the history of early medical and health services in …...hindu beliefs and indian folk prac-tices,...

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THE HISTORY OF EARLY MEDICAL AND HEALTH SERVICES IN MALAYSIA by Tan Sri Datuk Dr. Hj. Abdul Majid Ismail P.S.M,, S.P.S.K., J.M.N., M.B.B.S., M. Ch. Orth., F.R.C.S.E., F.R.A.C.S. Director-General of Health Malaysia Introduction The development of a com- p rehensive medical and health services within what is now Penin- sular Malaysia, and the subsequent decline in the incidence of certain debilitating diseases has been a relatively recent achievement. It was not until after British inter- ference in the affairs of the Malay States in 1874 that the machinery of the various state governments was turned to the task of designing a medical and health delivery sys- tem based upon Western Medical practice. Before this time the go- vernment of the various states were not interested in the health situa- tion of their respective people- rather they were more interested in consolidating their own positions and acquiring wealth through trade. However with British interference more attention was placed on the health situation of the people, special emphesis was placed on health matters that affected their imperialistic aims of deriving maximum economic gains from their interference. Thus before Independence only an initial effort was made towards improving the general standard of health in the country. With the advent of Indepen- dence in 1957 this initial effort was further strengthened by m aking health a federal matter and by establishing the rural health service. The latter has been extremely important to the government's overall programme of development as it expanded the medical and health services from their previous- ly urban base and has equitably re- distributed them throughout the rural sector of the country. As near- ly 70% of Malaysians live in rural areas, the rural health services have gone a long way towards meeting the government's health objective of improving the general standard of health in the country. Much remains to be done in the field of medical and health services to bring Malaysia to a state of optimum health, but a significant portion of the ground work for this task has already been laid. With this paper, I will discuss how this early founda- tion was laid. Traditional Malay Medical Practice:- Prior to the white man's arri- val in the early sixteenth century, the Malay Peninsula has, at diffe- rent historical moments been thrust into the path of the world's major cultural streams. This exposure to such a broad and diverse cultural pool has had important implica- tions for the development of tradi- tional Malay medicine. At the outset, Malay medicine is essential- 6 Hak Cipta Terpelihara © 1974 – Persatuan Sejarah Malaysia Hak Cipta Terpelihara © 1974 – Persatuan Sejarah Malaysia

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Page 1: The History of Early Medical and Health Services in …...Hindu beliefs and Indian folk prac-tices, some of which later gave way to Islamic beliefs and traditional Arabic treatments

THE HISTORY OF EARLY MEDICAL AND HEALTHSERVICES IN MALAYSIA

by

Tan Sri Datuk Dr. Hj. Abdul Majid IsmailP.S.M,, S.P.S.K., J.M.N., M.B.B.S., M. Ch. Orth., F.R.C.S.E., F.R.A.C.S.

Director-General of Health Malaysia

Introduction

The development of a com-p rehensive medical and healthservices within what is now Penin-sular Malaysia, and the subsequentdecline in the incidence of certaindebilitating diseases has been arelatively recent achievement. Itwas not until after British inter-ference in the affairs of the MalayStates in 1874 that the machineryof the various state governmentswas turned to the task of designinga medical and health delivery sys-tem based upon Western Medicalpractice. Before this time the go-vernment of the various states werenot interested in the health situa-tion of their respective people-rather they were more interested inconsolidating their own positionsand acquiring wealth through trade.However with British interferencemore attention was placed on thehealth situation of the people,special emphesis was placed onhealth matters that affected theirimperialistic aims of derivingmaximum economic gains fromtheir interference. Thus beforeIndependence only an initial effortwas made towards improving thegeneral standard of health in thecountry.

With the advent of Indepen-dence in 1957 this initial effort wasfurther strengthened by m akinghealth a federal matter and by

establishing the rural health service.The latter has been extremelyimportant to the government'soverall programme of developmentas it expanded the medical andhealth services from their previous-ly urban base and has equitably re-distributed them throughout therural sector of the country. As near-ly 70% of Malaysians live in ruralareas, the rural health services havegone a long way towards meetingthe government's health objectiveof improving the general standardof health in the country. Muchremains to be done in the field ofmedical and health services to bringMalaysia to a state of optimumhealth, but a significant portion ofthe ground work for this task hasalready been laid. With this paper, Iwill discuss how this early founda-tion was laid.

Traditional Malay Medical Practice:-

Prior to the white man's arri-val in the early sixteenth century,the Malay Peninsula has, at diffe-rent historical moments been thrustinto the path of the world's majorcultural streams. This exposure tosuch a broad and diverse culturalpool has had important implica-tions for the development of tradi-tional Malay medicine. At theoutset, Malay medicine is essential-

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Hak Cipta Terpelihara © 1974 – Persatuan Sejarah Malaysia

Hak Cipta Terpelihara © 1974 – Persatuan Sejarah Malaysia

Page 2: The History of Early Medical and Health Services in …...Hindu beliefs and Indian folk prac-tices, some of which later gave way to Islamic beliefs and traditional Arabic treatments

ly based on folklore, beliefs andcustoms. Built upon this founda-tion and inexorably intermeshedwith this core are a number ofHindu beliefs and Indian folk prac-tices, some of which later gave wayto Islamic beliefs and traditionalArabic treatments. The resultingsynthesis, as described by Dr. J.W.Fields, is a "blend of ancient folk-lore, Hindu mythology, Muslimorthodoxy, and Arabic pharmaco-poepia." Because Malay medicinehas well learned the lessons of theArabic and Hindu healers, theMalay folk practitioner has had athis disposal a wide range of treat-ments, far surpassing in depth andbreadth than that which is found inthe majority of other folk cultures.

Health for the Malays hastraditionally been an individualmatter — a family matter — the solearena of the village's traditionalfolk practitioner (the bomoh).Armed with his incantations, treat-ments prohibitions, herbs andknowledge of folklore, the bomohis viewed as man's link with themystical unknown, and as such, heexercises a very powerful influencein the life of the rural kampung,even today. Countless examplesfrom every day life in modernMalaysia can be used to illustratethe sway of the bomoh in the ruralareas. The rite of berpuar, fir exam-ple, is one such illustration. Berpuaris one of the many regional ritespractised by the rural people toensure a successful padi harvest forthe forthcoming year. "No berpuar,no padi ," insist MinangkabauMalays, and "for ten days. . . theydrove the evil spirits down thecourse of the Rembau River, sacri-ficing a pink buffalo at the ulu,where the river emerges from the

forest and a black buffalo at thehilir or river mouth." This ritual isfollowed by a taboo period on theshedding of blood.

The implications of a stillpowerful folklore and traditionalcures like using and reciting versesfrom the Holy Koran on the deve-lopment and expansion of Westernmedical practice throughout thecountry are many and varied. Moreon this will be discussed later.

Initial Colonisation (1511-1880):

The impact of the West wasfirst felt on the Malay Peninsulawith the Portuguese settlement in1511 of Malacca. The Dutch re-placed the Portuguese in 1641, anda little more than one hundred andforty years later the Britishestablished trading posts on theisland of Penang. By 1795 theBritish had displaced the Dutch inMalacca and with the taking ofSingapore in 1819 from the Sultanof Johore, the British had success-fully consolidated their positionalong the western coast of thepeninsula. Western medical thoughtwas imported from Europe into thetrading areas by the tradingcompanies during these early years,and small treatment centres wereestablished by the companies inMalacca, Penang and Singapore totreat their European employees andtheir families. Perhaps local personswere occasionally treated at theseinfirmaties, but there was no signi-ficant effort on the companies tocater to the health needs of thelocal population. With the dissolu-tion of the East India Company in1868, control of and responsibilityfor the health care of Europeangovernment workers and private

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Hak Cipta Terpelihara © 1974 – Persatuan Sejarah Malaysia

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traders were transferred from theprivate sector to the British Colo-nial Office. In 1867 the civil ad-ministration of the three coastalcities — Malacca, Penang andSingapore — was strengthened bythe formation of the Straits Settle-ments under direct authority of theColonial Office. This act gave thegovernments in each of these threeareas a stronger hand in providingfor health protection although theprimary recipients of that careremained Europeans.

H o s p i t a l D e v e l o p m e n t(1874-1910):

In the late 19 th century,Chinese miners and labourers werebrought in by Malay rulers to workthe rich tin mines. With them theybrought traditional Chinese medi-cine. As the Chinese continued tosettle on the peninsula, Chines eherbalists, with hundreds of reme-dies derived from plants and animalorgans, began to slowly settle in thegrowing towns. By 1880 a smallChinese hospital of 28 beds wasbuilt in Kuala Lumpur by a wealthyChinese mine owner, marking forthe first time the establishment of anon-European treatment complexof any size and permanence.

The British interference in theaffairs of the Malay States in 1874marked the beginning of a new erain Western medicine for the Penin-sula. A British Resident was appoin-ted to each State, and except formatters of Malay custom and reli-gion, the advice of the Resident waslaw. Health matters fell under theResident's jurisdiction, and undergovernment impetus, the generalhospitals were built. Between 1883and 1910 hospitals of varying sizes

were built in the capitals of each ofthe four States. The General Hos-pital at Kuala Lumpur, built in1883, was the first of what nowconstitutes a network of generalhospitals in each of the elevenStates of Peninsula Malaysia.

Less under direct British rulebut still under her protection werethe five Unfederated Malay Statesof Perlis, Kedah, Kelantan, Treng-ganu and Johore. These States hadgreater autonomy in the manage-ment of their internal affairs.General hospitals were also estab-lished in the capitals of each ofthese States, although they tendedto be smaller and built later thantheir counterparts in the FederatedMalay States. The General Hospitalin Kota Bharu, for example, wasprobably a nine bed affair builtaround 1907.

By the turn of the century aclear, though fragmented, patternof British control began to emergealong the Malay Peninsula. Thiscontrol, the result of the treatiesestablishing the four FederatedMalay States, the five UnfederatedMalay States, and the three StraitsSettlements, put Britain in a strongposition to begin the task of im-proving the health of the variouspeoples residing throughout thecountry. Rubber and tin providedhard cash support for the Britishsterling and one of the govern-ment's early efforts in the field ofhealth was aimed at safeguardingthe health of those workers whotoiled on tin mines and rubberestates. On rubber plantations, forexample, it was compulsory to havea small estate hospital with fourbeds for every 100 workers.

Additionally, a network ofhospitals began to spring up across

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Hak Cipta Terpelihara © 1974 – Persatuan Sejarah Malaysia

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the country. By 1908, a wide pat-tern of hospital service began toemerge. There were 52 hospitals inthe Federated Malay States, andeach State had a state surgeon and anumber of district surgeons. (Theterm surgeon in those days wasused to designate general dutymedical officers and not qualifiedsurgical specialists in the strict sen-ser of the word.) The primary ser-vices at this time were basicallycurative, though, and hospital treat-ment was for the desperately sick.In the majority of cases thesepatients were brought to hospitalsto die. Health work, however, hadmade a few inroads in the majorurban areas. Kuala Lumpur, in fact,set up among the British govern-ment personnel a sanitary boardconcerned with cleaning the streets,maintenance of the public marketand so on.

British Colonial Medical Service andPublic Health (1910-1942):

In 1910 a health departmentwith headquarters in Kuala Lumpur

was set up. This brought the healthservices in the Federated MalayStates under a central administra-tion. Heretofore the health servicesin each State had been the respon-sibility of that State's British Re-sident who usuallly was not amedical man, and for whom healthwas a fairly low priority item.Centralised control meant that thisendeavour to improve health wasnow the responsibility of professio-nal men who were better qualifiedto develop and direct those services.It also meant direct access to fundsof the central administration of theFederated Malay States. The ori-ginal health department was staffedby colonial government medicalofficers qualified in public health,and its main functions were chieflyrelated to environmental sanitationin Kuala Lumpur and the surroun-ding areas. By 1920 the staff hadexpanded to 31 medical officersand 8 sanitary inspectors.

With the further developmentof the rubber industry in the earlypart of the 20th century, more andmore rubber plantations were es-

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tablished. By 1920 there were1,200 such estates. About this timegovernment stepped in to streng-then their influence on the opera-tion of these plantations. Theenactment of the Rum LabourCode was one result of this action.The Code was designed to protectthe welfare of the various workersand had specific guidelines formedical and health measures whichmust be undertaken by the estateowner to safeguard the health ofthe estate's employees. Outside themain cities, it was now the rubberestates (rather than the rural areas),upon which public health effortswere concentrated. Swamp drainageand mosquito larvacidal work tocontrol malaria on estate propertywas undertaken by health workersemployed by the plantation as wassmallpox vaccination and otherimmunization work.

In the decades between 1910and 1930, Medical Officers ofHealth (MOH) were appointed inthe capital cities of each of theMalay States. In some, their func-tions were confined to the interiorof those cities, and in others theyextended to enforcement ofsanitary conditions at the rubberestates and tin mines. In a fewcities, material and child healthclinics were established and someexaminations were done on schoolchildren. There activities composedthe vast bulk of health activities inthe country at that time.

Quite separate from publichealth work, the medical services asrepresented by district and generalhospital, had also been expanding.Small district hospital were beingconstructed in the major urbancentres, and general hospitals hadbeen established in each State

capital. Acting as satellites to theseinstitutions were the small "towndispensaries" which were begun bythe government in a few towns andwere staffed mainly by hospitalassistants. These were male dressersor medical auxiliaries who hadlearned basic medical skills byapprenticeship in the hospitals.

By 1937 there was approxi-mately one doctor for every 10,000people in the Federated MalayStates and in the Straits Settle-ments. This is based upon a totalpopulation of these two areas of alittle more than 3 million peopleand total number of doctors being304. Of these 304 medical officersin the government service, 12 weresurgeons or other medical specia-lists, 137 were European doctorsand 155 local doctors. The ratio,though, is misleading because thevast majority of these doctors wereconcentrated in the urban areaswhile most people continued to livein the rural areas. Vast areas of thecountry were still ostensibly with-out access to Western medicine.

As was mentioned previously,the primary function of the varioushospital was the treatment of thedesperately sick, and this wascarried out mostly by the generalpractitioner. The specialities es-pecially surgery, had gained a foot-hold in the medical service but theyremained in the background forsome time. This was due to the factthat most patients seeking admis-sion to the hospital were sufferingfrom non-surgical diseases (e.g.malaria, beri-beri, dysentery, cho-lera, etc.) and there was a lack ofqualified specialists and trainedassistants in the government service.These limitations did not totallyretard the practice of surgery in

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Malaya however, and some majorsurgery was performed in the gene-ral hospitals of the Federated MalayStates as early as the 1920s. By1927 a splenectomy was performedin the Seremban General Hospital,and an electrical beli and silverprobes were used in 1919 at Gene-ral Hospital, Kuala Lumpur tolocate bullets lodged in deep tissuesfollowing a gun battle betweenpolice and gangsters. The lack ofantibiotics and effective anaesthe-tics impeded the growth of surgeryuntil later periods, but by 1937over 14,803 operations were re-corded in the Federated MalayStates while 3,987 such operationsoccurred in the Straits Settlements.In the latter instance 37 deathswere also recorded.

From the foregoing it can beseen that since the onset of medicalservices, health has been a two-sided affair comprised of the"public health side" and the"hospital side." This division stillremains today, although both"sides" are now under one centraladministration and are a federalmatter.

The period between the twoworld wars was one of consolida-tion. Fewer hospitals were beingbuilt and attention was turned toimproving the services already exis-ting. From 1930 to 1942 the colo-nial public health and medical ser-vices were faced by several set-backs, one of which was the world-wide economic depression whichmade its presence felt in Malayafrom 1925-34. Beyond the boun-daries of the estates and mines, theonly services offered to the ruralareas were a few travelling dispen-saries emanating from the hospital,and even these were curtailed du-

ring the depression.

The Second World War and Post-War Period (1942-1952):

In December 1941 the Japa-nese invaded Malaya, landing in thenorth and pushing southward tocapture Singapore in February1942. With the invasion, most ofthe European personnel in Malayaand Singapore were either evacua-ted or interned by the Japanese.The hospitals, therefore, were leftin the hands of the local doctorswho managed them throughout theOccupation. As in other countrieshard hit by war, health matterswere ignored. Some hospitals weretaken for use by the Japaneseforces and others were looted forsupplies. The infant mortality ratein Kuala Lumpur, for example,leaped from 97 per 1,000 live birthsin 1940 to 156 per 1,000 in 1943.Outbreaks of diseases such as mala-ria, beri-bcri and cholera were leftunchecked, and the general healthof the people deteriorated signifi-cantly.

In August 1945 the Japanesesurrendered and the country cameunder British military adminis-tration, followed closely by civilianrule. The three political groupingswhich existed before the war weremerged in 1948 and the Federationof Malaya was born. This newgovernment was faced with thebreakdown and neglect of medicaland public health services duringthe Occupation which had taken itstoll both in human terms of faci-lities. To correct this situation wasone of the government's first tasks.The initial step to restore servicesto the people was the division ofthe twelve States into smaller

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Hak Cipta Terpelihara © 1974 – Persatuan Sejarah Malaysia

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administrative units called "admi-nistrative districts." The adminis-trative district was responsible forhealth matters as well as land con-trol, tax collection, and roadmaintenance and this system pro-vided the skeleton for a more sys-tematic and efficient governmentstructure. Currently, in Malaysiathere are seventy such adminis-trative districts and they — eithersingly or in combinations of two orthree — constitutes one health dis-trict, the framework around whichall public health service {both urbanand rural) is fashioned. Forty sevensuch districts are currently inexistence.

Beyond restoring order to thecountry and reviving the varioussocial services, the accomplishmentsof the government during the post-war period included a large expan-sion in the number of district hos-pitals. By 1956 fifty such hospitalexisted throughout the countrysupported by ten general hospitalsbut most were still located in urbanareas. Based at the various districtand general hospitals were a fewtravelling dispensaries which pene-trated into a few of the rural areasnearest urban areas. These travellingdispensaries served as a complementto the static dispensaries which hadexisted prior to the war in the smalltowns.

Maternal and child healthclinics were established in scores ofcities and towns in the post-warperiod extending health care to themost vulnerable groups in the po-pulations. In the State of Pahang,for example, eight such clinic hadbeen established in the State capital(then Kuala Lipis) and seven dis-trict towns by 1956. These pre-ventively oriented clinics came

under the administration of theHealth District MOH and they haveoften formed the nucleus of whatlater became the rural healthcentre.

Origin of the Rural Health ServiceScheme (1953-1956):

The "Emergency", the des-cription given to the confrontationbetween communist insurgents andgovernment forces, had its onsetaround 1948. Since communistguerillas derived much of their sus-tenance from Chinese settlers whohad been dirven by the Japanese tothe edge of the jungle to live, amajor counter-insurgency prog-ramme consisted in the systematicresettlement of about a half millionof these people in "New Villages."Some 500 new villages were builtbetween 1950 and 1953. Theattraction of the new villages wasthat it gave these settlers their firstclear title to a piece of land and itprovided basic social services withinthe village, i.e. schools, communityhall and health facilities. In thefield of health, the Emergency notonly contributed to a belated re-cognition of rural needs, but it alsohigh-lighted the special medical andhealth problems in the hundreds ofMalay kampungs in which no gue-rilla action took place. With all theattention given to the Chinese innew villages, it was argued in Par-liament, what about the socialneeds of the greater number ofrural Malays?

As a result of this inquiry intothe social needs of the rural Malays,a series of national programmeswere started to focus attention onthe rural areas. These included theRural and Industrial Development

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Hak Cipta Terpelihara © 1974 – Persatuan Sejarah Malaysia

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Authority (RIDA - 1951), theFederal Land Development Autho-rity (FLDA - 1956), and theMinistry for Rural Development(1959) which was leter known asthe Ministry of National and RuralDevelopment and now functions asthe Ministry of Rural EconomicDevelopment.

It was part of this swelling tideof concern for rural welfare thatthe Rural Health Service Schemewas born. The first seeds of the ideawere planted with the design of amodel "rural health centre" atJitra, Kedah, in 1953. This centrewas established in 1954 and was toprovide a broad scope of preventiveand curative service to the surroun-ding rural population. Additionally,a training programme for staff to beplaced in future rural health centreswas instituted at the Jitra centre.

The First Development Plan ofthe Federation was scheduled for1954-1956 and it contained theprospectus of the Rural HealthService Scheme. Initially, it wascomtemplated that twenty-fiverural health centres would be built,more or less on the Jitra model.Around each of these would even-tually be built four "sub-districthealth centres" and around each ofthese would be five "midwife cli-nics cum quarters" — the wholeconstellation serving about 50,000rural people. With the pressures ofthe pressures of the Emergency,only eight district health centreswere built in this period.

The Five-Year Plans (1956-1970):

Even before Independence(1957), planning on a national levelhad begun. The first Five-Year Planwas scheduled for the period 1956

— 1960. The construction ofnumerous component of the RHSSwere part of the plan. A furtherboost was given to planning in thehealth sector by transfer of allthose responsibilities for publichealth and hospitals from the Statesto the Federal Government in1958. Henceforward, both financialsupport and general direction (bothtechnical and administrative) camefrom a unified national "MedicalDepartment" — which later becamethe Ministry of Health. Thisarrangement permitted greater co-ordination of planning for theRural Health Service with theplanning schedule of other minis-tries.

By the end of the first Five-Year Plan in 1960, construction inthe Rural Health Service had beencompleted as follows:-

District health centres — 8Health sub-centres — 8Midwife clinics cum

quarters — 26

Staffing of these facilities, however,was far from adequate, since train-ing programme take longer thanbuilding programmes.

It was in the Second Five-YearPlan, 1961-1965, that the conceptof the RHSS became better crys-tallized, in relation to the overallprocess of "rural developmentplanning." In this period, it becameclarified that the "Medical andHealth Officer" in charge of each"Main Health Centre" would beresponsible to the MOH of thehealth district. The District MOH inturn is responsible to the ChiefMedical and Health Officer of theState — an official appointed by theHealth Ministry and responsible for

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all medical and health activities inthe state. The State Chief Medicaland Health Officer would meetwith the State Rural DevelopmentCommittees, the Health DistrictMOH with the District Rural De-velopment Committees (orCommittees in his territory), andthe rural Medical and HealthOficer with any "kampung" Deve-lopment Committees that wereformed. In this manner close co-ordination of the health serviceswith other government servicescould be maintained.

By the end of the SecondFive-Year Plan in 1965, furtherconstruction had achieved 39 mainhealth centres, 12 health sub-centres and 643 midwife clinic cumquarters. This was obviously aperiod of rapid progress, eventhough staffing of the rural healthunits could not keep up with thepace of construction. The verycompletion of buildings, however,provided an inducement toward therecruitment and training of per-sonnel. Perhaps the most seriousdeficiency was in the number ofdoctors as most the main healthcentres were without a medical andhealth officer, theoretically theteam leader. This critical gap wasnot filled until a decision was madein 1965 to import doctors for theseposts from overseas.

The third Five-Year Plan(1966-1970) became known as the"First Malaysia Plan" since Malay-sia had taken shape in 1963. It didnot contemplate construction offurther main centres, but did aim atcompletion of 60 more health sub-centres and 450 more midwifeclinics. The relatively slower paceof construction was due to chan-nelization of funds toward urgently

needed improvement of general anddistrict hospitals, as well as topermit consolidation of staffing ofthe various components of existingrural health units. As of December1967, some 17 additional sub-centres had been built, plus 60midwife clinics, bringing the totalnetwork to:-

Main health centres — 39Health sub-centres — 139Midwife clinics cum — 703

quarters

Construction and staffing ofthe various components of theRural Health Service has continuedto date although the progress wasslowed somethat by a recession inthe price of rubber in the 1960s,causing Malaysia's revenue to dip.As of the end of 1972 the numberof centres completed were asfollows:-

Main health centresHealth sub-centresMidwife clinic cum

quarters

Acceptance of GovernmentServices:

- 51- 200- 1107

Health

Acceptance of the govern-ment's full range of medical andhealth services by the public hasbeen generally satisfactory, al-though there are a number of fac-tors which tend to lower the effec-tiveness of these facilities and ser-vices. Unfortunately, space doesnot permit a thorough examinationof all these factors. Suffice it to sayth at the still relatively strongimpact of traditional Malay medi-cine upon the rural population hasretarded the full utilization of exis-ting services. Too often in cases of

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Hak Cipta Terpelihara © 1974 – Persatuan Sejarah Malaysia

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illness in the kampung, the bomohis first summoned and it is only af-ter he has exhausted his bag of treat-ments that the advice of govern-ment medical and health workers issought. Oft-times the crucial periodin the illness has past and thepatient when finally seen by thedoctor has gone beyond the pointof no return.

It has been suggested, though,that the spread and final acceptanceof Western medical practice by allsegments of the public will becarried on the tide of medicalsuccesses. Dr. J.W. Fields points outthat the effects of an injection ofarsphenamine in yaws are beyondphilosophical argument, and how-ever strong the rural people'sfaith in the bomoh, they will walkmany miles to get an injection withthis drug. Beyond mere successesusing the technology of modern

medicine, proper attitude on thepart of the public and on the partof the health staff will most likelybe the key that promotes effectiveand efficient utilization of govern-ment health services to reach anoptimum level of health. As it hasbeen stressed in the Second Malay-sia Plan and the Government'sGerakan Pembaharuan the rightattitude, a willingness to changewith the times is the essential ingre-dient for the public to ensureMalaysia's Development. On theother hand, all categories of me-dical and health staff must beconstantly receptive to the needsand desires of their patients, andmust exercise understanding in thecourse of their duties. Only in thisway can the government's healthobjectives be obtained and a higherstandard of living provided for thepeople of Malaysia.

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Hak Cipta Terpelihara © 1974 – Persatuan Sejarah Malaysia

Hak Cipta Terpelihara © 1974 – Persatuan Sejarah Malaysia