Speechs in the year
Oleh/By : DATO' SERI DR. MAHATHIR BIN MOHAMAD Tempat/Venue : THE SHANGRI-LA HOTEL, KUALA LUMPUR Tarikh/Date : 27/01/94 Tajuk/Title : THE OFFICIAL OPENING OF THE 9TH BIENNIAL SCIENTIFIC MEETING OF THE ASIAN-PACIFIC ASSOCIATION FOR THE STUDY OF THE LIVER It is a pleasure to be invited to officiate the opening of the Ninth Biennial Scientific Meeting of the Asian-Pacific Association for the Study of the Liver. 2. I am informed that this association is one of the five regional associations of the International Association for the Study of the Liver and was formed in 1978. I am pleased to note that one of the objectives of the association is to advance the knowledge, practice and research in the field of hepatology, particularly in prevention, recognition and treatment of diseases of the liver and the biliary tract. 3. This meeting which features the largest gathering of academics, clinicians and research members on all aspects of the liver, can certainly make positive contributions in their special fields for the benefit of not only advanced but developing countries which suffer more from these problems. I understand that more than 52 of the foremost authorities of hepatology in the world will discuss the latest advances in the prevention, diagnosis and management of liver diseases. 4. Not so long ago, diarrhoea, dysentery, maternal and neonatal diseases and infections and infestations of the liver were the principal causes of deaths in Malaysia, particularly in the rural areas. 5. With improvement of good water supply, a cleaner environment and better health education provided by the government, we have experienced a drastic decline in the bacterial, protozoal and other intestinal infections affecting the liver which plagued this country. Statistics show that cardiovascular diseases and trauma now rank as the top causes of deaths in Malaysia while diarrhoea and dysentery have dropped to the sixth place. 6. However, viral infections of the liver still remain a major health problem in the Asian-Pacific region. For instance, the world wide number of hepatitis B carrier is estimated to be 280 million and 78 percent of them are living in the Asian-Pacific region. Hepatitis B virus carriers account for 5 percent to 20 percent of the whole population in this area. 7. In Peninsular Malaysia, the incidence of hepatitis B carriers is 3.5 percent of the general population. In the Asian-Pacific region, the incidence of liver cirrhosis and its complications including liver cancer are also high with a maximum incidence of 150 cases of cancer in every 100,000 people. Hepatitis B is detected in 50 percent to 80 percent of these liver cancer patients and they are all hepatitis B carriers. 8. In contrast, the incidence of liver cancer in North America and Europe is very low, with one to three cases in every 100,000 people, while only three percent to five percent of these patients are hepatitis B carriers. 9. Since the most dangerous infective period of hepatitis B occurs in the neonatal period from mother to child, mandatory vaccination of all new born infants has been introduced by the Malaysian Government since 1989. I am happy to say that we were one of the first countries to do so. We believe this programme of vaccination will eradicate hepatitis B in Malaysia within one to two decades. In addition all regular blood donors, hospitals and health workers, blood transfusion depended patients like haemophiliac and thalassaemia are given vaccination free of charge. 10. The prevalence of hepatitis A in Malaysia is endemic since 70 percent of the general population have antibodies for hepatitis A between the ages of 14 to 69 years. Hepatitis A therefore still remains a childhood infection. With better sanitary conditions, good water supply and hygiene, the incidence is expected to decline. The source of occasional epidemic infections is often the food handlers. Accordingly there is strict supervision of food stalls. 11. As regards traumatic injuries to the liver, the compulsory use of seat belts has dramatically reduced its incidence in Malaysia. 12. In the last two to three years with the availability of immunoassay to screen for hepatitis C antibodies, it is now possible to identify those infected with hepatitis C. The Malaysian Ministry of Health has embarked on routine screening of all blood donors since 1993. Other private hospitals and institutions are now following this procedure. In the government hospitals, only voluntary blood donors are accepted. Replacement of blood from other sources is refused. 13. The source of infection of Delta Virus (D) is 34 percent among intravenous drug addicts in Peninsular Malaysia while the incidence of hepatitis B in this group is 39 percent. Every effort is being made to discourage young people from falling into drug addiction through education in schools, beginning with anti-smoking campaigns and parental supervision. It would seem that preventive measures are of vital importance in the eradication of all forms of hepatitis. 14. The Malaysian Government has spent considerable sums of money yearly towards the eradication of communicable and preventive diseases. Improving the health in rural areas and small towns has always been the Government's first priority. 15. Now that the mortality and morbidity rates in rural areas have been reduced significantly, we have opened new district hospitals and upgraded existing facilities. Currently, the Government is spending RM3 billion on health care yearly. 16. In the curative aspect, diseases of the liver considered untreatable or with poor prognosis during my days have now better survival rates. To quote a few such diseases - complications of liver cirrhosis, liver failure, portal hypertension, intractable ascites, liver cancer and congenital disease. The indications for surgical treatment have also widened, particularly with liver transplantation. Spectacular development in diagnostics - especially in imaging technology, in anaesthesiology and intensive care has substantially enhanced the care for our patients. 17. The public's cry for more sophisticated diagnostic and treatment procedures will increase medical costs, especially for Malaysia which has a non-contributory free medical service for all. Even rich nations find that the Government itself cannot afford to pay the high costs of medical care. Without private medicine, a National Health Service is just impracticable. 18. While liver resection has been available in Malaysia since 1964, there is currently no liver transplantation programme in Malaysia. The Ministry of Health has selected many young promising doctors to meet this demand by undergoing specialised training overseas. 19. During the past decade no area in surgery has captured the imagination of the public more than the solid organ transplantations, particularly of the liver. 20. The establishment of specialised transplantation units which perhaps will serve only 15 percent to 20 percent of the liver patients, will place an additional burden on our economy. Nevertheless, as Malaysia moves to be a fully developed industrialised country by the year 2020, I am confident that we will not only have the resources but highly trained medical personnel to equal the other developed countries in specialised medical care. 21. Health insurance schemes, charitable societies and private hospitals will also enable such services to be made available to all patients. 22. Although the long term plan should be one of prevention of liver diseases, communicable diseases such as viral, bacterial and protozoal infections should be eradicated by an improved environment, providing good sanitation and good water supply, early and mandatory vaccination against viral diseases, health education, better nutrition and changes in lifestyles. 23. Finally to our foreign participants, I hope you will find time to visit some of our most exotic resorts in Malaysia. As this is Visit Malaysia Year, the Tourism Development Corporation has laid out an exciting programme. After you have had busy scientific sessions, you will have the opportunity to relax and see the multi-ethnic, multi-cultural and multi-religious people of Malaysia living together harmoniously - a true symbol of unity in diversity. 24. I now have the pleasure of opening the Ninth Biennial Scientific Meeting of the Asian-Pacific Association for the Study of the Liver.