A LONG JOURNEY OF HOPE :
THE DEVELOPMENT OF PAEDIATRIC SURGERY IN MALAYSIA
( Extracted from the speech by Dato Mahmud b Mohd Nor’s 39th A. M Ismail Oration 2012 in the College of Surgeons Academy of Medicine Malaysia Newsletter Vol. 19 / No. 1 / OCTOBER 2012. )
BACKGROUND
I am honoured and privileged to have been invited to give this year’s 39 thAM Ismail Oration. Tan Sri Dato’ Abdul Majid Ismail, a renowned Orthopaedic surgeon is known to many. He founded the College of Surgeons of Malaysia and also became the Director General of the Ministry of Health in 1971. I am privileged to have started my career in medicine after my housemanship in 1971. He was the Director General of Health I reported to. In a way he shaped my future by seconding me to Universiti Kebangsaan Malaysia (UKM) as a trainee lecturer in surgery in 1972. He is known to many especially the older generation for his immense contributions to the development and modernisation of the Health care services of Malaysia. Not many are aware even in UKM of his contribution to the establishment of the Faculty of Medicine UKM and the support he gave to it in the early years of its development. It is especially important to mention his contribution to UKM as this year is the celebration of the 40 thyear of the establishment of UKM’s Faculty of Medicine. He and Dr Ungku Omar bin Ungku Ahmad the Director of the Institute for Medical Research (IMR) was instrumental in bringing to the attention of the Prime Minister Tun Abdul Razak the idea of another medical faculty. The Prime Minister was keen on the idea. This led Dr Ungku Omar to arrange for a meeting at the IMR. Among those present were Tun Razak himself, Tun Dato’ Dr Ismail bin Abdul Rahman the Minister of Foreign Affairs himself a medical doctor, Tun Tan Sri Dato’ Syed Nasir the Director of Dewan Bahasa dan Pustaka, Tan Sri Dato’ Sheikh Hussein, Tun Tan Sri Dato’ Abdullah bin Salleh, Tan Sri Dato’ Dr Majid Ismail and a few others. This meeting affirmed the need for a second faculty of medicine in the country and at UKM to address the issue of under representation of Malays in the medical profession and to provide better opportunities for students coming from the Malay medium of instructions schools to do medicine. There were only about 4% Malay and Bumiputra doctors in the country around 1970 and in my class of eighty at the University of Malaya in 1965 there were only four Malays. Tan Sri Dato’ Dr Abdul Majid Ismail who was then the Director General of the Ministry of Health played a significant role in assisting the development of the faculty. A piece of land behind the Maternity Hospital adjacent to the TPCA Stadium was allocated to build five blocks of temporary wooden buildings which surprisingly has survived to this day. The building was completed in a record time of four months. The Ministry of Health also removed bodies from the graves of unclaimed bodies of the hospital from an area close to Lake Titiwangsa and the Police Training school to a new site in Sungai Buloh. This piece of land was later used to construct the student’s hostels and a few blocks of staff housing. To give a glimpse of the challenges faced by Tan Sri Abdul Majid Ismail in modernizing the health facilities after Merdeka a look at the early Hospitals of Kuala Lumpur (Pauper’s Hospital) is relevant in this oration as this is the ground where Paediatric surgery took its roots. The first building was started in 1920. This was never completed during the slump. The ruins came to be known as the ‘Huxley’s Ruins’ which is now the site of the Orthopedic clinic. A new hospital was built in 1930 with Malay, Chinese and Indian wards. British officers and family were at a better facility at Tanglin Hospital. A lot of credit must therefore be given Tan Sri AM Ismail who as Director of Planning in the Ministry of Health started the planning of a new hospital for Kuala Lumpur as we now see it. His attempt to establish the College of Surgeons to be on the same footing as the British Royal Colleges however did not materialize as the government made the decision to place the responsibility for Postgraduate Medical Education to the Universities but with the involvement of the Profession and the Ministry of Health. This later led to the formation of the Conjoint Committee on Postgraduate Medical Education and its subcommittees around early 1980 consisting of the representatives of the Universities, Ministry of Health and Academy of Medicine. I was the first chairman of the main committee with Dr Yeoh Poh Hong and Dr Megat Burhanudin representing the Academy of Medicine and Ministry of Health respectively. The secretary was Dr Zainol Arif the under secretary of the Ministry of Education. This committee under the Ministry of Education was formed to advise the Minister on matters pertaining to Postgraduate Medical Education. The College of Surgeons of Malaysia is now playing an active role as a chapter under the umbrella of the Academy of Medicine in the subcommittees of all the surgical specialties including participation in the conjoint examinations.
INTRODUCTION
Paediatric Surgery Service in Malaysia Paediatric surgery as a specialty of surgery has been well established in most parts of the developed world with every major city having hospitals for children where doctors in almost all the specialisations of Medicine contribute to the care of children up to the age of eighteen. In Malaysia only children age twelve years and below are categorised as children and may get admitted to a children’s ward. Unlike the developed countries there is not a single comprehensive specialised hospital for children. The care for children has all this while been mainly integrated with adults. Children often sharing the same facilities but where possible they were placed in different wards. This was the scenario in the care of paediatric patients at the point of my graduation from the University of Malaya in 1970 as the second batch of graduates from the new medical faculty. In October 1972 I joined UKM as a trainee lecturer and was sent to the University Hospital to undertake academic training in General Surgery and later in Paediatric surgery at the Hospital for Sick Children Great Ormond Street London and at the Royal Children Hospital in Melbourne. The experience gave me an early insight into the development of Paediatric surgery in Malaysia. This oration is about my own experience and observation of the growth and development of Paediatric surgery in Malaysia with special reference to its development at the General Hospital Kuala Lumpur (HKL) and the major role played by Universiti Kebangsaan Malaysia (UKM). It spans over 40 years and I will try in this short period of time to give a glimpse of its historic developments, the aspirations of many Paediatric surgeons and our hopes for the future of this specialty in our beloved nation.
PHASES OF HISTORIC DEVELOPMENT OF PAEDIATRIC SURGERY IN MALAYSIA
From a historical perspective the development of Paediatric surgery in Malaysia can be divided into five phases:
1. Prior to 1970
2. 1970-1980
3. 1980-1990
4. Post 1990: Institute of Paediatrics
5. Post 2000
Paediatric Surgery Prior to 1970 ‘Phase of Relative Ignorance’
In this phase throughout the country surgery of children was the responsibility of general surgeons who operated on almost everything in adults and children. Undoubtedly the outcome especially the newborns could be described as disastrous. The infrastructure was poor and the human resources were inadequate to support surgery of children especially newborns. The earliest surgery done on babies by a properly trained paediatric surgeon was at the University Hospital by Prof Dato’ K Somasundram. He had his training at the Hospital for Sick Children Great Ormond Street London. Dr Karpal Singh was the Surgical Registrar in General Hospital Kuala Lumpur from 1964 to 1966 and then became the Senior Registrar from 1967 to 1968. During this time he took care of most of the Paediatric and neonatal surgical problems though he did not have full training in Paediatric surgery at that time. There was no special ward for children requiring surgery and they were placed in the Paediatric medical ward. The wards were situated on the ground of the old Malay ward I & II. (Present site of Institute of Pediatric).
1970-1980 ‘Phase of Awareness’
This phase of development coincided with the redevelopment of the entire Hospital Kuala Lumpur complex. Hospital Kuala Lumpur was intended to be the teaching hospital of UKM with a Management Board. Various institutes were established. The idea was that UKM will provide the academic umbrella and all specialists in the hospital would participate in service, teaching and research proportionately according to a formula depending on whether they were from the Ministry or UKM. This idea did not come to full realization due to legal impediments. It eventually became a hospital where teaching was done mainly by UKM teaching staffs. This prompted UKM in later years to develop its own hospital for its future growth and development. There was a separate Maternity Hospital with its own special care nursery but without a Gynaecology ward. The main hospital complex consisted of various departments. The Paediatric department had its own Neonatal care ward. Mr Karpal Singh was sent to Melbourne for training in Paediatric surgery in 1970 and returned with an FRACS in Paediatric surgery in 1972. He recommenced proper paediatric surgical practice in February 1972 in Unit 1 under Dato’ K A Menon. I came into the picture of Paediatric surgery in Malaysia at Hospital Kuala Lumpur in August 1976 after my Fellowship and a stint at Hospital for Sick Children Great Ormond Street (GOSH) and University Hospital. I was asked to start the department of surgery of UKM. In January 1976 the academic department of surgery UKM was established and soon followed by the establishment of the UKM surgical unit at HKL which took over Surgical Unit III from Mr Husin Salleh who resigned leaving two medical officers Dr Ahmad Zulkifli Laidin and Dr Yusha Abdul Wahab. Later in the year when Mr Karpal Singh resigned, the Paediatric surgical unit under Unit I was transferred to the UKM surgical unit together with Dr Leela Perumal as the medical officer. The UKM unit was on call every third day for general surgery and every day for Paediatric surgery with a single surgeon and three medical officers. Later Dr Freda Meah, Dr Bahari Habib Mohd and Dr Ismail Abdullah joined the unit in general surgery. This unit was later assisted by a Canadian trained Malaysian surgeon Dr Bakri Musa who also had some training in Paediatric surgery for close to a year before he was transferred to Johor Bahru. There was now a greater degree of awareness on the need for more and better trained surgeons to deal with children especially babies. It was during this period that there was serious planning for new Paediatric facilities which was initially supposed to be a children hospital. It was my dream, vision and hope when I took over the unit that one day we will be able to provide the kind of care for children similar to the ones that were provide by the developed countries like the one I saw at the children hospital in London. 1. Children will be treated differently from adults 2. Healthcare facilities addressing the special of children 3. Children requiring hospitalization will be treated in a hospital that is designed especially for children. 4. Children will be cared for by healthcare personnel specially trained to treat and care for children 5. The hospital would be well known as a teaching and research hospital. Up to 1976 most of the surgery done on neonates was for anorectal malformations. Other surgery like Intestinal Atresias and Hirschsprung’s disease were also done but the outcome of surgery was not well documented (Figure 1)
After 1976 there were significant improvements in the surgery of children at HKL despite the numerous challenges of this new surgical service. The infrastructure support for newborns was poor. Initially the other surgical units also insisted on carrying out surgery in children, as was the practice throughout the country. It was not surprising that the outcome of surgery then as measured by the neonatal surgical mortality rate was horrendous compared to the present day situation.
In the initial period of my undertaking the service the outcome of surgery especially in the newborn was dismal. We were handicapped not only by the lack of appropriate surgical instruments like small size scissors and forceps to do surgery in children but also by a lack of trained nursing staff in the operating theatre. The operating theatres were cold and there were no equipments like warming blankets to keep the child warm throughout surgery. The diathermy apparatus were big and not of the right size for children especially babies. We had to improvise ways to keep the baby warm during surgery. Despite these efforts many babies after long surgery became cold and hypothermic which led to metabolic complications like acidosis. Sclerema neonatorum a complication of hypothermia was quite common. It was not surprising that many babies died after surgery except for the simple conditions that did not require prolong surgery. The ward nursing staffs were also not well trained to handle children especially the low birth weight and premature babies. There was not a single case of oesophageal atresia that survived surgery for the first three years (Figure 2). Many of them died soon after surgery. A few survived for about two weeks. Better result was obtained for other abdominal operations and in Diaphragmatic hernias especially those that did not require preoperative ventilation or presenting late.
With the concentration of most Paediatric care in one unit the overall survival of neonates after surgery gradually improved. Initially the other units also carried out surgery of the newborn but with better outcome demonstrated by Unit 3 (UKM) and as words spread around about our successes more patients were referred directly to the unit and later the other units gave up entirely their work on children. As a result, the period between 1976 and 1981 saw some encouraging improvement in the postoperative survival of neonates compared to the years before that. In 1970 the postoperative mortality for neonates undergoing thoracic or abdominal operations was 75%. In 1975 it was 51.8% but in 1976 it began to drop rapidly from 47.6% to 10.3% in mid 1981 (Figure 3). The mortality rate for all operations in the neonates has since remained below 15%. This was a measure of success in the effort to improve the care of children especially neonates.
Oesophageal atresia was dubbed as the ‘epitome of modern surgery’ by NA Myers whom I worked under at the Royal Children Hospital Melbourne. Success in the surgery for this condition is cited not only as a measure of the skill of the surgeon, but also a reflection of the quality and sophistication of a Paediatric surgical unit and its supporting facilities. Prior to 1976 there was only a single survivor for this condition. After 1976 the first survivor was reported only in 1979 followed by a few more successes. During the period of 1976 to 1981 the total mortality for this condition was 38% and the deaths were mainly in the high-risk groups with severe associated anomalies or with very low birth weight (Figure 4).
The tremendous improvement in the survival of neonates with oesophageal atresia can be attributed to the establishment of a special neonatal unit and special care nursery at the General Hospital (HKL) main complex in 1980. The Intensive Care Unit was also improved with the purchase of open incubators and monitoring equipments. With better-trained nurses and neonatal specialists from the Ministry of Health working together with the neonatologist from UKM there was an overall improvement of the care of the sick newborns. The achievements were also contributed in no small measure by a group of dedicated anaesthetists from both HKL and UKM and improved facilities in the intensive care unit. The dramatic fall in the postoperative mortality of neonates was a landmark achievement of Hospital Kuala Lumpur. There can be no doubt that the involvement of UKM specialists in the care of patients at the hospital led to an overall improvement in patient care of the whole hospital.
Paediatric Surgery 1980-1990
The post 1980 period saw a greater degree of recognition for Paediatric surgery as a very special branch of surgery with many interests shown by trainee doctors and nurses. Paediatric surgery was undertaken entirely by the UKM surgical department. There was greater support from the administration of the hospital in providing more personnel and financial resources for the purchase and upgrading of equipments especially in the operating theatre and Intensive Care Unit. It was during this period that many trainees offered themselves to be trained. There was news that a children hospital was in the pipeline but there was slow progress and work only started in the early 80’s at the old site of the Paediatric wards. There was considerable delay in the progress of the hospital. Construction work of the new Institute started around 1984 but soon stopped after the stage of piling. I can still remember seeing steel structures left visibly protruding above ground for quite some time after cessation of work. A photograph taken on 20 thMay 1985 showed that shrubs and trees have overtaken the structures. This raised concern in many quarters and was even raised in Parliament by Dato’ Zainal Abidin an MP from Kedah. It was discovered that the ground was soft and of lime stone and the foundation would not take all the floors that had been originally planned. There was a long period of waiting and coupled with the recession of 1987 the construction only recommenced in 1989. A few floors had to be scrapped from the original design. It now consists of three levels with remnants of a staircase that can still be seen going up from level three to a non-existent floor. I was appointed Dean of the Faculty of Medicine UKM in February 1984 and was able to obtain from the University additional financial resources for the unit.
1990-2000: Institute of Paediatrics: Phase of Consolidation and Expansion
The Paediatric service of HKL finally moved to the new Institute of Paediatrics in May 1991. There were considerable discussions at various levels on what name to give to this new facility. Finally it was decided to name it the Institute of Paediatrics or Institut Pediatrik to be consistent with the name given to the other Institutes in HKL. It was decided that the new facility was only for general paediatrics and general surgery. Following protests from Dr Sivanantham the head of department of Orthopaedics, the scope of service was expanded to include orthopaedic surgery but orthopaedics would have to share the wards with general surgery. Thus from the very start the facility was not adequate for the needs of all children and it was never designed to be a comprehensive children hospital. Beside the considerable delay in the construction of the Institute, its floor space was reduced and when it was finally ready it was already outdated in its design. Despite this, it was a significant development in the care of children in general as for the first time most of the children in HKL were put under one roof. Unfortunately there were not enough beds to include patients in all the surgical specialties. In the early part only general surgery and orthopaedic patients were admitted to the Institute. The Institute could not initially be provided with all the facilities like a Burn unit, physiotherapy and supporting diagnostic services. Over the years some renovations were done to include some of these services. Some diagnostic services like MRI and CAT scan are still shared with the adult patients in the main block and patients have to be transported there with some risks. The decade between 1990 and 2000 can be considered as a great decade for Paediatric surgery. There were many outstanding surgeons from UKM and HKL and surgeons in training in the unit. More complex surgeries were performed with success due to better peri-operative care of patients especially neonates. The neonatal surgical mortality from 1990-93 remained at an acceptable level of 9.3% to 11.9% (Figure 5). When HUKM was opened in 1997 all UKM members of the team had to move to Cheras to their own teaching hospital
The Paediatric surgery department then came entirely under the Ministry of Health. Many improvements were achieved by using funds obtained from donations by the public and corporate organizations. Without the generous contributions of the public it would not have been possible to improve the facilities and reach the level of child friendly care that has been achieved by the Institute of Paediatric. This effort to develop and promote a more child friendly healthcare for children culminated in the formation of the Child friendly Healthcare Association of Malaysia to develop standards and criteria and promote child friendly practices. I was the inaugural President.
Paediatric Surgery Post 2000 at Institute of Paediatrics
There were further significant improvements in the outcome of surgery. The neonatal surgical mortality from 2003 to 2007 showed a mortality rate of between 10 to 12 percent, a slightly higher figure compared to previously (Figure 6). This is a reflection of more complex and high risk cases undertaken. The mortalities were mostly from necrotising Enterocolitis and abdominal wall defects (Figure 7). The mortality for oesophageal atresias between 17-24 percent has shown better outcome for high risk group (Figure 8). More complex surgical operations like separation of conjoined twins were carried out with success and there were better salvage and outcome of low birth weight babies.
Surgery of Conjoined Twins
I would like to make a special mention about the surgery of Conjoined twins in the department. Separation of Conjoined twins is a very special operation requiring meticulous organization, preparation, and coordinated team effort involving several categories of health professionals. For the record, the first Siamese twins were successfully separated at the University Hospital by a team led by Prof Somasundram on 5 thMarch 1981 followed by another pair on 19 thApril 1982. Both were Ischiopagus tetrapus females and both survived. On 17 thJuly 1988 Hospital Kuala Lumpur created history of some sort by successfully separating its first pair of Siamese twins joined at the upper abdomen and lower chest (Xipho Omphalopagus). The success was a great morale booster to the paediatric and surgical fraternity of HKL and was widely publicised in the news media. To date I have been involved in the separation of ten pairs of Siamese twins losing two full pairs and one each of two pairs i.e. 12 survivors (Figure 9). Hospital Kuala Lumpur has performed ten separations of conjoined twins over a period of fourteen years with good results. Of the babies who survived surgery and discharged home all are alive and well. We have twelve babies surviving out of a possible total of eighteen. This is a record that we can be proud of.
Liver Transplantation
Initially liver transplantation in children was planned to be done at the Institute of Paediatrics. Many attempts at getting support for it from the Ministry of Health failed because of financial constraints. This is understandable, as a liver transplantation service requires heavy financial investments not only in setting it up but also in maintaining the programme. We decided to try for an alternative source of funding from the private sector through donations. We were successful in securing an initial sum of RM 5 million to start the programme with a promise of another RM 4 million a year to support the programme from Maybank. The Ministry of Health later decided that liver transplantations must be done at the new Selayang Hospital. RM 5 million of the money pledged to us was transferred to Selayang Hospital. The first liver transplantation in a child at a Ministry of Health hospital was carried out successfully in April 2002 at Selayang Hospital. The hospital invited Prof Russell Strong from Brisbane and Dr S T Fan from Hong Kong for the surgery. Dr S T Fan and some local members of the transplant team did the harvesting of the donor organ while Prof Russell Strong and surgeons from Selayang Hospital and Dr Zakaria from the Institute assisted in the operation to transplant the organ. Anaesthetists and nurses from the Institute were also at hand to assist in the operation. Since then two more live living related donor transplants were carried out, the second operation was carried out by Dr Prabakharan from Singapore with the assistance of our local surgeons. The third transplant was carried out entirely by our local surgeons including Dr Zakaria Zahari and other staffs from the Institute of Pediatric.
Paediatric Surgery Outside Hospital Kuala Lumpur
Paediatric surgery initiated by Prof Somasundram in the late 60’s continued at the University Hospital and is now an active postgraduate raining centre. At the University Hospital in Kubang Kerian a general surgeon took an interest in Paediatric surgery and started operating on children in 1990. The service is continuing and there is also now paediatric surgical service at Kota Bahru hospital. Starting from the early 1990’s Paediatric surgical services were also extended to Kota Kinabalu, Kuantan, Penang and Ipoh with expatriate surgeons from India. Unfortunately the service in Kuantan had to be discontinued after the resignation of the surgeon from service. The service in Johor Baru was started on 1 stOctober 1994 and has continued since. In October 1996 Kuching Sarawak started the service at the Sarawak General Hospital and is continuing. The service in Alor Star started in December 1997 and to date the service is maintained. In February 2000 Melaka started the service there but is discontinued due to absence of a surgeon. Thus at the beginning of 2004 Paediatric surgery outside Kuala Lumpur in the Ministry of Health hospitals are available in Alor Star, Melaka, Johor Baru, Kuching and Kota Kinabalu. Unfortunately all these hospitals are a single consultant surgeon service, which makes them vulnerable to cessation of service without a backup senior surgeon.
Performance at the National Level
There is no accurate data to gauge our performance at the national level. Some indication of outcome can be gauged from the National Peri operative Mortality study from January 2000-December 2001. There were 152 deaths of patients below 12 years of age which accounts for 17.5% of all reported deaths. Majority of deaths were in neonates. The vast majority of deaths were due to failure to recognize, delay in diagnosis and operation, inadequate resuscitation and preparation for surgery.
Future Needs of Paediatric Surgery
The country needs at least one new Children hospital in Kuala Lumpur and several more regional child-friendly hospitals for the children of Malaysia if we want to be called a developed nation. Australia as an example with a similar population has at least a children hospital in each state. Sydney has two and Melbourne has the most recent and modern children hospital. It is proposed that the regional children hospitals should be in Kota Kinabalu Sabah Kuching Sarawak, Alor Star, Johor Baru and Kota Bahru in Kelantan. We also need specialists in other areas like Fetomaternal Medicine, better transportation of neonates, more trained personnel, a system of patient retrieval and long term follow up system, registry of surgical neonates and more postgraduate and research activities. Several attempts were made to lobby for the first proper children hospital but to no avail. The Minister of Health finally agreed to a Women’s and Children’s Hospital but to be built on the existing hospital ground. Unfortunately like the Institute of Paediatrics the project after a promising start at the Hospital Kuala Lumpur ground was unexplainably stopped and the construction delayed till today. It is uncertain when it will start again.
The Training of Paediatric Surgeons
There is an urgent need to increase the output of surgeons through our local postgraduate training programme as we are extremely short by 98 in 2008 in accordance with our population requirement (Figure 10). Paediatric surgery in Malaysia was a subspecialty of General Surgery. Most general surgeons conducted surgery in children including neonates without any special training. Paediatric surgery was only recognised as a separate specialty in the Ministry of Health on my return from UKM to the Ministry in 1990. I was the first to be gazetted as a paediatric surgeon on the recommendation of Tan Sri Abu Bakar Suleiman. Some surgeons went to Australia for higher training in Paediatric surgery and obtained the Fellowship in Paediatric surgery. General surgeons with recognized qualifications could also be gazetted as a Paediatric surgeon after two years of service as a general surgeon and another three years of supervised training in the Fellowship programme of the Ministry of Health. This was formalized in 2002. This is a long route and not a favourite choice of most surgeons. In 2006, UM took in the first Malaysian candidate of its four years Masters in Paediatric surgery. This seemed to be a better option to most aspiring Paediatric surgeons. The University Kebangsaan Malaysia will also start its Masters in Paediatric surgery programme in collaboration with University Malaya and the Ministry of Health. Its curriculum is a combination of the European Board of Paediatric Surgery and the Royal Australasian College of Surgeons. It is also now an examination centre for the Fellowship of European Board of Paediatric surgery.
Recent Developments at UKM Medical Centre
UKM will be developing a new children hospital. Hopefully this will be completed within the next four years. A new training facility called the Advanced Surgical Skills Centre which includes a facility for training in Laparoscopic surgery is almost ready. The UKM medical centre now has a well established laparoscopic service in children capable of performing surgeries in children and newborn as early as 2 weeks. Many surgical procedures are now done laparoscopically. Recently it performed an unprecedented near total pancreatectomy in a two week old baby successfully. I have been reliably informed that we have a justifiable hope that we will get two children hospitals in Kuala Lumpur within the next five years. One will be at UKM and the other at HKL. May Allah realise the dreams and hopes of our long journey.
Summary
- Paediatric Surgery in Malaysia has grown from a sub specialty of General Surgery to a separate specialty in line with similar developments of this specialty worldwide.
2. The outcome of treatment as a result has shown vast improvements and there is now greater awareness in Malaysia that a child should be treated by health personnel who are specially trained to care for them.
3. There is a recognised need that for better care, child friendly children hospitals have to be developed to serve identified regions of the country.
4. If Malaysia is to join the rank of develop nations it is imperative that a more serious effort should be taken and for a start to expedite the development of two Children Hospitals in Kuala Lumpur.
5. There is hope that the two new children hospitals will be ready within the next five years in Kuala Lumpur. We are hopeful that our long journey will end in joy and celebration as we proudly enter the status of a developed nation in 2020 with excellent care of our sick children.
“In Greek Mythology Pandora opened the box to the world and released all evils except hope. Hope was considered dangerous as its bedfellow can be delusion. Hope is also seen as the evil that prolongs human torment. Eventually Pandora released hope because without hope humanity was filled with despair”.
With the recent developments in our effort to establish children hospitals in the country we are now more hopeful in the coming years of a better future in the health care of our children.