Monday, October 16, 2006

Help! Help! Where is the ambulance.

I wrote a piece for the NST on 29th Sept 2006 about possible remedies for our poor ambulance service in Malaysia. This was in response, primarily, to the NST article on shortage of ambulances in Malaysia. That article quoted the fact that in UK, there was one ambulance to 25,000 population, whereas in the Klang Valley, there is 14 ambulance for about 6.5 million population.

We are all aware of the times when we ourselves or a relative called for an ambulance, and it took ages for the ambulance to arrive, if at all. We also know that there are some medical centers in the country with no reliable ambulance service. We all know of the untimely death of the medical officer who went out in an ambulance, which was involved in an accident, resulting in her death. I do not think that we need more horror stories. we certainly need the government to find a remedy.

My response was also partly in response to the suggestion by YB MoH, and supported by the MMA president, that the MoH may outsource the country's public ambulance service. Of course in this country, corporatisation or sometimes called privatisation often results in piratisation. In my article (which was edited and truncated by the editor), I put across the idea that an ambulance service is an important part of healthcare delivery. Patients with illnesses sometimes suffer complications, unannounced, and seemingly healthy people can develop an acute illness like stroke and heart attack. Having a reliable and good ambulance service is therefore essential to help ensure that these patients are brought to the nearest healthcare facility and given prompt treatment.

What more if the new PHCFS act mandates that GPs render emergency medical care. After the GP has commenced resuscitation, and if the ambulance takes ages to respond, what is the GP to do? His clinic is not a battlestation clinic. He would have to quickly get the patient transported to the nearest medical facility by ambulance. If ambulances are piratised, oops sorry, privatised, how are the poor going to afford it in their hour of need. Ambulance services must be under the care of the government to ensure that all who need it, get it.

I can understand that it is not easy to maintain an ambulance service, but it is the responsibility of the gvernment of the day. I think the money saved from sending our "Malaysian Astronaut" to space, or the money saved from the Laltrade fiasco, should be enough to buy and maintain ambulances for many years. I half suspect that the NST article and the YB MoH's respond is a harbinger of some government related company being given a contract to buy and maintain the countries ambulance services. I try to point out that if that is what the government wants, what to do-lah?

At the very least their operations, charges and services provided should be govern by a law (I propose an Ambulance Act) and code of conduct. This will at least ensure (hopefully) that the ambulance are of a certain quality and quantity, that the ambulance staff are adequately trained in basic, if not advanced cardiac life support care, and hope that the government will allow private ambulances and ambulances by NGOs to continue their ambulances services. Healthy competition is always good. I also hope that the poor will not be disadvantaged, when the government privatises the ambulance service (I am almost certain they will). At the end of the day we hope that the ambulance services in Malaysia will be one that we can be proud of.

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