Friday, December 19, 2008


I will write this piece as objective as I can. I have to declare from the offset, that 1. I have a legal dispute with Sime Darby Medical Center, 2. I am a practising interventional cardiologist since 1988 and have seen IJN grow since 1992.
IJN was set up in 1992 to help treat the public who have heart disease, especially those who could not afford to seek these treatments in the private sector. It was set up as a statutory body, by an act of parliament, following the heart attack and emergency CABG of the previous prime minister, Tun Dr Mahathir Mohammad. He felt that such important and technically sophisticated procedure should be horne under a center of excellence. That on its own is not wrong. It was built with taxpayers money, and government by a board of directors ( read political appointees ). Through the last 16 years, to the best of my knowledge, it has helped many and also lost alot of money. The government has poured alot of money into it. As a center of excellence, and also a service provider, it help trained many cardiologist, some overseas and some locally. 16 years is a longtime. And still the numbers trained were not quite sufficient. It also seem that the training program also followed the political affirmative policy. Some registrars ( consultant-in waiting ) left, because of this policy.
I firmly believe that one could built a cardiac center of excellence that can do original research, do training/teaching and still provide cardiac care to the needy. Even if you cannot achieve this in the early years, certainly after a decade, there must be a plan to do that. It is now 16 years.
It has built a certain reputation, and able to do some of the things that the private cardiac centers cannot do, like heart transplantation. The logistics and cost was just too prohibitive for heart transplantation to be done in any private center, at the moment. Besides this, it was essentially competing with the private cardiac patients for patients, doing single and double vessel angioplasties, straightforward by-pass surgeries, etc.. This I do not understand. We were hoping that with their ( virtually unlimited resources ) they would lead us in the field of cardiac medicine, researching cardiac disease ( especially in the Malaysian/Asian context ). For one, we needed to know disease patterns better and also compile valuable statistic that will help us to target our resources. Apeing the west, to me, was not a good strategy. Whenever we go to international meetings, even as they represent Malaysia, we only get to see how many procedures they have performed and their success rates ( read part marketing, part advertisement ). We do not see new innovations, or studies on disease patterns that we see that is peculiar to Malaysia.
Yes, there is an arm in IJN where non-fee paying patients can be treated. This queue ( Q ) is long and many get around it by knowing " friends " and " politicians ", to shorten the wait-time. The government servants have their own Q and then the fee-paying patients. When one comes to the fee-paying patients, the cost is not exactly cheap. Generally, it is about 10-20 % cheaper. But there is no freedom of choice of attending physician, and the ward-round and basic care is undertaken by trainee MOs and registrars. The " boss" seldom do the mundane work, after the " invasive procedure ". I suppose with economy of scale and also government subsidy, one could easily be 10-20% cheaper.
Coming to Sime Darby. We all know that as a medical center, Sime Darby Medical Center, has not been known for her philantrophy. Charity is not her middle name. The reverse is probably more true.
Anyway, as eveything in Malaysia, it is the politics that will dictate. The political masters, will decide whether the venture will be allowed, the public will just have to accept it. My colleague has a nice word for these privatisation exercises of government institutions ( and we have seen quite a few ). Jokingly, we call it " piratisation " of government institutions.

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