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Showing posts with label Doctors. Show all posts
Showing posts with label Doctors. Show all posts

Monday, December 26, 2022

Malaysia faces brain drain in every skilled sector, officials say

 

 Cause for concern: Dr Noor Hisham said the migration of health professionals was fuelled by many reasons, including economic factors. — LOW BOON TAT/The Star

Migration of health professionals was fuelled by many reasons, including economic factors. PHOTO: THE STAR/ASIA NEWS NETWORK

 

Brain drain is everywhere, says DG - The Star

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PETALING JAYA - Malaysia’s healthcare sector is not the only one facing a brain drain as other skilled sectors are facing the same problem, top officials say, as they responded to comments by a leading academic that the country’s top university loses at least 30 of its best medical graduates to Singapore every year.

New Health Minister Zaliha Mustafa said the brain drain is definitely a loss, but insisted that the right skills be inculcated to ensure that Malaysians continue to receive the highest quality services.

She said she was aware of the recommendations of the Human Resources for Health Strategy of her predecessors, including on the recruitment of doctors, improving the quality of training with clearer career pathways and improving their working conditions.

Health director-general Noor Hisham Abdullah said on Friday: “The issue of brain drain cuts across the workforce. It’s across all specialities, not only in the medical field.”

On complaints by medical students of poor working conditions, bullying, low wages, as well as inadequate training and career opportunities, he said there was no guarantee that migration would stop even if these issues ceased.

He said the migration of health professionals was fuelled by many reasons, including economic factors.

“Singapore’s currency is three times better than ours. Many Johoreans cross over to work in Singapore, so can the same argument be used?

“Even Singapore’s healthcare system has a similar issue with its citizens migrating elsewhere like to Australia,” he added.

The issue of brain loss was raised on Thursday by Professor Adeeba Kamarulzaman, who said the top college, Universiti Malaya, loses at least 30 of its best and brightest medical graduates to Singapore every year.

The professor of medicine and infectious diseases at Universiti Malaya’s medical faculty said in a tweet on Thursday that the brain drain will continue if nothing is done to address issues such as a lack of clear training and career pathways for doctors, nurses and allied health professionals

A male nurse working in Singapore told The Star that working in the Republic provided him the opportunity to gain wider experience.

“Singapore practises international standards and if I want to find jobs in Australia, New Zealand or even the United Kingdom, it will be easy for me,” he said, adding that nurses in Singapore undergo procedure competency courses frequently.

Malaysian Medical Association president Muruga Raj Rajathurai said the government needed to take steps to provide better career prospects in terms of career advancement and remuneration.

“Better pay is among the main reasons the junior doctors are leaving to work abroad. It doesn’t help that the cost of living has gone up in the country.

“Issues such as the contract system, permanent positions and even burnout need to be resolved or doctors will lose hope in the system and leave for greener pastures,” he said on Friday.

National Association of Human Resources Malaysia president Zarina Ismail, who runs a recruitment agency, said her firm found employment for qualified Malaysians such as nurses, doctors, lecturers and oil and gas professionals to work overseas.

“Many of the nurses say they don’t make enough here to have any savings at the end of the month.

“That is why they choose to look for jobs in countries like Saudi Arabia and other Middle Eastern countries, where they can earn RM12,000 (S$3,700) monthly,” she said. THE STAR/ASIA NEWS NETWORK 

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Monday, May 5, 2014

WHO's Alarm Bells: Antibiotic Resistance Now a 'Major Threat to Public Health'

The world's leading health organization is sounding serious alarm bells about the problem of antibiotic resistance.


In its first report on the issue ever, the World Health Organization (WHO) is sounding alarms about the issue of antibiotic resistance and the global public health threats it poses to our increasingly interconnected world.

"The problem is so serious that it threatens the achievements of modern medicine. A post-antibiotic era—in which common infections and minor injuries can kill—is a very real possibility for the 21st century," the report states.

Antibiotic resistance occurs when bacteria no longer die when treated with antibiotics. As a result, doctors have to use stronger, more potent antibiotics, and the more those are used, the more resistance bacteria develop to those as well. The WHO is warning that we're reaching a point in which the strongest antibiotics doctors have in their arsenal, the "treatment of last resort" drugs as they're called, no longer work.

And in fact, it's no longer just bacteria that are becoming resistant. The WHO has stopped referring to the problem as "antibiotic resistance" and now calls it "antimicrobial resistance," to encompass other organisms, such as viruses and parasites, that no longer respond to the drugs of choice. Namely, treating the viruses tuberculosis and HIV, and malaria (a parasite), has become harder as these diseases become resistant to medications. Even H1N1, the so-called "swine flu" that reached pandemic levels in 2009, has begun developing resistance to potent antiviral drugs.

Resistance Is a Worldwide Problem

One of the major points of the report is that diseases that used to be restricted to certain locales are now spreading internationally:

Among their key findings:
• Resistance to the treatment of last resort for life-threatening infections caused by a common intestinal bacteria, Klebsiella pneumonia—carbapenem antibiotics—has spread to all regions of the world. K. pneumoniae is a major cause of hospital-acquired infections such as pneumonia, bloodstream infections, infections in newborns and intensive-care unit patients. In some countries, because of resistance, carbapenem antibiotics would not work in more than half of people treated for K. pneumoniae infections.

• Treatment failure to the last resort of treatment for gonorrhea—third generation cephalosporins—has been confirmed in Austria, Australia, Canada, France, Japan, Norway, Slovenia, South Africa, Sweden and the United Kingdom. More than 1 million people are infected with gonorrhoea around the world every day.

• People with MRSA (methicillin-resistant Staphylococcus aureus) are estimated to be 64 percent more likely to die than people with a non-resistant form of the infection. MRSA, which can cause septic bloodstream infections when exposed to broken skin, is one of the most common "community-acquired" resistant infections, meaning you're likely to pick it up anywhere other people are—your gym, place of worship, a nearby park or even at schools. In the Americas, as many as 90 percent of staph infections are reported to be MRSA.

• There hasn't been a new class of antibiotics developed since the late 1980s.

We Can't Track What We Don't Know

The WHO is calling on countries all over the world to step up their surveillance of these deadly infections, something that happens rarely, if at all. An investigative report, "Hunting the Nightmare Bacteria," that ran on the PBS program Frontline in October 2013 revealed that public health officials in the U.S. have little to no data on the extent of antimicrobial resistance in this country. Healthcare facilities aren't required to report outbreaks, the report found, and many don't because they don't want to scare people or have to deal with bad PR.

“It is frankly embarrassing that we as a country do not know where resistance is occurring, how bad the problem is for various organisms or who’s using what antibiotics when,” Brad Spellberg, MD, an infectious disease doctor at Harbor-UCLA Medical Center, said in the documentary.

The Centers for Disease Control and Prevention has estimated that antimicrobial resistant infections hit two million people a year and kill at least 23,000. But the WHO notes that in most countries around the world, including the U.S., often only the most severe infections are documented and minor community-acquired infections (which can get passed along repeatedly and wind up as a severe infection) go unreported.

Clean Up the Food Supply!

For quite possibly the first time, the WHO also called out the food industry for its contribution to antimicrobial resistance. " The use of antibiotics in animal husbandry—including in livestock, poultry and fish farming—are leading to increasing recognition that urgent action is needed to avoid inappropriate use, and to reduce antibiotic usage in animal husbandry and aquaculture, as well as in humans," the report states. In the U.S., 80 percent of antibiotics sold go into animal feed to prevent infections in healthy animals or to speed growth. And we're not alone. "In many countries, the total amount of antibiotics used in animals (both food-producing and companion animals), measured as gross weight, exceeds the quantity used in the treatment of disease in humans," the authors found.

The same classes of antibiotics used on these animals are the same as those given to humans. In particular, fluoroquinolones, antibiotics used widely in the poultry industry, are increasingly ineffective against urinary tract infections caused by drug-resistant E. coli bacteria, which have been detected on all forms of supermarket meat, and against MRSA soft-tissue and skin infections.

Numerous groups in the U.S. have sued the Food and Drug Administration to revoke its approvals in animals for antibiotics that are valuable for humans. The agency's only response has been to set voluntary guidelines for the industry.

What You Can Do

Despite the damage factory farming has done to antibiotic effectiveness, the WHO and other public health officials insist that the first line of defense in controlling the problem of antimicrobial resistance is the healthcare setting: Stopping doctors from giving patients antibiotics for conditions they aren't designed to treat, for instance, when you're given antibiotics for a cold that's caused by a virus, not bacteria.

• Don't automatically ask for antibiotics when you feel sick and visit a doctor.

• If your doctor prescribes an antibiotic, ask if there's an alternative before just accepting the advice. Some doctors feel compelled to offer the drugs to make people feel better, but asking for an alternative can open up a dialogue about other options.

• When you do need an antibiotic, take the full course, even if you're feeling better.

• Wash your hands frequently to protect yourself from community-acquired infections, and keep your hands away from your nose, eyes and mouth, where infections can enter.

Contributed by  By EMILY MAIN

 Where Health Meets Life


Alarm bells over antibiotic resistance 

The World Health Organisation’s most comprehensive report to date sounds a warning that we are entering a world where antibiotics have little effect.

THE World Health Organisation (WHO) has sounded a warning that many types of disease-causing bacteria can no longer be treated with the usual antibiotics and the benefits of modern medicine are increasingly being eroded.

The comprehensive 232-page report on anti-microbial resistance with data from 114 countries shows how this threat is happening now in every region of the world and can affect anyone in any country.

Antibiotic resistance – when bacteria evolve so that antibiotics no longer work to treat infections – is described by the report as “a problem so serious that it threatens the achievements of modern medicine”.

“A post-antibiotic era, in which common infections and minor injuries can kill, far from being an apocalyptic fantasy, is instead a very real possibility for the 21st century,” said Dr Keiji Fukuda, WHO assistant director-general who coordinates its work on anti-microbial resistance.

“Without urgent, coordinated action, the world is headed for a post-antibiotic era in which common infections and minor injuries which have been treatable for decades can once again kill.

“Effective antibiotics have been one of the pillars allowing us to live longer, live healthier, and benefit from modern medicine.

“Unless we take significant actions to improve efforts to prevent infections and also change how we produce, prescribe and use antibiotics, the world will lose more and more of these global public health goods and the implications will be devastating.”

The report, “Antimicrobial Resistance: Global Report on Surveillance”, shows that resistance is occurring in many bacteria causing different infections.

It focuses on antibiotic resistance in seven bacteria responsible for common, serious diseases, such as bloodstream infections (sepsis), diarrhoea, pneumonia, urinary tract infections and gonorrhoea.

What is especially alarming is that the bacteria’s resistance has also breached “last resort” antibiotics, which are the most powerful medicines that doctors resort to when the usual ones do not work.

When patients do not respond to the usual medicines (known as first-line or first-generation medicines), doctors prescribe newer (second line medicines) which also usually also cost more.

When these also don’t work, newer and often more powerful (but sometimes with also more side effects) antibiotics are used, and they are even more expensive.

If these third-line or “last resort” medicines are not available or too costly for the patient, or if they don’t work on a patient because of antibiotic resistance, the patient remains ill or dies if the infection is a serious one.

New antibiotics have been discovered in the past to treat infections when the old ones became useless due to resistance.

But these discoveries dried up in the past 25 years.

The last completely new classes of anti-bacterial drugs were discovered in the 1980s.

Pathogens that are becoming increasingly resistant including to the more powerful antibiotics include E. coli, K. pneumonia, S. aureus, S. pneumonia, salmonelia, shigella and n. gonorrhoeae.

Key findings from the report include:

> Resistance to the treatment of last resort for life-threatening infections caused by a common intestinal bacteria, K. pneumonia — carbapenem antibiotics — has spread worldwide.

K. pneumoniae is a major cause of hospital-acquired infections such as pneumonia, bloodstream infections, infections in newborns and intensive-care unit patients.

In some countries, because of resistance, carbapenem antibiotics would not work in more than half of people treated for K. pneumoniae infections;

> Resistance to one of the most widely used antibacterial medicines for the treatment of urinary tract infections caused by E. coli – fluoroquinolones – is very widespread.

In the 1980s, when these drugs were first introduced, resistance was virtually zero.

In many countries today, this treatment is ineffective in more than half of patients;

> The sexually transmitted disease, gonorrhoea may soon be untreatable unless there are new drugs. Treatment failure to the last resort of treatment for gonorrhoea – third generation cephalosporins – has been confirmed in several countries; and

> Antibiotic resistance causes people to be sick for longer and increases the risk of death.

For example, people with MRSA (methicillin-resistant Staphylococcus aureus) are estimated to be 64% more likely to die than people with a non-resistant form of the infection.

There are many cases of patients being infected by MRSA in hospitals.

The report also gives useful information on the worrisome building up of resistance in four serious diseases — tuberculosis, malaria, HIV and influenza.

A major factor accelerating resistance is in the animal husbandry sector, where there is a liberal use of antibiotics mainly to promote the growth of the animals used for food, for commercial purposes.

This builds up resistance in the bacteria present in the animals.

These resistant germs are passed on to humans who consume the meat.

The report has a small section on the animal-food chain, which has been identified as a major problem.

The European Union has banned the use of antibiotics as growth promoters in animals, but it is still allowed in other countries.

A WHO press release on the report calls for some actions. These include:

> Setting up basic systems in countries to track and monitor the problem;

> Preventing infections from happening in the first place to reduce the need for antibiotics;

> Only prescribing and dispensing antibiotics when they are truly needed, and prescribing and dispensing the right antibiotic(s) to treat the illness;

> Patients using antibiotics only when prescribed by a doctor and completing the full prescription; and

> Developing new diagnostics, antibiotics and other tools to stay ahead of emerging resistance.

Contributed by Global Trends by Martin Khor

Martin Khor is executive director of the South Centre, a research centre of 51 developing countries, based in Geneva. You can e-mail him at director@southcentre.org. The views expressed are entirely his own.

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Wednesday, March 5, 2014

Doctors have bad days too

AS a doctor I have always been asked questions by enthusiastic parents about the job.

Among the questions are: “How is it being a doctor?”, “What do you think if my children become doctors?” and “How much do you earn per month as a doctor?”

Despite an overflow into this profession, many parents are still willing to invest in their children pursuing medicine. Recently, there was an incident in my clinic that still remains in my mind.

There was a patient complaining of the bad attitude of another medical practitioner. He was unhappy and alleged that the doctor did not explain to him politely and treat him appropriately.

I was not present at that time to comment on it, but tried to resolve the misunderstanding amicably by saying doctors too had bad days.

To my surprise, the patient replied: “To me, doctors should always have good days.”

The doctor–patient relationship is unique. It’s like a weighing scale that needs commitment from both parties to maintain its balance.

Undoubtedly, a patient sees a doctor when he or she is unwell and all patients deserve tender loving­ care from their doctors.

But how many patients have done anything to show their appreciation for what their doctors had done for them?

This is a routine day for a doctor. In government/private hospital settings, a doctor has to do ward rounds every morning at 7am, usual­ly examining 30 to 50 patients, depending on “good or bad days”.

After the rounds, the doctor continues seeing follow-up patients at the Out Patient Department (OPD) and that would easily be around 50 patients and more before late afternoon.

After the OPD service, the doctor has to do ward rounds again to review the patients.

On average, a doctor will see around 80 patients per day (working from 7am–5pm). This is one patient every 7.5 minutes.

That is why it is very common to hear patients saying that they waited two hours in the long queue, only to be treated by the doctor in a few minutes.

There is always a tendency for doctors to divide the time unequally with every patient, on a case-by-case basis. In complicated or life-threatening cases, more time is spent with the patient.

In a general practitioner’s clinic, the conditions are no better. The general practitioner is virtually trapped in the small consultation room for a whole day, seeing patients with various ailments.

Like every human being, doctors also face obstacles in life, besides the challenges from career, family, friends, etc.

Long working hours, patient load, stressful working environment and poor quality of life are issues faced by doctors.

We cannot be smiling happily all the time. Sometimes, doctors may look cold and stern. Yet, we try our best to treat the illness of each patient in every possible way.

We uphold the Hippocratic Oath that we took before joining this sacred profession. The essence of the oath is “Above all, do no harm”.

Yes, you may be right that doctors earn well. To most of the doctors, the money that we earn is merely numbers in a bank account. We might not even have a chance to spend it all.

A word of thanks, a small card from patients will truly enrich our days.

By DR H.B. CHEE Muar

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Thursday, February 20, 2014

Do You need jabs, antibiotics?


OUR population is getting more and more educated and knowledgeable. With the convenience of internet and smart phone, information can be assessed anytime and anywhere.

Facebook and Google have become the source of reference for most people. Many can now be “experts” in many specialised fields, including engineering, law and even medicine.

Nowadays, the medical practitioners enounter some patients who are so-called internet savvy, and refuse antibiotics and vaccines.

This issue arose due to the spread of such information in the internet, claiming antibiotics could lead to “superbug” and are associated with many adverse effects, while vaccines could cause autism or death.
Well, the risks of administration of both drugs are certainly debatable.

What we know for a fact is that since Alexander Flemming discovered penicillin and the pox vaccine, many lives were saved.

Nevertheless, I am not in the position to comment on the good and bad of both antibiotics and vaccines. But, it is more important for the general public to understand more about the need for antibiotics and vaccines.

Antibiotics or more specifically antibacterial, is a medicine indicated to kill (bactericidal) or inhibit the growth (bacteriostatic) of the bacteria.

There are various types of antibiotics with different mode of actions and indications. Strictly speaking, the mechanism of action for antibiotics is rather complicated.

However, it works mainly to counter attack the rapid reproduction of bacterial colonies, so that our immune system has enough time to defeat the illness.

Thus, the usage of antibiotics is strictly limited to the bacterial infection. In common clinical conditions, like acute exudative tonsillitis, abscess formation and urinary tract infection, antibiotics are strongly prescribed.

It must be understood that antibiotics have no role in curing diseases caused by fungus, virus or other parasites.

Therefore, it should not be overprescribed in cases like common cough and cold, flu and fungal infection of skin.

As for vaccines, they are biological preparations that help to boost immunity. Its primary focus is on disease prevention. It is always better to prevent a disease than to treat it.

Vaccines work by introducing the weakened form of “disease germ” into the body. The body will respond by producing antibodies to fight these invaders. At this stage, technically, the immune system is being sensitised. If the actual disease germ attacks the body, more antibodies will be produced to destroy the real enemy.

Vaccines are responsible for the control of many infectious diseases that were once common in this country and around the world, including polio, measles, diphtheria, pertussis (whooping cough), rubella (German measles), mumps, tetanus, Hepatitis B and Haemophilus influenzae type b (Hib).

Many patients question the need for further vaccination as diseases such as diphtheria, pertussis are very rare these days.

Furthermore, there are people that do not get vaccination, yet able to live healthily until old age. This is the myth behind “herd immunity”.

Herd immunity serves as a preventive barrier as most of the population had been vaccinated, thus, the disease is contained from spreading. If herd immunity is compromised, the widespread of the disease may occur.

A piece of advice to all, a little knowledge is a dangerous thing. Before you start to tell doctors about the negative effects of antibiotics and vaccines, why not, give them a chance to explain to you before you make a decision.

Contributed by DR H.B. CHEE, Muar, Johor The Star/Asia News Network

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