Of Tourism and Migrants by Dr Azida Zainal Anuar

By Dr Azida Zainal Anuar

As three of our northern states are set to become “green zones” if no new Covid cases emerge in 14 days, there is hope that the Movement Control Order will soon be lifted in these states. In time, other states will follow.

Impatience to go back to “normal Life”

There is an impatience to go back to “normal life”- this is what the public expects- but doctors know that we are not going back to life as we know it. The Minister of Defence has been very clear about the restrictions thus far and it is hoped that when the control order is partially or fully lifted, similar precise instructions on expected behaviour are conveyed to the public.

Are we ready for the sudden influx of patients?

What can be expected in hospitals after lifting of the MCO is an immediate influx of patients who have been managing worsening symptoms at home- these could be new symptoms which were not severe enough for presentation at the Emergency Departments or chronic symptoms which were slowly becoming uncontrolled because of the depletion of their medication supplies. While it will feel like a relief to be able to see patients and start operating again, we must not let our guard down. Testing is important in these situations and the precise test to be administered must be tailored to the estimated phase of the disease or anticipated duration someone has been a carrier. Blanket testing could give a false sense of security.

Preventing Imported Cases

Even with the lifting of the movement restriction, it is important for our borders to still be tightly controlled. Some neighbouring countries such as Singapore have very tight restrictions and thorough testing and the relevant ministers have good communications with each other. At the time of writing, Indonesia has 5923 cases and it has been touted to be the next Italy if their government does not implement high-scale interventions. The University of Indonesia’s prediction that cases could soar to 1.5 million across the country is worrying and will have implications on medical tourism in our country.

Medical tourism

In 2017, one million medical tourists visited Malaysia, of which 60% were from Indonesia. The projection for the total number of medical tourists for 2020 was two million.

As medical tourism plays an important role in the healthcare economy of this country, testing will play a very important role. Spending money on accommodation and living expenses for 2 days in Malaysia while waiting for a test result before seeing a doctor would be financially unfavourable for medical tourists.

What of our migrant workers? Malaysia is the destination for around 90,600 Indonesian workers, of which around 11,000 went home because of Covid-19. Many will want to come back. Do we accept testing results or letters from their home country verifying they have been tested? Do we impose testing at the border? Do we quarantine and test in phases?

Test results or “verification” of testing done in another country is perhaps the weakest option. There have been issues with  the authenticity of medical reports for migrant workers; I have personally come across  cases where maids have been verified to have “no medical problem” and seen to have large tympanic membrane perforations with severe hearing loss where her deafness and inability to perform was the reason the employer brought her to see me. Anecdotal, perhaps, but the infectivity of Covid-19 does not leave a lot of room for complacence.

Quarantine

The 14-day quarantine is doable but certainly comes at a cost- accommodation, manpower issues with monitoring and risk of breeding Covid clusters in quarantine accommodations. Second and third waves are expected- look at Singapore and Hong Kong- but we can still make decisions to minimise the impact.

The economy is already down at unprecedented levels. To get it going again will take sustained effort and injection of more funds into healthcare. At the moment, there is no way but forward.