Malaysia: Observations on Psychiatry and Society during a visit.

When people think of Malaysia what first comes to mind are the Petronas Twin Towers of Kuala Lumper.  It has a population of about 25 million.  The British during their time there left good structures which are benefiting Malaysia today unlike the behaviour of the Dutch in Indonesia.


During my time there I spent most of my time in Penang and at the Penang Medical School associated with RCSI and UCD. The founder of Penang was Francis Light who is reported to have hit upon a cunning method of getting the surrounding jungle cleared to make way for the town.  He loaded a canon with Spanish Silver Dollars, fired them into the forest, and invited local labourers to hack their way through the undergrowth to get to the money. Alfred Russell Wallace who discovered the evolution of the species at the same time as Charles Darwin lived in Malaysia.  The climate is warm and balmy.  The cost of living is much cheaper than Ireland and one can have an excellent dinner for €8.  Some companies are moving out of Malaysia to China because of cheaper labour in the same way they are moving out of Ireland.  Welfare is provided through Religious Organisations rather than the State. There is massive pressure on the children at school particularly Chinese children and grinds start from the age of six onwards.  Walking around the parks one sees endless monkeys roaming free. I was also told that the hills behind Penang have interesting walks but cobra snakes tend to frequent these places.  I was told that they didn’t attack one if they weren’t disturbed.  I decided this was an experiment that I wouldn’t make.  The “Ryanair” airline of Malaysia is called Air Asia and works on the exact same model.  I observed construction workers from my hotel window working 40 storeys up without protection. It made me dizzy to watch them.  It reminded me of the Irish workers in the early days of Manhattan while working on the skyscrapers worked also without protection.  There are endless motorbikes there who weave in and out quite similar to the couriers in Dublin but much more dangerously and much faster. People on motorbikes wear their coats back to front as this helps the circulation of air.


The Penang Medical College is extremely successful. It is approximately ten years old now. On my first day I met the Dean Amir and the President of the College Rathlingan a Physicist.  I had a chat with Professor William Shannon from RCSI who told me about developments in general practice in Malaysia.  He pointed out that there was major need for development of professional training programmes for General Practitioners. I was told that Dean Muiris Fitzgerald has been a regular visitor particularly in relation to graduation issues.  They were looking forward to Professor Niall O’Higgins President of the Royal College of Surgeons in Ireland visit soon. Professor Noel Walsh was a distinguished Professor of Psychiatry at UCD and spent a number of years as a pioneer with the Penang Medical College where he learned to speak Malay to huge approval of the local population.  I also visited a Centre called the Lion Centre for children with autism which works along similar lines to Centres in Ireland.  They gave me a book called The Reach Way to Transformation which had a Foreword by Professor Noel Walsh.  He arranged for medical students to visit this Centre during their undergraduate training. I was told that medical education can cost up to 150,000 Euros but that there are scholarships.  I met quite a number of medical students who the previous year had been at the Royal College of Surgeons in Ireland for their earlier medical education.  I had eleven professional / parent contacts during my visit there including five lectures and meetings with parents of children with autism, meeting with professionals, visits to Inpatient Psychiatric Units, and Outpatient Child and Adult Psychiatric Services.


In the Child Psychiatric Outpatients I met Dr. Lai a Child Psychiatrist.  On his wall he had a poster giving 88 ways to praise a child and another poster stating that families must try to achieve marital and family harmony.  I observed custody and access discussions there which were identical to Ireland using the same language and just as acrimonious. In the Child Psychiatric Outpatients they used the Swan Scales for Attention Deficit Hyperactivity Disorder and also the Vanderbilt Attention Deficit Hyperactivity Disorder Diagnostic Teachers Rating Scale.  The rates of Attention Deficit Hyperactivity Disorder seem very common and the treatments were the same as in Ireland.  The standard of psychiatry was the same as in Ireland.  In the Adult Psychiatric Outpatients some of the conditions would be different from Ireland in that there was koro which is the feeling that the penis is being withdrawn into the abdomen, amok and latah.  It seemed easier to diagnose psychosis because as in Uganda I observed that patients were more willing to be explicit about their psychotic symptoms.  The Adult Psychiatrists were doing research work on Sertindole which is a medication for the treatment of psychosis.  There are about 10 million children under 17 in Malaysia, 14 Child Psychiatrists which works out at about one Child Psychiatrist per 800,000.  I was pleased that the interest of the services was in providing direct assistance to patients rather than sitting around in teams discussing patients. I liked the Malaysians very direct way of seeing patients and helping them out to the best of their ability without the ‘team games’ so prevalent in other countries.  Of course teams are very relevant for about 5% of referrals where one is dealing with very complex psychological, social and psychiatric situation.


I had an opportunity to lecture to professionals from Penang as well as from the mainland up to the Thai border and I became aware that people with multiple disabilities tended to be placed together. This was not ideal but persons with autism were beginning to be separated out for their own services.


I met Professor Leela Ryan who is a much appreciated Consultant Psychiatrist in the South Western Area Health Board in the Naas Hospital is now playing a major role in Psychiatry in the Penang Medical School and is a key figure there.


I met Professor Saroja who is head of the Psychiatric Department and during the Tsunami which hit Malaysia and drowned people she developed with her colleagues an excellent Early Intervention Programme which was used throughout Asia.


Because of overcrowding in some schools, schools have one group of pupils coming in the morning and a second group of pupils coming in the afternoon.  This reminded me of Makere University in Uganda where some students would attend in the middle of the night because of a lack of places etc. during the day. Many of the population were Muslim and I was very impressed by their behaviour and the kind of country they had created with brilliant Chinese businessmen and Indians.  Nevertheless I did notice some concerns in the front page of a local newspaper which had the headline “Hugging and kissing in public:  freedom or indecent behaviour?”.  Malaysia is a country which symbolises Asia and is worthwhile a visit.  There is a mix of private and public hospitals just as in Ireland and medical tourism is big business particularly from Indonesia.  The issues that they have to face particularly in relation to infections are massively different from the issues in Africa.