ENG to CH Translation: 2 Malaysia in health services 一個醫療系統,兩個馬來西亞 (Malaysiakini 23 Sep 2009)

LINK: http://www.malaysiakini.com/columns/113415

2 Malaysia in health services
Sim Kwang Yang
Sep 5, 09
11:47am
As we approach September 16, the date on which Sarawak achieved independence through by joing Malaysia 46 years ago, my thought turns to the progress made in developing my home state.

The Malaysiakini report on the failed Flying Doctor Service is particularly illuminating, in highlighting the problems of public health care for the rural dwellers of Sarawak – and Sabah as well.

Readers of Malaysiakini are probably urban dwellers for whom medical facilities are taken for granted, along with clean water, sanitation, good roads, and all the amenities that are available aplenty in large cities and towns

If you get sick, there is always the neighbourhood GP’s clinic; a jab and some pills will take care of the usual minor-ailments.

If you are really sick, there are always the public or private general hospitals with all the latest sophisticated medial equipment and the professional expertise at your disposal, as long as you can pay the bills.

But imagine this: what do you do when you get sick if you are a citizen living in a remote village in the deep interior of Sarawak?

Well, you try to consult the old folk or the local village healer, look for traditional medicines like some herbs and roots, and try to sleep off your ailment.

If you are afflicted with some serious conditions like cancer or a difficult child birth, you just lie down and wait to die.

In my travels throughout Sarawak a long time ago, I have seen many rural Sarawakians just lying down and waiting to die. Why?

In the upper reaches of the great rivers in Sarawak, transportation facilities are really primitive.

The only semblance of medical facilities are the rural clinics run by a dresser or a nurse, and access to them may mean hours of walking on foot and travelling in a small boat up and down those infamous rapids.

And the medical personnel and the facilities are usually not sufficient to handle really serious cases at all.

Dubious deals and deaths

Let’s take the upper or middle Baram regions for instance.

In the vast mountainous terrain of that area, the only way to send the patients with a serious medical condition is to fly them down to the Miri General Hospital in a helicopter.

That is why my blood boiled when I read about the failure of the contractor who had not fulfilled their contract agreement to provide a helicopter service.

How many rural patients have died because of their dubious deals?

The other alternative is for the rural patients to take a boat ride down the treacherous water of the Baram for many hours.

The Penans and the Orang Ulu who live in the upper reaches of the river do not always have the kind of cash to pay for the fare.

Let’s say our rural patients finally get to the Miri GH one way or another.

Their problems have just begun. The hospital may not want to admit them as in-patient because many rural Sarawakians do not have identity cards.

When the Sarawak rural mother gives birth, she may not have the strength or money to travel to the nearest National Registration Department which is always half a universe away.

Even if rural patients are admitted without identification papers, they may still be denied the assistance rendered by the Social Welfare Department on the grounds that they are not bona fide citizens!

The public hospitals in Sarawak are always over-crowded and under-staffed.

The medical personnel there are almost always overworked and stressed out. The odd ones will take it out on the patients who had come a long way from home to seek treatment.

It is also a custom in Sarawak for relatives or family members of the rural patients to accompany them to the hospital in the big city.

They will take turns to be with the patients in the hospital 24/7, to help with simple tasks like bringing a glass of water or passing the bed pan, and even to call the doctor if there is a sudden turn for the worse in the condition of the patients.

Half-way houses for patients’ families

Where are they going to live in the duration of the patient’s protracted treatment in the hospital?

You cannot expect them to check into the Holiday Inn because they would have neither cash nor credit cards, as you and I have!

The obvious solution is for the government or some charitable organisations to build a kind of halfway house for these stranded rural people with minimal facilities for cooking and sleeping.

So far, I have heard of only one project in Miri where some kind-hearted citizens have rented a house to help the Penans caught in that kind of predicament.

Let’s say the patients do not die, but recover from the treatment and is discharged.

Will the hospital authorities waive their payment as a matter of policy, and even give them money for the fare home as is done by the NHS (National Heath Services) in the UK?

Or will the petty officer at the pharmacy humiliate them about their inability to pay for the medicines to take home for follow-up treatment?

The best way of providing health care is to take medical service to the rural people.

For quite a few years in recent past, this is what a group of selfless dedicated government doctors and nurses have done.

They do not take leave all through the years, so that with the accumulated leave, they can take a long trip into the Baram interior.

They raise funds on their own to finance expenses needed for their trips and to buy medicines.

They make a few trips a year deep into the jungle to bring modern medicine to the Penan settlements and the Orang Ulu villagers.

Very often, they are the first medical team that has ever been welcome in those remote human settlements.

A doctor who had frequently gone on these trips related one story to me.

They had encountered a Penan man in one village with a thorn from a rattan vine lodged deep in his thigh. It had been there for three weeks.

Thorn in the flesh removed…weeks later

Actually, he had gone to the health clinic at Lio Matoh, 3 hours boat ride and 2 hours hitch ride away.

The medical officer there removed half the thorn and said he could do no more.

So the man returned to his village, waiting for the infection to worsen, and perhaps to die, until our volunteer medical team arrived.

A young doctor from Kuching removed the offensive thorn with the under a torch light using a pair of primitive pincers.

I bet you this grateful Penan man will remember that young Chinese doctor for the rest life.

Their main problem is funding. They try to raise funds from charitable organisations like the Lion’s Club, as well as private companies.

The best solution is for them to set up a charitable trust fund that can begin to receive donations from overseas.

But for that, they will need a million ringgit to start with. So you guys with many millions to spare do remember these good doctors in your will.

As we are still located in this ambiguous period between two independence day celebrations, my thought goes out to this group of enlightened doctors and nurses.

They have sacrificed their time and talent, taken the long and torturous journey to bringing modern medicine to the homes of those Malaysians long forgotten by the nation 46 years after their independence from British rule.

You will not hear much about these good Samaritans, because they are publicity shy.

But they embody for me the best spirit of Merdeka. They have shown us all that charity indeed begins at home.

Unfortunately, this is the only voluntary effort I know of that does its best to relieve the physical suffering of Sarawak’s rural dwellers.

Those who receive help from them are indeed fortunate, but there are numerous people in the deep interior who continue to suffer neglect by the government.

For them, Merdeka has made no difference in their inability to gain access to public health care.

This just goes to show that the lives of rural people are cheaper than those in the towns and cities.

This is the 2Malaysia we have.

The first Malaysia belongs to those in the cities and towns whose life is precious, and the second Malaysia exists among those whose life is cheap and expendable, in the deep interior of Sarawak and Sabah.

原文:Sim Kwang Yang
翻譯:姚文傑

46年前的9月16日,砂拉越通過加入馬來西亞取得獨立。馬來西亞日跫音漸進,我的思緒轉移到我故鄉在這些年來所取得的進展。
《當今大馬》的報導點出了失敗的飛行醫生服務(Flying Doctor Service),也凸顯了砂拉越和沙巴兩州鄉區人民的公共衛生問題。
《當今大馬》讀者大概都是城市居民。大城市和市鎮地區的設施完備,醫院診所、清潔食水、衛生設備、完善公路等等一應俱全,也許居民都會認爲這些基本設施都是理所當然的。如果閣下生病了,鄰里就有一家家庭診所。打一支針,吃些藥丸,一般小病,迎刃而解。如果閣下真的生大病,在附近就可找到擁有最先進醫療設施的公立或私立醫院,以及隨時爲您服務的專業醫療團隊,只要閣下付得起醫藥費就行了。

原住民得病只有等死

但是,試想像一下:如果你是住在砂拉越內陸偏僻鄉村的公民,生病了應該怎麼辦呢?好吧,你試著跟長輩或當地鄉村醫者請教,討了一些傳統藥物如草藥和樹根,吃了倒頭就睡,看看會不會睡醒病除。如果閣下慘遭癌症、難產等嚴重症狀纏身,就只能躺下等待離開人間。
我在很久以前遊走砂拉越時,就看到很多鄉區砂拉越人躺下等待撒手塵寰。爲什麼?在砂拉越很多大河的上游流域,交通設施其實都還未開發。唯一勉強足以成爲醫療設施的,就是由醫療助理(注一)或護士經營的鄉區診所。要想見見他們,閣下必須親自走路,跋山涉水好幾個小時,坐著小船乘著忽高忽低越過無情的急流。這些醫護人員和設施,通常都對大病束手無策。
我們就以峇南(Baram)上游或中游地區爲例子。在那浩浩無際的山丘地區,動用直升機把病人送到美裡中央醫院是唯一的方法。這就是爲什麼當我讀到承包商沒有履行合約以提供直升機服務時,我會氣得七孔冒煙的原因。多少病人因爲他們的含糊交易而喪命?
鄉區病人的另一個選擇,就是花上很多個小時乘船越過驚險的峇南河。住在河流上游流域的本南人(Penan)和烏魯人(Ulu),通常都付不起船費。


沒身份證難進政府醫院

舉個例子,就假設我們的鄉區病人,終於以其中一個方式抵達美裡中央醫院了。他們的問題才剛開始—— 醫院並不願意收容他們爲住院病人,因爲很多鄉區砂拉越人沒有身份證。當一個住在砂拉越鄉區的媽媽生了小孩之後,她也許沒有力氣或車馬費走訪最靠近的國家註冊局——那註冊局通常都坐落在山長水遠的地方。即使他們沒有證件也被允許住院,社會福利局還可能會拒絕援助他們——理由是他們並非真正的公民!
砂拉越的公共醫院時常「客滿爲患」,醫療團隊人手不足。那裡的醫護人員通常都是超時工作,心理壓力極大。有些脾氣古怪的醫護人員,就會把那些遠道而來求醫的病人當出氣筒。
陪伴親朋戚友到大城市的醫院去看病,是砂拉越人的生活習慣。他們都會輪流在醫院守候24小時,幫親人斟茶遞水,或準備床上便盆,甚至是當病情急轉直下時召喚醫生。

康復之後卻無力償還醫藥費
在這段漫長的求醫過程,他們又應該在哪裡留宿呢?閣下當然不可以期望他們入住假日大飯店(Holiday Inn),因爲他們身無分文,不像我們「披金帶卡」。很明顯的解決方法就是:政府或福利團體搭建一種中途客棧的房子,房子裡有基本設施,讓那些陷入困境的村民可以在那裡烹飪、睡覺。到目前爲止,我曾聽說過美裡一些善心人合租一間房子,幫助那些面臨同樣困難的本南人。
再舉個例子,如果病人沒有病死,反而在接受治療之後康復了,然後又出院了。院方會否執行不收費的政策,抑或甚至如同英國的國民健保服務般,資助他們回家的費用?抑或藥房裡的小氣官員會否對他們不客氣,開腔羞辱他們沒錢買藥?

義務醫生進入山地行醫
提供健保服務的最佳方法,就是爲鄉區居民帶來醫療服務。最近這些年來,這就是一批無私的政府醫生和護士所致力獻身的工作。他們這些年來都沒有動用年假,當年假累積夠了,他們就可以長途跋涉到峇南內陸地區。他們自掏腰包資助遠行和藥物的費用,在一年內好幾次走訪本南區、烏魯村,爲他們帶來先進的醫療服務。他們常常都成爲第一次走訪這些偏僻地區的醫療團隊。
其中一位常參與這計畫的醫生跟我分享一個故事。他們曾在某個鄉村見到一個本南男子。有一根藤刺刺在他的大腿上已經三個星期了。

藤刺足以要一個人的命
其實他曾到過廖瑪多 (Lio Matoh )的診所。他乘了三小時的船,搭了兩小時的順風車才抵達那裡。醫生給他拔掉了一半的藤刺,然後說他無能爲力了。該本南男子也只能無奈地回家,等待傷口惡化,或許準備等死,直到我們的醫療團隊抵步爲止。一位來自古晉的年輕醫生,憑著簡單的鉗子和手電筒筒就把那惱人的藤刺給拔掉了。我敢說這個心存感激的本南男子,一輩子都會記得那位年輕華裔醫生。
這群醫生面臨的主要問題是資金。他們嘗試向慈善團體如獅子會募款,或者尋求私人公司協助。最好的解決方法就是:設立一個可接受海外捐助的慈善基金。但是這基金也必須要有一百萬令吉來啟動,因此諸位若有數百萬令吉的閒錢,寫遺囑時,就請不要忘記這些好醫生。

東馬內陸居民“獨立”了嗎?
正當我們還在兩個獨立慶祝日的模糊期間,我就想起這批開明的醫生和護士。他們犧牲了時間和才華,長途跋涉爲這些脫離英國殖民統治後,又被國家遺忘長達46年的大馬人提供先進醫療服務。
這批像撒馬利亞人(注二)的醫護人員,閣下是很少會聽到他們的消息的,因爲他們害怕曝光。但他們向我體現了最佳的默迪卡精神,也向我們展示:其實慈善始於家園。很可惜地,就減輕砂拉越鄉區居民的痛楚來說,這就是我所知的唯一一個志願行動。
能夠接受他們援助的居民其實都很幸運,但是還有很多住在內陸的人們因爲政府忽視而繼續受苦。對他們而言,他們沒能力享用公共醫療設施的事實,獨立其實並沒有改變一些什麼。
這顯示鄉區人民的生命,比城市居民的生命還要賤。這就是我們所擁有的兩個馬來西亞。第一個馬來西亞屬於城市和市鎮居民,他們的生命珍貴得很;第二個馬來西亞,就存在於沙巴和砂拉越內陸地區,那些居民的生命都很廉價,而且隨時可被犧牲。

譯註:
(一) 作者沈觀仰表示,醫療助理(dresser)是砂拉越的一個特殊職位。醫療助理不是醫生,而是一個曾受過一些醫療訓練的初級看護。“Dresser”一詞大概源自英文的敷傷口(dressing the wound)。
(二) 撒馬利亞人(Samaritans):(英國)撒馬利亞慈善諮詢中心(爲想自殺的人和其他不幸人士提供諮詢的組織,主要通過電話提供諮詢服務)(新牛津英漢雙解大詞典,第1881頁。)

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