Global Health Award 2016 Entries: Becky Thompson

A reflection on her elective in Borneo by Becky Thompson

I chose to undertake my elective in Borneo and I was based in Sarawak General Hospital. It is a large district hospital that is the main tertiary and referral hospital in East Malaysia. It also serves as a teaching hospital for the University Malaysia Sarawak. One of the main things I wanted to gain from my elective was an insight into the differences between healthcare in the NHS and in Malaysia, particularly in the rural settings of Borneo.

In Borneo, healthcare is divided between government hospitals, and for those who can afford it, private hospitals. I was surprised by the presence of a class system within Sarawak General Hospital. Different rates are charged to patients depending on the class in which they are treated. The patients in the third class wards were charged RM2 (40p) for each day they stayed, whilst patients in first class wards were charged RM75 (£13). The main differences appeared to be with the standard of the facilities. Whilst third class wards were more cramped, they also only had electric fans to cool the ward. In first class, patient beds were more spread out and was cooled by air conditioning. With very high temperatures and constant humidity in Kuching, some patients who were being treated in third class were definitely struggling in the heat.

I was however pleasantly surprised by the availability of treatments and the quality of care available to all the patients here regardless of socio-economic status. Although it is a government funded healthcare system with small fees at the point of care, the standard of health care is on a level with what we have in the NHS. If a patient requires treatment, whether that be surgical, medical or pharmacological, the patient receives that treatment regardless of the cost. The major difference between Borneo and the NHS however, appeared to be longer waiting times, not only for operations but accessing both primary care and emergency treatment. Another difference I noted was that the discharge of patients was often delayed. Whilst Kuching is a large city with reasonably good transport, out with Kuching, Sarawak becomes very rural and travel can become difficult. Therefore, to reduce very long repeat journeys to the hospital, patients must often stay for longer before discharge.

We were also able to spend some time in the Borneo Medical Centre, a private hospital within Kuching. It was interesting to see the differences in the facilities available between the two hospitals. The doctors within BMC took greater care in the clinical choices they made for their patients. Every single item is charged to the patient, so the doctors take care in choosing the investigations and treatment courses they recommend to their patients. This has made me consider how resources are used in both Sarawak General Hospital and the NHS. Patients may often receive tests or examinations as they are available, but are they always a necessity in the management of every patient.

Healthcare in Sarawak is officially carried out in English, however few patients actually speak English. Although the doctors tried to include us as much as possible in the general ward rounds, due to the large size of the groups on the rounds and the fast paced nature, it was often difficult to fully understand what was going on. Most wards rounds hand around 15 members of staff and this can be very intimidating for patients. Most ward rounds I have experienced within the NHS have fewer participants and this can prevent the situation being more stressful than necessary for the patients.

Bedside teaching sessions with one of the local professors however, were very beneficial. Sessions were held in Sarawak General Hospital and the Borneo Heart Centre. Patients that were seen in the sessions were interesting and were very good to learn from. Often in Borneo, the patients do not present as soon as they would in the UK. This is partially due to access to healthcare and the associated costs. This delay gives them longer to develop signs and symptoms, which are often not seen in Scotland. I found that this was particularly evident within the heart centre, where I was able to hear several different murmurs and examine patients with several other signs that I have not yet seen within the UK. There was also a weekly grand round with many doctors in the hospital participating in discussions over some interesting and challenging cases and it was great to see all the different perspectives on these.