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What does gender bias look like in the context of Malaysian women’s healthcare? Dr Saunthari Somasundaram of the National Cancer Society Malaysia and Dr Nazimah Idris of the International Medical University discuss how the issue may be more complex than we thought
In the context of the nation's women's healthcare, Malaysia recently launched the Clinical Practice Guidelines of Management of Menopause in July 2022. It was a landmark achievement of healthcare systems in Southeast Asia, which served to aid health providers in the better management of menopausal health clinically. In 2010, Malaysia conducted an ongoing national HPV (human papillomavirus) immunisation programme for female students over 13 years old, eliminating the risk of cervical cancer.
Despite the positive initiatives that have taken place in the nation’s healthcare system, for president and medical director of the National Cancer Society of Malaysia, Dato’ Dr Saunthari Somasundaram, and the professor of obstetrics and gynaecology at International Medical University Malaysia, Dr Nazimah Idris, the issues that lay within women’s healthcare didn’t just involve a lack of resources and insufficient health literacy, but are intertwined with a sociocultural factor that, inadvertently or otherwise, impacted a woman’s autonomy and the medical treatment she receives. As such, it is in this article that we ask: "Does the current state of our healthcare system adequately address women's health issues and where do we go from here?"
Above Dr Saunthari Somasundaram of the National Cancer Society Malaysia
Dr Saunthari Somasundaram of the National Cancer Society Malaysia
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More than just a patient
Regardless of gender, the compliance to gain treatment differs depending on a patient’s circumstances. Are they financially well enough to do multiple treatments? Do they have someone to take care of them or their family when they’re ill or cover their shifts?
For a long-term, noncommunicable disease like cancer, Saunthari explains that the healthcare system prioritises treatment over the holistic care of the patient—which, while "not gender-biased in a traditional sense", does not necessarily take into account the toll [treatments] can take on patients and their loved ones.
“Once you have cancer, it’s a lifetime diagnosis—so in that sense, our healthcare system is inadequate,” says Saunthari. “We do not have the capacities or the resources to do nutritional studies, nor check if the patient has a proper support system in place to continue their treatments.”
The public healthcare system, Saunthari adds, couldn’t afford the time to spend with the patient as they are short-staffed, where one doctor oversees over 30 to 40 patients a day. It didn’t help that for every hospital visit that the patient does, a new doctor comes to take over the following appointments, worsening the lack of communication and rapport between doctors and patients.
“To create an effective, holistic and inclusive treatment that focuses on a patient’s wellbeing, we need to have a multidisciplinary team that can specialise in patient care,” she says. “In other countries, the position of care teams, be it nurses, physiologists and rehab personnel, are elevated to nearly equal to that of the doctor. What this means is that while the doctor gives the plan and identifies the issues, it is the support team that implements the plan. They are the ones who talk to the patients, and would counsel them when needed.”
Above Dr Nazimah Idris of the International Medical University
Dr Nazimah Idris of the International Medical University
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Stagnancy isn't progress
According to Nazimah, while Malaysia’s sexual and reproductive health sector has improved tremendously from where it was 30 years ago, the fact remains that it has stagnated for the past 20 years.
In the 1930s, Nazimah explains that the maternal death rate was at 1,000 per 100,000 women. And when people started paying attention to it, the mortality rate gradually changed to 280 per 100,000 women. In 2020, it was said to have been lowered to 24.5—not without the hard work done by the Ministry of Health’s women development division—but it hasn’t decreased since.
“While [the healthcare system for women in Malaysia] is on the right track, we shouldn’t just settle on what we’ve achieved today,” she states.
As veterans in their respective fields, Nazimah and Saunthari have seen cases where a woman’s bodily autonomy is compromised. While a woman wasn’t necessarily restricted from wanting a certain procedure done, like a hysterectomy, she needed her husband’s consent to proceed.
Above Photo: Artem Kovalev/Unsplash
Photo: Artem Kovalev/Unsplash
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Who decides that she undergo surgery?
“When I was a houseman during my years as a medical officer, whenever it came to any decision on sexual reproduction health or the delivery of a baby, we had to speak to the husband about it,” Saunthari recalls. “I remember a case where we had a woman who was gravida eight, meaning that this woman was delivering her eighth child. So, this caused some complications during her delivery; the more children you have, the thinner the uterus lining becomes, which heightens the risk of bleeding. During the delivery, she was bleeding so much that we couldn’t stop it, so the simplest option at the time was to take out the uterus, as preserving the uterus would just endanger her and her future children.
“After we got the baby out and the woman was lying on the table, the surgeon asked me to get the husband’s permission [to take out her uterus]. And when I did, he says no. I told him that she was going to bleed to death, and he told me two things: the first was that ‘she will no longer be a woman’, and the second was ‘how will I know whether she will still stay faithful to me’. So, we tried doing radiotherapy for her. But needless to say, we couldn’t save her.”
It was the same for Nazimah, who was told by her superior that even if it wasn’t required by law, a woman needed her husband’s explicit consent to undergo tubal sterilisation because “it involved family planning”. To date, while this archaic practice isn’t practised as much, if it were a man who requested to have a vasectomy done, doctors will do it for him without asking for the wife’s consent.
“We had a patient years ago who was diagnosed with breast cancer and was advised to surgically remove it,” recalls Nazimah. “But the husband said no because he wasn’t willing for her to lose her breasts. So, she couldn’t remove them. When she came back, cancer had spread to the entirety of her breast, disfiguring it. It was leaking discharge and blood too. The husband left her then.”
"Whole of nation, whole of society" to better current healthcare system
“The Health White Paper is a great step towards change. It is a comprehensive look at changes within the system and how we can adapt to them,” Saunthari says. “But admittedly, change is going to be a while. We are a growing population, so the cost of drugs and treatments has increased tremendously.
“We need to pull apart the healthcare system and put a new one in place. But true change comes from mindset. Each and every Malaysian needs to realise that health is a right and essence of society.”
“The future depends on the work we do now; if we start the work now, the future will be good. If we don’t do anything now, it’ll get worse,” Nazimah stresses. “Health literacy, while a key component to health equity, will not be possible if we don’t empower our underserved communities. If you don’t know how to read or write, you won’t know how to appraise the information given to you, then you fall off the socioeconomic group, which then limits you from getting healthcare. Much like how we dealt with the pandemic, society needs to work together. It is the only way to achieve a better healthcare system where everyone needs to work together, and not just task a single organisation to handle a nationwide issue.”
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Photography: Imran Sulaiman
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Usually found at home and one with her couch, Koy Yi would either crack open a good book or game in her spare time to wind down after a long day. She also loves to scour art conventions and book fairs alike when she's able, collecting art books of all regions to gain inspiration for her own illustrations. With a keen interest in people and the stories they tell, she enjoys a good talk and a good laugh (preferably over food). Follow her on her Instagram @peiyi57.
