||Dear Dr Chin,
In response to the query in Parliament, we wish to put forward the following information to clarify this matter.
1) Human Resource
- Three cardiothoracic surgeons- HOD: Dr Jong Yuan Hsun since 2009
-Dr John Chan joined in 2013
-Dr Soon Sing Yang joined in 2014
- Three Cardiac anaesthetists
-Dr Hasmizy joined on March 2015
Cardiothoracic surgery requires team work. Even though the number of surgeons had increased from one in 2009-2012 to three since 2014, the number of cardiac anaesthetist had declined from the maximum of four down to two only from October 2013 – February 2015. During this period of time, we actually had only one full time anaesthetist, Dr Hanafi as Dr Norzalina is our state anaesthetist and she is very busy with her administration works. Sadly, Dr Thanasi had suffered two heart attacks while he was trying very hard to cope with three surgeons in 2014. We had taken several measures to overcome this shortage and these included engaging two private anaesthetist to do sessional work in our hospital namely Dr John Chew and Dr Nora. We had been regularly updating Datuk DG regarding our problem too. Luckily MOH has been very kind and sympathetic with our problem and we had our third anaesthetist, Dr Hasmizy joined us on March 2015.
2) Our output from 2011-2014
- Total number of cases performed
-2011 – 168 patients (one surgeon, four anaesthetists)
-2012 - 260 patients (one surgeon, four anaesthetists)
-2012 - 296 patients (two surgeons, three anaesthetists)
-2014 - 250 patients (three surgeons, two anaesthetists)
As we can see , our cases had increased steadily from 2011-2013. We were actually targeting to achieve 400 cases in 2014 but the severe shortage of cardia anaesthetist had resulted in the decline of the number of cases. With the arrival of our third anaesthetist, we can aim to achieve 350-400 cases in 2015.
3) Waiting time
- Waiting time is about 6-9 months
- Total out patients waiting for surgery; 223 patients
- Total in patients; 27 patients
This is fairly reasonable waiting time as Serdang and Penang Hospital also has similar length of waiting times, 6-9 months. Other than the shortage of cardiac anaesthetist which resulting in the decline of the output, the overall workload has also been increasing tremendously over the years. This can be reflected by our cardiology team’s increments in workload as well. As we know, they are our main source of patients. Their waiting time for Cath lab has increased from two weeks to three months. We are taking up more complex, high risk and unstable patients who required more urgent attention and this had disrupted our normal elective waiting list. We have taken several measures to overcome this problem. We have been referring those high risk patients regularly to IJN. We are running two OT simultaneously whenever we have two anaesthetist to increase the output. FPP will also help in increasing our output by adding extra operating times after office hours.
4) Patients who died in the waiting list
- We don’t have the exact figure for this group of patients but we believe this involves a very small number of patients, probably less than five patients a year.
I don’t think there is any single cardiac centre in the world can promise or achieve zero mortality in waiting list. However, we have taken every possible effort to avoid this from happening to our patients. For those unstable, symptomatic and deteriorating patients, we will keep them in the ward for stabilization and operation before discharge. Proper patient counseling preoperatively and effective communication with our cardiology team also help to reduce this undesirable outcome.
5) Non operating surgeons are redundant
- With enough anesthetists, each surgeon will have at least three operating sessions per week.
I don’t think it is fair to label any surgeon as redundant when he is not operating. Care for Cardiac surgical patient begins pre operatively until patient is discharged home, not just merely doing the operation. We have no trainee or registrar or ICU intensivist to help us to manage our patient. Open heart surgery is very labor intensive. We assess the patient preop, we do the operation and look after them in our Cardiothoracic ICU and ward until discharge. Our two surgeons who came back from UK, Dr John Chan and Dr Soon, can tell us how much more efforts and harder to manage patients in our own local Malaysian setting.
6) Future prospect
- Despite this query against our service, all of us here in Pusat Jantung Hospital Umum Sarawak remain very optimistic and excited with the future outlook of our service in Sarawak. We are getting our third anaesthetist now and we have been regularly running out two OT sessions a day since his arrival. It is our aim to bring down the waiting to 3-4 months by the end of this year. With generous contribution by the MOH and local NGO, namely Sarawak Heart Foundation, we are very well equipped to start many new cardiothoracic services like minimally invasive cardiac/thoracic surgery, endovascular stenting and AF ablation surgery. We are having very high hope to be selected as one of the training centre for the Cardiothoracic Fellowship under Royal College of Surgeons in Edinburgh as they will come to inspect our centre this coming June.
We are fully aware of our problem and shortcomings but we shouldn’t undermine the hard work and dedication that the entire team had contributed. Despite the problems that we are facing, we managed to provide the best quality of care to our cardiac and thoracic patients, our perioperative mortality had been remained around 2-3% for the past few years and these results are on par with any of the centre of excellent in the world. Our centre has been regarded as IJN of Sarawak, that’s the pride that we carry and we are obliged to work wholeheartedly to maintain that.
Dr Jong Yuan Hsun
Department of Cardiothoracic Surgery
Pusat Jantung Hospital Umum Sarawak