Sunday July 27, 2008

Practising integrative medicine

By AUDREY EDWARDS

Selectively incorporating elements of complementary and alternative medicine into comprehensive treatment alongside solidly orthodox methods of diagnosis and treatment ...

HOSPITALS can be scary places, even daunting. Images of grim-faced doctors and nurses in white coats, overcrowded wards and long hours of waiting to be treated are just some that crowd the brain when the word hospital is mentioned.

A relaxing ambience created in the traditional and complementary medicine unit.

Most avoid visiting one unless absolutely necessary. They would rather try to self-medicate or even seek help from unconventional quarters.

For centuries, traditional treatments have remained in the outer realm of modern medicine. This other side conjures thoughts of burning incense, massages in darkened rooms and needles pricked straight into the body.

Recently, however, there have been attempts to bring it to a more mainstream status.

Picture heavy wooden doors and stone panels with floral designs where potted fountains are placed beneath them. It has all the semblance of a modern-day spa where Malaysians go to have their wearied muscles kneaded on to drive away the stresses of living.

But this spa is in fact Putrajaya Hospital’s traditional and complementary medicine (TCM) unit.

The hospital is one of three in a Health Ministry pilot project to support evidence-based TCM.

Acupuncturist Chin See Hooi demonstrating how the procedure is done.

The other two are in Kepala Batas Hospital, Penang and Sultan Ismail Hospital, Johor.

In fact, one can say that the TCM unit at the hospital is a retreat for patients who suffer from specific illnesses.

“We went to some spas to get inspiration on how to set up the unit,” quipped hospital director Dr Mohd Norzi Ghazali. “And we have just gone to check out an Ayurvedic centre to see how things are done.”

He then proceeded to give us a tour of the establishment, which is open from 8am to 5pm. Among the facilities are a registration counter, examination room, massage and acupuncturist rooms.

The hint one gets that it is still within a hospital is there is no fragrance from essential oils and soft piped-in music that normally permeates a spa.

For entertainment while waiting, there is a television.

According to Health Ministry director general Tan Sri Dr Ismail Merican, the scepticism and lack of confidence by Western-trained medical doctors in TCM are mainly due to paucity and inadequate access to scientific evidence of TCM practices.

Deftly making his way through the unit, Dr Mohd Norzi opens a door, which leads out to the herbal garden.

It isn’t much yet. We just started and there are about 30 species of plants here, he said.

The garden even has a map indicating to visitors the various plants that are available. On the list include the ever popular tongkat ali, misai kucing and kacip fatimah.

We have a guard around to ensure that the plants don’t get stolen, he said. Research is being done on the plants with Universiti Putra Malaysia.

Currently, there are acupuncture and traditional Malay massage services at the facility. Plans are in the pipeline to start Chinese herbal treatment for cancer and an ayurvedic facility.

Dr Mohd Norzi sees such units as the way forward where TCM would eventually be an accepted medical discipline, just like surgery and obstetrics and gynaecology.

He said those who are encouraged to undergo the TCM procedures include post-stroke patients and those who suffer from migraines and backaches.

There are three masseurs: two men and a woman, and an acupuncturist, who are employed on a contract basis.

Patients and their families can come in to try it out. But there is a waiting list because of the limited staff. After they register, they have their vital signs like blood pressure and temperature checked to make sure they can undergo treatment, he said.

Masseur Puziah Monil has been working at the unit for the past three months. She has been in this line of work for about a decade. “I took up traditional Malay massage because I had a lot of interest in it,” she said. “Besides, I see it as my chance to sincerely help people. There is hardly any difference here (compared to ‘traditional’ outlets) except for the fact that I can only use the serai wangi (fragrant lemongrass) oil that is approved by the ministry.

The 52-year-old is on a one-year contract and said that she is happy to be working at the unit.

Masseur Puziah Monil has been working at the unit for the past three months.

Acupuncturist Chin See Hooi, 38 has been on the job for about three years, having spent years learning the art of acupuncture in China.

“I got the job after a friend told me about it. I decided to try it out,” he said. He treats about 10 people daily.

Norsuzaidah Abdullah, an occupational therapist who is currently in charge of running the unit said that not everyone is able to undergo treatment there. There are certain categories of people who would not be allowed in, including pregnant women, those with skin illnesses, diabetics whose condition is not properly controlled and heart patients who are on aspirin.

She said this was why the screening process at the registration counter is necessary.

To ensure that the facility is not misused, they had come up with a two-card system to check abuses - if the masseur found a person was actually lying about his/her condition, the nurse at the registration counter would be given a card marked with an A. The nurse will then tell the patient politely that they no longer require treatment.

If the nurse gets a card marked with a B, then they will get an appointment for the next session, she said.

The unit takes in walk-in patients and there are no referrals from doctors (who might still view such treatment as unconventional) yet.

TCM as viewed by the health ministry

Health Ministry director general Tan Sri Dr Ismail Merican reminds registered medical practitioners that TCM or integrated medicine is attractive to the public because it focuses on health and healing rather than disease and treatment.

Prospective TCM practitioners are required to undergo a formalised system of education, training and accreditation process, he said. Besides this, Western medicine healthcare providers will have access to adequate knowledge of TCM so there is a healthy coexistence and mutual understanding of both types of systems.

The scepticism and lack of confidence by Western-trained medical doctors in TCM are mainly due to paucity and inadequate access to scientific evidence of TCM practices, he added.

He said while countries like China, Korea and Japan have published articles on the safety and efficacy of TCM practices, the literature is not available in English. They can be made available by their respective researchers who strongly object to presumptions by Western-trained doctors that there is no scientific basis on the use of TCM, he added.

Their argument is that research methodology might and will have to be different where research in the area need not follow the conventional research methodology used by modern medicine.

Dr Mohd Norzi Ghazali sees traditional and complementary medicine (TCM) units as the way forward where TCM would eventually be an accepted medical discipline, just like surgery and obstetrics and gynaecology.

Also, TCM practitioners view patients as a whole, with minds and spirits as well as bodies, and involve their patients in maintaining their own health by focusing on lifestyle factors such as diet, exercise, quality of rest and sleep and nature of relationships, he said.

Another benefit was promoting individual responsibility and empowerment, he said.

Traditional medicine has been acknowledged by the World Health Organization and its definition on its website www.who.int is as follows: “The sum total of the knowledge, skills, and practices based on the theories, beliefs, and experiences indigenous to different cultures, whether explicable or not, used in the maintenance of health as well as in the prevention, diagnosis, improvement or treatment of physical and mental illness.”

The organisation’s objectives for activities in this area includes facilitating the integration of traditional medicine in a national healthcare system where it will assist a country to formulate their own national policies for it.

It also promotes using traditional medicine properly by developing and providing international standards, technical guidelines and methodologies and serves as a clearing house to help information exchange for the field.

Complementary medicine refers to a wide range of health interventions originating from different cultures across thousands of years of history. Recently, however, the term integrated or integrative medicine has been coined to mean practising medicine in a way that selectively incorporates elements of complementary and alternative medicine into comprehensive treatment alongside solidly orthodox methods of diagnosis and treatment.

WHO also estimates that in many countries, traditional practitioners take care of about 80% or more of the population living in rural areas while about half the population in developed countries use TCM.

Dr Ismail said expenditure for TCM in Malaysia could hit about US$300mil (RM960mil) by 2020, while up to December last year, there were 7,154 registered TCM practitioners.

A map of the herbal garden located at Putrajaya Hospital.

A survey carried out by the Institute of Health Systems Research and Institute for Medical Research three years ago found about 69% of respondents had used TCM while about 56% used it in the 12-month period of the survey.

Dr Ismail reiterates that for TCM to be accepted in Malaysia, there must be enough information on the subject on its potential clinical benefits, safety and risks.

He said there must be enough scientific evidence to convince those who are still sceptical about the field and appropriate legislation and enforcement to curb and control against illegal practices or misleading labelling or claims.

The upcoming TCM Bill will seek to address these issues, he added.

Among the steps taken by the ministry to promote this field of medicine in the country include setting up the national standing committee for TCM, having a National TCM Council to act as an advisory body to advise the committee and the National TCM Health Policy to form the basis for possible integration into the national healthcare system.

There are also plans to establish a TCM registry for practitioners before it can integrated into the healthcare system, besides a mechanism for complaints that will be made available to the public. Disciplinary action can be taken against members who breach the code of conduct and ethics.

He said while TCM bodies will be allowed to self-regulate based on certain criteria, they would eventually be required to adhere to statutory regulations.

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