In the fourth of our Living With COVID-19 series, where we learn how fellow health workers are adapting and coping with the ongoing pandemic, we hear from Sreenathan Ramanathan, based in Malaysia. Sree is a family medicine doctor who recently completed our University of Warwick, Postgraduate Diploma in Diabetes Care. Here he describes what it is like being a family medicine practitioner in rural Malaysia, touching on the difficulties faced during the pandemic.
I am 74 years old and commonly known as Dr Nathan here in Malaysia and Sree by family and friends. I graduated from Stanley Medical College, Chennai (Madras) in India in 1977 and have worked in the government services and served the army before I started my practice as a GP in the rural town of Triang, Pahang which is about 160 miles from Kuala Lumpur.
COVID-19 has had a profound effect on us and has been a clinical and economic disaster especially in my small town of Triang where most of us are independent contractors, daily wage earners or what we call smallholders, that is owning a piece of farmland and irking out a living out of it.
Being a Family and Primary Care Physician, I am like a jack of all trades but a master of none. At one time I have had to manage surgical cases, trauma cases and obstetric ones too. Back then, it used to take about 2 hours to reach a hospital from here and nowadays it is about 30 to 45 mins.
Just to give you a little piece of history, I was born in Ipoh and brought up in the Klang Valley. Both are urbanized and some of the most affluent areas of Malaysia. However, I decided to go to Triang because the diseases are the same between all areas and I felt I could do more here. Over 30 years ago, I brought the town’s first X-ray machine enabling us to manage trauma cases and deliver chest x-rays. Additionally, we acquired a blood analysis machine to do full blood parameters, blood pictures, renal, liver, lipid profiles and blood glucose monitoring. On top of this, we also obtained an ultrasound scanner. To help with this, I was fortunate, to get my colleagues who were specialists to further train me for all of this. This sounds like a lot and it was, but now, with younger doctors around, I have reduced my time in practice but am still called to provide clinical services and teaching.
Keeping an appointment during this COVID-19 pandemic is difficult, and even before, we were not known to keep appointments strictly. Now, regular cancellation of elective cases and frequent postponement of the review of chronic cases have hurt the elderly. Many have to wait for their children to come back from other towns where they are working to take them to their appointments. During these times this is the only outing that they have had. However, now with the movement control order (MCO), even that is not possible.
Socially, the elderly are put in a shell. Their outings to the corner coffee shop are gone. The visits by their kids, relations and friends are out, removing the things they used to look forward to. Economically it has also been a disaster. The people have to dig deeper into their savings to survive and at times to support their families, as some have lost their jobs.
For the people of Triang, this pandemic was always going to be a challenge. Their lifestyle has completely changed, and the fear of COVID-19 is like the proverbial Damascus sword hanging over their heads. There is a constant fear of getting infected, together with the lack of PPE and testing kits with the added controversy of the accuracy of antibody/antigen testing. Although it has been known, the gold standard is rtPCR, but it is expensive, and so a political decision has to be taken. In our suburban and rural areas, logistics are difficult, affecting storage and getting samples to a lab in time.
This has clearly shown that both the public and the private sector medical and health services were not prepared for this pandemic. Though overwhelmed initially, they appear to be getting it under control now.
This all highlights that education and empowerment of patients, especially in diabetes and chronic disease care, is essential. Healthcare is the first thing usually cut from budgets here until it becomes critical. Patients then have to spend more money, and it becomes a vicious circle. Now, even in my clinic, the fallout rate [defaulters] is now about 30% to 35%
As such, in my opinion, both patients and doctors have to adapt to new changes and challenges. A vaccine is needed, and reliable, approved, affordable testing kits are also required. Social distancing is painful, and the usage of masks when appropriate and maintaining personal hygiene must be taught from the beginning.
This is where we need empathy, not sympathy. So stay safe and take care.
General Practitioner [Family and Primary Care]