From Scotland to Negei Sembilan – Breaking Barriers in Healthcare Insights and Innovations

I wanted to share the profound impact that my Tuanku Muhriz Travelling Fellowship had on my understanding of rural healthcare dynamics, particularly during my immersive two-week stay in Negeri Sembilan late last year.

My exploration encompassed various dimensions of the healthcare landscape, ranging from rural surgical practices to community and specialized services at Hospital Tuanku Ampuan Najihah (HTAN), Hospital Jempol, and Hospital Tampin. These experiences offered invaluable insights into the challenges faced by healthcare teams in rural settings, highlighting their unwavering dedication to delivering exceptional patient care.

A key highlight of my visit was the opportunity to spend time with Dato’ Dr Harlina Abdul Rashid, the State Health Director, whose perspectives enriched my understanding of the complex dynamics in rural healthcare in Malaysia. Visits to Hospital Jempol and Hospital Tampin, integral components of the cluster hospital system, underscored the collaborative efforts of healthcare professionals in overcoming geographical barriers.

An enlightening experience was the discussion at Hospital Jempol, where innovative solutions were explored to address challenges in theatre capacity and staff shortages. Witnessing the resilience and adaptability of healthcare professionals in the face of resource challenges was truly heartening.

Our exploration extended to the crucial role played by Pejabat Kesihatan Daerah (PKD) in providing mobile clinics and essential healthcare services, especially in reaching remote areas. Witnessing mobile clinics in action highlighted the dedication of healthcare teams in ensuring comprehensive medical care for rural communities.

Commendations are due for the innovative approaches of healthcare teams at Modern Wound Care Services in Johol and dental health services in Serting Hilir. The commitment of these professionals, particularly the strong and capable women leading the teams, left a lasting impression on me.

Visiting the Orang Asli village in Guntur and witnessing a home visit to a paralyzed patient was an honour. This experience emphasized the challenges rooted in cultural differences and traditional medical practices, highlighting the importance of culturally sensitive healthcare.

Throughout my visit, we conducted a thorough healthcare system analysis, identifying challenges such as funding limitations, staffing shortages, and opportunities for improvement, including the potential of telemedicine in the post-pandemic landscape.

The challenges faced by the healthcare team at HTAN, reminiscent of those in remote and rural NHS health boards in Scotland, revolve around institutional funding, equipment shortages, and recruitment difficulties. Innovative solutions, such as utilizing clean procedure rooms, were proposed at Hospital Jempol to address theatre capacity and staff shortages.

Succession planning and inadequate funding for training were identified at Modern Wound Care Services, highlighting the need for more specialist input and advice. Chronic staff shortages at physiotherapy and occupational therapy departments hinder the delivery of desired services at KK Johol.

At PDK Bahau, addressing the disparity in allowances for attendance compared to staying at home emerged as a potential improvement within the well-run cluster hospital system in Negeri Sembilan.

Having left Malaysia to study abroad 20 years ago, my excitement to witness the development of healthcare, especially in a remote setting, was palpable. Long-term, I aspire to network with local surgeons, enhance medical education, and contribute to surgical pathways in both rural Malaysia and the Highlands of Scotland.

Despite being a remote orthopaedic surgeon in the Highlands, my goal is to contribute my experiences and skills to Malaysia. My hope is to foster collaboration, improve medical education, and enhance healthcare delivery in Malaysian rural communities.

I’m happy to conclude that my Tuanku Muhriz Travelling Fellowship experience in Negeri Sembilan was eye-opener, showcasing both the challenges and commendable efforts of Malaysian healthcare professionals. The collaborative spirit and commitment to overcoming geographical barriers were evident, reflecting the resilience, dedication, and innovative spirit of those providing quality healthcare to diverse communities.


Contributed by Adeline Clement, MBChB (Aberdeen)), FRCS TR &Orth (RCSEd), EBHS Diploma (FESSH), MSc Clin Ed (Aberdeen) is currently a Consultant Trauma Orthopaedic, Hand and Wrist Surgeon at Raigmore Hospital (NHS Highland) in Inverness, UK. She graduated from the University of Aberdeen and is also an International Medical University (IMU) alumnus. She completed her higher surgical training in the North of Scotland Deanery.

She then undertook a hand and wrist fellowship at Guy’s and St Thomas’ NHS Trust, London followed by Groot Schuur Hospital, Cape Town. She has completed the European Board of Hand Surgery Diploma from FESSH, and holds a Masters in Clinical Education with the University of Aberdeen.

She examines on the University of Aberdeen OSCE exams and is part of the faculty for the Highland Basic Science FRCS Course. She has recently been appointed as a Royal College of Surgeons of Edinburgh Regional Surgical Ambassador for the North and under the RCSEd’s Faculty of Remote, Rural and Humanitarian Healthcare and the Viking Surgeons Association, gives webinars and surgical advice. Adeline is an active member of the British Society for Surgery of the hand (BSSH) and the British Orthopaedic Association (BOA).

Images: Adeline Clement

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