ObSTETRICS GYNAECOLOGY FACILITIES AND DEVICES

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CHAPTER 10 PSYCHIATRY FACILITIES AND DEVICES

Expert Panel Members Chairperson : Dato’ Dr. Suarn Singh 1 Members: Dr. Siti Nor Aizah Ahmad 2 Author, Dr. Hj. Mohd Rasidi M. Saring 3 , Dr. Hj. Mohd Daud Dalip 4 , Prof. Dr. Mohd Fadzillah Abdul Razak 5 1 Hospital Bahagia Ulu Kinta, 2 Hospital Kuala Lumpur, 3 Hospital Sultanah Bahiyah, 4 Hospital Mesra, 5 Universiti Malaysia Sarawak REPORT Mental health disorders are diverse spectrum of diseases encompassing alterations in thinking, mood and behaviour. The prevalence of mental health disorders among Malaysians is 10.7 [1]; and ranked fourth as the leading cause of burden of disease-by-disease categories [2]. The novel discoveries and rapid advances in understanding psychiatric disorders in the last few decades catalyzed the changing structures in the treatment modalities, management and delivery of mental health services. The challenging issue is to ensure the services and facilities are equally available and accessible to all citizens. Since the era of deinstitutionalization, the psychiatric-related rehabilitation services gradually developed into broad categorization of hospital-based and community-based services. The day care centers and training shelter workshop constitute the hospital-based rehabilitation services; whereas psychosocial rehabilitation centers and psychiatric nursing homes are facilities based in the community. The number of facilities seems fairly equally distributed in hospital and community. This concurs with the direction in mental health service to deliver and develop more community mental health facilities. However, the distributions of these facilities are not uniform throughout the country. This could relect that specialized psychiatric rehabilitation expertise and service are currently only available in certain states. In comparison, the percentage of service contact in community mental health service in Australia was at least 50; and it reached 98 in certain states [3]. The hospital-based facilities form 53.5 of the total available facilities. However, 94 of the hospital- based facilities are manned by the public sector. All states in Malaysia have at least 1 day care center except Melaka, Pahang and Perlis. The training and shelter workshops are only available in 6 states. The psychosocial rehabilitation centers and psychiatric nursing homes are entirely run by public sector. It must be noted that once the Mental Health Act 2001 is enforced, the available therapeutic and diagnostic facilities will have to be recategorized into the 3 facilities as provided for in the said Act. The facilities are as follows: “Psychiatric Hospital” means a government psychiatric hospital or a private psychiatric hospital including a gazetted private psychiatric hospital “Psychiatric Nursing Home” means a government psychiatric nursing home or a private psychiatric nursing home, and includes a gazetted private psychiatric nursing home “Community Mental Health Centre” means a government community mental health centre or a private community mental health centre, and includes a gazetted private community mental health centre 36 Although its exact mechanism of action is still unknown, electroconvulsive therapy is an effective treatment modality to achieve rapid and short-term improvement in especially severe depression, severe mania and catatonia [4]. This device is widely available nationwide, mainly in hospitals, but also available in private practice 13. Its use in England is less, probably attributed to better antidepressants and psychotherapeutic interventions [5]. It is a safe treatment but its adverse effect resulting in cognitive impairment and retrograde amnesia which may happen to some patients, is a signiicant concern. Table 1: Available Diagnostic and Therapeutic Facilities in Psychiatry Population Hospital-based rehabilitation facilities Community-based rehabilitation facilities Day Care Centre Training and Shelter Workshop Psychosocial Rehab. Centre Psychiatric Nursing Home No in million No pmp No pmp No pmp No pmp Malaysia 26.64 16 100 1 7 100 6 100 5 100 Sector Public - 15 94 7 100 6 100 5 100 Private - 1 6 State Johor 3.17 3 19 1 1 14 1 17 2 40 1 Kedah Perlis 2.11 1 6 Kelantan 1.53 1 6 1 1 17 1 Melaka 0.73 N. Sembilan 0.96 2 13 2 1 17 1 Pahang 1.45 1 14 1 Perak 2.28 1 6 1 14 1 17 Terengganu 1.04 1 6 1 1 17 1 P. Pinang 1.49 1 6 1 Sabah 3 1 14 Sarawak 2.36 2 13 1 1 14 3 60 1 Selangor W.P Kuala Lumpur 6.43 4 25 1 2 29 1 17 37 Table 2 Available Medical Devices in Psychiatry Population Electroconvulsive Therapy ECT machine No in million No pmp Malaysia 26.64 45 100 2 Sector Public - 39 87 - Private - 6 13 - State Johor 3.17 3 7 1 Kedah Perlis 2.11 3 7 1 Kelantan 1.53 4 9 3 Melaka 0.73 1 2 1 Negeri Sembilan 0.96 1 2 1 Pahang 1.45 2 4 1 Perak 2.28 6 13 3 Terengganu 1.04 1 2 1 Pulau Pinang 1.49 7 16 5 Sabah 3 2 4 1 Sarawak 2.36 6 13 3 Selangor W.P. Kuala Lumpur 6.43 9 20 1 References: 1. The National Health Morbidity Survey, 1996. 2. Division of Burden of Disease, Institute for Public Health, Malaysian Bureau of Disease and Injury Study in Health Prioritisation: Burden of Disease Approach.2004, Ministry of Health Malaysia 3. Australian Institute of Health and Welfare AIHW 2008. Mental health services in Australia 2005–06. Mental health series no. 10. Cat no. HSE 56. Canberra: AIHW. 4. National Institute for Clinical Excellence, United Kingdom 2003 5. Royal College of Psychiatrists, United Kingdom 2008 39

CHAPTER 11 CARDIOLOGY AND CARDIOTHORACIC SURGERY

FACILITIES AND DEVICES Edited by: Dr. Aizai Azan 1 With contributions from: Dr. Alan Yean Yip Fong 2 , Dr. Chong Wei Peng 3 , Dr. Ernest Ng 4 , Dr. Faisal B. Ismail 1 , Co-contributors: Prof. Dr. Sim Kui Hian 2 , Dr. Ong Tiong Kiam 2 1 Institut Jantung Negara, 2 Hospital Umum Sarawak, 3 Pusat Perubatan Universiti Malaya, 4 Hospital Serdang REPORT In 2007, there were 73 dedicated coronary care units CCU reported in Malaysia. There were 36 cardiac catheterization laboratories, 47 echocardiography laboratories and 3 invasive electrophysiology laboratories. There was a single heart transplant unit located in the Klang Valley, which is complemented by all the acquired left ventricular assist devices LVADs in the country. They were 16 cardio- pulmonary rehabilitation programmes, which were not well represented nationwide. Table 1: Available Therapeutic and Diagnostic Facilities in Cardiology and Cardiothoracic Surgery Population Coronary Care Unit CCU Electrophysiology Laboratory Echocardiography Non-Invasive Cardiology Laboratory Cardio- Pulmonary Rehabilitation Programme No in million No pmp No pmp No pmp No pmp Malaysia 26.64 73 100 3 3 100 47 100 2 16 100 1 Sector Public - 41 56 - 1 33 22 47 12 75 Private - 32 44 - 2 67 25 53 4 25 State Johor 3.17 5 7 2 4 9 1 1 6 Kedah Perlis 2.11 5 7 2 3 6 1 2 13 1 Kelantan 1.53 3 4 2 3 6 2 1 6 1 Melaka 0.73 4 5 5 5 11 7 1 6 1 N. Sembilan 0.96 4 5 4 3 6 3 Pahang 1.45 4 5 3 1 2 1 1 6 1 Perak 2.28 7 10 3 4 9 2 2 13 1 Terengganu 1.04 1 1 1 1 2 1 1 6 1 Pulau Pinang 1.49 9 12 6 1 33 1 5 11 3 Sabah 3 4 5 1 5 11 2 2 13 1 Sarawak 2.36 5 7 2 3 6 1 1 6 Selangor W.P. Kuala Lumpur 6.43 22 30 3 2 67 10 21 2 4 25 1 40 Population Cardiac Catheterization Laboratory Cathlab Invasive Cardiovascular Lab Cardiac Transplant Unit No in million No pmp No pmp No pmp Malaysia 26.64 36 100 1 9 100 1 100 Sector Public - 28 78 - 4 44 Private - 8 22 - 5 56 1 100 State Johor 3.17 2 6 1 1 11 Kedah Perlis 2.11 1 3 Kelantan 1.53 2 6 1 1 11 1 Melaka 0.73 3 8 4 2 22 3 Negeri Sembilan 0.96 1 3 1 Pahang 1.45 1 3 1 Perak 2.28 1 3 Terengganu 1.04 Pulau Pinang 1.49 6 17 4 2 22 1 Sabah 3 1 3 1 11 Sarawak 2.36 3 8 1 1 11 Selangor W.P. Kuala Lumpur 6.43 15 42 2 1 11 1 100 Regarding the actual medical devices recorded, data was obtained for numbers of ambulatory blood monitoring system, ECG telemetry system, Holter system and Electrophysiology monitoring system. These devices were well represented nationwide. For invasive support systems, intra-aortic balloon pumps and heart-lung bypass units were located at facilities, which offered interventional cardiology and cardiac surgery procedures. Other non-invasive diagnostic devices data were obtained for Doppler vascular machines, echocardiography systems and transoesophageal echocardiography systems. In the main, these non-invasive devices were more commonly available compared to the invasive systems. 41 Table 2: Available Medical Devices in Cardiology and Cardiothoracic Surgery. Population Ambulatory blood Pressure Monitoring System ECG Telemetry System Holter system Electrophysiology monitoring system No in million No pmp No pmp No pmp No pmp Malaysia 26.64 217 100 8 97 100 4 87 100 3 42 100 2 Sector Public - 38 18 67 67 29 33 21 50 Private - 179 82 32 33 58 67 21 50 State Johor 3.17 17 8 5 6 6 2 4 5 1 10 23 3 Kedah Perlis 2.11 2 1 1 3 3 1 3 3 1 Kelantan 1.53 1 1 4 5 3 Melaka 0.73 3 1 4 6 7 8 N. Sembilan 0.96 15 7 16 3 3 3 2 5 2 Pahang 1.45 9 4 6 2 2 1 3 3 2 5 12 3 Perak 2.28 5 2 2 1 1 5 6 2 1 2 Terengganu 1.04 2 1 2 4 4 4 Pulau Pinang 1.49 17 8 11 19 19 13 15 17 10 9 21 6 Sabah 3 8 4 3 6 7 2 3 7 1 Sarawak 2.36 2 1 1 4 4 2 6 7 3 Selangor W.P Kuala Lumpur 6.43 136 62 21 58 59 9 32 36 5 12 28 2 Population Extra-Corporeal Membrane Oxygenator ECMO Machine Intra-aortic balloon Pump IAbP Machine Heart-Lung bypass Unit Left Ventricular Assist Device LVAD No in million No pmp No pmp No pmp No pmp Malaysia 26.64 1 100 62 100 2 32 100 1 1 100 Sector Public - 19 31 10 30 Private - 1 100 43 69 22 70 1 100 State Johor 3.17 7 11 2 3 9 1 Kedah Perlis 2.11 2 3 1 1 3 Kelantan 1.53 5 8 3 1 3 1 Melaka 0.73 4 6 5 2 6 3 N. Sembilan 0.96 Pahang 1.45 2 3 1 Perak 2.28 1 100 1 2 1 3 Terengganu 1.04 Pulau Pinang 1.49 12 19 8 8 25 5 Sabah 3 2 3 1 1 3 Sarawak 2.36 3 5 1 4 13 2 Selangor W.P Kuala Lumpur 6.43 24 39 4 11 34 2 1 100 42 Population Doppler machine Echocardiography system Trans- Oesophageal Echocardiogr. TEE system Intravascular Ultrasound IVUS machine No in million No pmp No pmp No pmp No pmp Malaysia 26.64 30 100 1 153 100 8 45 100 2 7 100 Sector Public - 21 70 66 43 21 47 3 43 Private - 9 30 87 57 24 53 4 57 State Johor 3.17 1 3 7 5 2 3 7 1 1 14 Kedah Perlis 2.11 10 7 5 3 7 1 Kelantan 1.53 1 3 1 10 7 7 1 2 1 Melaka 0.73 2 7 3 7 5 10 2 4 3 1 14 1 N. Sembilan 0.96 6 4 6 Pahang 1.45 1 3 1 5 3 3 1 2 1 Perak 2.28 1 3 10 7 4 2 4 1 Terengganu 1.04 2 1 2 Pulau Pinang 1.49 5 17 3 17 10 11 9 20 6 Sabah 3 1 3 11 7 4 1 2 Sarawak 2.36 12 8 5 9 20 4 1 14 Selangor W.P Kuala Lumpur 6.43 18 60 3 56 36 9 14 31 2 4 57 1 Commentary • Concentration of services and devices in the Klang Valley. • Despite the wide availability of coronary care units, there is a relative lack of cardio-pulmonary rehabilitation programmes. • Interventional electrophysiology laboratories are a very specialized area of Cardiology and resources are limited to a few centres. • We note that there are more heart-lung bypass units in the private sector. • Current data not available for implantable cardiac devices eg pacemakers, deibrillators and cardiac heart valves. • More detailed information on the cardiac surgery devices and facilities will be available in the future. • More detailed information on non-invasive devices used in cardiology diagnostics to be available in the future eg treadmill machines and tilt table devices. • National registries, concentrated at tertiary, and hospital-based, will provide targeted information at their respective levels eg Acute Coronary Syndrome, cardiac bypass surgery and percutaneous coronary intervention. 43

CHAPTER 12 RESPIRATORY FACILITIES AND DEVICES

Edited by : Dato’ Dr. Abdul Razak Abdul Mutalif 1 With contributions from : Ass. Prof. Dr. Roslina Abdul Manap 2 , Dr. Ashari Yunus 3 , Dr. Norhaya Mohd. Razali 4 , Ass. Prof. Dr. How Soon Hin 5 1 Hospital Pulau Pinang, 2 Pusat Perubatan Universiti Kebangsaan Malaysia, 3 Institut Perubatan Respiratori, 4 Hospital Sultanah Zahirah, 5 Universiti Islam Antarabangsa Malaysia, Kuantan REPORT The National Medical Devices Survey NMDS, a service initiated and supported by the Ministry of Health, gives complete information on the availability of devices and services in all states in Malaysia. This information is very important for future planning and inancing of equipment and manpower. As can be seen later, some states have more manpower and equipment when compared to others. These discrepancies can be due to availability of trained doctors and facilities in some states and none in the others. The data available in this survey can also aid in clinical and epidemiological research. Data on the availability of therapeutic and diagnostic facilities shows some variations in the public and private sector. With the public hospitals having problems in space and patient load, there is no speciic High Dependency Wards for respiratory cases. Almost all public hospitals use general intensive care units ICU to treat respiratory cases. The public hospitals however are well equipped with pulmonary physiology laboratories and sleep laboratories Table 1. Lung transplantation is a very new service provided by the Malaysian hospital. Only one hospital, National Heart Center with the collaboration of the Institute of Respiratory Medicine, screens cases and performs surgery. On the other hand, smoking cessation is a very well established activity in many health clinics and some public hospitals. A total of one hundred centers carry out this service. This is not enthusiasm of providing service is not noticed in the ield of Pulmonary Rehabilitation, as only four public hospital provide it. This is probably due to lack of manpower in the physiotherapy units Table 1. Medical devices in the respiratory medicine are well equipped in the public hospitals all over Malaysia. The commitment of the Health Ministry in early diagnosis of COPD is noted in the availability of spirometers, thrice higher then in the private hospitals. This is due to its cheap costs now and easier to use devices. Almost all states have at least one polysomnograph system in their hospitals and some also have portable somnograph machines Table 2. Body box is a very specialized device and very costly. It is available in most regional public hospitals. Broncho-videoscope systems are freely available in both public and private hospitals. This device is the most important equipment for diagnosis of several lung diseases, like cancers, infections and parenchymal lung disorders. Medical pleuroscope is also a new technology, done by physicians in the wards; this is in all public hospitals. In the private hospitals, rigid scopes were used by surgeons both for thoracoscopy and bronchoscopy for diagnostic and therapeutic procedures, done sometimes by surgeons. This is only done in some public hospitals and not yet available in private hospitals. BiPAP and CPAP systems are used in many public and private hospitals in the treatment of COPD and obstructive apneas. This report is done with the data provided by the contributors from all states. Some of the states cannot obtain accurate data from all hospitals, especially in the private hospitals. The future survey should look into other ways and methods of obtaining better information on the devices and services in the ield of Respiratory Medicine. 44 Table 1: Available Therapeutic and Diagnostic Facilities in Respiratory Medicine Population High Dependency Respiratory Ward bronchoscopy Suite Respiratory Laboratory Sleep Laboratory No in million No pmp No pmp No pmp No pmp Malaysia 26.64 24 100 1 34 100 1 15 100 1 16 100 1 Sector Public - 9 38 24 71 13 87 9 56 Private - 15 62 10 29 2 13 7 44 State Johor 3.17 3 12 1 2 6 1 1 7 1 6 Kedah Perlis 2.11 1 4 2 6 1 1 7 1 6 Kelantan 1.53 1 3 1 Melaka 0.73 1 4 1 1 3 1 1 6 1 N. Sembilan 0.96 2 8 2 2 6 2 1 7 1 Pahang 1.45 2 6 1 2 13 1 1 6 1 Perak 2.28 3 12 1 4 12 2 3 20 1 1 6 Terengganu 1.04 1 3 1 1 7 1 1 6 1 Pulau Pinang 1.49 4 17 3 5 15 3 3 20 2 2 13 1 Sabah 3 1 5 5 15 1 1 7 1 6 Sarawak 2.36 1 5 2 6 1 1 6 Selangor W.P. Kuala Lumpur 6.43 8 33 1 7 21 1 2 13 6 38 1 Population Lung Transplant Unit Smoking Cessation Centre Pulmonary Rehabilitation Unit No in million No pmp No pmp No pmp Malaysia 26.64 1 100 12 100 9 6 100 Sector Public - 1 100 12 100 6 100 Private - State Johor 3.17 2 17 1 Kedah Perlis 2.11 1 8 Kelantan 1.53 1 8 1 Melaka 0.73 1 8 1 Negeri Sembilan 0.96 Pahang 1.45 1 8 1 1 17 1 Perak 2.28 1 8 Terengganu 1.04 Pulau Pinang 1.49 1 17 1 Sabah 3 1 8 1 17 Sarawak 2.36 1 8 Selangor W.P. Kuala Lumpur 6.43 1 100 3 25 3 50