My Work At Sarawak General Hospital
I still remember the day I arrived at the old Kuching airport and greeted by a big and strong hospital driver who spoke fluent English. As he drove along a beautiful tree lined road towards the hospital, he asked me why I chose to come and work here in Kuching. I cant remember what my reply was then. However, today I would say, “Why not work in Kuching? It offers a doctor, especially an Oncologist a massive range of experience”.
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I began work with great earnestness and enthusiasm as there was only me and another young doctor. Despite long working hours, it was rather exciting as there were these wide range of cancer cases, patients with difficult issues and anxious families. Nevertheless, I have to salute the team that I was immensely privileged to work with. It was a team that was passionate and willing to look at changes that we could make and review if those modifications were helpful or otherwise. That was our starting point where by working together we aimed to keep “HOPE ALIVE” for our patients, families, friends and staff.
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Despite all our eagerness, we faced huge challenges too. Funding was always an issue. Just to give the readers an idea as to how the health system works in Malaysia. We have a great health care system which does not turn any patient away from our government hospitals. Everyone is charged a minimal cost irrespective of their income. For those who are unable to pay, they get a fee waiver. The downside of this would mean that patients may need to wait longer. For those who can afford may prefer to see doctors in a private hospital. We often get referrals from the private doctors as cancer care can be exorbitant even for the wealthy.
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The Oncology department was unique in the sense that it was the only cancer treatment centre for the whole state of Sarawak. Despite being the largest state in Malaysia it was not hugely populated. Its area is similar to West Malaysia minus the state of Malacca with a population of only 2Million vs 25Million (1992). The population comprises of Natives, Malays and Chinese. Under the native category there are many subdivisions but the largest group is the Ibans followed by Bidayuhs.
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In view of the landscape, most patients from far had to be admitted even though in many parts of the world these patients would receive cancer treatment as out-patients. This posed as our next challenge as we are always juggling for beds. Over the course of time our bed strength increased from 60 beds to more than doubled to 120 beds over 15 years. Now we have cancer treatment facilities in 2 government hospitals in Kuching and in 1 private hospital.
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One of our crucial challenge was the fact that many of our common cancers like breast, cervix, nasopharynx and lung were presenting at advanced stage. Most times we had to offer only palliative care. I then realised very early that I needed more training in palliative care and hence enrolled myself with Edith Cowan University to study palliative care. We planned out a State-wide training program for training staff in all government hospitals and clinics to be knowledgeable in early symptoms of the three common cancers (breast, cervix and nasopharynx) and palliative care. We began our training program in our own hospital first and moving onto the various district hospitals. That training gave me the immeasurable prospect of comprehending the difficulties that our patients face to come for cancer treatment and reasons for delay. Our training did have an impact resulting in downstaging for the two female cancers and not for the nasopharyngeal cancer. The full article can be read in the links under publications. Our Palliative care program too was recognised by WHO and the full article can be read under publications.
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Despite all the above, I am humbled by the strength and courage of the patients and families that I have had the opportunity to treat and know them. I have shared stories as I gained great insight that I feel may help some of my readers.