Community Health Visit: Klinik Kesihatan

An Introduction to the Malaysian Healthcare System

Most of us have been exposed to the Malaysian healthecare system one way another, be it, private clinics or government ones, even hospitals at times. The Malaysian healthcare system can be said to consist of a broad umbrella structure that encompasses the provision of healthcare to both urban, not to mentioni also, the rural regions of our beloved country. In general however, it can be classified under the public or private sector, which is very obvious in our country. The public sector which is backed financially by the government, constitutes a whopping 80% of the total health services in our country, the remaining 20%, needless to say, is provided by the private sector.

The backbone, or in other words, basis of Malaysian Healthcare, is formed on the foundations of the complementary network of private and government clinics together with hospitals that are available to the public. Each state of our country have their respective General Hospitals located in the state’s capital. District hospitals will be present in most administrative districts. Health Centers (Klinik Kesihatan) will supplement these district hospitals. Under Health Centers, are the Rural Clinics (Klinik Desa).

Comparing the healthcare system in Malaysia with other first world countries such as the United States of America and the United Kingdom, the healthcare system in Malaysia is heavily subsidized by our government, in the aforementioned first world countries, treatment costs can rocket sky high. Our government has made sure that the price the people pay for treatment from the public sector his reasonable and affordable to the majority of citizens. At least 5% of the national budget is allocated to healthcare system expenditures.

Our government has listed the 8 elements of primary healthcare. To fulfill the 8 ELEMENTS, they provide these services as follows:

Maternal and Child Healthcare

Outpatient services

Basic Dental Health

Nutrition

Environmental sanitation

Essential drugs

Control of Communicable Diseases

Health Education

Laboratory services

Organization of Klinik Kesihatan Bukit Pelanduk

Klinik Kesihatan Bukit Pelanduk is located in the state of Negeri Sembilan, Port Dickson to be even more specific. There are 12 villages in the Jimah District area, and this Klinik Kesihatan is located there. On the 29th of July 1986, operations begin to go on in this clinic and the clinic has served as major centre for the treatment and recovery of the Japanese Encephalities and Nipah virus infected patients. The vaccination for the deadly Nipah virus. There are subsidiary clinics such as Klinik Desa Chuah under the jurisdiction of Klinik Kesihatan Bukit Pelanduk that provides the medical services such as maternal and child healthcare services.

Klinik Kesihatan Bukit Pelanduk is also located within the radius of 30 km from the Tuanku Jaafar Hospital and the Port Dickson Hospital in Negeri Sembilan

Oganisation Chart

Community nurse Public Health assistant U19 (6) U17 (1)

Altogether there are 33 staff workers.

Klinik Kesihatan Mantin is headed by an Administrative Doctor, who is directly responsible to the District Health Officer. Under the Administrative Doctor are two posts, which are the Assistant Medical Officer, and the Head Nurse. The Head Nurse is an authoritative figure, there are 7 components of the staff directly under her, which are the Assistant Pharmaceutical officer Medical Lab Technician, Assistant Medical officer, Senior Community nurse, Public Health nurse, Health nurse, and the Trained nurse. Under the Senior Community nurse would be the Community nurse, and the Public Health assistant.

Components of Health Services.

The Klinik Kesihatan Bukit Pelandok has 6 main departments which are the Outpatient, Maternal and Child Health, Pharmacy, Laboratory, Dental Health, and Emergency Department. The outpatient department is by far the biggest service rendered to the public and can be broken down in the diagram below

The outpatient department consists of the diabetic, hypertension, mental health, healthy teen and out patient clinic. The out patient procedures of obtaining medical services is shown in the diagram on the left.

The outpatient department in other words, functions as the primary healthcare clinic. It is headed by an Administrator doctor( Medical Office). The out patient clinic sees an estimated 100 patients every single day. And the head nurse and assistant medical officers will do their utmost best to carry out their respective responsibilities to assist the Administrator doctor in any duties relevant to them.

The Maternal and Child Health Clinic is headed together by the administrator doctor and the head nurse. This helps in reducing the workload of the administrator doctor. The head nurse together with the staff under her will such as community nurses, will conduct frequent home visits and provide antenatal check-ups for pregnant women within that area.

Diagram on the left shows a brief summary of Maternal and Child Health services.

The Laboratory Department, which is headed by a medical lab technician. The medical laboratory is not as well equipped as those major hospitals, hence the Laboratory Department of Klinik Kesihatan will collaborate with the Laboratory Department of the Tuanku JaafarHospital such as urine protein tests, thyroid function tests, lipid profile and renal function tests.

Diagram on left shows a brief summary of services provided by the Laboratory Department of Bukit Pelandok.

Another important component of Klinik Kesihatan Bukit Pelandok. After consulting the medical officers, patients who are eligible for prescriptions, will have their medication prescriptions handed to the assistant pharmaceutical officer, who will then supply the patients and inform them of the usage of the medication.

Klinik Kesihatan Bukit Pelandok also has a dental department, the dental functions under the same operational hours of the clinic. Tooth extraction, filling, scaling, whitening are provided services. Major oral surgeries however would be referred to the Tuanku Jaafar and Port Dickson hospitals.

Last but not least, there is also an Emergency Department, this department is equipped to handle minor emergencies, it also has an ambulance and paramedics.

The bar chart on the left shows the ethnicity of the total number of patients in 2010.

Services Provided by Klinik Kesihatan Bukit Pelandok.

I have already stated the various departments of Klinik Kesihatan Bukit Pelandok in the Components of Health Services provided section.

The departments of this clinic provides a wide range of treatment modalities, hence allowing the clinic to ensure that patients enjoy effective treatment.

The outpatient department is the most busy of all the departments. The purposes of the outpatient department are to provide immediate treatment to patients who are acutely or chronically sick, and also to act as a control for the clinic against infective disease such as Tuberculosis. Klinik Kesihatan Bukit Pelandok also provides the Tuberculosis Direct Observed Therapy Short-course treatment.

Moving on to the Maternal and Child Health care department, the clinic mainly focuses on prenatal, antenatal, not to forget postnatal care of both the mother and foetus. There is a target to be achieved, which is the target of zero maternal deaths. They are accomplishing this target in a certain number of ways which include immediate diagnosis and treatment of pre-eclampsia, immunization of the mother and frequent antenatal check-ups up until the estimated delivery date. There are also activities scheduled by the department for disabled children on a case by case basis.

For the Laboratory Department, their main role is to enable the clinician in conducting relevant laboratory studies that will help in the diagnosis and management of the disease. The Laboratory Department allows the clinic to receive results much faster compared to the time it takes to receive results from a nearby hospital.

Some common tests conducted by this department are as follows:

Blood tests for HbA1c, lipid profile, platelet count, ESR

Light microscopy on blood smears to detect blood disorders such as anemia, or parasites in the blood smears.

Urinalysis for toxins, glycosuria, urea and red blood cell casts.

Pregnancy test

Other more intricate and complicated tests such as FTA-Abs for treponema pallidum, would require samples to be obtained and sent to the Tuanku Ja’afar or Port Dickson General Hospital for processing.

The pharmacy is responsible for dispensing medication in safe and legal amounts to patients, and to advise patients on practicing compliance in taking their medications. Patients will also be counseled on the side effects and contraindications of the drugs.

Reflections

From observing the complex structure of roles and responsibilities held by the different components and departments of Klinik Kesihatan Bukit Pelandok, it brings to light the vast value of this particular clinic in the provision and primary healthcare of the residents in Bukit Pelandok.

Many of the patients who visit this clinic are of the Malay ethnicity, I for particular, am one who is not fluent in Bahasa Melayu compared to the English language. I learnt that this could be a barrier in communicating with patients who can only speak the Malay language. I have decided that I will brush up my Bahasa Melayu, and master a few of the colloquial terms so that next time I would be able to communicate even better in the Malay language.

This clinic visit has taught me that every component of the staff has a part to play, and has managed to teach me invaluable lessons of becoming a team player.

Section II: Household Survey

Introduction

Bukit Pelanduk is most famous for the Nipah outbreak. Prior to the outbreak, during the 90’s, it contain the largest pig farming communities in Southeast Asia. In between October 1998 and May 1999, that was the darkest time in Bukit Pelanduk recent history, there were approximately 104 deaths out of 258 cases of Nipah infected patients.

Towards the Chinese new year in the middle of March 1999, a pig breeder from Sungai Nipah, which is located south of seremban, died suddenly triggering massive panic. Nearly half the population of the village migrated elsewhere out of fear towards the killer disease. The virus spread like a raging wildfire out of control causing many pig farmers not to mention villagers to abandon their farms and homes in panic. By March 1999, Bukit Pelanduk had become something like a ghost town due to the mass exodus.

The ministry of health then decided to raise the level of this epidemic to the level of national crisis. A Cabinet-level task force was set up, and then headed by the then Deputy Prime Minister Abdullah Ahmad Badawi. What was confusing was that at that time, the government adamantly insisted that it was right in tagging the disease as Japanese Encephalities, however both farmers and scientists opposed this theory and suspected that it was a different strain or virus altogether.

The virus then spread to Kampung Sawah, Kampung India and even Sepang. Farmers consulted temple mediums, and promptly put up red banners at the mediums’ advice in and around their houses to ward off the angel of death.

After months of futility in treating the outbreak as Japanese Encephalitis, the government finally decided to call in the Department of Medical Micribiology of University of Malaysa’s medical faculty for assistance in dealing with this disease. Dr Chua Kaw Bing was the doctor who managed to isolate the virus in five days. 12 days later, it was identified as a new Hendra-like virus and tagged as Nipah.

Over one million pigs, or half our contry’s pig population at that time, were culled. Around 36000 ppl suffered unemployment due to the destruction of farms. According to the United Nations Food and Agriculture Organization, it is estimated close to RM 500 million of pig production was lost.

Today, pig farming is no longer allowed legally in Bukit Pelanduk. Since the outbreak, the young had drifted elsewhere in search of a living. Only the old remain, to live out their days.

Objectives

The objectives of the study are