Sarawak’s Hidden Health Scandal – Maternal Deaths
Thursday, February 10th, 2011 GMT - Petikan dari Sarawak Report

Evidence shows that three times as many mothers die in Sarawak than in the rest of Malaysia and ten times as many as in Australia or the UK.

The Sarawak Government has been covering up a health scandal by deliberately concealing the true level of maternal deaths, according to exclusive information which has been made available to Sarawak Report.
Concerned doctors and health professionals have been investigating the true level of inadequate health care provided in the state, which is the richest in terms of resources in the whole of Malaysia. They say their findings show that the deaths of women in childbirth are far higher than are being admitted to in the official statistics, yet the spending on healthcare per person in the state is less than one quarter the amount spent on health care in West Malaysia!
“Sarawak is a large state with a small population spread over difficult terrain” commented one of the health professionals who passed on their information to Sarawak Report. “This means that you would expect far more money to be needed to provide adequate healthcare, not less. But the BN Government has clearly chosen to abandon the indigenous people of the interior instead.”

No facilities for problem childbirths
No way to travel in an emergency - crammed in the boot on a road like this. No wonder so many women die if things go wrong.

The shocking figures bear out the practical experience of doctors working in the field in Sarawak. Another senior obstetrician commented that most women from the interior suffer grave risk in childbirth, because the simple precaution of bringing them into hospital a few days before they are due to give birth has been ignored by the authorities.
“This precaution would be very cheap in comparison with the flying doctor service, which is a big waste of money” he commented. However, he says that since there is no opportunity for profit-making by people in power, there has been no interest in developing this method of saving hundreds of lives.
The obstetrician also commented that poverty and the appalling state of the roads are a major factor in deaths in childbirth. “People are getting poorer and costs of food an fuel are getting higher. This makes the women less strong and they cannot afford to go to hospital. If there is an emergency the roads are so bad it takes too long”.

Key statistics
Waiting in line – these women have made it to hospital

“We believe the Sarawak Health Department are fudging its figures. They are quoting the standardised figures for the whole of Malaysia and then just dividing them by the number of pregnancies in Sarawak. But in fact what available information there is implies that the death-rate is far higher in Sarawak . A paper published in 2008 based on genuine research in the 1990s shows that at least 92 in 100,000 women were dying in childbirth then, compared to the 30 in 100,000 currently quoted by the Sarawak Health Department. There has been no improvement in Sarawak’s health facilities since then and we challenge the Sarawak Health Department to produce the evidence for their statistics.”

The contested figures are to be found in the Sarawak State Health Department’s publication ‘Health Facts About Sarawak’, published 2008. However, the experts say that it is not based on genuine research in Sarawak, only on Malaysia-wide statistics.

Misleading statistics? 30 deaths in 100,000 births is the story according to the Sarawak Health Department.

By contrast the doctors say that a paper published in the book “Women and Health – Village Mothers, City Daughters” 2007, by Adeda Baer, quotes a peer-reviewed report “Sudden Maternal Deaths in Malaysia – A Case Report” by R Jejasothy in the internationally accepted Journal of Obstetrics and Gynaecological Research (Vol 28, No 4, pg 186-93) calculates the death rate to be 92 in 10,000 births.
Low spending for Sarawakians – less than one quarter what is spent on average Malaysians on health!
The doctors also point to shocking figures that indicate the people of Sarawak receive less than a quarter in health spending per person compared to people in mainland Malaysia, even though the remote communities would indicate the need to spend more money not less.
The same Sarawak State Health Department figures say only RM 422 is spent per person in Sarawak on health each year, whereas World Health Organisation figures state that the average spending per person in Malaysia is RM 1,800.

Shocking - Sarawakians receive less than a quarter health care spending compared to the average Malaysian

Helicopters ‘Useless for sick patients, but healthy for Jabu’s bank account!’

Flying healthy doctors, but not sick patients!

However, even more shocking is the allegation that what small amount of money is spent on Sarawak healthcare is spent on programmes that will more benefit Ministers’ bank accounts than sick patients!
The doctors spoken to by Sarawak Report say they blame the BN Government for the shocking death-rate, because they have been more interested in providing expensive facilities which provide Ministers with opportunities to make money, than far cheaper and more practical services that could save lives.
One obstetrician who has worked as a so-called Flying Doctor said he was sickened by the corruption of this service, which costs the country around RM 90 million a year. He told us:
“This Flying Doctor Service is a waste of money as far as the patients are concerned. It cannot fit people who are lying down and there is not enough room for the doctors to bring more than a few pills in terms of equipment. We go on scheduled trips and arrive in villages at a time convenient to the service and not when people are actually sick. We hand our a few panadol out and then we fly on to the next place. We very rarely perform emergency rescue trips. These helicopters are good for flying healthy doctors but not sick patients!”

The obstetrician told Sarawak Report that it would be far cheaper and more effective to have para-medics stationed in all communities to identify sick mothers and patients and to arrange for them to be transported to proper hospitals in good time. He also said that money should be spent on providing accomodation in District Hospitals for mothers for at least two weeks before their birth date. He said these two measures would save very many lives, while the Flying Doctor helicopters save virtually none.
However, he gave one good reason why the BN Government has always preferred to maintain the helicopter service.
“It is corruption. Ministers compete for who will get the contract for this service! It is worth RM 4,000 for every stop the helicopter makes. We go to four stops in one day and there are 3 helicopters. There are millions to be made for the company which gets the Flying Doctor contract and they like to take it in turns!”
Sarawak Report has investigated the ownership of the company that received the latest contract for the Flying Doctor Service, which was tendered in 2009. We can confirm that one of the major shareholders is the son of the Deputy Chief Minister, Alfred Jabu! We therefore challenge the BN Government to answer the charge of doctors that it has ignored the advice of medical experts and allowed ministers to put illegal profits before the lives of hundreds of vulnerable women in Sarawak!

Conflict of interest - How dare the BN Government hand the multi-million ringgit helicopter service to the son of the Deputy Chief Minister?

Kam Agong a case in point

Unsuitable transport for a pregnant women - often they have to travel for many hours while in labour

Chief Minister Taib himself has referred to the acute shortage of qualified medical staff in Sarawak’s rural areas. In 2008 he was reported admitting that only 22.2% of medical officers posts were filled in Sarawak’s health clinics! He also admitted that a third of Sarawak’s population has NO ACCESS to any hospitals or clinics, compared to 95% of the rest of Malaysia who do have access. Just last month the Prime Minister suffered the embarrassment of opening a clinic in Belaga for rural people, only to discover that it will have no doctors!
Surely addressing this scandal and not providing a useless helicopter service should receive what money is available? The family of Kam Agong, a mother of 8 who died in childbirth due to medical neglect have waged a determined campaign to publicise the greed and corruption that has drained the money from helping women in the interior into helping Taib’s ministers get richer. They have condemned the poor roads and transport that mean heavily pregnant women have to travel to clinics by sitting for hours in the back of open jeeps on bumpy tracks.

Every woman's right and Sarawak could afford it if ministers were less greedy!

They have shown how the lack of specialist care in all but 4 clinics in the whole of Sarawak meant that their mother was operated on and killed by an unqualified worker. Read their website and support their campaign for more trained doctors, more mid-wives and more medical officers. Sarawak is the richest state in Malaysia, so it can afford them if the money can be kept away from greedy ministers!
The doctors state that the main causes of maternal deaths in Malaysi are caused by haemorrhage, infection, brain seizures, hypertension, anaemia and obstetric fistulae. These are all conditions that can be managed if women are safely in hospital. However if they are a long journey away they will nearly always die. Because there are so few health professionals working in the interior there is virtually no monitoring of women in their pregnancy and dangerous conditions are not picked up until the woman is already in labour.
However, the doctors say that figures being promoted by the Sarawak State Health Department are highly misleading and attempt to give the impression that the death rate in the state is no higher than in Malaysia as a whole:

Saturday, February 12th, 2011 GMT - This post is also available in: English
Sarawak Report telah mendapat maklumat yang ekslusif mengenai skandal kesihatan yang berkaitan dengan kadar kematian sebenar di kalangan kaum ibu yang selama ini telah disembunyikan oleh Kerajaan Sarawak.
Para doktor dan pakar-pakar kesihatan yang merasa runsing dengan keadaan ini menjalankan siasatan mereka ke atas kadar sebenar kekurangan penjagaan kesihatan yang diberikan kepada penduduk-penduduk di negeri ini, walaupun negeri ini merupakan negeri yang kaya dengan sumber alam. Menurut kajian dan siasatan mereka kematian di kalangan kaum ibu yang melahirkan anak adalah lebih tinggi daripada yang diberikan kepada perangkaan rasmi, walaupun perbelanjaan untuk penjagaan kesihatan bagi seorang penduduk di negeri ini adalah kurang dari satu perempat berbanding dengan yang dibelanjakan di Semenanjung Malaysia!
“Sarawak adalah negeri bekependudukan rendah yang diam secara bertaburan atau berselerak di serata negeri” kata salah seorang pakar kesihatan yang memberikan maklumat-maklumat kepada Sarawak Report. “Ini bermakna kita perlukan lebih banyak peruntukan untuk penjagaan kesihatan di negeri ini, bukannya kurang. Tetapi Kerajaan BN tetap memilih untuk mengabaikan orang-orang asli yang mendiami kawasan pedalaman.”

Tiada peralatan untuk kes bersalin yang bermasalah
Data dan statistik yang mengejutkan tetap dialami oleh para doktor yang menjalankan tugas dan tanggungjawab mereka di Sarawak. Seorang lagi pakar kesihatan mengatakan bahawa kebanyak wanita-wanita hamil dari kawasan pedalaman yang akan melahirkan anak terpaksa melalu risiko, kerana langkah-langkah keselamatan yang mudahpun tidak dihiraukan pihak-pihak yang berwajib.“Langkah-langkah keselamatan ini adalah jauh lebih murah berbanding dengan membiayai perkhidmatan doktor udara” katanya. Walau bagai manapun, katanya lagi, jika sesuatu perkara itu tidak menguntungkan sesiapa dari golongan yang berkuasa dan berwibawa, maka kaedah yang boleh menyelamatkan ratusan nyawa seperti itu tidak akan dibangunkan.Pakar berkenaan juga memberikan komen bahawa kemiskinan dan keadaan jalan yang amat sukar dilalui adalah penyumbang utama kematian kepada kaum ibu. “Rakyat semakin miskin dan harga makanan dan bahanapi pula kerap dinaikkan. Ini akan menyebabkan kaum ibu menjadi semakin tidak mampu untuk pergi ke hospital. Jika berlaku apa-apa kecemasan, jalan yang tidak baik akan menyukarkan golongan ini sampai di hospital”.

Statistik-statistik utama
Kebanyakan pakar kesihatan yang memberikan maklumat kepada kami menyatakan penyebab utama kematian yang menimpa kaum ibu di Malaysia adalah pendarahan, jangkitan penyakit, kekejangan otak, darah tinggi, dan komplikasi-komplikasi merbahaya yang lain. Keadaan-keadaan ini akan dapat dielakkan jika ibu-ibu yang hamil itu berada dekat dengan hospital. Namun jika mereka berada jauh, selalunya mereka akan meninggal dunia dalam perjalanan. Kekurangan para pakar kesihatan yang ditugaskan di kawasan pedalaman juga menyumbang kepada kurangnya pengawasan yang rapi terhadap kaum ibu ini sehingga dekat pada masa mereka melahirkan anak.
Namun para doctor mengatakan angka-angka yang dikemukakan oleh Jabatan Kesihatan Negeri Sarawak tetap mengelirukan dan cuba digunakan untuk memberikan gambaran kepada umum bahawa kadar kematian di negeri ini tidak tinggi dari di Malaysia secara keseluruhannya: “Kami percaya bahawa Jabatan Kesihatan Sarawak telah memanipulasikan angka-angka ini. Mereka menyebut tentang angka-angka yang telah diselaraskan bagi seluruh Malaysia dan kemudiannya membahagikan dengan bilangan kehamilan di Sarawak. Tetapi pada hakikatnya, kadar kematian di kalangan ibu mengandung dan yang bersalin adalah tinggi. Suatu kertas kajian 1990-an yang diterbitkan dalam 2008 berdasarkan kajian sebenar menunjukkan bahawa sekurang-kurangnya 92 dari 100,000 mengalami kesukaran semasa bersalin, berbanding dengan 30 dari 100,000 seperti pada angka yang dimanipulasi oleh Jabatan Kesihatan Sarawak. Sejak sekian lama, tiada penambahbaikan dilakukan ke atas peralatan-peralatan kesihatan di Jabatan Kesihatan Sarawak dan kami mencabar sekeras-kerasnya agar jabatan berkenaan menunjukkan bukti untuk menyokong statistik-statistik mereka itu.”

Perangkaan yang meragukan itu dapat diperolehi dari terbitan Jabatan Kesihatan Negeri Sarawak yang bertajuk ‘Health Facts About Sarawak’, yang diterbitkan dalam tahun 2008. Walau bagamanapun, ramai pakar kesihatan bersetuju bahawa terbitan tersebut bukanlah berdasarkan kajian-kajian di Sarawak sahaja, tetapi bagi seluruh Malaysia.
Sebaliknya para doktor mengatakan terbitan yang berjudul “Women and Health – Village Mothers, City Daughters” 2007, oleh Adeda Baer, memetik laporan dalam kajian “Sudden Maternal Deaths in Malaysia – A Case Report” oleh R Jejasothy di dalam Journal of Obstetrics and Gynaecological Research (Jilid ke-28, No 4, mukasurat 186-93) yang diterimapakai di peringkat antarabangsa sebagai mengira kadar kematian adalah 92 dalam 10,000 kelahiran.

Helikopter ‘Tidak sesuai untuk para pesakit, tetapi hanya sesuai untuk akaun bank Jabu!’
Para doktor yang memberikan maklumat kepada Sarawak Report mengatakan mereka menyalahkan kerajaan BN kerana kadar kematian yang mengejutkan disebabkan kerajaan BN lebih berminat mengadakan kelengkapan yang mahal-mahal untuk memberi peluang kepada para menteri untuk memperolehi kekayaan, tetapi bukannya mengadakan khidmat yang lebih murah dan praktikal yang dapat menyelamatkan nyawa.Salah seorang dari pakar kesihatan yang pernah berkhidmat sebagai doktor udara memberitahu Sarawak Report bahawa dia pernah bertugas dengan khidmat yang dicengkam rasuah, yang melibatkan negara ini mengeluarkan belanja sehingga RM90 juta setahun. Katanya lagi:
“Perkhidmatan doktor udara ini adalah suatu pembaziran yang besar. Ia tidah boleh memuatkan pesakit yang berbaring dan tiada pula ruang yang cukup untuk doktor-doktor untuk membawa lebih dari beberapa biji pil-pil ubat. Kami pergi berpandukan penerbangan yang terjadual dan tiba di perkampungan pada masa yang sesuai dengan penerbangan dan bukannya pada masa pesakit memerlukan khidmat ini. Jarang kita dapat melakukan kerja-kerja menyelamat nyawa semasa kecemasan. Helikopter-helikopter itu hanya sesuai untuk doktor-doktor yang sihat dan bukannya sesuai untuk pesakit-pesakit yang merana!’

Pakar kesihatan berkenaan memberitahu Sarawak Report bahawa adalah lebih murah dan lebih berkesan jika para petugas para-medic diletakkan untuk mengawas sesebuah komuniti untuk membantu ibu-ibu yang bakal melahirkan anak dan kemudian menguruskan penghantaran mereka ke hospital-hospital pada masa yang difikirkan sesuai. Menurut pakar berkenaan peruntukan kerajaan itu sepatutnya dibelanjakan untuk membiayai ibu-ibu tersebut menginap di hospital sekurang-kurangnya dua minggu sebelum saat-saat melahirkan anak. Kedua-dua langkah ini, menurut pakar itu lagi, terbukti dapat menyelamatkan banyak nyawa ibu, tetapi sebaliknya, perkhidmatan Doktor Udara pula belum tentu dapat menyelamatkan apa-apa.
Walau baga manapun, pakar berkenaan memberikan satu sebab kenapa Kerajaan BN selalunya ingin mengekalkan perkhidmatan doktor udara itu.
“Ianya suatu rasuah. Para menteri berebut-rebut untuk mendapatkan kontrak perkhidmatan itu! Pada setiap pendaratan, kosnya adalah RM4,000. Kita akan mendarat sebanyak empat kali dalam sehari dan pada setiap perkhidmatan ada 3 buah helikopter. Syarikat akan memperolehi berjuta-juta ringgit dari kontrak perkhidmatan doktor udara ini, dan para menteri akan berebut-rebut untuk mendapatkannya secara bergilir-gilir!”
Sarawak Report telah menyiasat mengenai pemilikan syarikat yang telah mendapat kontrak yang terkini pada Perkhidmatan Doktor Udara ini, yang telah ditenderkan pada tahun 2009. Kami dapat mengesahkan bahawa pemegang utama saham-saham dalam syarikat berkenaan adalah Gerald Renytap Jabu, iaitu anak kepada Timbalan Ketua Menteri Alfred Jabu. Dengan ini kami ingin mencabar Kerajaan BN untuk menjawab tuduhan-tuduhan doktor-doktor bahawa kerajaan BN telah mengabaikan nasihat dari pakar-pakar perubatan dan membenarkan menteri-menteri mengutamakan keuntungan daripada nyawa-nyawa kaum wanita di Sarawak!
Kes Kam Agong
Ketua Menteri Taib Mahmud sendiri pernah mengakui bahawa kekurangan pekerja perubatan yang berkelayakan bertugas di pedalaman Sarawak. Dalam tahun 2008 Taib pernah dilaporkan mengakui bahawa hanya 22.2% jawatan pegawai-pegawai perubatan diisi untuk bertugas di klinik-klinik di Sarawak. Beliau juga mengakui bahawa satu-pertiga penduduk Sarawak langsung TIADA AKSES kepada mana-mana hospital atau klinik, berbanding 95% dari seluruh rakyat Malaysia. Hanya pada bulan lalu Perdana Menteri Najib pernah diejek kerana merasmikan sebuah klinik di Belaga khas untuk orang-orangorang pedalaman, hanya mendapati klinik berkenaan tidak ada doctor. Apakah ertinya membelanjakan peruntukan yang banyak untuk khidmat helicopter yang tidak memberi pulangan yang baik kepada rakyat? Ahli-ahli keluarga Kam Agong, seorang ibu yang mempunyai 8 orang anak yang meninggal dunia disebabkan kecuaian khidmat kesihatan telah mencetuskan kempen untuk menyebar-luaskan ketamakan dan rasuah yang telah membazir wang rakyat. Keluarga mendiang telah menyalahkan keadaan jalan yang teruk untuk menghantar ibu-ibu yang sarat mengandung yang terpaksa menanggung sangsara sepanjang perjalanan ke klinik hingga berjam-jam lamanya di belakang trak atau jeep terbuka.
Mereka telah menunjukkan bagaimana kekurangan penjagaan oleh para pakar di 4 buah klinik di seluruh Sarawak memberi makna bahawa ibu mereka telah menjalani pembedahan dan terkorban oleh pekerja yang tidak bertauliah. Sila kunjungan laman web mereka di untuk melihat sendiri. Sarawak diakui sebagai sebuah negeri yang terkaya di Malaysia, justeru elakkan para menteri yang tamak-haloba itu dari mendekati sumber-sumber asli Sarawak!