echo Written by: Mah Wen Yi
Edited by: Wong Kit Yin, Nicole
“Give a man a fish, and you feed him for a day. Teach a man to fish, and you feed him for a lifetime.” That is the working principle of Hospitals Beyond Boundaries (HBB), a NGO that was established in 2012 with a goal to improve the health of vulnerable communities through sustainable health care efforts. In order to understand more about what HBB does and what we can do to help HBB with its mission, I interviewed its founder, Dr. Lutfi Fadil Lokman. We talked about social health enterprise (SHE), the working model of HBB, healthcare issues in Malaysia and how to tackle them, as well as the future of Malaysian healthcare.
Q: Can you tell me the brief story of how and why you set up HBB?
A: As a medical student, I have always been inspired by volunteerism and wanted to start my own NGO. I’ve always thought that I had to become a specialist first, but an accident happened when I was a fourth year medical student, which changed my mind. I couldn’t walk, and couldn’t hear out of my left ear. It made me realize that life can be short, and that God can take away my abilities anytime. This accident motivated me to work on HBB. I met my co-founder, Dr. Wan Abdul Hannan and shared my ideas with him. When I was in India, I was inspired by the NGOs there, which focused on development, in contrast to those in Malaysia, which focus on providing funds and short-term aid. After 10 years, the community may still remain poor. The cycle goes on and the problem is not solved. HBB is special in that it focuses on the development of community instead of total charity. Our goal inspired more people to join our team. For example, we now have accountants, engineers and architects, and it’s important to note that, in the beginning, we were all students. We did a lot of promotion on social media, but we also did activities on the ground. Our Malaysian team is composed of full-time volunteers, but in Cambodia, we have 7 staffs, who are hired and salaried.
Q: What is a social health enterprise (SHE) and how is it different from other social enterprises?
A: The main difference is that SHE is sustainable financially and we empower community instead of maximizing profit. To put it simply, SHE is the “centre” way between private healthcare and total charity. The private sector mostly works for monetary causes, and not so much on charity work. However, the total charity model is imperfect as well in that it is not sustainable financially. Charity is important and necessary for disasters, where immediate response is required, but not in the long run. HBB uses the SHE as a working model. In Cambodia, the income inequality is very evident. For example, there can be a huge bungalow standing right next to a small hut of a poor fisherman. However, the community generally has the desire to help each other. The rich will come into our clinic and pay the normal price for consultation, and all the profits from this will be used to help treat the poor. At the same time, we generate economy by hiring community health workers from the poor community. We teach them how to do simple things such as taking blood pressure and this creates job opportunities for those who cannot afford education.
Q: Do we need more SHEs in Malaysia and why?
A: Yes, we definitely do. Social enterprise itself is a relatively new term in Malaysia. SHE in Malaysia tends to revolve around technology, such as developing an app to promote exercise. But in terms of health services, there is no SHE like HBB yet. It is especially important now and in the future, because the government plants to impose a 4-year contract with undergraduates. If the undergraduates perform well during that period, they will be recruited into the public health sector, whereas the rest will be left out to seek for their own future.
Q: What are some issues with the healthcare education in Malaysia right now, and how can these issues be tackled?
A: In Malaysia, there are too many undergraduates and not enough training available. This problem will propagate further into the Masters programme. As of now, there are not enough spaces to train housemen. In the future, there will not be enough spaces to train specialists. For now, specialist trainings are only available in public universities and hospitals such as UM and UKM. This problem is further worsened by the fact that there are no policies to make it compulsory for private hospitals to train doctors. However, in recent years, KPJ has started training specialists in ENT and radiology, and in the near future they will be training orthopaedics as well. This could help relieve the problem, and is the beginning of a brighter future in healthcare where private hospitals are willing to train specialists. Another issue often raised is that private patients do not want to be seen by medical students. In KPJ, they do one-to-one mentoring, where one medical student is attached to one doctor during bedside teaching. According to a survey that KPJ did, patients do not mind if there is only one student watching as it does not affect their care. This should encourage more private hospitals to improve the quality of our learning process.
Q: If you are given a chance to talk to all current and future medical students in Malaysia, what would you say to them?
A: The future is very competitive. Medical students cannot think in a mainstream way anymore. You can still choose to go into the more popular pathway, such as specializing to become a cardiologist or a paediatrician, but you need to keep your options open. Instead of thinking of how to become a more prominent doctor, think about how you can best contribute to your community. Think about how to reach out to the community and improve their health, study about public health, join NGOs, become a doctor who volunteers in rural areas, be different. When you are young, you have more energy and passion to do what you like, so start now. Many medical students are convinced that they’re too busy studying medicine to learn about anything else, but to survive in the new world, we need to learn about other happenings in the world, such as politics and economics. For example, doctors always think that our mission is to save lives, but our resources are limited. If you learn about economics, you will learn how to relocate resources to best serve the society, and figure out ways to save more lives using minimum resources.
What are some of the things that non-medical individuals can do to help HBB?
Financial aid is always welcomed. You can visit our website, www.hbb.org.my, to make donations. In terms of volunteering, we also welcome non-medical individuals to do simple things like calculating BMI, and do administrative work. Other than that, we also focus on community development. We don’t send a gastritis patient back into a house where there is no food available, so we also need volunteers to help with food package delivery and to educate on the importance of hygiene. For anyone who wants to fundraise for our project to build hospitals, you can send us an e-mail for further information at enquiries@hbb.org.my.
HBB began with an idea, followed by consistent hard work and determination. Now, HBB is up and running, spreading its wings and changing people’s lives. This is the power of students who come together to work toward a common goal. I decided to write this article for a few reasons. Firstly, I hope that HBB will get more recognition in the student community. Anyone who happens to read this article and has the financial capabilities or medical knowledge necessary can help HBB work towards their future goals. Secondly, I hope that HBB’s success will motivate our student community to work for a better future together. We have the potential to do great things together, but we need to start doing them now. As the future leaders of the world, we can only hope to improve ourselves and do our best in our respective fields.
