Abstract The development of neurosurgical services and training inMalaysia began in 1963,withthe first centre established in its capital city atHospitalKuala Lumpur, aimed to providemuchneededneurosurgicalservicesandtraininginthefieldofneurologyandneurosurgery.Thiscentersubsequentlyexpandedin1975withtheestablishmentoftheTunkuAbdulRahmanNeuroscienceInstitute (IKTAR);which integrated the three allied interdependent disciplines of neurosurgery,neurology and psychiatry. The establishment of this institute catalysed the rapid expansion ofneurosurgicalservicesinMalaysiaandpavedthewayfordevelopmentofcomprehensivetrainingfordoctors,nurses,andparamedics.Thisculminatedintheestablishmentsofalocalcomprehensiveneurosurgerytrainingprogramfordoctorsin2001;followedbyatrainingprogramfornursesandparamedics in2006.Todate, therearemore than60neurosurgeonsprovidingexpert care in 11centersacrossMalaysia,alongwithtrainedpersonnelinthefieldofneurosciences.
Keywords: Malaysia. Neurosurgery, history, IKTAR
The development of Neurosurgery andNeurologyinpost-independenceMalaysiabeganmore than50yearsago.ThefirstNeurosurgicalandNeurologyUnit inMalaysiawasestablishedon 12th August 1963 (1). Prior to that, therewere no organised neurosurgery or neurologyspecialities, and general surgeons, who wereworking to the best of their abilities, wereperforming neurosurgical services, whereasgeneral physicians and paediatricians providedneurologyservices.In1963,throughtheassistanceand auspices of a voluntary organisation, CAREMEDICO, an American neurosurgeon, Dr RoySelby, travelled to Malaysia to develop theseservices in a new established centre in GeneralHospitalKualaLumpur(1). Dr Selby provided both neurosurgical andneurology services in thenewly establishedunitduringitsinitialyearsofuse.Theunitconsistedofaseparatebuildingwitha45-bedward,clinics,conference halls, library, record room, officesand laboratories for electroencephalogram(EEG), neuropathology, and neuroradiology.Dr Selby functioned as a neurosurgeon,neurologist, neuropathologist, neuroradiologist,and neurophysiologist; in essence, he acted asa complete neurosurgeon. His vision and drive
resulted in a well-established, independentspecialtyunitinMalaysia,whichaimedtoprovideservicesforpatientsanddevelopmentsinthefieldof neurosurgery by training local doctors andpersonnel.Hisvisionandeffortsweresubsequentlycontinuedandcompletedbyhismedicalofficer,Dato’ Dr Nadason Arumugamasamy,Malaysia’spioneerneurosurgeonin1969(2). Dr Selby played an instrumental role inestablishing the Neurosurgical Foundation ofMalaysia in 1967 to promote the interests ofneurosurgery and its allied fields of neurology,neuroradiology, and psychiatry. With theformation of this foundation, the idea of aNeuroscienceInstitutionwasconceived. Dato’DrArumugasamy, thefirstMalaysianneurosurgeonwhoreturnedfromhis training inAmericain1969tohelmtheUnitinHospitalKualaLumpur,replacedDrSelby.Dato’Arumugasamy,the only neurosurgeon inMalaysia, built on thefoundations of his predecessor as he similarlyfunctioned as a complete neurosurgeon andactively developed neurosurgery and training inMalaysia(2). The establishment of the Tunku AbdulRahmanNeuroscienceInstitute(IKTAR)in1975catalysed the development of neurosurgery in
Special Issue - Neuroscience
History of Neurosurgery in MalaysiaAzman Raffiq1, Jafri Malin abdullah2, Saffari haspani1, Johari Siregar adnan3
1 Department of Neurosurgery, Hospital Kuala Lumpur, Jalan Pahang 50586 Kuala Lumpur Wilayah Persekutuan, Malaysia
2 Center for Neuroscience Services & Research, Universiti Sains Malaysia, 16150 Kubang Kerian, Kelantan, Malaysia
3 Hospital Sultanah Aminah, Jalan Persiaran Abu Bakar Sultan, 80100 Johor Bharu, Malaysia
Submitted:19Oct2015Accepted:2Nov2015
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Malays J Med Sci. Dec 2015; Special Issue: 5-7
Malaysia.TheNeuroscienceInstitutebecamethefirstgroupingofsubspecialtiesconceivedundertheSecondandThirdMalaysiaPlans.ItrepresentedthevisionofthethenPrimeMinister,TunkuAbdulRahman,theFatherofIndependence,afterwhomtheInstitutionisnamed.Thefoundationstoneofthe building was laid by Tunku Abdul Rahmanon20thApril 1970(1,2).The instituteconsistedof the three allied interdependent disciplines,neurosurgery, neurology, and psychiatry, underone institute, as well as supportive services,such as neuroradiology, neuropathology,operating theatres, intensive care units (ICUs),andneurodiagnostic laboratories.TanSriMohdDin Ahmad, the Chairman of the Ministry ofHealthMalaysia andNeurosurgical Foundation,significantly contributed to equipping theinstitute.Variousindividuals,localorganizationsand state and foreign governments generouslyhelped to equip the newly established institute.Theinstitutewasformallyopenedonthe25thofMarchbythenHealthMinister,TanSriLeeSiokYew. The Institute houses three operatingtheatres, an 11-bed Neuro-IntensiveCareUnit (Neuro ICU), a psychiatric ward with 40beds, a neurology ward with 60 beds and fourneurosurgerywardswith150beds.Italsohousesa neuroradiology unit with a CAT scanner, aswell as a neuro-diagnostic unit. The instituteserves as a national referral and training centreforneurosurgery.InrealisingthevisionofTunkuAbdulRahman, theMinistryofHealthMalaysiaand the Neurosurgical Foundation, many localdoctorsweresentoverseas to train incentres intheUnitedKingdom,Australia,andBelgium. Training was also expanded to includespecialisation in neuroscience for nurses andparamedicstoprovidecomprehensivespecialisedcareforpatients.Nursesandparamedicsfollowedsimilar training paths as doctors during theinfancy of neurosurgical development. The firstbatchofnurseswhowereselectedforspecialisedneurosurgerytrainingweresenttoJapanin1981fora1year trainingcourse inselectedJapanesecentres.Thistrainingprogramservedasthefirstjoint training venture in Neurosurgery betweenJapan and Malaysia; it was fully sponsored bythe InternationalNursing Foundation of Japan.Nurses fromMalaysiawere awarded aDiplomain Advanced Neurosurgery Nursing uponcompletion of training. This training programcontinued for 14 years until local training wasstructured and established in Malaysia in 1995(3). This exchange training programwas highlybeneficial for Malaysia in terms of developing
neurosurgical services and fostering strong tiesbetween the neurosurgical fraternities of bothnations, which continue to prosper. Apart froma 1 year training program in Japan, a smallgroupofnurseswasalsosenttoreceivetrainingfor 2 years degree in Neuroscience Nursingfrom Oxford Brooks University in the UnitedKingdom.Thegraduatesof thisdegreeprogramsubsequently established a structured trainingprograminMalaysia.ThelocaltrainingprograminNeurosurgerybegan in2006withsixmonthsofcertifiedtraininginNeurosciencenursing(3).This was the first structured training course inthe field of neuroscience training in Malaysia,and it had a clinical emphasis on neurosurgery,neurologyandneurorehabilitation.Theprogramaimed to produce competent nurses whocould provide efficient and specialized care inneurosurgery,neurologyandneurorehabilitationinvariouscentresacrossthecountry. As a result of recognising the rapidlyexpanding demand and importance of efficientdelivery of health services in the field ofneurosciences, the Ministry of Health Malaysiaintroduced a 1 year Advanced Diploma inNeuroscience Nursing training program in2013, which aimed to train a specialised groupof Registered Neuro Nurses in Malaysia.This program provided focused, concise, andcomprehensive training in various neurosciencefields, which placed additional emphasis onresearch. To date 400 staff are trained inNeurosciencenursingacrossthecountry. This allowed for neurosurgical servicesto be expanded across the country to all majorstates in Malaysia: Pulau Pinang; Ipoh, Perak;Sungai Buloh, Selangor; Johor Bharu, Johor;Kota Kinabalu, Sabah; and Kuching, Sarawak,providingmuchneededservicestoanexpandingpopulation. Neurosurgicalcentresandtrainingprogramswere also established in major universities,namely Universiti Malaya, Universiti SainsMalaysia and Universiti Kebangsaan Malaysia.Through the efforts of these local universities,local lecturers were sent abroad to train inneurosurgery; subsequently, they establishedservices and training programs in neurosurgeryupontheirreturn. The first and only local training programforneurosurgerywas established in2001underthe guidance and leadership of Professor Dato’Dr Jafri Malin Abdullah in the Departmentof Neurosciences, School of Medical SciencesUniversitiSainsMalaysia.The trainingprogramconsisted of two plus four years of focused,
Special Issue - Neuroscience |HistoryofNeurosurgeryinMalaysia
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comprehensive clinical training in the field ofneurosurgery, which was aimed at developingcompetent neurosurgeons who could provideeffectiveandsafeservices,fulfillingtheneedsofarapidlydevelopingnation.Withtheestablishmentof this local training program, neurosurgeryservices were further extended to include morestates, includingAlor Star,Kedah andKuantan,Pahang. From its humble beginnings in 1963,neurosurgeryinMalaysiahasdevelopedrapidly,and therearenowmore than60neurosurgeonsproviding services in the public, university andprivate sectors. The Neuroscience Institute inHospital Kuala Lumpur has played an integralrole in the development of neurosurgery inMalaysia since its inception in 1963. With theestablishment of a local training program,currentexistingservicescanbestrengthenedandexpanded, and future neurosurgical centres canbe established, along with the development ofsub-specialties in the field of neurosurgery. Thesubspecialtiesthatarecurrentlybeingdevelopedinclude Radiosurgery, Paediatric Neurosurgery,Neuro-Spine, Minimally Invasive Neurosurgery,Endoscopic Neurosurgery, and FunctionalNeurosurgery.Neurosurgery inMalaysia is nowestablished on the international stage and hasactivelyparticipatedandhostedmanyprestigiousinternational meetings and conferences forvarioussectors.
Acknowledgement
None.
Conflict of Interests
None.
Funds
None.
Authors’ Contributions
Conception and design, drafting of the article,critical revision of the article for importantintellectualcontent:MAMR,JMA,SH,JSA
1. Unknown Author. History of Neurosurgery & Neurology in Hospital Kuala Lumpur, Malaysia.Kuala Lumpur (MY); Hospital Kuala LumpurArchives:1988.
2. Fadzli CA. Tribute to Dr Nadason Arumugasamy, Pioneer Neurosurgeon in Malaysia.Malaysia (MY);NeurosurgicalAssociationofMalaysia:2003.
3. Amiruddin Salbiah. Neurosurgery Nursing in Malaysia, Past, Present and Future. Joint ISMINSEducation Meeting & 15th NAM Annual ScientificMeeting;2015Oct2–Oct4;Kualalumpur.
