OPEN LETTER TO THE MALAYSIAN GOVERNMENT BY THE MALAYSIAN MEDICAL ASSOCIATION

25 June 2021

Dear Elected Members of Parliament and The Malaysian Government,

The COVID-19 pandemic has caused widespread devastation across our country, wreaking havoc on the economy and our way of life. We have had nearly 700,000 COVID-19 cases and more than 4000 deaths since this disease crossed our borders in January 2020. Our RM5-billion National Immunisation Programme has finally taken off after many bumps on the road, and we hope that it will play a significant role in suppressing the pandemic's devastating blows to all aspects of our daily life.

Our healthcare workers have been at the forefront in the war against COVID 19, working tirelessly round the clock to ensure that our fellow countrymen receive the best available care possible. Having to work non-stop without any breaks or holidays in between since 18 months ago, many of us are already suffering from burnout. Yet, we have remained steadfast at our posts to discharge our duties and serve our nation.

We, the Malaysian Medical Association (MMA) and Section Concerning House Officers, Medical Officers, and Specialists (SCHOMOS), are now calling upon YOU, the Members of Parliament and the Government of Malaysia, to do the same and perform YOUR duties.

Our healthcare system has been ailing for several years now and on the verge of collapse. While our doctors and medical teams focus on rehabilitating individual citizens from the scars of this pandemic, we need you to act NOW to expedite reparative actions to nurse our system back to health.

MMA and SCHOMOS have relayed these concerns via an open letter to all of you on 19th February 2021, pleading that our voices be heard. MMA has also asked the Prime Minister for an urgent audience since 18th January 2021 but until now, has yet to be given a scheduled date.

As MMA and SCHOMOS have been emphasizing repeatedly, there are three items that require urgent attention from our lawmakers and administration:

(1) Correcting the severe lack of human resources and providing avenues for its development in the public healthcare sector.

(2) Acknowledging the critical nature of the healthcare sector, and

(3) Need for implementation of a well-coordinated, science-based approach across all sectors of government toward the National Recovery Plan to ensure its success.

Lack of Human Resource and Avenues for Professional Development

MMA and SCHOMOS have raised the alarm several years ago that there has been a severe lack of human resources in the Public Healthcare system, despite a seemingly healthy doctor-to-population ratio. This has clearly been evidenced by the rise in burnout syndrome amongst healthcare personnel in the country. especially during this COVID-19 pandemic. This issue is exacerbated by the lack of job security and opportunities for career progression faced by our junior contract doctors, who form the bulk of our COVID-19 response teams. With this Sword of Damocles hanging over their heads, is it any wonder that many of them are growing increasingly disillusioned and thinking of leaving the country for greener pastures?

Remember that facilities and equipment are only one-half of a functioning hospital unit! The human resource component is the other half, and it requires serious investment in terms of money and especially time to get trained workers. Physical capital can be bought in a matter of days, but human capital requires decades of nurturing. Manage the latter poorly, and we will surely see a tsunami wave of brain drain.

Yes, we were informed of the proposal of an extended contract by the Ministry of Health, but we have been waiting for such a resolution since this contract system started in December 2016! Even while warding off death in the COVID 19 wards, our junior doctors are still waiting for a fair decision and clarity from the government if they are able to continue working when their contract expires and if they are able to undergo training for specialization.

"The current contract system is messy, biased and a failure as it has given them uncertainty in their employment in the government service and in their future as healthcare professionals."

We stated this in our letter on 19th February 2021, and we have to strongly reiterate it here. Just what is being done about this and how long does it take to come up with a resolution? We have even provided a host of cost-effective suggestions, but they were met with a lack of meaningful engagement and empty lip service from the authorities that be. Where are the sorely-needed answers and accountability? Many contract doctors are already leaving whilst waiting for a definitive verdict from the government. The longer we wait, the more we have to lose.

Acknowledging the Critical Nature of the Healthcare Sector

Healthcare is one of the crucial pillars of national development. The Government of Malaysia has to recognise the critical nature of our healthcare sector and safeguard its integrity! One such method of recognition is the Critical Allowance, which was almost revoked in the past year. It was previously announced that there were plans to review its removal at a later date. Nevertheless, this COVID-19 pandemic has shown that our profession cannot be judged by the number of working hours but by several other factors. Let there be no other doubt or queries if this allowance should be continued indefinitely, as healthcare workers have proven time and again to be critical to our nation's health and security! If there were to be a review, this should be made for an increment and not otherwise.

A comprehensive science-based approach for the National Recovery Plan

While our healthcare workers have been defending the country's health for the past 18 months, our energy is waning despite our best intentions. We cannot go on like this forever. Malaysia urgently requires a comprehensive plan that is firmly founded in scientific evidence, in line with international standards. The National Recovery Plan announced on 16 May 2021 falls short of this standard. It merely stated the various indicators of the country's readiness to progress to the subsequent phase of recovery and fails to outline any measures the Government will be employed to work towards those goals.

Even then, those stated numbers are highly disputable. We cannot use gross numbers alone to guide public health decisions; rather, these decisions have to take into account a lot of other factors, such as daily positive detection rates. daily testing numbers, development of new clusters, the spread of new strains etc. How can we label our intensive care unit (ICU) usage as "moderate" when many general wards are being repurposed into makeshift ICUS? Even with these makeshift ICUS, some hospitals have found it necessary to erect field hospitals for more ICU capacity. Furthermore, many doctors are being pulled from their departments for deployment to the COVID-19 frontlines, worsening the manpower deficit in those departments.

Our Malaysian healthcare system is suffering, and it is barely holding the fort during this COVID-19 pandemic. Its resilience will be tested many more times in future pandemics to come. The time to fortify our public healthcare system is NOW.

We have done our duty. We leave it to those who helm the power to rule hereafter.

Yours Sincerely.

Dr Thirunavukarasu Rajoo

Honorary General Secretary Malaysian Medical Association