmes and the number of students entering local medical schools by 70%, or get the private schools to merge and pull their teaching staff together.

Although the Government had argued that it needed to increase the number of doctors for the nation, he said there was more than enough doctors now and it was a case of uneven distribution.

In the Klang Valley – the doctor-patient ratio was 1:100 while in Sabah and Sarawak – 1:1,000, he said.

In Putrajaya, Deputy Health director-general Datuk Dr S. Jeyaindran admitted there were too many students taxing the limited resources.

The ministry would have to look at the nation’s needs first before deciding if it could reduce the number of medical programmes in private universities.

He said the system could cope with 2,500 to 3,000 medical graduates a year currently and foresees some private schools subsequently closing down or merging.

Two more detainees confirmed to have meningitis

The star

BY LOH FOON FONG

PETALING JAYA: Three cases of meningococcal meningitis from the Jalan Ayer Molek detention centre in Johor Baru have been confirmed, including the one reported on Friday.

Deputy Health Minister Datuk Seri Dr Hilmi Yahaya said the cases were confirmed yesterday morning and the patients were being treated in the intensive care unit (ICU).

“The detainees are given treatment and their conditions are stable,” he said in a press conference after launching the “You’re somebody’s type” blood donation drive yesterday.

He also said that the rest of the cases with general symptoms had not been confirmed.

On Friday, one confirmed case, a 43-year-old Malaysian Chinese detainee, was admitted to the Johor Baru Sultanah Aminah Hospital ICU for treatment.

Meningococcal meningitis is caused by the bacteria Neisseria meningitidis and infects the membranes that cover the brain.

It can be fatal or cause great harm if not given fast treatment.

Among the symptoms are tightness in the neck area, fever, sensitivity to light, confusion, headache and vomiting.

The infection can be passed from a carrier to another individual via droplets through coughs or sneezes.

At the event, Dr Hilmi also said that only 2.5% of Malaysians donated blood and urged more to donate.

He said that in Sweden, 10% of the population donated blood while in Britain it was 5%.

He said that people should not believe in false myths such as donating blood would affect their health or cause them to put on weight.

He urged the young to step forward to donate blood as they make up the biggest population in the country.

National Blood Centre deputy director 1 Datuk Dr Faraizah Abd Karim said that 1.4 million units of blood were needed a year.

Related story:
Overcrowding may have contributed to outbreak

Fomca: Keep tabs on who dispenses antibiotics

The star

BY LOH FOON FONG

PETALING JAYA: Easily available antibiotics without prescription at some pharmacies have been identified as another cause for increasing bacterial resistance to drugs.

Fomca vice-president Muhammad Sha’ani Abdullah said while there was a need for greater awareness of antibiotics use, enforcement also needed to be tightened.

“There must be an online register to monitor who has been dispensing antibiotics,” he said.

A 51-year-old businessman, who wanted to be known only as Chin, said he would get antibiotics from pharmacies when he failed to recover from a sore throat.

“I normally take strong lozenges and if that doesn’t help, I will go to a pharmacy and ask for antibiotics,” he said.

The Star highlighted yesterday that there was a need for doctors to limit the use of broad-spectrum antibiotics to only certain bacterial infections and that one’s misuse or overuse of antibiotics could lead to others’ deaths.

Chin said he could obtain antibiotics dispensed by pharmacists at smaller outlets in Kuala Lumpur.

He claimed to have also bought antibiotics for his son to treat his acne problem. Asked why he did not get a doctor’s prescription, he said it would cost more to do so.

Chin said he could get antibiotics for less than RM20, while going to a doctor would set him back more than RM50.

Malaysian Medical Association president Datuk Dr N.K.S. Thar­maseelan said unregulated and over-the-counter sale of antibiotics was another major cause of antibiotic resistance, adding that the Health Mi­nistry’s enforcement division needed to be vigilant and regularly monitor all pharmacies just as they did doctors.

He said some pharmacies dished out antibiotics for common coughs, cold and fever without any prescription or medical examination.

Malaysian Pharmaceutical Society president Datuk Nancy Ho noted that licensed pharmacists were not allowed to dispense antibiotics without a doctor’s prescription as it was against the Poisons Ordinance 1952.

“Patients should not opt for shortcuts as they may not get the right dose without a proper examination by doctors,” she said.

Specialist: Limit prescription rights

The star

BY LOH FOON FONG

Unnecessary use of antibiotics can result in drug-resistant bacteria.

  

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KUALA LUMPUR: Doctors should restrict the unnecessary use of broad spectrum antibiotics.

Limiting their prescription rights is also necessary in view of the increasing bacteria resistance to a wide range of antibiotics, said Universiti Malaya’s de­­partment of medicine Assoc Prof Dr Sa­­sheela Ponnampalavanar, who speciali­ses in infectious diseases.

“Although all antibiotics used for bacterial infection could cause resistance, some such as fluoroquinolones, broad spectrum cephalosporins and carbape­nams are the main drives of multi-drug resistant organisms,” she told The Star.

“These drugs should be strictly restricted to the treatment of specific bacterial infections and used only if alternative antibiotics are not available.”

Dr Sasheela said the Health Ministry should strictly monitor their use not only in public and university hospitals but also among general practitioners and private hospitals.

She said prescribing rights to these antibiotics should also be limited.

“To reduce multi-drug resistant organisms in our community, the right to prescribe these antibiotics should be given to only doctors trained to use them prudently,” she said.

For public hospitals, the prescribing of medicines, including antibiotics, is guided by the ministry’s drug formulary. The category of prescriber determines what medicines, including antibiotics, can be initiated.

In Australia, broad spectrum antibiotics could only be prescribed with approval by designated authorities for very specific infections, Dr Sasheela said.

The World Health Organisation’s Anti-microbial Resistance Global Report on Surveillance 2014 revealed antimicrobial resistance was a major threat to public health worldwide and, without urgent coordinated action by many stakeholders, common infections and minor injuries that had been treatable for decades could once again kill.

The Star reported on Friday that the National Surveillance of Antibiotic Resistance (NSAR) showed increasing resistance in bacteria towards antibiotics which could lead to some people dying when the last line of antibiotics do not work.

Dr Sasheela also said the NSAR should include private hospitals and be made easily available on the Health Ministry’s website.

“This will keep hospitals on their toes to maintain good antibiotic prescribing and infection control practices,” she said.

Most sore throat cases do not merit antibiotics use

KUALA LUMPUR: Chris (not her real name) went to see a doctor for a sore throat and he gave her antibiotics without even knowing whether the cause was bacterial or viral.

According to Sungai Buloh Medical Department head and consultant infectious diseases physician Datuk Dr Christopher Lee, 85% of sore throats were from viral infection and patients did not need antibiotics.

“Doctors need to be judicious in giving antibiotics and use clinical tools such as the Centor score to gauge whether patients have a bacterial sore throat,” he said, warning that antibiotic-resistant bacteria or superbugs could affect everyone.

He said that if patient A, loaded with normal bacteria and a small amount of resistant bacteria (superbug) as a result of previous history of overusing antibiotics, came in and was given regular antibiotics for the normal bacteria, he might be well for a while as the antibiotics would kill the normal bacteria.

However, the superbug would continue to replicate and he would become ill again with the infection driven by the superbug.

Dr Lee said those in contact with the patient could be infected by the superbug and if they had a weak immune system and other medical problems, he or she might die or require a long hospital stay.

He said doctors would then have to use stronger drugs such as carba­penems or polymixin as a result of antibiotic resistance but these drugs could impair some organs.

He stressed that the fight against antibiotic resistance must be a community, national and global effort.

MMA: Monitor private hospitals and GPs for antibiotic abuse

KUALA LUMPUR: The Malaysian Medical Association wants the private sector to be accountable for the use of antibiotics too as careless usage had contributed to the rise in antibiotic resistance.

Its president Datuk Dr N.K.S. Tharmaseelan said private hospitals should also be included in the National Surveillance of Antibiotic Resistance report, which only monitored public hospitals at present.

“As patients are paying, there may be a tendency to use more ‘expensive and stronger’ antibiotics even when there are no indications,” he said.

Dr Tharmaseelan said the Health Ministry should ensure the private sector adhered to clinical practice guidelines on antibiotic usage and urged patients not to doctor-hop and change antibiotics without completing them as this could perpetuate antibiotic resistance.

He concurred with infectious diseases expert Universiti Malaya’s department of medicine Assoc Prof Dr Sasheela Ponnam­palavanar that certain classes of antibiotics be re­­stricted in the treatment of specific bacterial infections and used only if alternative antibiotics were not available.

Dr Tharmaseelan said general practitioners did not routinely do tests to ascertain the organism cau­sing the infection because culture and sensitivity tests could be expensive and waiting for results could delay treatment.

“As such, doctors would initiate therapy based on experience and provisional diagnosis, which may lead to drug resistance too,” he said.

Growing concern over superbugs

The STar

BY LOH FOON FONG

Weak fightback: The Health Ministry is concerned that patients infected with superbugs could die or at the least be in hospital for a long time.

   

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KUALA LUMPUR: Antibiotics are becoming less effective because bacteria are mutating and the Health Ministry is concerned that patients infected with these superbugs could die or at the least be in hospital for a long time.

The ministry’s National Surveillance on Antibiotic Resistance report showed an increasing resistance by acinetobacter baumanii to the antibiotic meropenem, from 47.7% in 2007 to 58.3% last year.

That means almost 60% of patients infected with this drug-resistant bacteria cannot be treated with meropenem.

They were only responding to colistin, the last line of antibiotics and one step away from being pan drug-resistant where no antibiotics would work.

Health director-general Datuk Seri Dr Noor Hisham Abdullah said doctors should not overprescribe antibiotics despite pressure from patients to do so.

He said doctors should adhere to the guidelines and administer to their patients based on clinical judgment.

Doctors should also educate their patients regarding their illness and make them understand that viral infections could not be treated with antibiotics, he said.

As for the patients, Dr Noor Hisham said, “Don’t pressure doctors to prescribe anti­biotics and don’t self-prescribe because this could lead to dire consequences.”

Instead, other preventive measures should be considered, such as immunisation, better hand hygiene, food safety and improved sanitation, he said.

The ministry also reported that strepto­coccus pneumonia’s resistance to the anti­biotic erythromycin increased from 21% in 2007 to 39% last year.

Klebsiella pneumoniae has also recorded an increased resistance each year to the cephalosporin family of antibiotics.

For instance, its resistance to cefotaxime increased from 22.1% in 2008 to 27% last year and its resistance to ceftazidime went up from 22.3% in 2008 to 24.2% last year.

Dr Noor Hisham said surveillance on the carbapenem-resistant enterobacteriacea (CRE) superbug showed that the number of infections increased from 65 cases in 2012 to 150 cases last year, with the mortality rate rising from 9% in 2012 to 10% last year.

CRE is a type of gram-negative bacteria resistant to carbapenem antibiotics and this affects patient recovery because the antibiotics are often the last line of defence against gram-negative infections.

Crisis defused in Terengganu

The star

BY JOCELINE TAN, JOSEPH KAOS JR, FARIK ZOLKEPLI, ZUHRIN AZAM AHMAD, LOH FOON FONG, RASHVINJEET S. BEDI,TASHNY SUKUMARAN, YUEN MEIKENG, NEVILLE SPYKERMAN, HEMANANTHANI SIVANANDAM, AND G.SURACH

From left: Datuk Seri Ahmad Said, Roslee Daud and Ghazali Taib

KUALA TERENGGANU: The constitutional crisis in Terengganu may have been averted after one of the three Barisan Nasional assemblymen who quit Umno retracted his resignation while another is close to being persuaded to return following intervention by top party leaders.

At press time, Bukit Besi assemblyman Roslee Daud is back in the fold and Ajil assemblyman Ghazali Taib was close to returning to Umno. Umno supreme council member Datuk Seri Shahidan Kassim confirmed Roslee had retracted his resignation.

State executive councillor for Tourism and Culture Datuk Mohd Jidin Shafee, who is Permaisuri assemblyman, said Roslee had done so after being advised by his Umno colleagues.

However, former Mentri Besar Datuk Seri Ahmad Said, who ignited the crisis by refusing to go quietly, was still holding out.

It is understood that Commu­nications and Multimedia Minister Datuk Seri Ahmad Shabery Cheek played a key role in the negotiations with Ahmad.

Both are from the Kemaman Umno division, of which Ahmad is chairman and Shabery the deputy.

Ahmad Said, who resigned from Umno on Monday, had taken along with him Ghazali and Roslee, hours after the new Mentri Besar Datuk Ahmad Razif Abdul Rahman (pic below) was sworn in before the Sultan late that night.

It had been a dramatic day in Terengganu following Ahmad Said’s resignation.

Terengganu had been rocked by rumours that more assemblymen would be jumping ship and even that the State Legislative Assembly would be dissolved.

However, it had been an anti-climax, now that one assemblyman has decided to stay with Umno and another is set to do the same. While the negotiations were going on in Terengganu, other Barisan Nasional assemblymen were hunkered down in Putrajaya and they are expected to meet the Prime Minister after the Cabinet meeting today.

Meanwhile, Pakatan wants fresh polls in the state.

Terengganu PAS commissioner Satiful Bahri Mamat claimed that the party was not interested in taking any ex-Umno assemblyman. PAS president Datuk Seri Abdul Hadi Awang has distanced himself from the controversy, saying the party was not interested in entering a rumah berhantu(haunted house).

Earlier, the palace and the state assembly building in the heart of this oil-rich state were quiet in contrast to the roller-coaster ride of its politics.

Reporters waiting at the entrance of the palace in Bukit Cendering and the state assembly building expecting these places to be a hub of activity yesterday left disappointed.

There was hardly any movement at the palace, except for members of the press milling about at the entrance waiting for the rumoured arrival of the state Speaker.

There were no signs of the state Speaker or Ahmad Razif asking for the Sultan’s consent for the dissolution.

Kemasik assemblyman Rosli Othman, Pengkalan Berangan assemblyman A. Latiff Awang, Batu Rakit assemblymen Bazlan Abdul Rahman and Mohd Jidin were forced to deny rumours they would follow Ahmad Said.

At the Mentri Besar’s official residence where Ahmad Said was said to be holed up, there was no sign of him vacating what has been his home for the past six years.

Pressmen were led on a cat-and-mouse game with local politicians as both Ahmads (Ahmad Razif and Ahmad Said) have been elusive over their activities.

While the political manoeuvring and negotiations are at an all-time high, state events, including the Terengganu Umno liaison meeting, have been cancelled or postponed.

Related stories:

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EC: Avoid holding fresh polls in Terengganu

Power play that rocks Terengganu

State reps should put people's interest first, says Liow

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Deja vu of political crisis

Ahmad Razif to hold meeting with PM