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Tip of the iceberg of a medical crisis?



urgent-letterCPI's introduction

We received a letter of complaint on public healthcare services in Negeri Sembilan.

A ruling has been issued stating that blood tests for many medical conditions can no longer be carried out by the government hospitals and clinics in the state.

We are reproducing the complainant's letter in its original Bahasa Malaysia as well as providing a translation of the text in English (see below).

We have discussed with various doctors the likely impacts of this ruling on discontinuing blood tests. Prospective patients, healthcare workers and the general populace should be made aware of these.

The consequences include:

    • Cancer detection. Patients who have undergone surgery or chemotherapy for cancer now cannot check for the recurrence of the following cancers (the relevant blood test are here cited): colon cancer (CEA), prostate cancer (PSA blood), ovarian cancer (CA125) and testicular cancer (AFP).
    • HIV detection. It cannot now be confirmed whether patients have HIV or not. For patients already being treated for HIV, the progress of their treatment cannot be monitored (CD4/CD8 counts).
    • Diabetes monitoring. The gold standard for monitoring a patient's blood sugar level (HbA1c) in government diabetic clinics in the state will no longer be available.
    • Drug abuse. Tests that are required to identify new candidates for drug rehabilitation programmes, like the methadone programme, cannot now be done (HIV; Hepatitis B and C). Monitoring cannot be done to ensure that patients are not taking illicit drugs such as cocaine, morphine and amphetamines (urine drug tests for these).
    • Epilepsy tests. Epileptic patients who are not responding well to medical treatment for seizures need certain tests to determine the correct concentration of a prescribed drug for treating seizures effectively. These tests are now not available (carbamazepine, phenytoin, valproic acid). Without these tests, doctors cannot check whether the patient is being correctly medicated for seizures, or whether the patient will require a different drug.

See the complaint letter for more information.

This matter has broader implications. These are:

Poor patients now have to resort to private healthcare

Given that these tests now cannot be done in public hospitals and clinics, patients might have to go to private hospitals or private blood testing companies. This is a financial burden for lower and middle income patients, particularly in a belt-tightening economy.

The performance of doctors would be affected

In a setting where blood test information and/or medicine supplies are lacking, the judgement and services of the government doctors will likely be impaired. This would be to the detriment of the patients. There could occur a kind of triage situation where only the most urgent cases will receive treatment while other patients who still need treatment may be denied it.

Rationing could mean queues and bottlenecks at hospitals

The rationing of blood tests or even medicine supplies might mean that there could be bottlenecks or queues at the affected hospitals and clinics. Aside from inconveniencing sick patients, this could further strain the operations of hospitals and clinics. Hospitals elsewhere might have to cope with the possible spillover of patients from the affected hospitals.

A sign of other crises

If a basic and critical part of healthcare such as blood tests cannot be carried out because of financial difficulty, other areas of healthcare are also likely to have been affected, such as the provision of medicines and health programmes (e.g., diabetes and smoking cessation), which is indeed the case. The possibility cannot be discounted that this Negeri Sembilan episode may be the tip of the iceberg of bigger financial misgovernance. It forces open questions about the actual health of our country's finances.

The authorities should respond swiftly given the gravity of this complaint. Other stakeholders might want to investigate the efficacy and integrity of our public health system. The adequate provisioning of basic needs for the people cannot be compromised in any properly managed country.


From: XXX

To: The authorities concerned

December 14, 2012

Urgent Crisis: Important Blood Tests No Longer Available at All Negeri Sembilan Hospitals and Health Clinics Due to Lack of Funds


I am a retired Malaysian civil servant and diabetic patient with a thyroid problem.

I need to do blood tests to check that my thyroid level is healthy.

Two days ago I sought treatment at a government health clinic in Negeri Sembilan.

The doctor said he cannot carry out the usual blood tests for me.

I was surprised to be told that blood tests have been discontinued at the clinics as well as government hospitals in Negeri Sembilan.

I was informed that this directive is an order from the government.

Quite recently, the shortage of medicines in government hospitals and clinics was debated in Parliament and the matter remains unresolved. Now (we’re told) even blood tests cannot be carried out.

It defies logic that a crisis such as this can occur in a peaceful and prosperous country like ours. If we were a war zone like Gaza in Palestine then it could make better sense that blood tests and medicines could not be provided. How is it possible that our situation in Negeri Sembilan has become akin to that in a conflict zone?

A total of 50 blood tests have been listed as discontinued, and they include important ones such as:

- Tests for HIV

- Tests for cancers

- Tests for dengue fever

- Control tests for diabetes

- Tests for hepatitis B and C

- Follow-up tests for thyroid treatment

- Tests for thalassaemia

- Tests for infertility

I received information that blood testing is unavailable because the government has no more financial allocations for laboratory materials.

In fact, it is said that laboratory materials worth RM500,000 procured earlier were obtained on credit (that is, by incurring debt) from medical suppliers .

Many patients including myself have given blood samples but it is likely that these samples will be discarded as the blood tests will no longer be carried out.

This is a waste of the rakyat's time and the rakyat’s money.

I am angry and disappointed with the lackadaisical attitude shown in dealing with this serious matter.

It is not logical when the federal government can afford to spend millions of ringgit on KR1M/BR1M handouts and on bonus payments to the civil servants.

What use is all that if the government does not have a single sen to guarantee the provision of a basic service in public healthcare?

The Negeri Sembilan government announced last week that it obtained a 'smart city' grant of USD400,000 (~RM1.2 million) from the IBM computer company for the state.

Is the ‘smart city’ status a greater priority than the health of the suffering masses?

I hope that my complaint will open the eyes and hearts of our leaders and that immediate action can be taken for the basic wellbeing of the people.

Thank you.


A retired civil servant





Pihak-pihak yang berkenaan.

14 Disember 2012

Krisis Gempar: Ujian-ujian Darah Penting Tidak Lagi Dapat Dilakukan Di Semua Hospital Dan Klinik Kesihatan Di Negeri Sembilan Kerana Kekurangan Wang

Salam sejahtera.

Saya seorang pesara kerajaan Malaysia dan pesakit masalah tiroid dan kencing manis.

Saya perlu melakukan ujian darah untuk memastikan paras tiroid dalam badan saya adalah sihat.

Dua hari lepas saya telah pergi ke sebuah klinik kesihatan kerajaan di Negeri Sembilan untuk mendapatkan rawatan.

Doktor memberitahu saya beliau tidak boleh lagi melakukan ujian darah untuk saya.

Saya terkejut apabila saya diberitahu bahawa kebanyakan ujian darah telah diberhentikan oleh klinik-klinik mahupun hospital-hospital kerajaan di Negeri Sembilan.

Saya dimaklumkan ini perintah daripada pihak kerajaan.

Lewat-lewat ini, masalah kehabisan bekalan ubat di hospital-hospital dan klinik-klinik kerajaan telah dibahaskan di Parlimen dan perkara ini masih belum selesai. Sekarang ujian darah pula tidak boleh dibuat.

Pelik sekali krisis seperti ini boleh berlaku di negara kita yang aman dan makmur. Boleh diterima sekiranya ujian darah dan pemberian ubat tidak dapat dilakukan di zon peperangan seperti Gaza di Palestin, tetapi apakah situasi di Negeri Sembilan sudah tenat seperti di kawasan peperangan?

Bayangkan, sejumlah 50 ujian darah telah disenaraikan tidak dapat dilakukan lagi. Ini termasuklah ujian-ujian darah yang mustahak seperti:

- Ujian untuk HIV
- Ujian untuk penyakit barah/kanser
- Ujian untuk demam denggi
- Ujian kawalan untuk kencing manis
- Ujian untuk hepatitis B dan C
- Ujian untuk rawatan lanjutan tiroid
- Ujian untuk penyakit 'thalassaemia'
- Ujian untuk pasangan kurang subur

Saya menerima maklumat bahawa ini berlaku kerana kerajaan negeri tidak ada peruntukan wang lagi untuk membeli bahan ujian makmal.

Malahan bahan ujian makmal bernilai RM500,000 yang diperolehi sebelum ini dikatakan didapati secara pinjaman (atau hutang) daripada pihak pembekal.

Ramai pesakit termasuk saya sudah memberikan sampel darah mereka tetapi kemungkinan semuanya terpaksa dibuang sekarang kerana ujian-ujian darah tidak dapat dibuat lagi.

Ini satu pembaziran masa dan wang rakyat.

Saya marah dan kecewa dengan sikap sambil lewa yang ditunjukkan dalam menangani perkara yang serius ini.

Tidak logik apabila kerajaan pusat mampu membelanjakan berjuta-juta ringgit untuk KR1M/BR1M dan untuk wang bonus pegawai kerajaan.

Apakah gunanya semua itu kalau kerajaan tak mempunyai satu sen pun untuk menjamin kepentingan asas seperti kesihatan rakyat?

Minggu lepas kerajaan Negeri Sembilan mengumumkan penerimaan geran bernilai USD400,000 (~RM1.2 juta) daripada syarikat komputer IBM untuk menjadikan Negeri Sembilan 'bandar pintar'.

Apakah status 'bandar pintar' diutamakan manakala kesihatan rakyat yang menderita dikebelakangkan?

Semoga keluhan saya ini membuka mata dan hati para pemimpin kami dan tindakan segera dapat diambil demi kebajikan asas rakyat.



Seorang pesara kerajaan Malaysia.



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