As hospitals became clogged with patients, the need for an adequate number of beds became painfully evident 

by SHAUQI WAHAB 

THE pandemic has underscored a crucial lesson: The absolute necessity of robust healthcare systems in our rapidly evolving world. COVID-19 serves as a stark reminder of how swiftly an unforeseen crisis can strain existing infrastructure, leaving healthcare professionals and patients grappling with unprecedented challenges. 

It has been more than three years since the pandemic first emerged, impacting individuals of all ages and resulting in numerous tragic losses of friends and family members. This crisis has not only taken a toll on the economy but has also laid bare the insufficient hospital capacity and bed availability for infected patients. As hospitals became clogged with patients, the need for an adequate number of beds became painfully evident. 

The Ministry of Health (MoH) is targeting a hospital bed ratio of 2.08 bed to 1,000 residents by the end of the 12th Malaysia Plan (12MP). 

The then Health Minister Khairy Jamaluddin said the ratio achieved in 2020 at the end of the 11MP was 2.01 beds, with the number of beds increasing from 55,952 in 2016 to 65,508 beds in 2020 — right before the global pandemic looms. 

Reflecting on the healthcare turmoil during the pandemic, every Malaysian vividly recalls the day when the outbreak surged. It permeated social media and dominated both local and global news headlines. The government swiftly implemented the inaugural Malaysian Movement Control Order (MCO). 

The contagion spread rapidly, affecting many unsuspecting individuals going about their daily routines. The insidious nature of the virus, with symptoms manifesting after a period of latency, renders it particularly dangerous, potentially exposing those in close proximity to infected individuals. 

All the matters were also being noted in the Health White Paper to reform Malaysia’s healthcare that was published earlier this year. 

A retired cleaner Sepiah Ahmad who stayed at the Covid-19 Integrated Quarantine and Treatment Centre (PKRC) 2.0 at the Malaysia Agro Exposition Park Serdang (MAEPS) shares her experience after she was infected. 

Due to her advanced age and with her breathing worsening, the MoH staff sent her to be treated at the nearest government hospital which is Hospital Shah Alam. 

“However, the closest hospital to us is already full,” she said, before describing a horrific situation where so many people crowded the hospital grounds that they spilled by the roadside. 

“I saw lots of people being untreated, and it was overcrowded,” she recounted. 

Sepiah said the most frustrating thing at that time was the waiting; long hours of not being attended to, and when it was finally her time to get a bed to rest, she was required to move to a different bed, and the moving did not stop. 

The MAEPS PKRC at that time was a massive field hospital, which could accommodate 5,000 patients. However, Sepiah said it was still too crowded to the point that there were not enough mattresses to go around. 

“It was very uncomfortable for old people who got those hammock blankets instead,” she said. 

Healthcare Facilities During Disasters

Hospitals play a pivotal role during natural disasters and emergencies. Increasing hospital capacity is integral to disaster preparedness. 

It enables healthcare facilities to provide immediate care to those affected not only due to the pandemic, but also disasters such as earthquakes, or other mass casualty events. 

When a hospital is small and disaster strikes, there would not be enough space to handle the patients such as what Sepiah has experienced, so, in that respect, the government should consider either expanding or creating new hospitals. 

Additionally, hospitals with enhanced capacity can serve as crucial hubs for disaster response efforts, ensuring that medical professionals and resources are readily available in times of crisis. 

Dr Z, who wanted to remain anonymous due to the punishing nature of speaking up against government matters, insisted that COVID-19 showed that hospitals needed to be expanded, especially as old hospitals were built only on single floors.

“Reconstruction of new buildings in the old hospital compound may improve the facilities in a local hospital, rather than building a new hospital in other places which is cumbersome for the government to find a suitable place and not cost-effective,” he said.

Dr Z said expansion is more needed in the urban areas as their population is denser and most of the subspecialties are concentrated there. 

Furthermore, he added that most state hospitals have so-called cluster hospitals in which certain urban hospitals may accept a referral from the rural/small/district hospital if required. 

“Sometimes, the respected primary team from the urban hospital may visit the district hospital for procedures such as minor operations, subspecialty clinics,” he said. 

He however said currently, the hospitals have enough beds for patient as most influenza-like illness are not warded. 

“Current bed occupancy is adequate as most of the COVID-19 cases are treated as influenza-like illness, thus not requiring admission to hospital. Most of the hospitals can mobilise beds for Covid-19 cases, when necessary,” he said. 

Another government doctor who wanted to be known as Dr Faiz also shared his colleague’s view but added the need for more people in the medical field. 

“If there are new hospitals but we do not have enough workforce to handle it, then there’s no point,” he said.

According to the data provided on MoH’s data centre, most of the bed occupancies are adequate except for certain cases. Until Nov 2, Hospital Sultanah Aminah in Johor Baru which has 939 non-critical beds is utilised for more than 111.9% and 30 of its critical beds are at 93.9% utilisation. Other high utilisation also includes places in Selangor like Hospital Shah Alam, Hospital Tunku Ampuan Rahimah in Klang and Hospital Serdang.

Among the 12 new hospitals currently being built also addressed the matter with Hospital Sultanah Aminah 2 and Hospital Pasir Gudang in Johor, as well as Hospital Kapar and Hospital Cyberjaya in Selangor. 

In the recent Budget 2024, the government is also looking at building and developing more health facilities to help. 

These include building the first phase of Universiti Sains Malaysia Teaching Hospital Complex (USIM) in Kota Tinggi, Johor, an additional Pathology Block at Raja Perempuan Zainab II Hospital in Kelantan and a building for the Emergency and Trauma Department’s Sultan Abdul Aziz Shah Hospital in Universiti Putra Malaysia (UPM), Serdang. 

Furthermore, the government plans to allocate a total of RM150 million to build five new clinics in Rantau (Negri Sembilan), Kuala Tahan, Jerantut (Pahang), Kuala Jengal, Dungun (Terengganu) and Mantanani Island, Kota Belud (Sabah). 

The government also announced that RM300 million will be allocated to upgrade 400 clinics with wooden structures and outdated wiring while RM766 million will be channelled for medicines procurement in MoH hospitals, replacement of beyond economic repair (BER) equipment, and new service areas. 

Private Hospitals Development

Association of Private Hospitals Malaysia President Datuk Dr Kuljit Singh told The Malaysian Reserve (TMR) that the private sector would help to cater the urban folks with the gap. 

“The people in the urban area are the ones who have the affordability. Is there a pressing need? Yes, it could be.” he said. 

However, he said unlike the government facilities, the private hospitals are much smaller and could not cater for too many patients. 

He gave an example of the Prince Court Hospital daily occupancy rate being around 80% to 90% on average and could not take as many patients. 

“Private hospitals are not as big as government hospitals. The government hospitals have a bigger base” he said. 

The MoH is also seeking more help from the private hospitals, another lesson learned during the pandemic. 

In Sept, Dr Kelvin Yii, advisor to Health Minister Dr Zaliha Mustafa, said they are in negotiations to decant patients from public to private hospitals for diagnostics and imaging. 

“In an ideal situation, we want to be able to collaborate more. We want to decant some of our patients to the private sector like what happened during the COVID-19 pandemic. 

“During that time, there was a necessity and an incentive for the private sector to participate due to the pandemic. That is where an agreement, in terms of pricing, was agreed upon. 

“Post-pandemic, unfortunately, the negotiations are still continuing. We are exploring models to see how we can decant certain patients to the private sector — not for treatment, but more on diagnostics and imaging because this is where the long queue is in the public sector here in Malaysia. 

“The difficult thing is finding that win-win situation. We have to admit that the cost of healthcare is increasing,” Dr Yii said at Siemens Healthineers’ “Creating a World Without Fear of Cancer” panel discussion. 

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• This article first appeared in The Malaysian Reserve weekly print edition