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
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

《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。




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!

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。


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。


(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。)