Speechs in the year
Tarikh/Date 	: 	27/01/94 

    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
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
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
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
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
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
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
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.