Eow Gaik Bee

Penang General Hospital, Penang 10990, Malaysia

HEALTHCARE SITUATION IN THE DEVELOPMENT OF T&CM IN MALAYSIA

Conventional Western medicine is the main healthcare system in Malaysia. However, traditional and complementary medicine (T&CM) remains in high demand.

The T&CM practices in Malaysia include traditional Malay medicine, traditional Chinese medicine (TCM),traditional Indian medicine, homeopathy, and Islamic medical practice.

HISTORY OF TCM IN MALAYSIA

At the 18thcentury, Traditional Chinese Medicine practices began to take root in the Malayan soil, with the booming number of immigrants from China.

At the end of the 19thcentury, modern medicine was brought in by the British.

The first voluntary TCM clinic was opened in Selangor state (Pei Shan Tang) and is now known as,Tung-Tshin Hospital in Kuala Lumpur.

In 1955, Federation of Chinese Physicians and Medicine Dealers Associations of Malaysia established Malaysia Chinese Medicine College for the first time.

By the 20thcentury, modern medicine was the mainstream medicine practiced in Malaysia; while TCM treatments available as a complementary medicine.

Currently, TCM healthcare is increasingly gaining acceptance among Malaysians not merely in maintaining a healthy body, but also as an alternative remedy in treating ailments.

BRIEF SUMMARY OF THE DEVELOPMENT OF T&CM IN MALAYSIA

In 2001, Ministry of Health, Malaysia launched the National Policy of T&CM.

In 2007, practice guidelines and Good Practice Guidelines in each T&CM clinical practice, such as Practice Guideline on Islamic Medicine, Chiropractic,Herbal therapy as an Adjunct treatment for Cancer, Malay Postnatal Care, Acupuncture, Cupping were developed and published.

The National Policy stated that T&CM shall be an important component of Malaysian health care system that co-exist with modern medicine to contribute towards enhancing the health quality of life of all Malaysian.

The Malaysian Government is also embarking on the development of a National T&CM Blueprint 2018-2027 which will guide the 10-year development of T&CM in the country.

EFFORTS ON INTEGRATION

In Malaysia, the integration of TCM and Western medicine is still in its infancy. From 2007 to 2011, a few integrated hospital were established, first at Hospital Kepala Batas then followed by other hospitals, such Putrajaya, Johor, Terengganu, Negeri Sembilan, Kedah,Pahang, Sabah and Sarawak. Most of the hospitals offered the traditional Malay massage, acupuncture and herbal therapy as an adjunct treatment for cancer patients.

The T&CM Division within the Ministry of Health Malaysia was established in 2004.

In 2016, Malaysian government made another move to put Traditional and Complementary Medicine Act 2016[Act 775] on gazette on July 22nd, 2016. The enforcement of the T&CM Act 2016 was just implemented on August 1st, 2016. This is in line with the World Health Organization (WHO) Traditional Medicine Strategy 2014-2023 which recognizes the contribution of T&CM to health (WHO, 2013).

Since 1992, Malaysia initiated the registration of T&CM products followed by the licensing of T&CM manufacturers and importers in 1999. T&CM products are subjected to similar criteria for regulation, surveillance,pharmacovigilance, licensing and adverse drug reaction reporting that has been established for pharmaceutical products.

The T&CM Act 2016 is set to become an important catalyst to the Government's efforts in transforming the T&CM industry into a more regulated and standardized arena.

Under the Act, a T&CM Council is formed with the sole responsibility of regulating all activities related to T&CM in Malaysia and ensuring only safe and quality services are provided to the public.

In near future, when the T&CM Act 2016 is fully enforced, any individual who wish to practice T&CM is required to register with the T&CM Council and hold the recognized qualification as determined by the T&CM Council.

The Malaysian government also put great emphasis on T&CM research, which was envisioned through (i)the establishment of Herbal Medicine Research Centre under Institute of Medical Research; (ii) formation of the National Committee for Research and Development(R&D) in Herbal Medicines within the Ministry of Health Malaysia; and (iii) publication of Malaysian Herbal Monographs. However, TCM clinical and research are still very limited, compared to China. Not many studies have been done locally due to funding issues.

EDUCATION AND TRAINING OF T&CM

Education and training of T&CM in Malaysia consist of 2 pathways: academic pathway and skills pathway. Up to July 2018, there are 10 private higher education institutions offering T&CM courses locally.Currently, education of TCM is still having either twin program with China or traditional college by local association. Recent years, we have started a few TCM courses in local universities.

In addition, the Malaysian Public Service Department has recognized three universities from China to offer the bachelor degree programs in Malaysia.Currently, Division of TCM, Ministry of Health and Ministry of Higher Education; has approved 11 institutions to offer TCM education.

Students may major in Chinese Herbal Medicine(Traditional Chinese Medicine), Acupuncture or other TCM clinical subjects, such as Tui-na, Natural Medicine,Homeopathy, Malay Medicine, Malay Massage, Ayurveda Medicine, Chiropractic, Reflexology Aromatherapy and Islamic Medicine.

Generally, the clinical practice training programs are conducted in China, Taiwan (China) or Australia and India. Malay Medicine, Malay Massage, Ayurveda Medicine and Islamic Medicine Universities, Colleges, on the other hand, conduct students' clinical practice training programs in India or other collaborated Universities,Colleges or Institutions in foreign countries.

MY EXPERIENCE OF USING TCM IN CLINICAL PRACTICE OR RESEARCH

I have participated in CHIMES trial that used NEUROAID which is a mixture of compound derived from multiple herbs and animals derivatives, to improve stroke recovery. Some patients showed significant improvement with reduced disability. Currently the product is available commercially but still not in government formulary.

FUTURE PERSPECTIVE OF CLINICAL MEDICINE

TCM plays a significant role in the healthcare.There are a lot of chronic diseases of cancers, chronic pain which failed to be treated effectively with western medicine. It will be great if TCM can be regulated and offer alternative therapies to selective patients who may benefit. In fact, although some patients improve with radiotherapy and chemotherapy, but there are also a lot of patients who were diagnosed malignancy received chemotherapy that accelerated death, and also died in a very painful, distressing manner.

In Harvard, UCLA and Boston, acupuncture, Prana and TCM are being studied and some even covered by insurance. The 2015 National Health Morbidity Survey(NHMS) showed the inherent demand. 29.25% of the Malaysian population had used T&CM with consultation in their lifetime and 21.51% had used T&CM with consultation within the last 12 months (Institute for Public Health, 2015). In an estimated population of 30 million Malaysians, 9 million would have used or are using T&CM for the prevention or treatment of medical ailments.

The future will be integrative medicine. There may be a long drive ahead before T&CM can be fully incorporated into the mainstream healthcare system.However, the journey of a thousand miles begins with the first step. With continuous and consistent effort from all stakeholders, hopefully the Ministry's vision that one day T&CM and modern medicine will be integrated to enhance the health and quality of life of all Malaysians can be achieved in the near future.

ACKNOWLEDGEMENTS

I would like to acknowledge Director of General of Health of Malaysia, Datuk Dr. Noor Hisham Abdullah,Dr. Goh Cheng Soon, Head of TCM Division, Dr. Feroza Sulaiman, Tan Boon Sengg, (Deputy Principal, North Malaya TCM Training Centre), Retailed Pharmacist with TCM background, Faiz Suhaimi, for their valuable assistance. They have shared and summarized the relevant information. The report is prepared by Eow Gaik Bee with their assistance.