Bismillahi Rahmani Rahim.
Assalamualaikum Warahmatullahi Wabarakatuh.
[Professor Jianan Li, President of the International Society for Physical and Rehabilitation Medicine (ISPRM);
Professor Dato’ Dr. Zaliha Omar, President of the 10th ISPRM World Congress]
It gives me great pleasure to be able to officiate at this opening ceremony of the 10th World Congress of the International Society of Physical and Rehabilitation Medicine. To the delegates who have travelled from all corners of the globe, I bid you a warm welcome to Kuala Lumpur.
- I wish to express from the very outset that I hold in great regard the work of the ISPRM, firstly, as a global catalyst in scientific research and knowledge proliferation in the specialty of Physical and Rehabilitation Medicine (PRM). While I do not represent the medical profession myself, a commonality that we share is a deep reverence for knowledge and education. I am heartened to note ISPRM’s efforts in facilitating research and international exchange on the different dimensions of the specialty, which in turn, allows for the continuous capacity building of physicians according to the needs of the communities in which they serve. There are presently 64 national member societies of ISPRM as well as individual members representing countries in all the continents, and through the ISPRM network, they have invaluable access to high quality international journals, cases and best practices that serves to strengthen the quality of care in individual jurisdictions.
- Secondly, alongside its scientific focus, ISPRM, through its work, has also demonstrated a strong social and humanitarian mandate, often playing a unique social advocacy role. By promoting collaboration with governments, non-governmental organisations and organisations of persons with disabilities, among others, ISPRM endeavours to influence policies to the extent that they can maximise the quality of life of patients and allow them to participate in their communities in the least restrictive ways.
- This reflects the core values of PRM as a patient-centric specialty. Recalling the distant origins of medicine, healing was predicated on taking a holistic view of patients – the body, the emotions, the mind and the spirit. Over two millennia ago, Hippocrates, the father of modern medicine, said:“It is more important to know what sort of person has a disease than to know what sort of disease a person has”.
- I believe these words resonate with PRM as the speciality seeks to understand how disability affects the ways in which patients interface with their environments. Enabling patients to be meaningful participants in education, the labour market and civic life are seen as equally important, if not more, than curing a disability. Indeed, the rehabilitative model acknowledges the connection between the physical as well as the psycho-social aspects of treatment. When the possibilities of physical intervention are limited, it is the psycho-social aspects that can make the biggest difference. This brings to mind another pearl of wisdom by Hippocrates:“Cure sometimes, treat often, comfort always.”
- Although the Physical and Rehabilitation Medicine as a speciality is relatively young, fundamentals in the concept of physical rehabilitation can be traced back to ancient times. For centuries, societies have used movement and natural physical agents such as water, sunlight and hot springs to treat various ailments. One of the tutors of Hippocrates, the Greek physician Herodicus, in the 5th century BCE, described elaborate systems of therapeutic gymnastic exercises for the prevention and treatment of diseases. His theories are considered to have formed the foundations of sports medicine.
- It was not until the early 20th century, however, that the field began to be developed as a specialty in its own right. This was following increased awareness in the western world of the necessity for some forms of rehabilitative interventions due to the substantial numbers of debilitating war injuries and the tens of thousands who were disabled by epidemic poliomyelitis. President Franklin D. Roosevelt became an avid proponent of rehabilitation due to his own experience with polio and time spent undergoing a wide range of therapies, including hydrotherapy at Warm Springs, Georgia. The centre continues to operate today, now known as the Roosevelt Warm Springs Institute for Rehabilitation.
- In Malaysia, rehabilitation medicine, though it was not called that at the time, was best documented in the work done by the Malayan Leprosy Relief Association (MaLRA), established in 1959. Social rehabilitation, particularly at the Sungai Buloh Leprosarium, was revolutionized by the leaders of MaLRA, notably Tan Sri TH Tan and Tun Dato’ Seri Hamid Omar. Patients and ex-patients were provided with wheelchairs, walkers, artificial limbs and spectacles, as well as medical, educational and vocational assistance to allow them to regain movement, functionality and eventually, self-sufficiency.
- This was a vast improvement from when the leprosarioum was first established in 1930 mainly as an isolation facility. And prior to that, patients were forcibly placed in either remote jungle camps, or in the leper asylum in Cicular Road, Kuala Lumpur (now known as Jalan Tun Razak), where they endured both the suffering of their disease as well as squalid living conditions. Less than a century ago, this was considered acceptable practice, not just in Malaysia, but all around the world. Even though rehabilitation medicine already existed, access to it was limited due to scarce resources. In fact it was common for people with all kinds of disabilities, whether congenital, or due to injury or disease, to be subjected to segregation in institutions and asylums. Some were shackled to their beds, gassed, drugged and sometimes starved. Many were stigmatised as inferior or as criminals; and many were subjected to all types of abuse.
- Rehabilitation medicine began to make very rapid progress, as disability came to be viewed more and more as a human rights issue, particularly since the 1970s. There grew a tendency for those with disabilities to self-organise and emphasise that they were not just disabled by their bodies but more so by their environments.
- When the United Nations proclaimed the year 1981 as the International Year of Disabled Persons (IYDP), it called for a plan of action with an emphasis on equalization of opportunities, rehabilitation and prevention of disabilities. The slogan of IYDP was “a wheelchair in every home”, alluding to the right of disabled persons to participate fully in the life and development of their societies, and to enjoy living conditions equal to those of other citizens. The rights and freedoms of disabled persons were further cemented with the entry into force of the UN Convention on the Rights of Persons with Disabilities (CRPD) in May 2008. Today, 163 nations have ratified the convention. Malaysia did so in July 2010.
- With the CRPD coming into force, national policies of segregation shifted towards those of inclusion, and this presented a large base of the previously underserved that needed to be ensured access to healthcare and rehabilitation. According to former UN Secretary General, Kofi Annan, the adoption of the CRPD marked “the dawn of a new era – an era in which disabled people will no longer have to endure the discriminatory practices and attitudes that have been permitted to prevail for all too long”.
- A better understanding and appreciation of disability led to the tremendous changes and modernisation in physical and rehabilitation medicine. Research and publications in this field has grown dramatically. Running a search on PubMed, one of the largest online databases of medical publications, one can see that there were around 4500 publications on Physical and Rehabilitation Medicine in 2015 alone, which was three times the number published in 2010, four times that of 2005, and eight times that of 1995. It is also remarkable how technology has brought dramatic changes to this specialty. Today there are resources describing how advanced procedures like robotics, regeneration technologies, simulation technologies and virtual reality are being explored and applied. One can therefore only imagine, with great optimism, the possibilities that the future holds.
- Having said this, however, the World Report on Disability 2011, published by the World Health Organisation and the World Bank, has highlighted that gaps in the availability of services continue to result in inequitable access. Of the more than 1 billion people living with disability around the world, many of them, especially those from lower income communities, experience barriers in accessing healthcare, education, employment, transport and information.
- Analysis of the World Health Survey data shows that among the main barriers to access to healthcare for persons with disabilities are cost, geographical distance to available services and inadequate specialised care available. In 51 countries, it was found that 51 to 53 per cent of persons with disabilities could not afford healthcare.
- There is undoubtedly a growing burden on governments to fund wide-reaching healthcare services. Ageing populations, the rise of disability-causing chronic conditions, increasingly expensive medical interventions and heightened community expectations for good and affordable healthcare services are forcing governments to find ways to stretch available resources. This is a challenge for all countries, rich and poor. At the lower end of the scale, some countries struggle to make even basic services accessible. For these countries, ODA flows will be necessary for a considerable period of time. All countries, however, have the option to re-examine budget priorities if they are serious about expanding accessibility to healthcare, and make the necessary budget allocations where they are most needed.
- In Malaysia, in order to address accessibility constraints and to be on par with other developed nations, the government has set a targeted doctor to population ratio of 1 to 400 by the year 2020. According to the Ministry of Health estimations, this will require increasing the number of available posts for doctors in the public sector from the current 27000 to about 47000. While this is a plausible target, I believe, it is necessary to invest judiciously in the corresponding facilities and infrastructure to place and train medical practitioners, with particular emphasis on specialties that are most in need as well as geographical areas that are underserved. Needless to say, quality must trump quantity. According to the Ministry’s data, the doctor to population ratio in Malaysia as at 2014 was 1 to 661, but the concentration of medical professionals remains in urban areas. In states like Sabah and Sarawak, it was approximately 1 to 1500 and 1 to 1100 respectively, indicating a large underserved population, and according to WHO’s estimates, there is the likelihood of a large proportion struggling with disabilities.
- In this regard, allow me to quote Professor Stephen Hawking in his foreword to the World Report on Disability:“…we have a moral duty to remove the barriers to participation, and to invest sufficient funding and expertise to unlock the vast potential of people with disabilities. Governments throughout the world can no longer overlook the hundreds of millions of people with disabilities who are denied access to health, rehabilitation, support, education and employment, and never get the chance to shine.”
- I understand that ISPRM, through its active national member societies, have been working hard to overcome the many barriers at the respective national levels. One of the many efforts worthy of our commendation is your work in developing best practices on how to integrate specialised medical rehabilitation into Community Based Rehabilitation (CBR) programmes. I understand that ISPRM had worked closely with the WHO to develop the guidelines for CBR through evidence-based knowledge of interventions used in various jurisdictions to optimize the use of available local resources. In Malaysia, although there are only about 75 physicians who specialise in rehabilitation medicine, CBR initiatives have enabled more access to rehabilitation by leveraging multi-disciplinary teams of primary care practitioners, allied health professionals, nurses, social workers and families of disabled persons.
- I believe CBR will feature prominently in this year’s Congress and, in line with the theme of the Congress, I am certain there will be invaluable insights on how to transfer knowledge to practice in order to further empower rehabilitation medicine.
- I congratulate ISPRM and the Malaysian Association of Rehabilitation Physicians for organizing this Congress. From the attendance here, I can see how greatly members value the contribution of knowledge and the contribution of experiences that will no doubt expand the understanding of the various dimensions of your specialty and empower you further to shape its future.
- It is with great pleasure that I now declare the 10th World Congress of the International Society Of Physical And Rehabilitation Medicine officially open.
- Malaysian Leprosy Relief Association; malra.org.my ↑
- Toby J. Karten, Embracing Disabilities in the Classroom, (Corwin, 2008), p. 3. ↑
- PubMed.gov ↑
- World Health Organisation and World Bank, World Report on Disability 2011. ↑
- World Health Organisation, World health report 2010: Health systems financing – the path to universal coverage ↑
- Director General of Health’s Keynote Address, ‘Optimising Human Capital And Enhancing Specialist Services’ at the Medical Program Specialists’ Conference, 8 August 2015. ↑
- Ibid. ↑
- Sabah Health Department targets 1:1400 doctor-patient ratio, Borneo Post, 11 May 2014 ↑
- 1:1104 doctor-patient Ratio in Sarawak, Daily Express, 23 April 2015 ↑