Rheumatologist Shortage (in Malaysia)

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Needed - 400 rheumatologists

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KUALA LUMPUR, Apr 1:

Dr Chow Sook Khuan is a one in a million - literally. She is one of 19

specialists trained to look after a growing

number of Malaysians suffering from arthritis. There is just one

rheumatologist to more than 1.2 million Malaysians.

The Health Ministry is aware of this grave shortage of

rheumatologists.Health Minister Datuk Dr Chua Soi Lek

said to achieve a ratio of one rheumatologist to 85,000 population, a target

for developing countries, Malaysia

needed at least 400 of them by 2020. " This means that we will have to beef

up our speciality and sub-speciality

training and recruitment program- mes, " he said.

Of the 19 rheumatologists, seven are in government hospitals - four in

Selayang and one each in Putrajaya,

Taiping and Seremban. Generally, Dr Chua said, rheumatologists undergo a

minimum of three years' training after

acquiring their post-graduate qualification in Internal Medicine.

Currently, he added, there were six rheumatology training centres -

Selayang, Putrajaya, Seremban, Taiping,

Universiti Kebangsaan Malaysia and University Malaya Medical Centre. There

are eight doctors now undergoing

training in rheumatology.

Meanwhile, the Malaysian Society of Rheumatology has set up an accreditation

board to determine the training

requirements, and the training guidelines have been posted on its website at

www.msr.org.my.

Dr Chow, who sits on the accreditation board, said: " Rheumatology is a

relatively new field. We had our first

rheumatologist in the 80s. "

Asked why many doctors did not specialise in the field, she said it was not

considered lucrative. However,

the number of patients seeking treatment for rheumatic diseases and

musculoskeletal conditions in both public

and private hospitals was " high " . Unlike diseases that kill, she said,

rheumatic diseases did not attract much

attention, but they could severely debilitate people and place a tremendous

burden on healthcare systems.

Rheumatoid arthritis affects five in 1,000 Malaysians. Worldwide, 40 per

cent of people over the age of 70

suffer from osteoarthritis of the knee. Eighty per cent of those with

osteoarthritis have some degree of limitation

of movement, and 25 per cent cannot function normally.

" Many people do not know that musculoskeletal or rheumatic diseases are a

major cause of morbidity

throughout the world, having a substantial influence on health and quality

of life and inflicting an enormous burden of

cost on health systems, " said Dr Chow, a consultant rheumatologist, who is

also the president of the

Arthritis Foundation of Malaysia.

To assist doctors in the management of arthritis, Dr Chua said his ministry

had distributed the Clinical Practice

Guidelines on the Management of Osteoarthritis in 2002 with support from the

Academy of Medicine and the

Malaysian Society of Rheumatology.

" There is a public misconception that arthritis is a single disorder

affecting only the elderly and that not much can

be done about it. This is far from the truth, " said Dr Chua, adding that

there were actually a large number of different conditions and syndromes

that could come under this label with the common denomination being pain and

inflammation

of the joints.

He said the most common arthritis was osteoarthritis, a degenerative

condition whose hallmarks were joint pains

and limited movement resulting from progressive loss of cartilage,

especially among older people, those

with previous joint injuries and the obese. Osteoarthritis of the knee

affects five to 10 per cent of the adult population,

30 per cent of them over the age of 65.

" About three times as many women as men have the disease and about half of

the patients suffer from work-related

disability, resulting in total cessation of employment 10 years down the

line from the onset, " Dr Chua said.

Dr Chua said life expectancy may be reduced by three to 10 years. He also

pointed out that arthritis did not spare

children as there was Chronic Juvenile Arthritis that afflicts them.

He said arthritis also occurs in connective tissue disease that usually

affected young women in the reproductive age

group and may damage any organ in the body.