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Cover Story: Can Our Public Hospitals Cope?

By Nabilah Hamudin, Tan Mei Kuan and Ili Aqilah

Healthcare in Malaysia, without doubt, has undergone tremendous changes compared to several years ago. Government hospitals are now the pillar of the nation’s healthcare system which guarantees cheap and affordable healthcare services.

The Health Ministry website states that there are 15 public hospitals in Perak, with a total of 5780 beds to cater for 2 million people in the state.

Although the number of private hospitals in Malaysia, as well as Perak, has increased, the charges imposed by these private entities can burn a hole in one’s pocket. This explains why most Malaysians visit government hospitals for their health needs.

However, are the services provided abreast with patients’ needs? In this issue, Ipoh Echo examines common problems – the good and the bad – at Hospital Raja Permaisuri Bainun (HRPB) and elicits suggestions from patients and medical professionals.

The Good, the Bad and the Ugly of Public Hospitals

Insights Into Patients’ Experience

Seventy-seven-year-old retiree, A. Jeyaraj, has been frequenting the eye clinic of the general hospital for about eight years now. “Most of the doctors are kind and do respect my age and speak English so I have no communication problem,” he told Ipoh Echo.

His only unpleasant experience is the long waiting time. “The doctor can only see a certain number of patients per hour and that number must be allocated. When a doctor is on leave, there’s no replacement and the doctors on duty have to handle more patients. The first appointment is at 8am, but the doctors don’t call in the patients at that time. One general hospital (GH) for Ipoh is not enough for a population of over 700,000. Ipoh needs another hospital,” Jeyaraj reasoned.

Hospital Raja Permaisuri Bainun, HRPB

“The waiting rooms are full and there is no room for extension. I feel sorry to see elderly patients standing. On the patients’ side, some elderly ones who are too old and can’t hear properly have communication problems. Doctors must be really patient to treat them. Someone must accompany these oldies. In one incident, an elderly person fainted. I was told there are volunteers from NGOs to help out, but I haven’t come across any,” he added.

Being a retiree without a steady income, there is no other choice for Jeyaraj other than GH. He used to go to the Hussein Onn Eye Hospital in Kuala Lumpur. “The doctor’s fee was not high, but the eye drops are expensive and there’s the traveling cost. There’s also a long waiting time,” he stated.

When asked about the shuttle bus service provided by the HRPB, he commented, “I use the shuttle service. It is convenient. The shuttle bus doesn’t go to the parking area of the polyclinic though there is a timetable. Patients like me staying in Pari Garden and surroundings must travel all the way to the stadium. If you board the bus at the stadium and request to be dropped at the polyclinic, the drivers oblige. Actually, it is difficult for elderly people to get on and off the bus. The steps are too high.”

According to him, some of his doctor friends say that it is best to send emergency cases to GH which is well equipped and have the expertise to handle them. “GH does not demand upfront payment before treatment is started. After initial treatment patients can be transferred to other hospitals,” he pointed out.

Hospital Raja Permaisuri Bainun, HRPBAnother Ipohite who used to frequent the pharmacy and outpatient departments for health check-ups once every six months said, “Two years ago, my friend had a painful swelling in the hand. The doctor diagnosed it wrongly as skin infection when eventually it turned out to be a blockage in her artery.”

“The pharmacy always claims that they run out of medicine, especially Zohor for my cholesterol yet the one who came after me could get the exact one! After giving the prescription at the pharmacy, my sister has to come back after one hour to collect it,” she told Ipoh Echo.

“In general, the nurses are very rude and can’t be bothered. My sister has been checked to have no high blood pressure but every time they claim that she has. This is because when they put the blood pressure monitor on her, they go roaming!” she recalled. Now, she stops going to the general hospital altogether.

“The services should be improved. Senior citizens shouldn’t be made to wait so long. Give us oldies an appointment and let us come according to the time and date fixed. Why can’t that be done?” she lamented.

Another patient who only wanted to be known as Nurzimirrah, 21, was admitted for seven days when she had an accident in 2016. The tragedy had forced her to undergo neurosurgery and physiotherapy sessions to recover.

Hospital Raja Permaisuri Bainun, HRPB“During my stay at the hospital, the staff were helpful and friendly. Not only towards patients but also visitors. My mom had to accompany me throughout the seven days and the staff were so kind, providing a special bed for all caretakers,” said Nurzimirrah.

“Even after I was discharged and had to continue my physiotherapy sessions, I was impressed by their exceptional treatment. Our hospital can get over-crowded but the staff always give their best. In fact, I can recall a nurse who was pregnant and she had to work the night shift. The doctors were also helpful. I’d like to express my thanks to everyone who has made my stay easier, especially Doctor Farhan and Doctor Azmel,” Nurzimirrah added.

However, she believes that the facilities in the hospital are in dire need of repairs. She had to stay in ward 6B where the doors almost broke down due to the strong wind. The same worry was expressed by our photojournalist, Luqman Hakim Radzi, 25, who used to bring his mother for her monthly check-ups at the general hospital.

“The staff in HRPB definitely deserve praise. They’re helpful, friendly and polite. My mother needs to visit the hospital every two months for consultation and since we have scheduled appointments, she doesn’t have to wait for long. The hospital might want to consider upgrading some of their facilities though, for example providing more wheelchairs as the ones they have now aren’t enough and a few chairs are broken,” said Luqman.

He said that the hospital should also pay heed to the cleanliness of the compound, especially the toilets.

“The GH receives a lot of patients and visitors daily, hence they need to check on the toilets regularly. Some toilets are smelly. I too wish they will give priority to elderly patients and not make them wait too long for consultation,” added Luqman.

Hospital Raja Permaisuri Bainun, HRPBThe facilities at the hospital are a mixed bag – some good and some bad. The hospital only provides one ATM machine near the pharmacy. Is one ATM machine sufficient for all the people and staff of the hospital?

The public toilets on the ground floor are surprisingly clean and well-maintained by the staff.

However, we noticed that some chairs at the waiting area in front of the emergency department were broken and some patients have to play ‘musical chairs’ just to rest while waiting for their turn. This is something that the hospitals should address. Otherwise, people have to stand while waiting.

The observation also revealed that a mini mart in the hospital is operating 24 hours, which is convenient for the relatives to get something for their loved ones. The cafeteria is also clean and the food offered are affordably priced.

Suggestions from an Experienced Doctor

Dato’ Dr Ramanathan RamaiahDato’ Dr Ramanathan Ramiah, was the former head of the Orthopaedic Department of HRPB and had served 34 years in public hospitals. He shared his experiences and suggested ways to overcome problems in order to provide better services to the public.

Dr Ramanathan felt that decentralisation of services at the general hospital is the way forward.

“About 15 years ago, when I was an orthopaedic surgeon and Dato’ Amar Singh was a paediatrician, we suggested to the hospital, the state government and the Ministry of Health that it’s time to build an annex in Batu Gajah or Meru or anywhere nearby.

“However, our suggestion fell on deaf ears. As doctors, we felt that there was a need for an extension to take on the load,” said Dr Ramanathan, who served 20 long years at HRPB. He retired in April this year.

He suggested other ways also, such as build a similar hospital in another place nearby or detach certain departments of HRPB to other areas and allot them different buildings.

“For example, maternity and paediatrics hospitals can be built together in Meru. This will reduce the congestion,” he said.

Hospital Raja Permaisuri Bainun, HRPB

Even the late Sultan of Perak, Sultan Azlan Muhibbuddin Shah had suggested to the Health Minister to buy an abandoned building in Ipoh and turn it into an annex.

“Had it gotten through, we’ll not be facing this problem today,” he reasoned.

Commenting on the parking issue at HRPB, Dr Ramanathan said it is unfair for the hospital to not provide sufficient parking. “It’s true that you should not block the road, but there’s no parking at all. So, it boils down to proper planning.

“Many years ago, KL Hospital and HRPB parking lots were discussed in parliament. It was such a major issue but it’s still an issue in Ipoh. Over in KL, they’ve built a multi-level parking lot,” he said, adding that there were many businessmen who wanted to put up a private multi-storey parking lot for HRPB but were rejected.

He said the establishment of the Ambulatory Care Centre (day-care centre) was not only premature but without the advantage of hindsight. It does not have a parking lot.

“They could have reserved a few floors in the building for parking purposes. When I suggested this to one of the directors, the answer I got was that parking was not the hospital’s problem. It’s unfortunate that we have such people. Looks like consultants are more concerned about patients than the directors,” he posited.

The provision of a bus shuttle service is admirable but it is a waste since not many people use it, as most are unaware of its existence. “Perhaps, it’s not user-friendly. The service, I feel, is not properly managed and scrutinised,” he said.

Hospital Raja Permaisuri Bainun, HRPB

Dr Ramanathan added that the new huge building which is being built within the hospital will provide two floors of parking to the visitors.

“The new building which is being built will cater for the three fields of Cardiology, Maternity and Paediatrics.

“Initially, it was to be built with four floors of parking but I hear it has been reduced to two floors,” he said.

On the delay in waiting time he has this to say, “One reason, I think, is the general economic situation.  More Malaysians are now resorting to general hospitals for their medical needs. Another reason is the preponderance of junior doctors who are unable to make decisions for serious illness, conditions and injuries. We have many junior doctors but insufficient senior doctors.

“Most of the senior doctors have left to operate their own clinics or work as locums. Allowing doctors to work as locums is good, as it allows them to earn an extra income. However, there must be a definitive long-term plan in place to retain these experienced doctors,” he said.

Another reason for the delay in waiting time is insufficient space and facilities in emergency wards. “I’d prefer a bedside X-ray so patients need not move about. These unnecessary movements delay treatments. The moment they’re in the emergency department, they don’t have to move. That’s how it should be. In the red zone, the hospital should have at least four to six beds equipped with all the required facilities including bedside X-rays. By doing so, standards of the emergency department will improve,” he suggested.

He voiced that the emergency department should have a drive-in roadway, and it should be isolated to avoid crowding. This is not so at HRPB.

Dr Ramanathan suggested that those in positions of authority should get their heads together and think rationally how to improve services on the whole.

“At the moment this is not happening. Nobody seems to care about the general health of the public. It’s only the professionals, the doctors, paramedics and the nurses who are concerned for the wellbeing of the rakyat. And this is not good,” he deplored.

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