Kidney transplants: More questions than answers

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By Dr Jacob George

I refer to the article “Kidney failure on the rise in Malaysia” in Free Malaysia Today.

The above article extensively quoted statements by Health Ministry deputy director-general, Dr Jeyaindran Sinnadurai, which I found to be extremely troubling and certainly misleading to the Malaysian public.

Extremely troubling because we are told that the number of patients requiring kidney dialysis will double by 2040. And that nine out of 100 Malaysians have chronic kidney disease today.

Rather than join a chorus of extreme negativism, allow me to address the various issues raised by Dr Jeyaindran in the said article which cannot go unchallenged as CASSA has done a lot of work in these areas and our findings raise several points that need to be explained in regard to accountability, good governance and transparency at the Health Ministry of Malaysia.

It is not our intention to embarrass any quarter but to ask pertinent questions in the interest of the public.

Prevention is better than cure

Firstly, may I humbly ask whatever happened to the Health Ministry’s preventive health programme?

Is it not time to conduct an audit by independent assessors as to why if any, all of the ministry’s programmes have failed? How much of ratepayers monies have been spent on such programmes?

Let us start with the ministry’s infamous Lifestyle Campaigns costing millions to date, but which seem to have failed?

Dr Jeyaindran should realise that as a medical practitioner and now wearing the hat of an administrator, that talking about organ transplants is a secondary issue. Transplants are not cheap.

Does he and his ministry colleagues not feel that greater emphasis should be given to the prevention of organ failure?

If indeed our preventive medicine and healthcare programmes are effective, we would not need to be talking about expensive organ transplant programmes and the lack of specialists we are experiencing at present.

More focus on cheaper preventive medicine, not kidney transplants

Secondly, in the said article, the deputy director-general also mentioned that the health ministry wanted to increase the capacity for kidney transplant patients. How come nobody seems to be bothered about cheaper preventive medicine?

At this juncture, we need to also ask whether we have allowed far too many eateries to serve unhealthy and unhygienic food to unsuspecting consumers. Do we not need to now regulate and limit the number of such places?

We need to also ask whether patients today have easy access to drugs and alternative treatments, some of which are damaging to their organs, and offered by fly-by-night operators.

What happened to kidney transplant programme in our hospitals?

Thirdly, are generic medicines effective in controlling the blood sugars and blood pressure of patients? If they are effective, why are diabetics developing kidney failure?

Those familiar know organ transplants are expensive. It also requires highly-trained teams and other assets to be effective. It is a passionate skill requiring dedication, sacrifice and vision.

I know that there was an effective kidney transplant programme in Hospital Kuala Lumpur and Selayang Hospital. Would the deputy director-general care to answer whatever happened to that programme? Has the government pumped in enough funds to sustain it?

If they indeed have stopped the programme, the pertinent question is why the government did not do enough to sustain these tertiary services?

The deputy director-general has taken pains to give the impression that the health ministry is looking into engaging foreign experts to train more specialists in these areas so that kidney transplants can be conducted here.

A very strange statement coming in the 2017 era.

Where have all our specialists gone?

Members of the Malaysian public are surely curious about whatever happened to all the trained specialists we previously had. Care to honestly explain? Why were no steps taken to retain these specialists? Whose incompetence or lack of professionalism resulted in this state of affairs?

For example from 2015, no liver transplants were conducted in the country. Why? Does this have any link to specialists retiring without efforts made by ministry bureaucrats and pencil pushers, to ensure their reemployment? Or did others leave the service out of sheer frustration at the lack of promotions and appreciation for their dedication, passion and service to the nation?

And does not what I am alluding to have indeed grounds for a comprehensive investigation by an external non-partisan task force?

At the same time have our so called ministry intelligentsia ever done a root cause or analysis as to why specialist are leaving the service?

CASSA is aware that international experts like Professor Russell Strong, a dear friend, was brought in to facilitate the development of organ transplants in this country. Why was the effort not sustained?

Other countries far ahead of Malaysia

Embarrassingly, in comparison with other countries where specialist services are developed, exponential growth has been registered. Why not in Malaysia?

Are we not ashamed that even countries, whose talents were trained in Malaysia like Pakistan are developing transplant programmes in all their districts? 36 districts to be exact.

Even India, that started organ transplants after us, have moved far ahead of us. Perhaps the health ministry deputy director-general can enlighten us as to why this is so.

Embarrassingly, nothing seems to be moving in a progressive manner and is allegedly hampered and frustrated by politics, back-stabbing, private and personal interests, personalities, and racism.

Since we are on this topic, may I also ask whatever happened to Malaysia’s version of the Organ Transplant Act?

CASSA was consulted to provide feedback decades ago and I am advised this is still another issue that has not seen the light of day or has been resolved.

Perhaps, this is a classic example of something being seriously wrong at the Health Ministry’s leadership, which at one time stood tall, talented and transparent.

Dr Jacob George is a theologian, corporate lawyer, social worker and president of the Consumers Association of Subang & Shah Alam, Selangor (CASSA).

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Kidney failure on the rise in Malaysia