Oleh/By		:	DATO' SERI DR. MAHATHIR BIN MOHAMAD 
Tempat/Venue 	: 	FAKULTI PERUBATAN, UNIVERSITI 
			KEBANGSAAN MALAYSIA 
Tarikh/Date 	: 	13/11/81 
Tajuk/Title  	: 	PERASMIAN PERSIDANGAN "PERSPECTIVES 
			IN PERINATAL MEDICINE" 




Terlebih dahulu saya mengucapkan ribuan terima kasih kepada penganjur
Persidangan ini yang telah memberi penghormatan kepada saya untuk
merasmikan Majlis ini pada pagi ini. Saya mengambil kesempatan ini untuk
mengalu-alukan kunjungan dan penyertaan peserta-peserta luar
negeri. Kepada peserta-peserta tempatan pula saya mengucapkan
setinggi-tinggi tahniah di atas daya usaha mereka untuk meneliti satu
aspek bidang perubatan yang penting bagi negara kita.

Ladies and Gentlemen.

Before I go into the subject proper of this meeting, may I be permitted to
say a few words on Man and his plans.

"What man proposes, God disposes". We have often heard this saying quoted
usually to imply that man can plan for all he is worth but God can
frustrate all his plans. Obviously this saying derives from the
pre-Islamic concept of God as baleful and oppressive and constantly
demanding sacrifices.

2. But we know that Allah is Merciful and Compassionate.

He does not frustrate us because He is spiteful. Therefore we can plan and
regulate, with faith in Allah and His bounty, and what He determines
should be our achievement may be even greater than we have a right to
expect. Indeed if we look back our good fortune is totally undeserved. But
we do not look back, nor are we given to gratefulness to our Creator.

3. I say this as a preamble because there are likely to be people who will
regard planning for health care as a trespass on the power of Allah to
dispose things as He wills. Nothing is further from the truth. All we are
doing is to tie the proverbial camel. If Allah wills that the camel be
stolen after that, we do not question His wisdom.

But surely to do nothing to prevent the loss of the camel is tentamount to
expecting Allah to work for us. I cannot think of anything exhibiting a
lack of taqwa than to regard Allah as literally your servant, to look
after your property.

4. Health is a property, a nikmah, conferred us by Allah.

As we learn more and more about health and the sciences related to it, we
must realize that it is not Allah Who conferred upon the newborn the
deformities and the weaknesses. It is all largely our fault. Allah meant
the newborn to start life well and healthy, as clean physically as it is
spiritually. But, we through our laziness and failure to learn to
understand the physiological and pathological laws of Allah, we have
caused the newborn to be handicapped at birth. It is not the will of Allah
to cast a blight on the child. It is we who have caused it. And we are
doubly to be blamed if, knowing we can prevent the handicap, we do not do
so.

5. It is in this light that I see all our efforts to ensure freedom from
ill-health. Just as Allah has given us light so we may see our way, so has
He given us the faculty to think in order that we may understand His laws
and use them to prevent our blundering around in the world He created.

6. It is in this light that we should see the provision of basic health
care as a priority in this country. It is in fact an important aspect of
our total effort to improve and uplift the quality of life of our
people. One of the ways for achieving this objective has been the
provision and improvement of infrastructure services for as wide a segment
of the population as possible. This has contributed to a considerable
decline in our mortality trends and a steady increase in life expectancy
over the years since our Independence in 1957. With regard to infant
deaths, we have also seen an encouraging decline of more than 60% since
1955.

7. This Conference is, I believe intended to look at a narrower aspect of
health hazard, namely the perinatal mortality rate. The perinatal period
is now considered to be a very important phase of human development
because what happens during this period may affect the quality of life
period. Health care providers and planners in their respective roles ought
to be concerned with this discrepancy. I understand this concern has been
translated into a proposal for a Perinatal Project in Malaysia funded
initially by the United Nations For Populations Activities (UNFPA). This
project aims to study the rather slow improvement in our perinatal
performance and to suggest corrective measures which could be undertaken
to rectify this. Since various agencies are involved in the design and
provision of broad health care services for the population, it is perhaps
appropriate that the Ministry of Health, the National Family Planning
Board and the National University of Malaysia are collaborating in this
Project. The functions of these agencies should be clearly defined. It
appears that the National Family Planning Board is providing the initial
fund and core personnel to allow experts from the National University of
Malaysia to develop a system of perinatal care which is of acceptable
standard using the facilities of the Ministry of Health already in
existence in and around the Maternity Hospital, Kuala Lumpur. The
interaction and cooperation of these agencies should help us assess our
performance critically, and ultimately give rise to measures for improving
our perinatal performance in the near future. If this commendable
collaborative effort should succeed in its goals, perhaps this framework
could lead to the establishment of the first Perinatal Centre in the
country, to be followed in later years by the establishment of similar
centres.

8. Mishaps which occur during the perinatal period are implicated not only
in neonatal and infant deaths, but, the survivors of these mishaps could
end up with various types of mental and physical handicaps. Prediction of
mishaps before they occur and proper intervention could conceivably enable
the practising specialists in this field of medicine to reduce
disabilities arising during this crucial period of human
development. However, before the specialists can step in, the ordinary
health care personnel should be able to detect pregnant mothers who are
high risk cases, and to refer them. Thus not only the specialist but the
generalist physician and other allied personnel, particularly nurses and
midwives, have their respective roles to play in order to optimise
pregnancy outcome.

9. The role of informed public health personnel in educating the public is
also of relevance here. Counselling on spacing of pregnancies, proper
nutrition during pregnancy and recognition of early danger signs by the
lay public could also lead to better perinatal performance at the national
level.

10. Technological advancement has been rapid over the last couple of
decades enabling the present day specialist to doctor the mother as well
as the baby while still in the womb. Expertise available at the National
University of Malaysia should continue to develop this area of study and
help transfer relevant knowledge for the benefit of all in this
country. Despite preventive measures, however, some babies may still be
born with problems requiring urgent attention. Therefore, an organized
approach in the management of these babies in special units need to be
developed.

11. Investments in sophisticated technology alone may not be a sound
economic proposition. Only special centers can hope to handle these
because specially trained manpower, both medical and para-medical, is
required. It is here that the Faculties of Medicine in the universities
can play a role, both in terms of training and organisational planning.

12. In order to plan strategies, problem areas need to be defined. One of
the tools of modern scientist is statistics. I was made to understand that
during the preparatory stages of this Project relevant statistics have
been compiled. Here, again the various agencies involved in the Project
could interact to translate these into tangible terms for practical
application. Data collection and management should be standardized to
facilitate comparative studies of performance in other areas of the
country as well as for comparing our performance with those available at
other international centres. The National University of Malaysia, as the
research and training element of this working group should consider the
enhanced role it could play.

13. This Conference has brought together various people involved in this
branch of Medicine. The deliberation of this Conference with the
participation of the invited speakers should serve to improve your
understanding of the relevant aspects of Perinatal Medicine in this
country.

Tuan-tuan dan Puan-puan sekelian.

14. Saya harap Persidangan ini akan berjaya melahirkan buah fikiran yang
dapat meningkatkan lagi kemampuan bidang perubatan perinatal di negara
kita. Dengan kata-kata ini saya dengan segala sukacitanya merasmikan
Persidangan ini dan melancarkan Projek Perinatal Malaysia.

Pejabat Perdana Menteri, Jalan Dato Onn, Kuala Lumpur.