Veteran doctor has 'cure' for ailing KK hospital

Joe Fernandez | Mar 21, 09 12:37pm

Retired government medical specialist Dr Anil Kumar Kukreja thinks that he may have come up with a comprehensive action plan, the “perfect” antidote if not a cure, for everything that ails public healthcare in Sabah and Kota Kinabalu’s troubled Queen Elizabeth II General Hospital, largely declared unsafe late last year.

The Anil Plan at the micro-level, basically a variation of numerous suggestions made so far by stakeholders, brings Hospital Mesra (HM) into the picture as well for the first time.

HM is KK’s mental hospital where Dr Anil served as director from 1997-2000. He has also been acting Director of the Health Department of Sabah for several stretches over the years.

“The colonial blocks at QEH II housing the medical wards can be easily relocated to Hospital Mesra,” said Dr Anil who still helps out in the private sector while keeping an eye on his franchise outlets under Himalaya Herbals.

“This will allow the creation of the 50-metre construction work space required by safety regulations around the site for the proposed twin tower blocks. Work cannot begin until the colonial blocks are vacated and the abandoned Tower Block demolished.”

New emergency hospital proposal

“The mental wards themselves are more suitable for the four-story podium block at the nine-storey Wisma Khidmat. They should not be in open wards, as at present, at Hospital Mesra. Fortunately, the number of violence-prone patients number less than ten.”

The state government has proposed the currently vacant state GLC-owned Wisma Khidmat as a new emergency hospital to make up for a shortfall of 250 beds in KK. Also in the pipeline is a new hospital in Kinarut, on the outskirts of KK, to replace the Tower Block at QEH II which had been declared unsafe.

The state government has already made the required land available to the Ministry of Health. Another state government proposal is to build a decanting ward with 250 beds within four to five months near the QEH II car park.

Dr Anil’s idea is that Kinarut should be the new mental hospital.

He came forward with his plan in the wake of concerns expressed in recent days by the Malaysian Medical Association (MMA) over the dilly-dallying by the Ministry of Health (MOH) since the decanting of the QEH II.

MMA president Dr Khoo Kah Lin has warned that “the MMA hopes the Ministry of Health is able to expedite support and resources for a sustainable and long-term solution to the unfortunate situation (QEH II)”.

“Fragmentation of crucial services will be detrimental to patient safety and good clinical practice,” added Dr Khoo. “Logistical issues will impair the continuity and quality of care.”

Sabah is not obviously the place to be if one is a stroke victim and can only rely on a government hospital, needs elective surgery at public facilities where the waiting period could be four months, suffers a heart attack requiring immediate surgery or intensive care. The list of inadequacies in public healthcare extends.

Dr Anil said that demolishing the tower block would create a Catch 22 situation

50-metre free work space

Demolishment must be followed by the creation of a 50-metre free work space around the site for the proposed Twin Tower blocks and this would necessitate the temporary abandonment of the low-rise 200-bed colonial blocks on the QEH site which house the medical wards and are still functioning.

Another nearby structure, the emergency and accident centre, does not have to be vacated but suffers from flooding whenever there’s a heavy downpour in the city. Likewise, the low-rise outpatient block and the Post-Graduate Medical Centre on the QEH site can continue to function as usual during construction work on the Twin Towers.

The question was where to re-locate the medical wards from the colonial blocks?

Housing the medical wards from the colonial blocks at a suitable location and immediate intervention by the Finance Minister with a suitable budget seems to be the key to unraveling the public healthcare puzzle in Sabah.  

One advantage of Hospital Mesra in Bukit Padang is that it has about 50 acres available for future expansion. Anil thinks that the medical wards should stay at Hospital Mesra even after the twin towers are completed and the old colonial wards converted under the macro level of his plan into a centre of excellence for neurology and separately for orthopedics.

Centres of excellence

“Gone are the days when a hospital was judged by the number of beds. At present a hospital bed in KK can reach anything up to a million ringgit and that means a 400-bed hospital can cost RM400 million.

“Of course, this figure includes all the facilities that go with the bed,” said Anil. “Now the trend is towards setting up centres of excellence for various ailments.”

Other centres of excellence envisaged by Dr Anil are oncology at the Likas Hospital, formerly the old Sabah Medical Centre (SMC), infertility centre, obstetrics and gynaecology, pediatric/dental care and nephrology, all housed independently but at the same hospital. The proposed Heart Centre can be housed at the proposed Twin Towers, adds Dr Anil.

At present, there is no heart centre in Sabah and the only service available is once a month when a team from the National Heart Institute (IJN) visits the SMC. Alternatively, patients have to be sent to the IJN for which Sabahans including other Malaysians habitually resident in the state and registered at the QEH II have to fork out just RM 1,000. The rest of the medical fees are paid by the state government.

“When mental patients shift to the proposed new hospital in Kinarut, the podium block can be the centre for excellence for gastro-enthrology services,” said Dr Anil.

In addition, Dr Anil urges that the purchase of the new SMC go ahead as the owners are willing to let it go for a reasonable sum. Apparently, they intend to use some of the proceeds to build a RM50 million boutique hospital along the waterfront near the Sutera Harbour Resort, a stone’s throw from downtown KK.

The Sabah Medical Centre – originally built at RM150 million – is expected to cost RM400 million after the owners have renovated the structure as per the ministry’s specifications and requirements.

Unreasonable stance

There are distinct differences in layout between a five-star hotel-style private hospital and an open ward government hospital. The sticking point, according to those in the know, appears to be the insistence by the MOH and the Federal Government (Ministry of Finance) that the state government fork out half the purchase cost of the SMC.

This is seen as an unreasonable stance by the MOH and the Ministry of Finance, and one which has thrown a spanner in the works, since public healthcare matters are a federal matter under the federal and state constitutions.

The Health Ministry is at present renting space at SMC at RM30,000 daily following the decanting of QEH II. Use of personnel, services and facilities at SMC are billed separately.

The tragedy of QEH II cries out for an immediate solution, pleads Dr Anil. “Already, patients suffering from diseases that require urgent treatment, such as cancer and heart diseases, are being flown to Kuala Lumpur and Penang for treatment. “

“Moreover, matters are being compounded by some patients who refuse to go out of the state for treatment as disclosed by the Sabah Health Director Dr Marzukhi Mohd Isa.”

It is known that the state government is bearing the brunt, if not all, of the costs involved in ferrying patients to other states for medical treatment.

Decanting of QEH has further compounded the situation at the dependent hospitals in Kuala Penyu (60 beds) built at RM50 million; Pitas (60 beds) built at RM50 million; Sipitang (100 beds) built at RM100 million; and Keningau (200 beds) built at RM200 million.

“All of them continue to be white elephants sitting in the tropical sun, being understaffed and lacking in the necessary equipment,” according to the medical community.