FMSC Final 210921

KUALA LUMPUR 2021

23RD FAMILY MEDICINE
SCIENTIFIC CONFERENCE

“Embracing Primary Care Evolution, Upholding Core Values”

Fully Virtual 20

Pre-Conference CPD
22nd September 2021 points

Conference
23rd-25th September 2021

Organised by : In collaboration with :

“Embracing Primary Care Evolution, Upholding Core Values”

CONTENTS 01
02
Acknowledgment 03
FMSA Objectives 04
Foreword by The Director General of Health, Malaysia 05
Foreword by The Minister of Health, Malaysia
Foreword by The State Health Director, Wilayah 06
Persekutuan Kuala Lumpur and Putrajaya 07
Welcome Message from The FMSA President 09
Welcome Message from The Organizing Chairman 19
Committee Members 20
FMSA EXCO Members 22
Virtual Exhibition Booths 23
Advertisement (Sanofi) 24
Opening Ceremony 25
Scientific Programme 27
30
Pre-Conference 31
Conference 32
Closing Ceremony 82
Advertisement (Novo Nordisk) 91
Speaker’s Abstracts
List of Topics for Oral & Poster Presentations
Advertisement (Menarini)

23RD FAMILY MEDICINE SCIENTIFIC CONFERENCE

Acknowlegdement

We would like to convey our utmost appreciation to
everyone who has contributed to the success of the 23rd
Family Medicine Scientific Conference 2021 including all of
the following for their invaluable support and participation :

01

“Embracing Primary Care Evolution, Upholding Core Values”

FMSA Objectives

To promote and maintain the honour and
integrity of the profession of Family Medicine

1 Specialist in every one of its segments and
help to sustain professional standards and
medical ethics.

The Objectives To serve as the vehicle of the integrated
of the Association voice of the whole profession and all or

are :- 2 each of its on special problems and in
relation to educating and directing public
opinion on the problems pertaining to
family health and the community at large.

To promote, facilitate and participate in

3 the conduct of family medicine research
and education, as may be appropriate.

4 To promote, social, cultural, charitable and
spiritual activities in building a caring society
and a united Malaysian nation.

02

23RD FAMILY MEDICINE SCIENTIFIC CONFERENCE

Foreword by The Director
General of Health, Malaysia

YBhg. Tan Sri Dato' Seri
Dr. Noor Hisham Abdullah
Director General of Health, Malaysia

Kudos to the organising committee of the 23rd Family Medicine Scientific Conference.
Notwithstanding a fiendishly difficult year managing the COVID-19 pandemic, the fraternity
has persevered and worked meticulously to materialised this conference. I am convinced
that it took a strong team with tremendous effort to pull this through, with various COVID-19
related activities in the primary care, on top of ensuring the essential services in health
centres remain uninterrupted.
I welcome the various appealing and pertinent topics assembled in this conference,
portraying a wide range of intricacies within the primary care providers, notably those that
require family medicine specialists' regular interventions, be it with conventional or new
cutting edge methods. Hence, the theme "Embracing Primary Care Evolution, Upholding
Core Values" is a shrewd selection, to reflect on the 'new normals' of operationalisation of
the primary healthcare services, in parallel with ensuring the values of patient
management are adhered to solemnly and with integrity.
Embracing the new normal, with the conference conducted entirely virtual, I believe this
conference will be of great magnitude for all participants.
Have a great conference!

Thank You

YBHG. TAN SRI DATO' SERI DR. NOOR HISHAM ABDULLAH
Director General of Health, Malaysia

03

“Embracing Primary Care Evolution, Upholding Core Values”

Foreword by The Minister of
Health, Malaysia

YB Khairy Jamaluddin Abu Bakar
Minister of Health, Malaysia

It is my pleasure to welcome all participants to the 23rd Family Medicine Scientific
Conference 2021.

I welcome all speakers and guests that have been invited to share their knowledge and
vast experience in this ever evolving world of medicine. The theme “Embracing Primary
Care Evolution, Upholding Core Values” reminds us that the primary care system has and
continues to evolve, with many new and emerging tools for providing care outside
traditional clinical settings, and changing health needs following evolving population
demography. This evolution affects the dynamics of primary care in delivering quality
healthcare to everyone.

Primary care is recognized internationally as pivotal to health care. Strong primary care is
associated with better population health, improved patient outcomes, increased lifespan
and lower-cost health care. Technology has become a crucial part of our daily agenda.
Patients’ care is made possible in every circumstance and even better in this digital era.
The outbreak of the COVID19 pandemic has indeed accelerated the preparation and need
for digital healthcare. The news and reports from the initial outbreak was shared faster
through digital platforms, allowing us to prepare ourselves to face this invisible force. We
soon realised the need to minimise physical contact with our usual patients while at the
same time maintaining accessibility and continuity of quality care for them, and this was
made possible with digital healthcare through telemedicine and virtual consultations. With
adequate promotion and encouragement, mobile-learning tools can drive greater
preventative and health-seeking behavior among patients and healthcare personnel.

Finally I would like to congratulate the organising committee, the FMSes of Federal Territory
of Kuala Lumpur and Putrajaya, led by Dr Rohayah who have contributed their time and
effort in making this conference a reality. Many of you had gone above and beyond the call
of duty to make this conference a successful and fruitful event for the fraternity.

I wish you all a successful conference.

Thank you.

YB KHAIRY JAMALUDDIN ABU BAKAR
Minister of Health, Malaysia

04

23RD FAMILY MEDICINE SCIENTIFIC CONFERENCE

Foreword by The State Health Director,
Wilayah Persekutuan

Kuala Lumpur and Putrajaya

It is my pleasure and privilege to extend a warm welcome to all our distinguished speakers
and delegates to the 23rd Family Medicine Scientific Conference organised by the Family
Medicine Specialists’ Association.

In line with this year’s theme : ‘Embracing Primary Care Evolution, Upholding Core Values’, I
do believe that all key relationships in primary care whether with patients, colleagues, the
wider health service as well as the local communities are underpinned by basic core values
passed down by tradition.

One of the greatest examples of primary care evolution is being witnessed during this
pandemic. The core values of primary care include compassionate care, a generalist
approach, continuity of relationships, reflective mindfulness and lifelong learning.
Concepts such as care coordination, preventive care, access to care, professional
competence, resource management and community-based care, are also part of the
principles above.

Primary care practitioners are challenged to guard these values, recognising that values
may be affected by evolution in health care and its delivery. Indeed, with the continuation
of the scientific conference which is virtual this year, it is evident that the evolution of
primary care is a conscious process that prioritises lifelong learning and forging
relationships.

The primary care team along with public health services, as well as the secondary and
tertiary care teams must work together towards a vision of a healthcare system where
quality care is accessible to diverse populations of Malaysia, promotes wellness and
disease prevention, reliably improves health outcomes and provides compassionate care
across the lifespan.

I believe that this conference will be of the highest standard and
wish you all an enjoyable and productive meeting!

Thank you

YBhg. DATUK DR. PARAM JEETH SINGH A/L PAKAR SINGH
Director,
Wilayah Persekutuan Kuala Lumpur
& Putrajaya State Health Department

05

“Embracing Primary Care Evolution, Upholding Core Values”

Welcome Message from
The FMSA President

Assalamualaikum and Salam Sejahtera.

It is a joy to be addressing you again in this 23rd Family Medicine Scientific Conference
brought to you on a virtual platform. Welcome dear delegates in this very unusual
circumstances. We have enjoyed physical conferences all these years. This is the first time
the conference is held virtually. We must not blame the COVID-19 pandemic, in fact
because of the pandemic, many of us have becoming IT savvy. Not only that, we have now
become closer to each other because the virtual meetings are conducted more frequently
and conveniently at the comfort of our home. However, we do not want the pandemic to
affect our lives longer and we do need our livelihood and physical interactions back.

Congratulations to the organizing committee for tirelessly keeping up with the conference
progress and development. I salute your versatility, resilience and initiatives in order to
materialize the conference. I know you have been challenged with overwhelming
uncertainties, multiple changes in decisions and planning. Nevertheless, you have kept
your head strong, very motivated and full of dignity. These are the special properties of
family medicine specialists. When the going gets tough, the tough gets going.
Congratulations again.

As with previous conferences, the FMS Conference will only give you the best. The scientific
program is diverse and definitely there will be updates on COVID-19 pandemic. Influenza
vaccination is not to be forgotten and a tinge of Women’s Health completes the scientific
program. Non-Communicable Disease (NCD) therapeutic updates are essential despite
COVID-19 pandemic because those poorly control NCD patients will fare worse compared
to those who are under control. Sharing local experiences with our FMS colleagues will
enrich delegates and you will be more knowledgeable by the end of conference. To all FMS
trainees who have registered, I say thank you and you will not regret it. The conference
prepares you well in your zest to uphold the fraternity and taking over from the seniors when
the time comes. Thank you.

Finally, enjoy the conference and stay abreast with the latest
updates in family medicine. Representing the Exco Committee of
FMSA Malaysia and its members, my heartfelt gratitude and
appreciation for your support. May Allah bless us all. Stay safe and
stay healthy. Together we will win this war.

Thank you

DR SRI WAHYU TAHER
FMSA PRESIDENT

06

23RD FAMILY MEDICINE SCIENTIFIC CONFERENCE

Welcome Message from
The Organizing Chairman

Assalamualaikum wbt and Salam Sejahtera,

On behalf of the organizing committee, I am honored and delighted to welcome your
presence to the 23rd Family Medicine Scientific Conference, held virtually for the first time
ever in history.

This much awaited yearly event has attracted > 1000 participants nationwide and
internationally, this year.

Our theme this year “Embracing primary care evolution, upholding core values” could not
be more apt considering the unprecedented situation we are in currently.

Fellow delegates,
As we all know, primary care is an essential aspect of health care in any country’s health
system. Regardless of a country’s level of development, primary care continues to justify a
significant proportion of the nation’s health care expenditure. Understandably,
compromising with primary care quality can equally compromise the basic elements of
nation building, specifically the health quality of the human resources, the necessary
support systems and the desired conducive environment for national development.

Primary care has always been the first contact with the community, providing health care
services to all walks of life, from womb to tomb. Major advances in primary care have been
making its way into our practice over the recent years, and primary care services have
been enhanced throughout the country.

These advances are occurring at lightning speed, and embracing this evolution has been
especially important for us in the primary care (be it doctors or allied health). Since we are
the people in closest contact with our patients, their families and the community, we are
therefore their primary point of reference as well as their most trusted source.

The recent pandemic has accelerated this evolution further. Locally,
Covid-19 numbers has stalled at unacceptably high levels, ranging
from 18,000 to 20,000 per day with more than 12,000 deaths since
the nation was hit with the pandemic. Ever since then, primary care
providers have been forced to evolve and adapt in ways we could
never have imagined.

07

“Embracing Primary Care Evolution, Upholding Core Values”

Our roles in the frontline have expanded to include mass screening and testing of Covid-19,
managing Covid Assessment Centers (CAC), and subsequently caring for those with the
long-term complications of COVID. We have been actively involved in the vaccine roll out,
provision of medical services at Enhanced Movement Control Order areas, and much,
much more. It is clear that we have a lot of work to do to realise our vision of achieving herd
immunity and primary care has indeed been at the fore front of the battle.
With all this in mind, our committee has come up with an exciting list of conference topics
and symposiums, presented by distinguished speakers in these areas, lined up throughout
the next 3 days.
I would like to encourage the participants to participate in the discussions and activities
held over this digital platform over the next three days and to visit the interactive virtual
booths we have available.
Last but not least, to the organizing committee – family doctors from Kuala Lumpur and
Putrajaya, a very big thank you from the bottom of my heart, for making this event possible.
I know, it has been a challenge organizing this event in the midst of a global pandemic, but
with the excellent teamwork each and every one of the committee members have
portrayed over the last 2 years, we are where we are today.
We sincerely hope, our participants will have an enjoyable, fruitful and memorable time at
our 23rd Family Medicine Conference.

Thank you so much.

DR. ROHAYAH ISMAIL
ORGANIZING CHAIRMAN

08

COMMITTEE

MEMBERS

KUALA LUMPUR 2021

23RD FAMILY MEDICINE
SCIENTIFIC CONFERENCE

“Embracing Primary Care Evolution, Upholding Core Values”

COMMITTEE MEMBERS

ADVISOR

DR. SRI WAHYU TAHER
Consultant Family Medicine Specialist,
Klinik Kesihatan Simpang Kuala.

CHAIRPERSON

DR. ROHAYAH BINTI ISMAIL
Family Medicine Specialist,
Klinik Kesihatan Sentul.

VICE CHAIRPERSON 1 VICE CHAIRPERSON 2

DR. BAIZURY BINTI BASHAH DR. HAMIMAH BINTI SAAD
Consultant Family Medicine Consultant Family Medicine
Specialist Specialist,
Klinik Kesihatan Kuala Lumpur.
SECRETARY
ASSISTANT SECRETARY

DR. SHEELA BAI DR. NURZEITI YUSLINDA
PANNIR SELVAM BINTI YUSOF
Family Medicine Specialist, Family Medicine Specialist,
Klinik Kesihatan Cheras. Klinik Kesihatan Bdr Tun Razak.

SECTRREEATASURYRER ASSISTANT TREASURER

DR. SITI SHAFIATUN DR. NOR FAIZAH
BINTI MOHSIN BINTI GHAZALI
Family Medicine Specialist, Family Medicine Specialist,
Klinik Kesihatan Cheras. Klinik Kesihatan Tanglin.

10

23RD FAMILY MEDICINE SCIENTIFIC CONFERENCE

SCIENTIFIC COMMITTEE

HEAD

MEMBER DR. NARUL AIDA BINTI SALLEH
Family Medicine Specialist
Klinik Kesihatan Kuala Lumpur.

MEMBER

DR. VALARMATHI DR. NAGAMMAI
A/P MASILAMANI A/P THIAGARAJAN
Family Medicine Specialist Family Medicine Specialist
Klinik Kesihatan Batu Muda Klinik Kesihatan Kuala Lumpur

MEMBER MEMBER

DR. ROSLINAWATI DR. NUR SYAHIDA
BINTI MAT ZIN BINTI SAADON
Family Medicine Specialist Family Medicine Specialist
Klinik Kesihatan Dato Keramat Klinik Kesihatan
Salak Selatan

MEMBER MEMBER

DR. BANU NISA PROF. DR. ANIS SAFURA
BINTI ABDUL HAMID Consultant Family Physician,
Family Medicine Specialist Department of Primary
Klinik Kesihatan Care Medicine, Universiti
Kuala Lumpur Teknologi MARA (UiTM)

MEMBER

PROF. DR. CHING SIEW MOOI
Professor and Consultant Family Physician
Department of Family Medicine
Faculty of Medicine and Health Sciences
Universiti Putra Malaysia (UPM)

MEMBER

DR. MAIZATULLIFAH MISKAN
Consultant Family Medicine Physician
Primary Care Medicine Unit
Faculty of Medicine and Defence Health
National Defence University of Malaysia (UPNM)

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“Embracing Primary Care Evolution, Upholding Core Values”

MEMBER

ASSOC. PROF. DR. MALIZA MAWARDI
Consultant Family Physician
Department of Family Medicine
Faculty of Medicine and Health Sciences
Universiti Putra Malaysia (UPM)

MEMBER

DR. KHASNUR ABDUL MALEK
Family Medicine Specialist & Clinical Lecturer
Faculty of Medicine
Universiti Teknologi MARA (UiTM)

MEMBER

ASSOC. PROF. DR. SURAYA ABDUL RAZAK
Consultant Family Medicine Specialist
Department of Primary Care Medicine
Faculty of Medicine,
Universiti Teknologi MARA (UiTM)

MEMBER

PROF. DR. NOOR AZAH ABD AZIZ
Professor and Senior Consultant in Family Medicine
Department of Family Medicine
Universiti Kebangsaan Malaysia (UKM)

MEMBER

ASSOC. PROF. DR. NOORLAILI MOHD TAUHID
Senior Lecturer and Consultant in Family Medicine
Department of Family Medicine (UKM)

MEMBER

ASSOC. PROF. DR. NOOR AZIMAH MUHAMMAD
Consultant Family Medicine Specialist
Head of Department
Department of Family Medicine
Universiti Kebangsaan Malaysia (UKM)

MEMBER

ASSOC. PROF. DR. AMBIGGA DEVI S. KRISHNAPILLAI
Consultant Family Medicine Physician
Primary Care Medicine Unit
Faculty of Medicine and Defence Health
National Defence University of Malaysia (UPNM)

12

23RD FAMILY MEDICINE SCIENTIFIC CONFERENCE

MEMBER

DR. NURAINUL HANA SHAMSUDDIN
Medical Lecturer & Family Medicine Specialist
Department of Family Medicine
Faculty of Medicine & Health Sciences
University Putra Malaysia (UPM)

MEMBER

DR. NAVIN KUMAR DEVARAJ
Medical Lecturer & Family Medicine Specialist
Department of Family Medicine
Faculty of Medicine & Health Sciences
University Putra Malaysia (UPM)

MEMBER

DR. ANEESA ABD RASHID
Medical Lecturer & Family Medicine Specialist
Department of Family Medicine
Faculty of Medicine & Health Sciences
University Putra Malaysia (UPM)

MEMBER

DR. FADZILAH MOHAMAD
Medical Lecturer & Family Medicine Specialist
Department of Family Medicine
Faculty of Medicine & Health Sciences
University Putra Malaysia (UPM)

MEMBER

ASSOC. PROF. DR. CHEONG AI THENG
Medical Lecturer & Family Medicine Specialist
Department of Family Medicine
Faculty of Medicine & Health Sciences
University Putra Malaysia (UPM)

MEMBER

DR. IRMI ZARINA ISMAIL
Family Medicine Specialist & Head of Department,
Department of Family Medicine
Faculty of Medicine & Health Sciences
University Putra Malaysia (UPM)

MEMBER

ASSOC. PROF. DR. ADINA BINTI ABDULLAH
Consultant Family Medicine Specialist,
Head of Department,
Department of Primary Care Medicine,
Faculty of Medicine, University of Malaya (UM)

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“Embracing Primary Care Evolution, Upholding Core Values”

IT, PUBLICITY & PROMOTION
COMMITTEE

HEAD

MEMBER DR. SURIANI BINTI SULAIMAN
Family Medicine Specialist
Klinik Kesihatan Kampung Pandan

MEMBER

DR. WONG PING FOO DR. FATIMAH ZAHRAH
Family Medicine Specialist BINTI MOHD ZAIDAN
Klinik Kesihatan Cheras Baru Family Medicine Specialist
Klinik Kesihatan Tanglin
MEMBER
MEMBER

DR. ROSANNA PATRICIA DR. MEGAT MUHAMMAD HARIS
CHRYSHANTHI GREGORY BINTI MEGAT ZAINAL
Family Medicine Specialist Family Medicine Specialist
Klinik Kesihatan Kuala Lumpur Klinik Kesihatan Jinjang

MEMBER MEMBER

DR. ADILAH AIDIT DR. AINI AYU BINTI SURIYADI
Family Medicine Specialist Family Medicine Specialist
Klinik Kesihatan Sentul Klinik Kesihatan Kuala Lumpur

MEMBER MEMBER

DR. NUR SA'ADAH DR. SANGEETHA
BINTI MOHD ABD RASID A/P NALLA THAMBE
Family Medicine Specialist Family Medicine Specialist
Klinik Kesihatan Putrajaya Klinik Kesihatan Tanglin
Presint 9
MEMBER
MEMBER
DR. SUHAZELI ABDULLAH
DR. AVNI PATEL Family Medicine Specialist
Family Medicine Specialist Klinik Kesihatan Tengkawang
Klinik Kesihatan Cheras Baru

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23RD FAMILY MEDICINE SCIENTIFIC CONFERENCE

REGISTRATION COMMITTEE

HEAD

DR. NOR AZLINA BINTI SIDDIK
Family Medicine Specialist
Klinik Kesihatan Jinjang

MEMBER MEMBER

DR. FUZIAH BINTI PAIMIN DR. ALIDAHANI
Consultant Family Medicine BINTI MOHD YUSOF
Specialist Family Medicine Specialist
Klinik Kesihatan Petaling
Bahagia

MEMBER MEMBER

DR. HONG CHIA YIN DR. MOHD KHAIRUL ANWAR
Family Medicine Specialist BIN ISMAIL
Klinik Kesihatan Sungai Besi Family Medicine Specialist
Klinik Kesihatan Kuala Lumpur

SPONSORSHIP COMMITTEE

HEAD

DR. NORHASLIRA BINTI ABDUL RAHIM
Family Medicine Specialist
Klinik Kesihatan Sungai Besi

MEMBER MEMBER

DR. WAN NOOR AZLIN DR. SITI KHAMSIAH
BINTI WAN IDRIS BINTI ABD. SHUKOR
Family Medicine Specialist Family Medicine Specialist
Klinik Kesihatan Putrajaya Klinik Kesihatan Jinjang
Presint 9

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“Embracing Primary Care Evolution, Upholding Core Values”

PROTOCOL COMMITTEE

HEAD

MEMBER DR. RAFIDAH BINTI MOHD RAFIE
Family Medicine Specialist
Klinik Kesihatan Setapak

MEMBER

DR. ROZITA BINTI ZAKARIA DR. LEONG YIN HUI
Consultant Family Family Medicine Specialist
Medicine Specialist Klinik Kesihatan Setapak
Klinik Kesihatan Presint 18
MEMBER
MEMBER

DR. FATIMAH ZAHRAH DR. JASMIN AQILAH
BINTI MOHD ZAIDAN BINTI ZAHARI
Family Medicine Specialist Family Medicine Specialist
Klinik Kesihatan Tanglin Klinik Kesihatan Batu Muda

MEMBER MEMBER

DR. HANIS BINTI AZMAN DR. BAIZURY BINTI BASHAH
Family Medicine Specialist Consultant Family Medicine
Klinik Kesihatan Specialist
Kuala Lumpur

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23RD FAMILY MEDICINE SCIENTIFIC CONFERENCE

LOGISTIC & ACCOMODATION
COMMITTEE

HEAD

DR. RADZIAH BINTI JABIR
Consultant Family Medicine Specialist

MEMBER MEMBER

DR. ADAM FIRDAUS DAHLAN DR. NORAN BINTI RAMLI
Family Medicine Specialist Family Medicine Specialist
Klinik Kesihatan Sungai Besi Klinik Kesihatan Putrajaya
Presint 9
MEMBER
MEMBER
DR. NURZAITIL ASWANI
BINTI ZAINUDDIN DR. ANUAR BIN MOHAMAD
Family Medicine Specialist Family Medicine Specialist
Klinik Kesihatan Putrajaya Klinik Kesihatan Cheras
Presint 18
MEMBER
MEMBER
DR. ONG JUE JING
DR. CHITRA SULURAJU Family Medicine Specialist
Family Medicine Specialist Klinik Kesihatan Batu Muda
Klinik Kesihatan Petaling
Bahagia

MEMBER

DR MARINA ANTONY
NICHOLSON
Family Medicine Specialist
Klinik Kesihatan Sentul

17

“Embracing Primary Care Evolution, Upholding Core Values”

SOCIAL & SOUVENIR
COMMITTEE

HEAD

DR. HAZIRA HANUM BINTI MOHD YUSOF
Family Medicine Specialist
Klinik Kesihatan Putrajaya Presint 18

MEMBER MEMBER

DR. AZIRA BINTI BAHARUDDIN DR. NURZEITI YUSLINDA
Family Medicine Specialist BINTI YUSOF
Klinik Kesihatan Kuala Family Medicine Specialist,
Lumpur Klinik Kesihatan Bdr Tun Razak.

MEMBER MEMBER

DR. SITI KHAMSIAH DR. ELEZA NAZEFAH ROSLI
BINTI ABD. SHUKOR
Family Medicine Specialist Family Medicine Specialist
Klinik Kesihatan Jinjang Klinik Kesihatan Putrajaya
Presint 18

18

23RD FAMILY MEDICINE SCIENTIFIC CONFERENCE

FMSA EXCO MEMBERS

PRESIDENT VICE PRESIDENT HONORARY SECRETARY
DR. SRI WAHYU TAHER DR. NOR HAZLIN TALIB DR. NURAINUL HANI
SHAMSUDDIN

ASSISTANT SECRETARY HONORARY TREASURER ASSISTANT TREASURER
DR. NURAFIZA MOHD ARIF DR. WONG PING FOO DR. MARYEM SOKHANDAN

FADAKAR

EXCO IT AND EXCO IT AND EXCO ADVOCACY
PUBLICATION PUBLICATION DR. AHMAD FITHRI AZAM
DR. ZAINAL FITRI ZAKARIA DR. LEE YEOW SIONG
BIN ABDUL RAHMAN

EXCO TRAINING EXCO SOCIAL AND EXCO RESEARCH
DR. ALYANI MOHD MOHSIN WELFARE DR. NUR AMANI
AHMAD TAJUDDIN
DR. HANIS SAADAH HUSIN

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“Embracing Primary Care Evolution, Upholding Core Values”

VIRTUAL EXHIBITION BOOTHS

SANOFI AVENTIS NOVO NORDISK
MENARINI SERVIER
DUOPHARMA DKSH
DUTCH LADY SUNPHARMA
FARMASIA BAYER
PHARMANIAGA ABBOT

20

23RD FAMILY MEDICINE SCIENTIFIC CONFERENCE

GOLD Gold / Premium

Sponsors SANOFI AVENTIS

SILVER Silver / Premium

Sponsors NOVO NORDISK

BRONZE Bronze DUOPHARMA

Sponsors SERVIER
MENARINI

Basic / Standard

BASIC ASTRA ZENECA NOVARTIS ABBOT
DUTCH LADY FARMASIA BOEHRINGER INGELHEIM
Sponsors PHARMANIAGA SUNPHARMA DKSH
SANOFI PASTEUR BAYER GSK

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23RD FAMILY MEDICINE SCIENTIFIC CONFERENCE

Opening Ceremony

23rd September 2021
(Thursday)

10.45am : Opening remarks by emcee
NEGARAKU
10.55am : FMSA theme song ‘BERSAMA’
11.05am : Doa’ recitation
11.15am : Welcome message from Chairperson of Organizing
11.30am : Committee - Dr. Rohayah Ismail
11.45am : Speech by FMSA President - Dr. Sri Wahyu Taher
Opening speech by Minister of Health, Malaysia -
Yang Berhormat Khairy Jamaluddin Abu Bakar
Video montage FMSC 2021
End of opening ceremony

23

SCIENTIFIC

PROGRAMME

KUALA LUMPUR 2021

23RD FAMILY MEDICINE
SCIENTIFIC CONFERENCE

25

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“Embracing Primary Care Evolution, Upholding Core Values”

Closing Ceremony

25th September 2021
(Saturday)

1.30pm : Opening remarks
1.35pm : Summation speech- Dr. Rozita Zakaria,
Head of Service, Family Medicine Specialists
1.40pm : Announcement of winners:

1.50pm : Oral and poster presentation
1.55pm : Top 20 most active delegates
2.30pm : Announcement of the 24th Family Medicine
Scientific Conference
List of sponsors FMSC 2021
Video montage - ‘A tribute to all of you’
End of program

30



SPEAKER’S

ABSTRACTS

KUALA LUMPUR 2021

23RD FAMILY MEDICINE
SCIENTIFIC CONFERENCE

23RD FAMILY MEDICINE SCIENTIFIC CONFERENCE

PRE-CONFERENCE :
22nd SEPTEMBER 2021

WORKSHOP 1

How to develop digital health solution ?
Hands-on guide for family physician

by Associate Professor Dr. Adina Binti Abdullah, Associate Professor Dr. Chiew Thiam Kian,
Associate Professor Dr. Nasriah Binti Zakaria, Professor Dr. Ng Chirk Jenn, Dr. Lim Hooi Min,
Dr. Teo Chin Hai,
Department of Primary Care Medicine, University Malaya (UM), Malaysia

ABSTRACT

Digital solutions particularly mobile apps and webs are increasingly being used to
improve health care. Digital health solutions have many advantages over conventional
interventions as patients can access these solutions anywhere and at any time.
Interactive and fun gamification elements could be applied to these solutions to
improve patient engagements. Digital health solutions had been shown to improve
healthcare-related outcomes such as asthma treatment knowledge, exercise time,
nutritional knowledge, sexual health behaviour, depression coping, self-injury
prevention and medication error reduction. These positive effects are especially
noticeable when these solutions are developed using a user-centered design
approach. Solutions that are developed based on users’ needs; grounded on scientific
evidence; and guided by proper software development theories are highly usable and
more effective in improving health outcomes.

In this workshop, participants are exposed to software development concepts and
methods for developing digital health solutions. Participants are guided to choose an
appropriate platform (web or app) and plan the development stages for their
intervention. For all digital health solutions, the first step of development is to form the
requirements/content. Participants are taught how to collect the intervention's
requirements/contents from users and stakeholders, then synthesise the requirements,
conduct storyboarding, and create mock-ups. Participants are also taught how to test
the prototype in alpha and beta testing, which is required before the solutions are
released. Participants are exposed to good instructional design principles so that the
intervention developed has a user-friendly interface with high learnability. Finally,
participants will be given advice on how to communicate with software developers and
technical teams so that the entire development process runs smoothly and meets the
expectations of both parties.

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“Embracing Primary Care Evolution, Upholding Core Values”

WORKSHOP 2

“Mindful-SPA: For Cultivating Emotional Resilience
& Preventing Burnout”

by Low Mi Yen, Clinical Psychologist Self-Compassion Trained Teacher
ABSTRACT
Most of us globally lived with the challenges of Covid-19 pandemic coming to 1.5 years
now. Frontliners are a breaking point and we need everyone’s effort to break the chain
of infection. Many are experiencing prolonged fatigue and even burnout. Hundreds of
studies are pointing to self-compassion and mindfulness as the most powerful
resources to help us meet inevitable crisis and transform our experiences by providing
emotional strength and resilience. While we all have this inner capacity within us, but
when we are struggling and overwhelmed, we could not to practice /use these
self-compassion and mindfulness skills. In this half day training, Mi Yen will facilitate the
rediscovering of these capacities within us. Participants will be able to learn some basic
self-compassion and mindfulness exercises that can help all of us especially medical
frontliners, caregivers and those in other helping professions i.e. mental health, social
work, allied health professionals, etc.

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23RD FAMILY MEDICINE SCIENTIFIC CONFERENCE

WORKSHOP 3

Empowering Healthcare Provider with Exercise Prescription

by Professor Dr. Sazlina Shariff Ghazali, Associate Professor Dr. Cheong Ai Theng,
Dr. Abdul Hadi Abdul Manap
Department of Family Medicine, Faculty of Medicine and Health Sciences,
Universiti Putra Malaysia, Malaysia

ABSTRACT
Physical inactivity and sedentary lifestyle are fast-growing public health problem that
leads to many non-communicable chronic diseases and health complications. In
Malaysia, the National Health and Morbidity Survey 2019 reported the overall physical
inactivity was 25.1%. However, 83% were physically inactive. Improving a patient’s overall
health through regular physical activity has proven effective in the treatment and
prevention of non-communicable chronic diseases such as stroke, diabetes,
Alzheimer’s disease and cancer, as well as reduced mortality. In order to achieve these,
for all health care providers (HCPs), regardless of specialty, to review and assess every
patient’s physical activity level at every visit. Patients should be counselled on exercise
regimens and assessed for exercise clearance and provided with a prescription.
Therefore, healthcare professionals should be equipped with the necessary skills, tools
and resources to prescribe exercise to prevent and treat common non-communicable
chronic diseases for patients. The aim is for physical activity to become a vital sign, with
HCPs routinely discussing the physical activity level with each of their patientsduring
patient visits. This workshop will be conducted by certified exercise prescribers and will
discuss on the benefits of exercise on health, pre-participation safety evaluation in
exercise and principles of exercise prescription. Participants will be able to participate in
a hands-on circuit on aerobics training, functional testing such as 6 minute walk test
and 3 minute step test, and resistance training.

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“Embracing Primary Care Evolution, Upholding Core Values”

CONFERENCE DAY 1 :
23rd SEPTEMBER 2021

PLENARY 1

Transforming Primary Care Service Delivery:
Upholding Family Medicine Core Values

by Dr. Rozita Zakaria
Head of Service for Family Medicine, Ministry of Health Malaysia

ABSTRACT

The history of Primary care service in Malaysia has come a long way. Upon
independence in 1957, Maternal and Child Health services came to fore as an essential
component of the National Rural Health Development Programme. It has now
transformed in phases from a vertical programme delivered through a 3-Tier System
with only 1 medical officer in the Main Heath centre, to Health Clinics with a wide range
of primary care services provided by medical officers and Family Medicine Specialists.
The year 1997 started off as the early years of Family Medicine where there is a
metamorphosis of general practice at outpatient department into the specialty of
family medicine.

Primary care which is the backbone of our health system is under immense strain. To
meet the health challenges of the 21st Century and secure the future of family medicine,
transforming Primary Care Service Delivery is inevitable. Three important strategies will
be deliberated mainly Enhanced Primary Health Care, Virtual Clinic and Uberisation of
Health Care services.

Virtual Directly Observed Treatment (V DOT) which is a personal initiative introduced to
Klinik Kesihatan Putrajaya Presint 18 will also be discussed. V DOT is a modified treatment
strategy from the World Health Organisation’s Directly Observed Treatment whereby
observing patients taking their anti TB treatment is done virtually using Virtual Clinic
platform.

With transformation, the ways in which care is delivered will definitely change. Despite
the changes, family medicine in the future will need to remain true to its core values.
There is a need to define its own core values according to the local situation. Once the
core values have been defined, it must be shared with the whole team so that the
elivery of services will be congruent.

With the right tools, skills and investment, on top of upholding family medicine core
values, family medicine specialists can continue to deliver world class patient care and
being a Family Medicine Specialist can be the best job one can ever have.

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23RD FAMILY MEDICINE SCIENTIFIC CONFERENCE

PLENARY 2

Uberization of Primary Care: The Defining Healthcare
Trends of the 21st century

by Dr. Mohd Safiee bin Ismail
Director, Hospital Tuanku Fauziah, Perlis, Malaysia
ABSTRACT
Uberization of primary care : the defining healthcare trends of the 21st century
Undoubtedly, future technology disruption will change PHC service delivery
landscape to make it more efficient , accesible and support high quality primary
care . The traditional facility based PHC services where face to face interaction
occurred shall no longer dominate the ways health care are delivered. Nowadays,
patients demand more convinient care within friendly environment in home and
community setting.Uberisation of primary care service through usage of digital
platform and mobile applications offers choice and save a lots of burdensome
travel time in seeking care for those who can pay out of pocket. To gain the full
benefit of this technology , issues relate to quality care, equal accces to ICT (digital
equity), digital literacy and regulation pose great challenges to country health
system worldwide.

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“Embracing Primary Care Evolution, Upholding Core Values”

KEYNOTE ADDRESS

Turning The Tides in Combatting The Covid-19 Pandemic

by YBhg. Tan Sri Dato’ Seri Dr. Noor Hisham Abdullah
Director General of Health
Ministry of Health Malaysia

ABSTRACT
The year 2020 and 2021 were stricken by the COVID-19 pandemic instigating
unprecedented challenges to the whole world. The impact on the socio-economical
aspects in many countries has affected people’s basic daily living. Many countries
faced extreme challenges to balance lives and livelihood, including Malaysia.
In dealing with these challenges, Malaysia adopted the whole-of-government and
the-whole-of-society approach by consolidating cooperation between the ministries,
government agencies, non-governmental organisations from various sectors
combined with local communities. The Ministry of Health is unwaveringly determined to
ascertain that at every level of society, notwithstanding their status, age, race, or
nationalities for equity and equality of access to healthcare services. Importantly, this is
in concordance with the global solidarity spirit of leaving no one behind.
Undoubtedly, we are yet to win this war against the COVID-19 that has proven to be a
ruthless battle to fight. Nevertheless, every one of us can play a crucial role in taking care
of ourselves and the people all around us. Social compliance and discipline at every
level of the community are imperative to the success of a nation. Hence, we must
continue to remain vigilant. Let us join forces and unite to persevere through these
challenging times, and hope that the coming days will be eased in every affair.

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23RD FAMILY MEDICINE SCIENTIFIC CONFERENCE

SYMPOSIUM 1

1. Primary Care Governance & Service Delivery Reform:
Why, How and When?

by Dr. Norsiah Ali, Consultant Family Medicine Specialist
Klinik Kesihatan Masjid Tanah, Melaka, Malaysia

ABSTRACT

Primary care is the provision of integrated, accessible health care services by
physicians and their health care teams who are accountable for addressing a large
majority of personal health care needs, developing a sustained partnership with
patients, and practicing in the context of family and community.

Primary care has been regarded as the thrust of health care services worldwide. Primary
care providers sit at the point of first contact. It is very crucial to make correct decisions
at this level of care in order to ensure patient safety and good quality service delivery.
Moreover, patients come in an undifferentiated manner as certain symptoms could
possibly reflect the clinical presentation of a few system. Hence working at this point of
care can be very challenging. Therefore, a good primary care governance is deemed
needed.

Primary care governance comprises of five main pillars: risk management & clinical
audit, continuous training & education, evidence based medicine, staffing & staff
management and patient & carer centred. It offers the opportunity to all healthcare
workers in primary care who are directly involved in providing the services to take
charge of the agenda to improve the health and health care of their local population
while at the same time providing the accountability that is now expected. Primary care
system varies as some countries are fully funded by the government, some are based
on healthcare financing and some comprises mixtures between government
funding and private practice with out-of-pocket burden to patient. Malaysia belongs to
the third category with very challenging issues especially in ensuring the five pillars of
primary care governance are being followed fully. As a result, quality of care maybe
jeopardized due to imbalance patient workload. When will the two wings of primary care
providers merge and taken charge by primary care providers itself is still a big question
mark as there are many factors and issues to be harmonized.

Over the years, there are improvements and promising future for implementation of
primary care governance in this country. It will take strong clinical leadership to develop
clinical governance to its full potential. Hopefully one day we will be there.

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“Embracing Primary Care Evolution, Upholding Core Values”

SYMPOSIUM 1

2. Peka B40: A Public-Private Integration Model for
NCD Screening & Management

by Associate Professor Dr. Mohammad Husni Haji Ahmad Jamal
Department of Family Medicine, Faculty of Medicine, University of Cyberjaya, Malaysia
Academy of Family Physicians of Malaysia

ABSTRACT
This paper aims to highlight the concept of Public-Private Partnerships (PPPs) with a
focus on primary care and the deficiencies of the PEKA B40 program as a form of PPP.
Public-private partnerships are cooperative agreements between the public and
private sectors working together by various mechanisms to achieve their common
objectives. PEKA B40 is a health screening programme involving public health clinics
and private Malaysian general practitioners (GPs) which was launched in 2019 by the
Malaysian government. The purpose is for the early detection of non-communicable
diseases which are prevalent in the 40% low-poverty sector of the population described
as the B40 group. Although laudable, it has many shortcomings. Many GPs are still not
receptive due to various reasons. A Public – Private Partnership committee was recently
established between the Family Medicine Specialist Association of Malaysia and the
Academy of Family Physicians of Malaysia to create a framework of bilateral
cooperation. It is appropriate therefore for this committee to design a comprehensive
program that is mutually beneficial for a better PEKA B40 platform. Two relevant studies
are looked at in this context – the first is an expert panel recommendation for optimising
non-communicable disease (NCDs) management in the ASEAN region whilst the other
is an Indian study pertaining to designing a comprehensive NCD programme for
hypertension and diabetes at primary health care level. By adopting the principles,
outcomes and recommendations of such studies would be able to create a more
effective PEKA B40 program in the Malaysian setting.

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23RD FAMILY MEDICINE SCIENTIFIC CONFERENCE

SYMPOSIUM 1

3. Health Financing Reform to Achieve Universal Health
Coverage in Primary Care

by Dr. Muhammed Anis Abd. Wahab
Public Policymaker and Deputy Director
National Health Financing Section (NHF)
Planning Division, Ministry of Health Malaysia
ABSTRACT
The current COVID-19 crisis has created an opportunity and provided momentum for
reform in the health system. Governments should adopt a problem-based policy
development approach in moving towards health financing reform. This begins with
clarity on the objectives and goals to be achieved, which should be to improve
population health, provide financial risk protection, and ensure citizen satisfaction, by
achieving equity, efficiency, effectiveness, and responsiveness.
Regardless of the label of a country's health system, all systems perform similar
functions in terms of health financing. This includes raising revenues for the health
system, pooling these revenues on behalf of some or all of the population, and then
transferring these resources to health care providers through strategic purchasing.
Health systems then need to make policy choices, either explicitly or implicitly,
regarding the benefit package or entitlements of the covered population.
A health financing reform focusing on primary care should be able to address
Malaysia’s epidemiological transition, as well as improve continuity, coordination, and
comprehensiveness of health care, thereby improving health outcomes and overall
patient experience.

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“Embracing Primary Care Evolution, Upholding Core Values”

SYMPOSIUM 2

1. SARSCoV-2 Infection: What Have We Learned

by Dato Dr. Suresh Kumar A/L Chidambarami
Consultant Infectious Disease Physician
Hospital Sungai Buloh, Selangor, Malaysia

ABSTRACT
Across the country the number of cases are coming down, however in the last few
months the virus has taught us lots valuable lessons albeit not new ones. Old adages like
“Prevention is better than cure” and ‘a stich in time saves nine” are some that come to
mind.
Moving forward, the post vaccination era is making us pivot once more. We need to deal
with less sick patients but the numbers can still be overwhelming given that we can no
longer keep non-covid services in the back burner.
We need to use the lessons we have learnt so far to chart a new course. Going back the
pre-pandemic ways of doing things will be doing injustice the thousands who
succumbed to this disease.

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23RD FAMILY MEDICINE SCIENTIFIC CONFERENCE

SYMPOSIUM 2

2. Mental Health Issues Among Covid 19 Survivors

by Associate Professor Dr. Amer Siddiq bin Amer Nordin
Consultant Psychiatrist
Universiti Malaya (UM), Malaysia

ABSTRACT
Globally, the pandemic that is Covid-19 has resulted in massive loss of life and crippled
economies across the globe. However, as we are all focused on tackling this pandemic,
silently in the background, another equally devastating pandemic is growing insidiously
– a mental health pandemic. This latter pandemic has not been highlighted, supported
nor thought thoroughly as the former, and only recently noted on its negative effect. As
we move towards the second year of the Covid-19 pandemic there is a growing number
of reported mental health decline especially among the most vulnerable and, also
increasing reports of suicide.
One population that is often not mentioned are the survivors of Covid-19. A recent
international study reported that nearly 1 in 3 covid-19 survivors struggle with a
neurological or mental health condition. Closer to home, it was estimated that amongst
those who had covid-19 in hospital, nearly 7-7.5% of them were found to have
depression and anxiety. Moreover, for those who survived a difficult infection, survivors’
guilt was reported.
This presentation will explore further into this issue and attempts to highlight known risk
factors on mental health risk amongst people with Covid-19 apart from possible
solutions to assist those who have survived to lead better meaningful lives.

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“Embracing Primary Care Evolution, Upholding Core Values”

SYMPOSIUM 2

3. Primary Healthcare and Covid-19: A Journey Beyond Expectation

by Dr. Azah Abdul Samad
Consultant Family Medicine Specialist
Klinik Kesihatan Seksyen 7, Shah Alam, Selangor, Malaysia

ABSTRACT
The spread of COVID-19 is one of the biggest challenges the global community has
faced. It has been almost 2 years since the Covid-19 pandemic hit Malaysia and has
presented unprecedented challenges in primary health care as most of the health
workforce is focused on the activities related to COVID-19. In primary care settings,
physicians were encouraged to triage medical appointments, prioritize services,
reschedule chronic disease appointments, and increase their use of virtual care. This
has resulted in a reduction of visits to the outpatient clinics and delay doing routine
preventive health care screening. Assessment should be made whether the changes in
how family medicine is being practiced have impacts on the health outcomes of the
patients. With this COVID-19 pandemic, a visit to a Family Medicine Specialist would be
a one-stop centre as we screen, diagnose, monitor and see them post recovery. As the
disease evolves, we encounter many post covid patients at the clinics. Long-term
manifestations are increasingly recognized in COVID-19 patients, with systemic clinical
presentations affecting a wide range of organs and systems. More training and support
staff in rehabilitation will avoid fragmented care. Primary care entered the crisis facing
greater demand with fewer resources than the tertiary centre. Playing its role as the first
contact with the health system, it has successfully adapted and complied with the new
norms while preserving and expanding care for the needs of patients and communities
over the past year. The COVID-19 crisis demonstrates the importance of placing primary
health care at the core of health systems, both to manage an unexpected surge of
demand and to maintain continuity of care for all. An organized primary care system,
well equipped with digital technologies and multidisciplinary teams helps deliver a
successful health system response.

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23RD FAMILY MEDICINE SCIENTIFIC CONFERENCE

SYMPOSIUM 3

1. Eliminating Cervical Cancer In Malaysia: What Does It Take?

by Professor Dr. Woo Yin Ling
Consultant Obstetrician and Gynaecologist, Subspecialist in Gynaecological Oncology
Department of Obstetrics and Gynaecology
Faculty of Medicine, University Malaya (UM), Malaysia

ABSTRACT
In November 2020, the World Health Organization launched the strategy to accelerate
the global effort to eliminate cervical cancer. The strategy involves vaccinating 90% of
our adolescent girls with HPV vaccine by the age of 15, screening 70% of our women at
the ages of 35 and 45 with a HPV testing and ensuring that 90% of those with abnormal
tests receive the appropriate treatment. Malaysia made a commitment to work towards
those targets. This is achievable as we now have very effective tools to implement in a
country such as Malaysia. Furthermore, Malaysia has had a very successful HPV
vaccination program since 2010.
Like many countries, the uptake of cervical screening has been low despite it being free
in governmental clinics since 1969. And most women do not undergo regular screening.
The advent of HPV testing via self-sampling is set to transform the landscape of cervical
screening. Unlike the previous conventional pap smear which requires an
uncomfortable speculum examination to obtain cervical cytology every 3 years, HPV
testing from a low vaginal swab (Floqswab) offers much higher sensitivity in identifying
cervical intraepithelial neoplasia.
Malaysia is well-placed to achieve the cervical cancer elimination targets if we start
incorporating HPV testing among women who are eligible. The ability to perform
self-sampling for HPV testing only as few as twice in a woman’s lifetime is achievable.
Ensuring proper communication between women and healthcare professionals will
build trust and a workable system to ensure that everyone is aligned with this goal.

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“Embracing Primary Care Evolution, Upholding Core Values”

SYMPOSIUM 3

2. Hospice and Palliative Care in Malaysia

by Dr. Sylvia McCarthy
Medical Director, Hospis Malaysia

ABSTRACT
This talk gives an overview of how palliative care has developed in Malaysia in the last
20-30 years alongside some of the developments in the understanding of palliative
internationally. The evidence that early palliative care benefits patients with all life
limiting illness will be discussed as well as the evidence around patients’ palliative care
needs. Most patients wish to spend as much of their time as possible in the community
and their preferred place of death is usually home. Family Medicine and Palliative care
have much in common and in many ways Family Medicine is ideally placed to respond
to the need to provide palliative care in the community; however, there are challenges.
Using cases, some of the issues facing patients with life limiting illness in the community
will be highlighted. Finally there will be an overview of the work done by Hospis Malaysia
and a discussion of some of the challenges that lie ahead if we are to develop truly
patient centred care that enable patients to be cared for in their preferred place at the
end of life.

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23RD FAMILY MEDICINE SCIENTIFIC CONFERENCE

SYMPOSIUM 3

3. Hospice And Palliative Care Integration Within Community Setting

by Dr. Norhana Yazid
Consultant Family Medicine Specialist
Klinik Kesihatan Chendering, Terengganu, Malaysia

ABSTRACT
Palliative care is a specialised field for terminally ill patients to achieve the ultimate goal
in providing holistic care and improving quality of life for them and their families.
Collaboration between community palliative care and hospital-based palliative care is
essential to maintain the continuity of care. This is accomplished by delivering
consultation services in hospital or hospice organisation and providing home care team
in the community. It varies in different states, depending on available resources they
have but the goal remains the same. Challenges present in every flow of management
but it can be ironed out with creativity and empathy. For certain issues highlighted in
Terengganu in managing palliative patients, it shows that the integration of hospice
organisation and Family Medicine Specialists with modifications done to suit our current
situation in COVID-19 pandemic are proved to be beneficial.

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“Embracing Primary Care Evolution, Upholding Core Values”

SYMPOSIUM 4

1. STEMI Network In Pahang

by Dr. Saniah Senik
Consultant Family Medicine Specialist
Klinik Kesihatan Maran, Pahang, Malaysia

ABSTRACT

Pre-hospital thrombolysis (PHT) is an effective management strategy in patients with
ST-segment elevation myocardial infarction (STEMI). PHT is safe and beneficial in
remote areas, distant from a Cardiac Catheterisation Lab. The Malaysian CPG on STEMI
2019 recommended PHT when trained doctor/personnel are available and transport
time to a PCI-capable centre is expected to be prolonged. Another option is nearest
in-hospital thrombolysis.

The benefit of early treatment in STEMI is to reopen the blocked coronary artery as soon
as possible to limit myocardial damage and preserve heart function. Primary PCI is
superior to fibrinolytic therapy as a reperfusion strategy. However, in patients who
present within 3 hours of onset and are at low risk, both treatment strategies appear to
have similar benefits. Door to needle (DNT) time is shorter with pre-hospital
thrombolysis.

PHT was started in Pahang since 2018. It was a collaboration between Departments of
Emergency Medicine, Family Medicine, Cardiology/Medical and Pharmacy. It was
supported by The State Health Director, Deputy Director as well as the District Health
Officer. The challenges in starting this programme included staff knowledge, limited
ambulances with ECG, inavailability of thrombolytic agent in health clinics and distance
to hospital. A few strategies to overcome the problems included I. Hands-on training
(PHT and ALS workshop), II. Utilization of ALS ambulance, III. ‘Thrombolytic pack’ in health
clinic, IV. Simplified referral system and collaboration between health clinic and hospital.

Among the positive outcomes of this STEMI Network programme were: I. Reperfusion
success of thrombolysis achieved in more than 80 % of cases without a major
complication. II. Mortality in 30 days was less than 5%. III. The availability of Tenecteplase
and Streptokinase in health clinic. IV. Medical equipment was upgraded such as the
Defibrillator Machine and Syringed Pump. V. Primary Health Care personnel were
trained for Advanced Life Support.

In conclusion, DNT time was significantly reduced with Pre-Hospital Thrombolysis.
Successful reperfusion was achieved with neither increase in mortality rate nor
complication of therapy. PHT was safe and feasible if given by a well-trained doctor and
dedicated mobile retrieval team. A good team work made the programme successful.

48