Global Health – Why Malaysian Medical Students Should Bother?

Dr. Valkuthan RajaratnamMBBS(Mal),AM(Mal),FRCS(Ed),FRCS(Glasg),FICS(USA),MBA(USA),

Dip Hand Surgery(Eur),PG CertMedEd(Dundee),FHEA(UK).

Senior Consultant Hand Surgeon, KTPH Alexandra Health,

Singapore

Global Health

• problems that transcend national borders• best addressed by cooperative actions and

solutions"The failure to engage in the fight to anticipate, prevent, and ameliorate global health problems would diminish America's stature in the realm of

health and jeopardize our own health, economy, and national security."

-The Institute of Medicine, America’s Vital Interest in Global Health

Global Health why bother

• Humanitarian reasons• Equity reasons• Direct impact reasons• Indirect impact reasons

What’s in it for me?

• Practice• Training and Education• Research• Altruism

What is in it for them?

• Practice• Training and Education• Research• Altruism

Personal Experience

• UG & PG ME• Service establishment , and training• Building experience• Delivering wisdom across borders• Teaching and learning different systems• Communicating and collaborating• Leaving legacy through education

Malaysian Population

Total: 28.4 million

Migrant Workers: 1.8 million

Expats: 313,000

Illegal immigrants: estimated 450,000 to 1.2 million

Migrant Workers in MalaysiaCountry of Origin

Indonesia Bangladesh

Nepal Myanmar

India Vietnam

Others

Key Contributions to Global Health

Queen Elizabeth Hospital, UHB NHS Foundation Trust

Open air out patient clinic

Current make shift classroom

Residual mines and their effects

A below knee amputee following land mineInjury with prosthesis

Major flash burn contracture of post axillary fold needing release and reconstruction

AO Instructional course for medics/nurses

Compressed air unit for power tools

“Portable” Xray unit using dental Xray tube

Surgery with implants and power tools

Median and ulnar nerve injury treated with sural nerve cable graft bridging gap

SSG done by member of nursing staff

IED – Improvised Explosive Device• Since 2007, IED blasts are

commonest combat injury seen at RCDM

• Improvised devices with evolving sophistication

• Difficult to detect• Frequently placed at road

side to target foot and vehicle patrols

The Team

• Unique injuries– Patterns emerging

• Unique patients• Multidisciplinary care• IEDs – large zone of injury• Difficult reconstruction

• Very rewarding

Regular Royal Visitors

be different

make a differenc

e

Life Expectancy at Birth

Bangladesh

Indonesia

Malays

ia

Singa

pore UKUSA

0102030405060708090

Years

Years

Maternal Mortality Ratio(Inter agency estimates)

Bangladesh

Indonesia Malaysia Singapore UK USA0

50

100

150

200

250

300

per 100 000 live births

Comparison of International Health Statistics

Bangladesh Indonesia Malaysia Singapore UK USA

Population in thousands

148 692 239 871 28 401 5 086 62 036 310 384

% pop. living in urban areas

28 44 72 100 80 82

Governmentexpenditure on health as % total govt expenditure

7.4 7.8 9.2 8.0 16.0 22.4

Annual per capita govt expenditure on health (US$)

8 38 204 629 2 938 4 437

Physicians Density

Bangladesh

Indonesia Malaysia Singapore UK USA0

5

10

15

20

25

30

per 10 000 population

per 10 000 popu-lation

Infant Mortality Rate(probability of dying between birth & 1 year)

Bangla

desh

Indonesia

Malays

ia

Singa

pore UKUSA

0

5

10

15

20

25

30

35

40 per 1 000 live births

Top 3 causes of death in Malaysia

Cerebrovascular Disease6.6%

Pneumonia7%

Ischaemic Heart Disease12.9%

124,857 deaths in 2008

Top 3 causes of death in Malaysian Men

1. Ischaemic Heart Disease

2. Road Traffic Accidents

3. Pneumonia

Hospital Beds

Bangladesh

Indonesia Malaysia Singapore UK USA0

5

10

15

20

25

30

35

per 10 000 population

per 10 000 population

Incidence of Polio in Malaysia

Year No. of

Cases1976 391977 1211978 181979 41980 51981 11982 5

Year No. of Cases

1983 21984 51985 41986 11987-1991 01992 31993-2011 0

Source, MOH Malaysia

Malaysia & Global Fight Against Polio

Member of the Global Polio Eradication Initiative

Incidence of Dengue in Malaysia

2000 20100

5000100001500020000250003000035000400004500050000

Cases

Cases

Malaysia & Global Fight Against Dengue

3 Key Areas:

FundingExpertiseResearch

Global Health & Non-Communicable Diseases

TobaccocontrolInter-governmental cooperation

Global Health & Communicable Diseases

SARS

Inter-governmental cooperation

Mercy Malaysia Programmes

International

Open air out patient clinic

Bilateral Agreements

Malaysia Thailand

Bilateral Agreements

Malaysia Brunei

VWO Contributions to Global Health

Mercy Malaysia Programmes

Malaysian Outreach Programmes

ReferencesHealth imperatives in foreign policy: the case ofMalaysia: Simon Barraclough & Kai-Lit Phua, Bulletin of the World Health Organization 2007;85:225-229.