(Speech by Parliamentary Opposition Leader, DAP Secretary-General and MP for Petaling, Lim Kit Siang, in the Dewan Rakyat on Monday, 8th June 1981 on the motion to extend the Parliamentary resolution requiring new doctors to perform three years of compulsory government service)
Call on the Government to treble the intake of non-bumiputra students for local medical places to help solve the acute doctor shortage in the country
The requirement of new doctors to perform three years of compulsory government service was introduced 10 years ago as a measure to counter the acute doctor shortage in the hospitals and government service.
Although ten years ago, the Health Minister then was talking about planning for solving the doctor shortage in the next decade – just as the present Health Minister, Tan Sri Chong Hong Nyan, had been talking about ending the acute doctor shortage by 1990, – he government faces the most acute shortage of doctors in recent times, caused by the double migration firstly of doctors leaving the government service for private practice, and secondly, doctors migrating abroad.
The failure of the government’s planning to solve the doctor shortage problem in the country could be seen from Table 5-4 of the Fourth Malaysia Plan which showed that the number of persons per registered doctor has worsened in 1980 as compared to 1970. Malaysia’s doctor training programme is literally going backward.
Thus in 1970, country-wide, there were 4,263 persons to one registered doctor, but in 1980, this ration has worsened, becoming 4,321 persons to one registered doctor.
Reduced to state terms, it means that for Selangor, from a ratio of 1,801 persons per registered doctor in 1970, it had worsened to 2,293 persons per registered doctor in 1980; for Penang, from a ratio of 2,502 persons per registered doctor in 1970, it had worsened to 2,957 per registered doctor in 1980; and for Perak, from a ratio of 4,345 persons per registered doctor it worsened to 4,710 persons per registered doctor in 1980.
Every year, Malaysia has to recruit doctors from Indonesia, India and Bangladesh, countries which need doctors even more than Malaysia, to help fill some of the vacancies in Malaysian hospitals.
The time has come for the Government to deal frontally and seriously with the grave problem of medical brain drain, both of the government service and from the country, for otherwise, one day the Minister of Health would have to come to Parliament to ask what new doctors be required to serve 6 six years of compulsory government service to help overcome the acute doctor shortage in the country.
It is most regrettable that the Malaysian Medical Association Report on the ‘The Future of Health Services in Malaysia’ headed by Dr. M. K. Rajakumar, which dealt extensively with the problem of medical brain drain has been thrown into the waste-paper basket by the Medical of Health. This does not augur well for close-coperation between the medical profession and the Health Ministry to work together to solve the medical and health problems in the country.
One of the ways to overcome the acute shortage of doctors in the government service is to improve on the conditions of service of the doctors and specialists, in particular with regard to their promotional and higher education prospects.
The promotional prospects of medical officers are far inferior to those of MCS officers. Although there were some rectification exercise in recent years, the promotional gap between medical officers and MCS officers are still too great to induce medical doctors to remain in service.
In fact, I understand that certain promotional exercises to rectify glaring injustices to long-serving medical officers approved before the death of the former Director of Medical Services, Tan Sri Dr. Pillay, had been frozen, causing further discontentment in the medical services.
Another way to overcome the acute shortage of medical doctors is to increase the intake of medical students locally and overseas. In this connection, there is a need to have a greater intake of non-bumiputra students for the medical faculties of University of Malaya and Universiti Kebangsaan.
Last academic year, the local university intake of the two medical faculties were:
| Universities | Bumiputras | Non-Bumiputras | Total |
|---|---|---|---|
| Universiti Kebangsaan Malaysia | 173 (90.1%) |
19 (9.9%) |
192 |
| Universiti Malaya | 80 (62.5%) |
40 (37.5%) |
128 |
I understand for the new academic year 1981-1982, the same ratio of bumiputera-non-bumiputera students in both medical faculties remain unchanged, with the Universiti Kebangsaan taking in some 190 students of which some 10% were given to non-bumiputera students; while the University Malaya has places for 160 students, of which one-third were given to non-bumiputeras.
I understand that the Universiti Kebangsaan does not have a reserve list for non-bumiputera students, should five or more students decline the offer because they have gone overseas or switched to other courses, their places would not be offered to other non-Malay students. On the other hand, the Universiti Kebangsaan maintains a reserve list for eligible bumiputera students so that places not taken up are offered to others.
For the last ten years, the University of Malaya had limited itself to recruiting 128 students a year although it had the capacity of taking 160 students on the ground that there were not enough Malay students. This is preposterous especially as there is acute doctor shortage in the country. Furthermore, why can’t the University of Malaya medical faculty expand its capacity to match that of University Kebangsaan’s?
The intake of non-bumiputera students into the medical courses locally is clearly too low and inadequate, and should be trebled. I hope that the Minister of Health would draw the attention of the Education Minister to this grave imbalance of student intake and rectify it.
This is all the more important with continuing reports of school fee increases for foreign students in the United Kingdom and in other countries. Even before the further university fee increase, a U.K. medical education would cost a student some $250,000 before they could qualify, then probably there would have been very few doctors in Malaysia today.
Public Services Department discriminating between unscheduled medical degrees
The recent furore between the Malaysian Medical Council and the Administrative and Diplomatic Services Association over the PSD decision to send 20 students to the unscheduled Catholic University of Leuven in Belgium for medical studies has highlighted the arrogant attitude of certain government officers, who are not only discriminating between unscheduled medical degrees, but usurping the powers of the Malaysian Medical Council given by Parliament on the recognition of medical degrees.
I want to know whether Minister of Health was consulted on the sending of Malaysian students to the Belgium medical faculty, whose degrees are not recognised, and why the Malaysian Medical Council, which was set up by Parliament specifically with this function, was not consulted at all. If one or two PSD officials can arrogate to himself the powers entrusted to the Malaysian Medical Council, then there is no need for either the MMC or even Parliament itself to function.
The PSD has been advising Malaysian students not to study in unrecognised universities and colleges when they go abroad. Why is the PSD breaking its own advice?
In the Belgium university, Malaysian students had to learn Walloon – a type of French. The PSD assures the people that Malaysian students can acquire proficiency in Walloon language in six months’ time, which will probably make them come out with double-Dutch!
Here I want to make it clear that I am not disparaging the medical degrees of standards of the Catholic University of Leuven in Belgium, for although it is an old university with high academic standards, nothing is known about its medical standards.
Does this incident mean that the PSD is now going to decide, even before the Malaysian Medical Council knew anything about it, what unscheduled medical colleges and universities it is going to favour and recognise? This is completely unacceptable, and a stop must be made. More medical degrees of foreign universities with international repute and standards must be recognised, but this must be done by the proper process through the Malaysian Medical Council and not by one or two PSD officials who may know nothing about medicine.
In this connection, the new ruling that the government would not recognise post-graduate medical degrees and qualifications if the first degrees is not recognized, even through the post-graduate qualifications are recognised in the country, is inexplicable and indefensible.
Thus, a Malaysian who takes his first medical degrees, whether in India, Taiwan or Indonesia, which are not recognised, but proceed to the United States, the United Kingdom or Australia and attain higher or post-graduate qualifications which are recognised in Malaysia would still remain unrecognised.
I do not know whose idea this is, by this form of self-denial of qualified talents in Malaysia is short-sighted and self-defeating, and I urge the Government to revert to the previous sensible position where regardless of whether the first medical degree is recognised or not, recognition is given where hgher or post-graduate qualifications are themselves recognised. Surely, those who have been unfortunate enough to study in unscheduled universities through no fault or of their own, should be encouraged to regularise their position by seeking recognised post-graduate qualifications, which will also be of great contribution to the medical service in the country.
College of Physicians, Surgeons, and other Post-Graduate studies: Why no action taken
For a considerable time, there has been talk of the establishment of post-graduate medical studies in the country.
In June last year, the Health Minister, Tan Sri Chong Hong Nyan, said a Bill providing dor post-graduate studies in local institutes of higher learning in the various medical specialties would be tabled in Parliament soon. He also said that consultations were being carries out with professional bodies and colleges of physicians, surgeons and general practitioners.
This is now even more pressing with the great increase of fees and costs of living in the United Kingdom, where most Malaysians go for their post-graduate medical studies.
However, I understand that the establishment of post-graduate medical facilities locally have been blocked by the medical establishment at the Universiti Kebangsaan for reasons best known to themselves.
The Health Minister should explain the reasons for such obstruction and dilatory tactics, for it is by creating new local opportunities for Malaysian doctors to gain post-graduate qualifications that we can attract more Malaysian to remain in government service and in the country.
Reports of specialists leaving the government service have become normal reading diet. For instance, at the Kuala Lumpur General Hospital, many doctors and specialists have resigned. There is there a shortage of specialists especially for Neurosurgery, Anesthesia, Plastic Surgery, Ear-Nose and Throat surgery, etc. in fact, the ENT department at the Kuala Lumpur General Hospital has been closed. At one time, ‘cold’ surgery (i.e. relatively less urgent cases) was stopped because of shortage of surgeons and anaethetists. The general hospitals in other parts of the country face similar if not bigger problems.
Call for inquiry into death of Gerald Tiew
Morale of doctors and specialists is one reason for the exodus from the government service, especially if they cannot get efficient and competent service from the supporting staff, which could cause avoidable deaths.
For instance, on 9th May 1981, a housewife, Mrs. Teo Siong Huat of 31 Kampong Enam, Bachang, Malacca, called for a hospital ambulance as her two-year-old son. Gerald Tiew, had fallen into a bucket of water. The ambulance arrived within 15 minutes, they boy was carries into the ambulance and the oxygen mask was put on the boy. But the hospital assistant asked the ambulance attendant to release the oxygen, the attendant realised that he did not bring the instrument to release the oxygen. The child died on arrival at the hospital 15 minutes later despite all attempts to revive him with oxygen at the hospital. I call on the Health Minister to cause an immediate inquiry and punish these responsible for the boy’s death through their negligence.
Such negligence, causing public criticism and attacks on the hospital, can only undermine further the morale of the doctors. There has been a deterioration in the service, courtesy and public relations of the hospitals in the country. A national campaign must be conducted in all hospitals to improve on their public image and relations.