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.
|
|