1Malaysia Clinic Versus District Health Clinics / Hospitals

ARCHIVES 2010

By admin-s On Mar 7, 2010

Though it would paint a remarkable picture that these initiatives are emblematic of a benevolent government superficially, it betrays a lacklustre health care policy if it is scrutinized in depth. The flawed mechanics of the clinic is a knowledge partially unknown to the public (only to patients, like myself and to the most inquisitive) but quite glaringly available to both health care providers and health administrators who have experience in running the clinic.

By The Black Cactus (http://theblackcactus.wordpress.com/)

Introduction

The first 1Malaysia Clinic was launched at Lembah Pantai, Kuala Lumpur, on the 7th of January 2010 by the Prime Minister Najib Abdul Razak. It would be located at densely populated areas so that it would address the health needs of the citizens adequately. Opening hours would be from 10.00am till 10.00pm, helmed by an experienced medical assistant and staff nurses. The scope of the clinic covers the following as mentioned by Health Minister Datuk Seri Liow Tiong Lai :

- Minor treatments for fever, cough and flu;
- Follow-up treatments for stable chronic patients like those who are diabetic, have high blood pressure and asthma cases;
- Minor surgical procedures like cleaning wounds and taking out stitches;
- Simple laboratory tests;
- Stabilising patients under emergency cases before referring them to hospitals;
- Health consultation and promotions for patients.

Most clinics would be set up at a nearby shop lot, which would be converted into a health clinic (similar to a private general practitioner’s clinic) after renovation. The cost for the 50 initial 1Malaysia Clinic was estimated at a figure of RM10 million.

Also quoted was if there were emergency cases that was beyond the ability of the 1Malaysia Clinic to cope, it would be aptly referred to the nearest hospital.

Shortfalls

This 5 part blog series will enlighten readers pertaining this issue, giving it a better perspective as a whole.

1. Extended Hours, Minimal Benefits

The 1Malaysia Clinic is opened from 10am to 10pm every day with a medical assistant in charge. It is worth to note that many District Health Clinics have an extended hours scheme that ensures services are given to patient from 8.00am to 9.00pm (10pm at some selected clinics). However the difference is that medical officers are present at a district health clinic and they do treat patients with the help of a medical assistants. Isn’t it very ironic that both clinics charge RM 1 for consultation when there is a disparity in medical care? Any citizen would pay RM 1 to see a medical practitioner (which is a privilege that they are entitled to without any extra cost upon request after seeing a medical assistant) rather than pay RM1 to just see a medical assistant at a 1Malaysia Clinic. Most patients, as any other ordinary person, yearns for optimal health care, would neglect visiting a 1Malaysia Clinic and flock to the nearest District Health Clinic which now provides similar services.

Even medications are siphoned off the District Health Clinics to be stockpiled at the 1Malaysia Clinic when there are lesser patients being seen there when compared to a District Health Clinic. It is also surprising how certain basic medications are available in abundance (and also given generously) at 1Malaysia Clinic but is kept in scarcity (and given at a ration) at a District Health Clinic which requires them more urgently where in general see majority of patients in a given district. There is clearly an overlap in a very similar job description between a District and 1Malaysia Health Clinic. And it is the patient’s will to visit either clinics (preferably a District Health Clinic which has more facilities and a doctor present).

2. So Far, Yet So Close

It is easy to recognize that if you carefully sifted through the list of 1Malaysia Clinics are currently functioning in this country, you would realize that most 1Malaysia Clinics are located at densely populated urban area consisting of affluent or middle class wage earners. Well, this is the purpose to have such clinics, some argue, so that medical care is accessible to a large number of people at a very cheap price of RM 1. But what they failed to grasp is that these urban areas already have an established District Health Clinic and mostly affluent people or middle class wage earners live there who could always afford treatment at a private centre if they are dissatisfied with the services offered in the government sector. Then, is it feasible to provide health care to densely populated areas when rural areas are deprived of these medical benefits? To any layman in the rural village, they would assume or say that the hands of medical care are not extended to them adequately. While there is a thriving District Health Clinic with myriad of highly sophisticated facilities, is there a need for a 1Malaysia Clinic to be situated at highly populated areas? Could the 1Malaysia Clinic be a project dedicated to serve remote outskirts of a district so that illnesses could be treated and referred promptly to a hospital or a District Health Clinic if required? The answers to these questions, though simple, remain highly elusive.

Most baffling would be how closely situated are both District Health Clinics and 1Malaysia Clinics are. In Negeri Sembilan for example, the Rasah District Health Clinic in Seremban is just a stone’s throw away from the Rasah Jaya 1Malaysia Clinic. Another striking example is the Seremban Jaya 1Malaysia Clinic in Senawang which is adjacent to a newly erected Senawang District Health Clinic. The usual argument naturally would be that the 1Malaysia Clinic is designed to lower the burden of the District Health Clinics which are inundated by patients on a huge scale. However what is not emphasized on is that most staff members from District Health Clinics are being rotated based on a roster to serve at the 1Malaysia Clinics from the same district. This stretches the already wafer thin human resource of medical staff at the District Health Clinic or hospitals to a near snapping point.

3. Slowing Down Urgent Emergencies

Patients, no matter how well informed or educated, are not equipped with medical knowledge and experience requisite to promptly recognize plus manage emergencies. Not knowingly, patients having a serious illness would blindly frequent a 1Malaysia Clinic, requesting for medical help.

With the absence of a medical officer at the premises of 1Malaysia Clinic, serious illnesses such as heart attacks, serious bronchial asthma, life threateningly high blood pressures or trauma cases, could face the risk of not being given the treatment they duly deserve. Also, certain life saving medical directives and procedures does not encompass the responsibilities of a medical assistant but of a medical officer.

Theoretically, stabilizing patients before sending them off to the hospital seems to be an easy and straight forward process. The fact is (and still remains till this day), there is much obstacles or red tape to sort out before achieving the final outcome of getting the patient to the hospital to begin with. Each step of referral will require making a call to a specific health care centre. The various combinations and permutations are stated below :

- Directly to the hospital
- District Health Clinic ( stabilization )à Hospital ( adequate treatment )
- This was how things were before the inception of 1Malaysia Clinic
- 1Malaysia Clinic ( little or no stabilization ) à Hospital
- 1Malaysia Clinic ( little or no stabilization ) à District Health Clinic ( stabilization ) à Hospital ( adequate treatment )

Each (à) symbol represents making a call to refer to a higher authority

Time is of essence. As illustrated above, there would only be a prolongation of a patient in receiving adequate care. Despite quoting that emergencies could be seen at 1Malaysia Clinics and referred henceforth to a hospital, this merely delays time and only serves as a ‘blanket statement’ for a clinic that is ill prepared to handle any life threatening emergencies that needs to be directly seen at a hospital (or at least a nearby District Health Clinic which hosts a medical officer).

4. Diagnosing Burden Economics With Simple Lab Tests

Simple lab tests that are offered by the 1Malaysia Clinics (Urine Dip Stick / Urine Pregnancy) are insufficient do deal with public health issues such as Dengue, Malaria, Sexually transmitted diseases (HIV, Gonorrhoea, Syphilis) and many others. Without the existence of a proper laboratory to help clinical diagnostics, there would be little (if not nil) way to treat these cases (not even a Full Blood Count or Total Serum Bilirubin test is available as of yet).

Hence, commencing follow up treatments for chronic stable diabetic patients would be inaccurate since the only available test would be a random blood glucose test (there are no laboratory investigations compulsory for diabetic treatment follow up such as HbA1c, Fasting Blood Sugar or Fasting Serum Lipid available). Even if an attempt is made to determine the control of blood glucose in the patient using the random blood glucose test, the question that remains is the intervention in the medication modification of a patient. This eventually will necessitate the medical assistant to contact a medical officer (who is at a District Health Clinic) for further instructions rather than confidently alter the medication regime himself (especially insulin dosages). Thus, there would be no real reduction in the burden of District Health Clinics or hospitals dealing with Non Communicable Diseases such as Diabetes, since (and ultimately) the final method of management lies on the discretion of medical officers at the hospital or District Health Clinics.

5. Survival Of The Subsidized Not The Fittest

The subsidized fee of just RM1 for any treatment at the nearest 1Malaysia Clinic would only spell the early demise of legally running private general practitioner’s livelihood. Private GPs who once provided access to medical treatment at populated areas now face an extremely stiff competition. This is attributed to the unfair advantage bestowed to 1Malaysia Clinics. The average sum made by a GP for treating cough and cold would usually be a modest RM20 and the similar treatment at a 1Malaysia Clinic costs only a fraction or twenty times lesser ( RM1 ). Private GPs are compelled to divide his income to pay off both rent and staff wages as well. Let us not forget that the GP thas to purchase medications at a cost that is not subsidized as how the 1Malaysia Clinics.

Most patients are oblivious to the fact that they are actually seen by a medical assistant rather than a doctor at a 1Malaysia Clinic. Majority of them are disillusioned, assuming that they are receiving medical treatment from a medical assistant. The standard care offered by a doctor and a medical assistant is substantially different. Doctors tend to be more alert in detecting subtle clues that might be overlooked by medical assistants.

From an economic standpoint, building 50 new clinics will only boost the government sector but gives little room for the private sector to flourish. Government sector involves a hugely funded enterprise which could afford bailouts and subsidies in the event of failures. Self funded private practices are founded on personal assets and unpredictable risks without any security. Though very miniscule in scale, this would create a gross imbalance in the economy. The government sector will thrive, and the private sector will inevitably succumb to its colossal competitor.

Epilogue

Issues discussed above are just tip of the iceberg that plague the inception of 1Malaysia Clinic. Very select problems have been highlighted as many other concerns could have been mentioned ( but the length of the narrative would be long and too dreary ). As a whole, as with any other pilot projects, much pondering needs to be done on ironing out the loose ends of this programme has to be undertaken. If this is not done soon, a complete overhaul is recommended.

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1Malaysia Clinic Locales

PERLIS (Jan 1)
1. Klinik 1Malaysia Kangar, No 6 Grd Floor, Jalan Lintasan Kangar, Taman Pertiwi, Kangar

KEDAH (Jan 6)
1. Klinik 1Malaysia Bandar Puteri Jaya, No 41, Grd Floor, Jalan BPJ 1/1, Bandar Puteri Jaya, Sungai Petani
2. Klinik 1Malaysia Taman Kota Kenari, No 208, Jalan Kota Kenari 3 shophouses, Taman Kota Kenari, Kulim

PENANG (Jan 6)
1. Klinik 1Malaysia Jelutong, 116, Grd Floor, Jalan Jelutong
2. Klinik 1Malaysia Teluk Air Tawar, No 6, Kedai 1 Tingkat, Lorong Teluk Air Tawar 14, Butterworth
3. Klinik 1Malaysia Batu Kawan, No 19, Lorong Cempaka 1, Taman Cempaka, Batu Kawan, Seberang Perai Selatan
4. Klinik 1Malaysia Sungai Ara: 2A1, Tkt Kenari 5, Taman Desa Ria, Sungai Ara Bayan Lepas
(Jan 7)
5. Klinik 1Malaysia Alma Jaya, No 38, Grd Floor, Lorong Alma Jaya 11, Taman Alma Jaya, Bukit Mertajam

PERAK (Jan 8)
1. Klinik 1Malaysia Teluk Intan, No 1, Taman Medan Maharaja, Jalan Kampung Banjar, Teluk Intan
2. Klinik 1Malaysia Bandar Seri Iskandar, No 32, Blok D, Bandar Seri Iskandar shophouses, Perak Tengah
3. Klinik 1Malaysia Aulong, No 51 dan 53, Jalan Medan Bersatu, Taman Medan Bersatu, Taiping
4. Klinik 1Malaysia Bercham, No 6A1 dan 10, Persiaran Medan Bercham 7, Pusat Bandar Bercham Timur, Ipoh

SELANGOR (Jan 7)
1. Klinik 1Malaysia Lembah Subang, No 112 dan 113, Blok A, Taman Putra Damai, Lembah Subang, Petaling Jaya
(End of January)
2. Klinik 1Malaysia Seri Setia, Community Hall, Jalan 230, Seksyen 51 A, Petaling Jaya
3. Klinik 1Malaysia Puchong Intan, Multipurpose Hall, Jalan 1, Puchong Intan, Batu 12, Puchong
4. Klinik 1Malaysia Kota Kemuning, Sri Nevilia Hardcore Poor Housing Programme, Kota Kemuning, Shah Alam
5. Klinik 1Malaysia Taman Samudera, Taman Samudera, Batu Caves

KUALA LUMPUR (Jan 4)
1. Klinik 1Malaysia Perkasa, B01, Blok B, Perkasa People’s Housing Programme, Jalan Nakhoda Yusof, Kampung Pandan
2. Klinik 1Malaysia Kerinchi, Lembah Pantai, B01 , Kuala Lumpur City Hall Quarters, Jalan Pantai Permai 1, off Jalan Pantai Dalam
3. Klinik 1Malaysia Taman Melati, Gombak Community Centre, Taman Melati
4. Klinik 1Malaysia Intan Baiduri, B005, PPR Intan Baiduri, Kepong Utara, Mukim Batu, Kepong
5. Klinik 1Malaysia Desa Rejang, Blok B00, PPR Desa Rejang, Setapak

NEGRI SEMBILAN (Jan 7)
1. Klinik 1Malaysia Taman Rasah Jaya, No 3773 (Grd Floor), Jalan RJ611, Taman Rasah Jaya
2. Klinik 1Malaysia Taman Seremban Jaya, No 2294 (Grd Floor), Jalan SJ10/1, Taman Seremban Jaya
3. Klinik 1Malaysia Taman Semarak 2 Nilai, PT 5742 (Grd Floor), Jalan TS 2/1E, Taman Semarak, Nilai

MALACCA (Jan 7)
1. Klinik 1Malaysia Taman Merdeka, Batu Berendam, No 39, Jalan M1, Batu Berendam
2. Klinik 1Malaysia Bukit Katil, 17, Jalan IKS, Bukit Katil
3. Klinik 1Malaysia Sri Pengkalan, Alor Gajah, KM 4615, Jalan Samarinda 2, Taman Samarinda, Pengkalan, Alor Gajah

JOHOR (Dec 28)
1. Klinik 1Malaysia Taman Megah Ria, No 15 dan 15A, Jalan Bayan 37/2, Taman Megah Ria, Masai
(Jan 4)
2. Klinik 1Malaysia Taman Manis, No 392, Jalan Manis 17, Taman Manis, Kelapa Sawit, Kulaijaya, Kulai
3. Klinik 1Malaysia Stulang Laut, Blok G, Sri Stulang 1 Flat, Bakar Batu, Johor Baru
4. Klinik 1Malaysia Bandar Sri Alam, Blok A, Sri Alam Flat, Masai, Johor Baru
5. Klinik 1Malaysia Taman Seri Lambak, JKKMB Hall, Taman Seri Lambak, Kluang

PAHANG (Jan 1)
1. Klinik 1Malaysia Kempadang, No 2E, Lot 4629, Kampung Kempadang, Kuantan
2. Klinik 1Malaysia Padang Jaya, Grd Floor, B32, Kampung Padang Jaya, off Jalan Sungai Lembing, Kuantan
3. Klinik 1Malaysia Temerloh, No 12, Grd Floor Jalan Pak Sako 4, Bandar Sri Semantan, Temerloh

TERENGGANU (Jan 3)
1.Klinik 1Malaysia Bukit Payong, Marang, No 8216, Tkt Bawah, Permint shophouses, Bukit Payong, Marang
(Jan 6)
2. Klinik 1Malaysia Wakaf Baru, Kuala Terengganu, Lot PT30712, Wakaf Baru, Mukim Kuala Nerus, Kuala Terengganu
3. Klinik 1Malaysia Binjai, Kemaman, GM562, Lot 1190, Mukim Binjai, Kemaman

KELANTAN (Jan 8)
1. Klinik 1Malaysia Sri Cemerlang, Lot 348, Jalan Sri Cemerlang, Seksyen 27, Kota Baru
(Jan 3)
2. Klinik 1Malaysia Jelawat, Lot 34, Bandar Jelawat, Bachok
3. Klinik 1Malaysia Pengkalan Batu, Lot 633B, Kampung Pengkalan Batu Jalan Pasir Pekan, Pasir Mas

SABAH (End of January)
1. Klinik 1Malaysia Bandar Sri Indah Tawau, Lot 334, TB 15058, Batu 10, Jalan Apas, Tawau
(Jan 6)
2.Klinik 1Malaysia Bundusan Square, Lot 67, Grd Floor, Blok H, Bundusan Square, Penampang
(Jan 7)
3. Klinik 1Malaysia Sandakan, Lot 7A dan 7B, Grd Floor Blok B Bandar Leila, Jalan Leila, Sandakan
(Jan 15)
4. Klinik 1Malaysia Kota Kinabalu, Lot 37, Grd Floor, Blok E, Fasa 2 Sulaiman Sentral, Kota Kinabalu

SARAWAK (Dec 31)
1. Klinik 1Malaysia Jalan Teku, Sibu, Lot 302, Blok 7, Teku Road, Sibu
(Jan 4)
2. Klinik 1Malaysia Matang Jaya, Lot 9746, Seksyen 65, KTLD Taman Lee Ling, Jalan Matang, Kuching
(Jan 5)
3. Klinik 1Malaysia Taman Tunku, Lot 2350, Blok 5, LLD Jalan Kuching, Taman Tunku, Miri
4. Klinik 1Malaysia Sungai Plan, S/L 517, Sungai Plan, Tanjung Kidurong, Bintulu
— Bernama