Ensure quality care at 1Malaysia clinics

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 our countries, urban poverty has now become a major and it time for the government to seriously address the issue.

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 the 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.

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 clinics instead of starting new 1Malaysia clinics to be manned by Medical Assistants (MA) and Staff Nurses (SN). The name itself denotes a political motive in providing health services to the urban poor.

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

MA and SN have definite and important roles in any health-care system. In fact they had played pivotal roles as ‘holding the fort’ in many hospitals, outpatient and maternal and child health clinics in the past when we did not have many doctors. They had done excellent jobs in providing dedicated and quality medical care.

There are no doubts that many of our senior nurses and MA 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 MA 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 reported shortage of doctors is only relative and with better management they can be distributed more evenly to cover these clinics.

The public must be educated not to abuse these clinics, meant for the poor, as a means to obtain cheap medication. Those who can afford should continue to patronize the private clinics and not be selfish to “compete” with the poor for treatment at these clinics. This will also allay the fears of private practitioners who have expressed concerns for their “business” with the mushrooming of these 1Malaysia clinics.

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.

Dr.Chris Anthony