HISTORY OF GYNAECOLOGY ONCOLOGY IN MALAYSIA
This article covers the history of gynaecology oncology training and services involving the ministry of health, academic institutions and private sectors. The list of contributors is long and some names may be missed unintentionally.
THE ROLES OF THE MINISTRY OF HEALTH, ACADEMIC INSTITUTIONS
AND ACADEMy OF MEDICINE
University Malaya was probably the first institution that provided gynaecology oncology services in Malaysia. In 1965, under the leadership of O&G Professor Dr Donald Chan, the doctors there were already doing operations for gynae cancer patients and giving chemotherapy. This interest was continued by lecturers like Doctors WF Chan and KH Ng and subsequently Associate Professor DK Sen. By 1976, the University’s dedicated Gynae Oncology Unit was planned with 2 doctors being sent for full training in UK and Europe. They were Prof Emeritus. Dato. Dr. Sivanesaratnam and Dr. Haji Ahmad Adlan Nuruddin. Numerous other doctors had since, came along. The other universities (UKM and USM) followed suit in the early 1980s and 1990s. In UKM the early gynaecologist with special interest in oncology were Dato Dr Haji Onny Yahya and Dato Dr. Abdul Aziz Yahya. USM had Associate Professor Dr. Haji Nik Mohd Zaki Nik Mahmood in the later stage. Professor Emeritus Dato Dr.Sivanesaretnam is the longest serving Gynaecologic Oncologist, whose contribution is not not only in providing Gynaecology Oncology services in University Malaya, but also in research and the training of many O&G specialists in Malaysia.
Prior to 1996, while the universities were developing their services, there were already government doctors performing surgery and administering chemotherapy for selected patients. In the late 1960s and 1970s, one such person was Dr. (Mrs) Mehra in HKL. Through the years; other experienced doctors came along in places like HKL and Ipoh General Hospital. Some of the familiar names will be Dato Dr. Alex Mathews and Dato. Dr. N. Sivalingam. In 1990; Dato Dr. N. Sivamohan from HKL was awarded the British Commonwealth Medical Foundation Scholarship for Gynae-Oncology in the UK. Upon his completion of the 2 years fellowship, he returned to work at Hospital Kuala Lumpur as Consultant Obstetrician& Gynaecologist/Gynae-Oncologist. Over in Penang; the role of gynae oncologist was shouldered by Dr. Suresh Kumarasamy following completion of his training in the UK in 1995. He continued his contribution in the field of Gynaecology Oncology in a private institution in Penang until now.
In 1996, the senior O&G Specialists in Ministry of Health under Jawatankuasa Pengurusan dan Perkembangan O&G Malaysia (JKPPOG), Ministry of Health under the leadership of Dato’ Dr. Sivalingam Nalliah begin to initiate the idea of formulating a structured sub-speciality training program in Gynaecology Oncology for the O&G specialists and consultants in Malaysia. This would allow proper credentialing and privileging and also place our Malaysian doctors on par with their international counterparts. In 1998-99, the fellowship training program for Gynaecology Oncology MOH was started. The subcommittee of Gynaecology Oncology of JKPPOG was created to coordinate the program and first chairman of this subcommittee was Dr. Ng Kok Ying. When she retired, the responsibility was taken over by Dr. Madam Lim Keng Joo. In 2004, the mantle was passed to Dato Dr. Ghazali Ismail who is also instrumental in expanding and improving this training program until today.
The Gynaecology Oncology sub-specialty committee, JKPPOG consists of 7 selected members; all seniors, in this field. Three members are consultants from the Health Ministry, one is from the Academy of Medicine (College of O&G or CHOGAMM) while the other three represents the 3 major universities (i.e. UM, UKM and USM).The committee will interview all the aspiring candidates, vet them, and assist in their training, both locally and outside Malaysia. The committee members; especially the chairman, will also use their goodwill and contacts to procure scholarships from the Public Services Department (PSD) and work opportunities in hospitals all over Asia, UK and Europe. So far, the candidates had been trained in places such as Singapore, Thailand, Hong Kong, Taiwan, Japan, Australia and South Africa. Upon completing 3 years training, the candidates will submit their application for exit certifications and their application will be vetted by the central committee of JKPPOG before approval and credentialing.
The first product of Gynaecology Oncology Sub-speciality training completed the 3 years training program in 2001. The first returnee from that batch was Dato Dr. Mohd Rushdan Md Noor. He went on to set up the Gynae-Oncology Unit in Hospital Alor Setar, Kedah (now known as Hospital Sultanah Bahiyah) and his unit became the first designated government hospital cum established referral centre for the Northern Region. It was the first training centre for Gynaecology Oncology Sub-speciality under MOH. Since then; the numbers of fellows had grown and most major hospitals now have one or two trained Gynae-oncologists to serve the public. They have contributed in providing the gynaecology oncology services to patients from their respective states and regions.
Some of these hospitals are also recognized as training centres for Gynaecology Oncology sub-speciality training programmes. They include Hospital Sultanah Bahiyah, Hospital Ampang, Hospital Kuala Lumpur, Women’s and Children’s Hospital Likas, Hospital Umum Sarawak, Hospital Sultan Ismail, Johor, etc. Beside government hospitals, academic institutions such as UMMC, UKM and USM are also currently recognized training centres for this program. At the time of this article, the MOH Gynaecology Oncology subs-peciality training program had recruited 48 O&G specialists throughout this country, including those who are still undergoing training. Currently almost all major government hospital in this country have at least one resident Gynaecologic Oncologist.
THE ROLE OF THE O&G SOCIETY OF MALAYSIA (OGSM) AND
MALAYSIAN GYNAECOLOGIC CANCER SOCIETY (MGCS)
Gynaecology Oncology services, teaching and training is also contributed by non-governmental organization such as the O&G Society of Malaysia (OGSM) and Malaysian Gynaecologic Cancer Society. OGSM through its Gynaecology Oncology subcommittee had been involved in various academic and training activities since this society was registered. The contribution of OGSM has undeniably given an opportunity to many doctors to understand more about Gynae Oncology in order to provide better care to gynae cancer patients.
The Malaysian Gynaecologic Cancer Society (MGCS) was registered in 24th April 2011 and it has been endorsed by the International Gynaecologic Cancer Society (IGCS). The first president of this society was Dato’ Dr. Mohd Rushdan Md Noor. The idea of having such an organization was first mooted way back in 2005 during the 1st National Gynaecology Oncology Symposium held in Alor Setar, Kedah. The pioneers who initiated it were Dato Dr.Mohd Rushdan Md Noor, Dato' Dr.Ghazali Ismail, Prof. Emeritus Dato Dr.Sivanesaratnam, Prof Dr.Siti Zawiyah, Prof Dr.Nik Mohd Zaki, Prof Dr.Ahmad Zailani Hatta, Dr.Vijaendrah, Dr.Lim Keng Joo and Dr.Zaridah Shafie. They sat down and explored the idea to form a society of gynae-oncologists. The main agenda of this society is to bring together all Gynae Oncologist, both in the Health Ministry, academic institutions and also private institutions under one roof with a common goal. The initial aim was to have collaborative groups in research but later was expanded to cover more roles including creating a wide network to facilitate better coordination and cooperation among all Gynae oncologists not only in Malaysia but also from neighbouring countries. These in turn help provides better care for gynae cancer patients. With the support from Ministry of Health, academic institutions and the O&G Society of Malaysia, MGCS have been involved in various training and CME programmes including organizing Gynae Oncology Conferences, workshops, and also training and educating the public. MGCS is also currently involved in preparing the Clinical Practice Guideline and research projects. The latest is a multicenter trial on the role of HPV DNA testing as primary screening test for cervical cancer.
In summary, gynaecology oncology services in Malaysia is progressing towards the correct direction and this would not be possible without great contributions, hard work and cooperation from everyone involved, as well as all the institutions; be they from government, the academia or the non-governmental organizations.
Dr.Zamzida bt Yusoff
Consultant Gynae Oncologist