LETTER TO SUN DAILY, ON THE IJN ISSUE

Since I last wrote on this blog about the IJN / Sime Darby issue, I have been asked many times (the last being last night at a gathering in Penang), for my comments. In fact, after the blogs that I wrote, I read Mr Terrence Fernandez's article on the same issue in Sun Daily on 24th Dec 2008. I wrote to him as a reply on the evening of 24th Dec 2008. I have not seen my comments published. I thought that I will just document it on this blog, and not write anymore on this issue, until further developments occur and see if it needs a response.

This is what I wrote to the Sun daily, in reply to the article by Terrence Fernandez piece on the proposal by SD to take over IJN. I also wrote two blogs on it at <www.hmatter.blogspot.com>

I read your column with great interest. Your article on IJN contain many inaccuracies. If you look deeper into the matter, IJN was set up in 1992, to allow the rich and powerful, a cardiac center ( with up to date facilities ) where they can get treatment quickly, in the event that they are unwell, or relapsed. Of course there was some service to the public. As a result of this initial primary aim, they were very much service orientated. They were never planned to become a center of excellence.
When we plan a cardiac program, and when we wish to make centers of excellence, we will incorporate into the center 3 essentials - 1. 30% research into what the country's disease patterns are and how to improve ( in heart disease- prevent ) the disease. Study what remedies can help our rakyat, and not just apt the West. You could read that from any textbook. 2 ) Teach and train ( 30% ), so that there is a multiplier effect. Your ( trainees then become registrars and consultants through-out the country ). 3. Service ( 30% ) , to do the cases that the other public centers cannot do, because of your special expertise. We do not want a center of excellence doing run of the mill angioplasties, and by-pass surgeries? Yes, you chalk up impressive numbers of common procedures, what for? This is tax-payers money not well spend.

You cannot have one heart center to serve 27million rakyat. It is impossible. We probably need 10 cardiac centers to serve the needs of the rakyat. Well you may know that the government realised this, About 5 years after IJN, the government again started the JB cardiac center, the Penang cardiac center, Sarawak cardiac center, Serdang cardiac center, together with heart centers at UMMC, HUKM, USM-Kubang Kerian. The Sabah Heart Center is in the planning. We were all hoping that the various heart centers will do the usual cardiac care work, and IJN will take care of the difficult to do patients, besides research and training. With a good training program, they can train maybe 10 consultants a year for the public sector. For IJN to run with the other heart centers doing the bread and butter stuff, is a waste of funds. That is NOT the work of a center of excellence. IJN send teams to Sabah Medical Center for the last 10 years to " do cases", and after 10 years, they are still sending IJN teams there. There is no vision to train locals to take over. How can this be? How short sighted.

To my knowledge, there is almost no research done there. They have not been able to collaborate with other institutions to look into our cardiac disease patterns, and work out good " Malaysian" preventive programs. There were some collaborative work on some drugs and stent trials, as one of the participating centers. (by comparison, the Sarawak Heart Center had done a piece of outstanding work on the value of the 64MSCT).

I think that by now, you would have got the gist of what I am trying to say. IJN has lived up to about 50% of her purpose. She has done 30% service ( doing bread and butter cases ) and maybe trained some specialist ( training program is very much in-line with our national affirmative policy ), and doing almost no research. Yes, she has a reputation of doing alot of cases, and she has access to the media, to publicised her work ( well marketed ) What work is another issue.

In summary, if IJN wants to be piratised ( oops " privatised " ), so be it. There are good public sector hospital doing good bread and butter work. The Sarawak Heart Center is doing good work and training and research. The government will save some money subsidising a set-up that is for the rich-famous. BUT, the cost to Sime Darby must be market value, with cost of brand and goodwill thrown in. It took money to get IJN to where it is today. That cannot be for RM1.

This is my view, the view of a practising cardiologist who knows the scene. I hope that you are clearer now.