Evolusi Demokrasi di Malaysia - Relevansi dan Keabsahan Proses Pilihanraya
Ahmad Arif Astaman Ogos 2020, berakhir tempoh dua tahun Jawatankuasa Reformasi Pilihanraya (Electoral Reform Committee, ERC) bagi mengemukakan saranan kepada kerajaan dan hampir 50 saranan telah diserahkan khusus bagi penambahbaikan sistem pilihanraya Malaysia. Kandungannya masih belum diumumkan, namun kita wajar mengambil berat tentang perkembangan sistem ini memandangkan ia merupakan tonggak utama dalam keabsahan demokrasi Malaysia. Apapun tanggapan terhadap kerajaan pimpinan Tun Dr Mahathir Mohamad yang lalu, keputusan beliau bagi mewujudkan ERC untuk mengenalpasti kelompongan sistem pilihanraya merupakan langkah yang amat diperlukan. Seiring dengan perubahan zaman, begitu juga dengan sistem perundangan yang telah menjadi cerminan situasi negara sejak 1950an dan 1960an, ianya perlu diulas dan disemak semula secara konsisten agar kekal relevan dan mampu memenuhi aspirasi rakyat tatkala melangkah ke abad ke-21 ini. Kita dapat lihat susulan positif apabila had kelayakan mengundi diturunkan ke 18 tahun, ini merupakan pindaan Perlembagaan Persekutuan yang pertama sejak tahun 2007 dan telah mendapat sokongan sepenuh merentas parti sewaktu di bentangkan di persidangan parlimen. Ini membutikan bahawa sistem pilihanraya itu mampu berevolusi dan boleh diubah ke arah yang dipersetujui semua pihak. Namun, meluaskan kelompok pengundi semata-mata tidak mampu menyelesaikan masalah pokok yang mempengaruhi kematangan politik sekiranya ia tidak ditangani secara serentak. Pengundi Bermaklumat Asas Demokrasi Sihat Realitinya kadar kematangan politik di kalangan rakyat secara keseluruhannya masih lebih cenderung kepada demografi dan geografi setempat. Suka ataupun tidak, kematangan politik tidak boleh dipisahkan dengan faktor jurang dari segi pendidikan, pengalaman dan pendapatan rakyat. Hak untuk memilih itu akan hanya mempunyai bermakna sekiranya digunakan oleh individu yang memahami pilihan yang ada dari segi calon dan parti politik. Justeru, memupuk kapasiti untuk berfikiran secara kritis, mengajukan soalan yang tepat, memahami jawapan yang diberikan oleh politikus dan berkeyakinan untuk memperjuangkan hak sendiri. Hak memilih akan terus didominasi oleh yang golongan berkepentingan demi mengekalkan ‘status quo’ yang sentiasa memihak kepada mereka sekiranya hal ini tidak dihiraukan. Demokrasi yang tidak membawa perubahan ini lama-kelamaan akan menghakis kepercayaan rakyat terhadap sistem tersebut, dan ini dimanifestasikan dengan defisit kepercayaan (‘trust deficit’) yang semakin melebar di antara rakyat dan pemerintah. Akhirnya, mereka akan lebih cenderung terhadap ideologi ekstrim yang hanya akan menempah kancah krisis sekiranya tiada intervensi serius untuk meningkatkan tahap pendidikan dan kepekaan sivik pengundi, khususnya di kalangan pengundi muda. Pendidikan politik harus diketengahkan di peringkat awal agar asas sistem politik dan dan demokrasi mampu dimaknai di setiap lapisan. Kita harus lahirkan generasi yang fokus pada isu sebenar dan manfaat yang lebih besar buat masyarakat dan bukan sekadar perbincangan retorik dan anjakan ‘tiang gol’ yang kini semakin berleluasa. Setidaknya pengundi muda akan lebih cakna dengan janji dan bersifat lebih relevan. Sistem Westminster Bukan Kitab Suci Kepekaan seseorang pengundi itu kepada sejarah sistem pilihanraya juga adalah satu aspek penting. Sistem pemerintahan Negeri-negeri Tanah Melayu (samada Bersekutu mahupun Tidak Bersekutu) sebelum kesatuan politik secara ‘terpaksa’ pada tahun 1946 merupakan sistem majlis negeri yang dipengerusikan oleh setiap Raja Melayu, yang diselingi ‘nasihat’ pegawai British. Hanya pada tahun 1955, iaitu 65 tahun yang lepas, rakyat Malaya (ketika itu) diberikan pengalaman pertama untuk memilih pemimpin mereka di dalam sebuah pilihanraya umum, mengikut acuan sistem Westminster yang diperkenalkan oleh pentadbir British. Peralihan tersebut merupakan suatu perkembangan penting di dalam penentuan kemerdekaan Persekutuan Tanah Melayu, dan telah kita gunakan sehingga kini. Namun, Britain sendiri, dan banyak lagi negara-negara Komanwel lain seperti Singapura, Australia, New Zealand dan India yang juga menggunakan sistem ini sebagai asas politik mereka sudahpun melalui proses evolusi bagi mencerminkan kesaksamaan yang semakin dituntut oleh rakyat negara masing-masing. Aspek seperti pengunaan sistem penjumlahan undi secara perwakilan berkadar (‘proportional representation’), penetapan tempoh penggal Parlimen, meletakkan kuasa persempadanan semula kawasan pengundian kepada agensi bebas dan mewajibkan pengundian untuk wakil ke kedua-dua Dewan Parlimen merupakan contoh pembaharuan yang telahpun dijalankan oleh sesetengah negara. Ini bukan sahaja akan meningkatkan kesaksamaan keputusan pilihanraya, tetapi sekaligus memperbaharui keyakinan rakyat terhadap konsep demokrasi berparlimen itu sendiri sebagai satu perkara yang dinamik, dan bukan statik. Sebagai permulaan contohnya, pelarasan semula saiz kawasan Parlimen perlu dibuat engikut satu piawai yang tidak mewujudkan jurang bilangan pengundi yang terlalu ketara. Nilailah sendiri keadilannya apabila Ahli Dewan Rakyat untuk kawasan Parlimen terbesar mengikut jumlah pemilih mewakili seramai lebih 177 ribu orang pengundi, manakala Ahli Dewan Rakyat bagi kawasan terkecil pula hanya mewakili kurang 20 ribu orang pengundi. Walaupun kesaksamaan mutlak itu adalah mustahil untuk dicapai, memperkenalkan semula julat nisbah yang munasabah adalah perlu untuk berlaku adil kepada rakyat. Ini dijadikan lebih buruk dengan ketiadaan parti politik yang mempunyai majoriti 2/3 di dalam Dewan Rakyat, sekaligus menghalang apa-apa pertambahan kerusi sekiranya tidak boleh dipersetujui oleh pihak kerajaan dan pembangkang, walaupun bilangan pengundi dijangka meningkat dengan mendadak menjelang piliharaya umum yang akan datang. Teknologi Sebagai Asas Ketahanan Menghadapi Masa Hadapan Aspek terakhir yang patut diperhatikan ialah penggunaan teknologi bagi memudahcara proses berkaitan pilihanraya, seperti perubahan alamat di dalam daftar pengundi, pengesahan identiti pengundi dan aktiviti mengundi itu sendiri. Bagi kebanyakan negara, khususnya di negara Barat, batu penghalang utama kepada menggunakan sistem pengundian elektronik sepenuhnya ialah ketiadaan skim identiti kebangsaan yang mandatori, seperti yang dilaksanakan di Malaysia. Tanpa dokumen identiti yang diwajibkan kepada semua rakyat, penggunaan sistem pengundian elektronik merupakan satu risiko besar dan amat menyulitkan. Namun, bagi negara yang sedia ada dengan skim pengenalan warganegara serta kadar akses internet yang tinggi seperti Estonia, penggunaan konsep ‘i-undi’ ini telah dimulakan semenjak tahun 2005 lagi, dan semasa pilihanraya mereka pada tahun 2019, hampir 50% undi telah dibuat secara atas talian. Walaupun ia tetap mempunyai kritikan tentang keselamatan sistem tersebut, contoh ini menunjukkan bahawa teknologi sedia ada sudah boleh dikaji sebagai asas kepada cara pengundian masa hadapan, dan kesediaan kerajaan untuk melaksanakan perubahan seharusnya mengambilkira teknologi selaku memudahcara, lebih-lebih lagi di dalam keadaan pandemik seperti yang kini masih lagi melanda dunia. Di samping itu, penggunaan kemajuan seperti jaringan ‘blockchain’ di dalam rekabentuk cara mengundi juga akan membolehkan isu verifikasi pengundi diselesaikan tanpa membolehkan pengundi itu dikenalpasti. Di Australia, cadangan untuk pilihanraya peringkat tempatan menggunakan teknologi jaringan ‘blockchain’ telahpun dibentangkan untuk pertimbangan dewan undangan di beberapa negeri, dan berasaskan kepada kepercayaan mereka terhadap keselamatan sistem tersebut di dalam merekod dan meluluskan transaksi kewangan. Usaha ke arah ini sewajarnya mula digerakkan dari sekarang bagi memastikan yang bilangan pengundi yang mengambil bahagian di dalam semua pilihanraya umum atau kecil di Malaysia kekal stabil pada satu tahap yang tinggi. Kesimpulan Adalah menjadi harapan kita semua, bahawa 49 saranan yang telah dibuat akan dibincangkan oleh Jemaah Menteri dengan teliti dan menyeluruh, dan kemudiannya dibentangkan di Parlimen supaya wakil-wakil pilihan rakyat juga akan dapat memberikan maklumbalas serta pendapat masing-masing. Sebagai warganegara dan pengundi, peranan kita tidak sepatutnya terhad hanya kepada proses pengundian pada hari pemilihan, tetapi sebagai penyumbang terus kepada perincian keseluruhan sistem pilihanraya di Malaysia. Perkongsian hasil kajian ERC ini perlu dibuat secepat mungkin dan dihadam oleh segenap lapisan rakyat supaya amalan demokrasi ini dapat diperbaik sebelum kita mengharungi persiapan bagi pilihanraya yang akan datang.
Fake news and Covid-19: Sharing is not necessarily caring
Helmy Haja Mydin “More than 90,000 people have died from the novel coronavirus outbreak.” “A cure is being withheld by forces within the Malaysian government in order to kill off Malaysians.” These inaccurate statements — fake news, lies, call them what you will — were made on the “Ibu Yati” Facebook account in January. They’re just two of many examples of misinformation that spread like wildfire across social media in Malaysia, far more swiftly than that of the hitherto unknown coronavirus strain that’s since been christened as Covid-19. The above statements are unique in that they were made by a journalist, who’s since been charged in court for knowingly making statements with the intention of causing fear among the public. “Ibu Yati”, or Wan Noor Hayati Wan Alias, was charged under Section 505(b) of the Penal Code that carries a maximum two years of imprisonment, or a fine, or both, if convicted. However government intervention in curbing information is not always a good thing — censorship and freedom of speech have been in a tug of war since time immemorial. While halting the spread of fake news may seem straightforward on paper, the motives and tactics of the state are not necessarily in tandem with the best interests of the public. The story of the late Dr Li Wenliang is a recent example. Having identified a new mysterious illness affecting a number of patients, his warnings via social media allegedly led to visits by officials from the Wuhan health authority, demanding to know why he had shared such information. He was later compelled to sign a statement that his warning constituted ‘illegal behaviour’. The report in The New York Times went on to describe efforts by authorities to silence doctors for raising red flags whilst downplaying the dangers in public. These included suggestions by city officials that the virus had been stopped at its source and clusters were limited — helpful if true, but disastrous as they led to insufficient public health measures. Finding the equilibrium between freedom and censorship is no easy task. This has been made more challenging with the increasing ubiquity of social media over the past decade — compare the pandemonium caused by Covid-19 vs SARS. The speed of dissemination and the anonymity that social media provides have led to platforms acting as avenues for the liberation of opinions without corresponding personal responsibility and liability. Fake news can only be curbed if we understand how it spreads. Inaccurate information and rumours have significant impact on issues as diverse as election results to stock market fluctuations. More latterly, it affects the manner in which we respond to national emergencies, both perceived and real. The consequence is not only on the individual — it is not inaccurate to say that in some circumstances, government responses are dictated by what is being circulated in social media as opposed to facts on the ground. This can lead to misallocation of resources, which will ultimately influence outcome in a negative fashion. While fake news is just one of many factors that affect sentiment, it plays a disproportionate role. The social media analytics company Berkshire Media conducted a public sentiment analysis on the Covid-19 with a sample size of 500,000 Malaysians on social media. According to its Chief Executive Officer, Shahid Shayaa, there were four waves of fear and panic in Malaysia. These were affected by domestic & international news, netizens sharing unverified content, posts from Government official accounts and instigative posts by political supporters, often with negative and misleading headlines. People also react far more readily to fake news — a study unearthed the fact that fake news travels significantly farther, faster, deeper and more broadly than truth, especially when related to political news. The authors investigated approximately 126,000 stories between 2006 to 2017 that were tweeted by around three million people more than 4.5 million times. The authors went on to note that “People thrive on novelty. Novelty attracts human attention, contributes to productive decision-making and encourages information-sharing. In essence, it can update our understanding of the world. When information is novel, it is not only surprising, but also more valuable — both from an information theory perspective (it provides the greatest aid to decision-making), and from a social perspective (it conveys social status that one is ‘in the know’, or has access to unique ‘inside’ information)”. Adding a dash of political intrigue alongside a sprinkle of conspiracy theories to the story of a new virus that has the potential to alter humanity’s future allows for easy consumption of fake news, especially when involving governments with trust deficits. The sheer number of data points and sources of information is also overwhelming to the normal human being, especially if cultural and generational gaps are taken into account. Those above the age of 65 for example, are seven times more likely to share fake news than those between the ages of 18-29. This has led to some taking matters into their own hands. Many Malaysian doctors have gone online to share and disseminate information in tandem with the communications machinery of the Ministry of Health. One medical student, Chen Liang, has even gone so far as to coordinate a team of data scientists, medical professionals, designers and developers in setting up the Corona Tracker initiative (www.coronatracker.com). “I’ve asked myself, how can I contribute? I want to educate the public, help them know what they should and shouldn’t do. I want to stop them from being fooled by fake news,” he said. “We know that the public wants a nice narrative, they want information that’s packaged nicely. Therefore besides collecting data, we prepare articles, infographics, videos and interactive sessions. This tracker will provide a more definitive approach on how to handle any contingency with less anxiety and stress.” Individual efforts like these are very welcomed, but would only work well with appropriate support from both government and the private sector. Platform providers struggle between corporate profitability, privacy issues and their responsibilities to both the state and society. Platforms have difficulty in weeding out fake news. A combination of approaches are needed — from unleashing the power of machine learning on big data to engaging third parties and the public to fact-check and report suspicious materials. SY Lau, Tencent’s Senior Executive Vice President, highlighted the importance of spreading real news and dispelling rumours in real-time. ‘At Tencent, Fact Check, a product on Tencent News, has launched a dedicated section called ‘Real-time Facts and Rumours Concerning 2019 nCoV’. This enables users to check if an item is true or fake.’ The experienced and well-respected digital media guru went on to add that ‘in addition, ‘110’, the Chinese police’s Mini Program on WeChat, has launched a means of access for users to report illegal behaviours such as charity frauds and those starting or spreading malicious rumours.’ Some may argue that even these efforts are too little, too late. As the adage says, prevention is better than cure. One way to prevent panic and anxiety over health issues is by increasing health literacy — ensuring that large swathes of the population have access to information that can be used to protect and improve their well-being. The vast majority of medical information is too technical for public consumption. This makes it all the more important that those who seek to enlighten the public use easy and jargon-free language. For example, it would make far more sense to talk about how easy it is for Covid-19 to spread instead of highlighting its R0 (R naught) values. Governments alone will not be able to put out all the fires of fake news. Wan Azrin Izani, a health promotion practitioner has likened the war against fake news to asymmetrical warfare. “Look at how Vietnam defeated the Americans. A smaller, less tech-savvy army utilises its increased maneuverability and can think outside the box.” Wan, the former Corporate Communication Director of the Malaysian Health Promotion Board believes strongly in social media entities and non-governmental organisations being made partners in health promotion initiatives as this will help navigate red tape and bureaucracies as well as help engage those on the ground. This article assumes that the spread of fake news related to Covid-19 is a consequence of misinformation (honest mistakes) as opposed to disinformation (deliberate sharing of incorrect information). It also does not take into account the role of bots and fake accounts for message and cluster amplifications, which may very well be part of a tactical modus operandi to destabilise governments. Even if these are placed aside, it is clear that fake news is here to stay and is an important variable to consider when coming up with public health strategies. Its influence will become even more widespread when the next epidemic hits us (a question of when, not if) and will continue to wag the dog as we increasingly live our lives in the digital world. Governments have the responsibility of utilising the apparatus of the state in ensuring public safety, and should have the authority to implement greater control measures in both the real and digital world should the situation warrant it. However, emergencies are oftimes capitalised by rulers to ensure greater concentration of power. Ceding control after a crisis is over is of paramount, just as proactive measures are taken in tandem with corporate and public players before crises occur in the first place. At the end of the day, it all starts with the individual. Taking a pause is perhaps the most essential tool in a fast-paced world that rewards instant gratification — take the time to look into the source, identify things that are too good (or too bad) to be true, read that article in full or verify the credibility of its author — before passing it on to someone else. Sharing might be caring but as the aphorism goes, ‘the road to Hell is paved with good intentions’. This article was originally published in The Malay Mail Online.
From UK to Malaysia, do our democracies suck?
Rashaad Ali In truth if we are honest with ourselves, the UK election was a foregone conclusion, a realisation that quickly dawned as the first results started to trickle in. The Conservatives led by Boris Johnson look set to take an even larger majority in Parliament with preliminary reports suggesting a massive voter swing from Labour to Tory. The Liberal Democrats despite gaining a greater vote share have lost one seat, with leader Jo Swinson the casualty. This is a result that shouldn’t surprise, but one which should trouble us deeply. Each sides’ individual campaign merits attention. The Tories took a leaf out of the new right-wing playbook, making sweeping promises and doubling down on the key issues of their voter base: Brexit, and the question of British identity. Labour by contrast suffered an impossible Brexit position: their own voters want to Remain, but the votes they need want to Leave. The result was a confused, muddled mess led by a man that has been successfully painted as Marxist terrorist-sympathising racist. Labour clearly suffered from many ambiguities exacerbated by a strong Tory position to “get Brexit done”. Notably, criticism against Labour leader Jeremy Corbyn was louder than that directed at Boris Johnson despite the many parallels. Perhaps this says something about the state of the media and the manner in which it portrays certain issues, as well as the “values” the average voter considers to be quintessentially “British”. But again, this result should not shock us a great deal. Globally the world has been moving to the right, whether via the ballot box or in the reemergence of mainstream nationalist movements. The problems in the United States are already well documented. Witness instead India’s recent election which saw a large mandate handed to the incumbent Narendra Modi and his Bharatiya Janata Party that has taken a distinctly Hindu turn. Emboldened by his virtually unassailable position, Modi has begun to systematically disempower Muslim minorities in India, whether by removing the special status of Kashmir, or passing a controversial citizen law that discriminates against Muslims. This week has also seen Aung San Suu Kyi, de facto leader of Myanmar and former peace icon defiant in hearings at The Hague that lay bare the atrocities committed in the state of Rakhine. It is not her silence or blindness to the genocide that is disturbing, but rather her willingness to travel to The Hague to challenge the claims. Suu Kyi is pandering to her people back home who support her in droves, believing the atrocities committed against the Rohingya to either be works of fiction or justified to prevent alleged acts of terror from happening. In Malaysia, the sweeping change from 2018 is swiftly being undone. Umno and PAS have been successful in capitalising on the indecision of the Pakatan Harapan government, itself beset with problems, preying on the fears of the rakyat, the same precarious fears that PH sought to eliminate from the country but have so far failed to do so. If our economy fails to improve and the government continues to act indecisively, these feelings will only intensify. Is there something wrong with our democracies, something wrong with our governments? This isn’t a question of whether a voting system works: clearly elections empower decision-making in people, allowing for some proportional representation of views. Logistically it works out fine (provided the election day is on a weekend). But rather why are large swathes of people voting for parties that do not represent their aspirations whatsoever? Do our democracies suck? Let’s unpack this a little. Voting trends show older, rural, lower-middle and lower class voters tending to vote for right-wing parties. This is true in the UK, in the US, indeed in Malaysia as well. What is astounding is that this disenfranchised demographic, these political “outsiders” who until recently have lacked proper political representation, have ended up supporting the parties that are least likely to be even remotely interested in their livelihood. The Tories and the Republicans, have been in bed with business elite for too long to the point where business interests are the most likely views to be represented in government policies, not initiatives that will help the working-class citizen (itself now an expanded definition considering the current gulf of inequality). The business elite are reliant on continuous suppression of those beneath them in order to reap maximum profit from a limited pie, all the while continuing to peddle the lie that if we work hard enough, we too can be just as wealthy. Meanwhile, politicians tell us the reasons for our economic hardship are other people, other nationalities, those poorer than us. Unfounded populist sentiment, often driven by ethnonationalism is now normative. We vote them in power thinking they will right all our wrongs, ignorant of what the real problems are. And the cycle begins anew. Why is it about right wing parties and their use of nationalism that has tapped into the psyche of these voters? How have they laid bare our insecurities and exploited them for their benefit, and what does this reflect? It reflects a system that has become deeply unrepresentative of the needs of the people it claims to represent. All political parties are to blame here in their pursuit of self-interest and enrichment. Parties such as Labour or the Democrats have abandoned their working-class base in favour of supporting those that provide them with greater financial reward. In the absence of representation and as economic hardship worsens, we as an electorate are desperate to find and cling on to any semblance of meaning and identity. Conservative parties offer this, the cure to our malaise. Someone to blame, an Other to shoulder the burden of guilt. Irrational arguments are made, met with equally irrational support. The Left scurry to make up the ground already lost to populism but struggle to abandon their self-proclaimed rational position. The result is a half-measure which will never sit well with any electorate, resulting in a loss or a switching of sides. The Left then changes tact. Goalposts shift. Everyone now moves closer to the irrational Right. Malaysia experienced a real shock to the system in 2018, one that was necessary to jolt our political parties out of their complacency. A year and a bit on and we have yet to see whether the government under Prime Minister Tun Dr Mahathir Mohamad will make any significant difference in our lives. We are not unreasonable; shoots of progress would be enough to satiate the electorate. But instead we have a government that continues to dither, while ethnonationalist sentiment built up for years begins to tip over, in an economy that continues to exclude the average Malaysian. If we take our cues from what’s happening around the world, any promise of progressive change that remains unrealised is vulnerable to a wave of populism. A populism that continues to perpetuate the same model, sell us the same lies and force us to live in the same illusion that everything will be alright in the end. Breaking this cycle in an age of post-truth seems impossible. Facts become irrelevant as the problems of capitalism in its current form drive levels of inequality to new heights every day. What is our escape route if politics is represented by business that peddles a placebo in place of a cure? How long can this unsustainable system fuelled on bad credit continue to last? At what point will we awaken to realise the promises made to us were not so much a salve as it was an opiate to numb us to reality? If global politics is anything to go by, it will be some time yet. But considering our increasingly uninhabitable earth, by that point will it be too late? This article was originally published in The Malay Mail Online.
Knowing the unknowns
Helmy Haja Mydin To paraphrase the former United States Secretary of Defence Donald Rumsfeld, there are known knowns, known unknowns and unknown unknowns. As much as it may sound of gobbledygook, his comments can be applied to many situations including the developing novel coronavirus epidemic. Known knowns A form of the coronavirus that was hitherto unknown — hence the term “novel coronavirus” or nCoV — was identified in the Chinese city of Wuhan towards the end of 2019. Having most likely originated from animal sources, it is from the same family as the viruses that caused the Severe Acute Respiratory Syndrome (SARS) and Middle Eastern Respiratory Syndrome (MERS). Individuals affected appear to have symptoms very similar to patients with influenza. These include high fever, coughing and breathlessness. Pneumonia occurs in some cases and in very severe cases, multi-organ failure develops. There is no specific cure for the disease — healthcare workers support the body whilst waiting for the body’s immune system to fight off the viral infection. As of the 29th of January 2020, there have been more than 6000 cases worldwide, with the vast majority in China and others spread across more than a dozen countries. Of these, there have been more than 130 fatalities, mostly from the Hubei province. There is increasing evidence of spread between human beings, with people who have never visited China falling ill in Germany, Japan, Taiwan and Vietnam. Known unknowns There are two major concerns when dealing with infectious diseases — how easy it is to spread and how dangerous the disease is. For example, the common cold and conjunctivis or “pink eyes” spread very easily, but they rarely lead to severe disease and fatality. For influenza, America’s Centers for Disease Control and Prevention estimates that there were approximately 810 000 hospitalisations with 61 000 deaths. MERS-CoV is less contagious but is even more severe, with 35 per cent death amongst the approximately 2,500 confirmed cases. The evidence for nCoV so far seems to indicate that it spreads relatively easily, but is not particularly severe. The mortality rate seems to hover just below the 3 per cent mark, with most deaths associated with the elderly or those with underlying chronic diseases. The numbers are likely to rise significantly over the next few weeks. It is also worth bearing in mind that those who have mild symptoms are unlikely to seek medical help and may not be diagnosed. The real number of cases may thus be far higher than what the data indicates, which also means that the mortality rate may not be as high as suggested. However, we will not know the true extent of the “spreadability” and severity of nCoV until the situation stabilises over the next few weeks. The manner in which we respond collectively will also have a huge consequence on the economy. Oftentimes fear and anxiety have greater impact than the disease itself. While the manufacturers in healthcare products such as medicines, gloves and masks may see an increase in sales, nations’ balance sheets will be tipped into the red by increased public healthcare expenditure and a dip in travel, leisure, retail and energy consumption. The degree to which we are affected will depend on the severity as well as the duration of the perceived emergency. SARS cost the world economy approximately USD40 billion, and was felt by more than just the countries with positive cases as the world’s interconnected financial services and economies means that a domino effect takes place even if only a minority of countries in the supply chain are directly linked with the disease. Unknown unknowns The world’s increasing connectivity is both a boon and a bane. The Chinese government has obviously learnt a lesson from the SARS epidemic and have been very forthright in the sharing of data. It took a grand total of one day for the World Health Organisation to be alerted which has led to unprecedented levels of data sharing and analyses at an international level. High levels of transparency has led to quicker diagnostics, genome sequencing and reporting. It is hoped that this will lead to faster identification of treatment options and creation of vaccines. However, there is definitely room for improvement. Data can be shared in real time, with health ministries across the world sharing more granular data using HTML tables or CSV. Sharing infographics and visuals are helpful for strategic communications and public education, but do little to capitalise on the opportunity to crowdsource analytical prowess. While identification of confirmed cases is no doubt useful, we have the technology to do predictive analyses if sufficient good data is made readily available. This will not only guide the allocation of finite resources, but as with other experiences from machine learning, might uncover unexpected patterns that may prove useful in managing the epidemic. Digital connectivity has allowed healthcare workers to share treatment regimes and guidelines, but it has also bred large online clusters of misinformation and fake news that arguably spread even more rapidly than the nCoV. It is unfortunate that those with xenophobic and racist views have taken to stage to spout vitriol that is ostensibly a result of fear and anxiety. The degree to which this impacts society is difficult to predict, as the consequences will be felt both online and offline. Moving forward Fear is a potent paralytic agent, particularly when faced with the new and unknown. Malaysia’s Ministry of Health has been doing a commendable job of addressing concerns raised by the rakyat. It should continue to increase efforts at communicating in a timely and consistent manner, alongside the rest of the government machinery. It is not too early to identify weak spots in the handling of the crisis so far. These will allow us to avoid repetition and to ensure that future crises are dealt with in as efficient and effective a manner as possible. The nCoV is not the first respiratory virus epidemic, and it is definitely not going to be the last one. This article was originally published in the Malay Mail Online.
Lifting of MCO will not mean the Covid-19 pandemic is over
Helmy Haja Mydin Tehmina Kaoosji Let us be clear about one thing: the lifting of Malaysia’s Movement Control Order (MCO) will not mean that the Covid-19 pandemic is over. Viruses do not follow arbitrary deadlines set by us humans, and will continue to propagate. Over time, we can anticipate thousands more cases. However, there is a difference in treating 1000’s of cases a day vs a 1000 cases spread out over a month. The rationale of the MCO is to ‘flatten the curve’ i.e. to stretch the cases out over time so that our healthcare facilities and frontliners are not overwhelmed nor exposed to unmanageable viral loads, increasing their risks of contracting and succumbing to Covid-19. Stretching cases out is also particularly crucial for those who require a ventilator or to be admitted into the intensive care unit (ICU). We have less than a thousand ventilators across the country, and these are needed by non-Covid-19 patients as well. It is a mark of success that the number of Covid-19 patients requiring ventilators has remained less than 100, despite the increasing overall number of cases in Malaysia. This does not mean that we should rest on our laurels. This is especially true as we approach Ramadan and Hari Raya. Iranian’s experience with Nowruz this year should give us food for thought. Iran instituted a MCO-equivalent in late February, approximately a month before Nowruz, or the Persian New Year, which fell on 20th March . On February 20th, Iran recorded 5 Covid-19 cases and 2 deaths, by March 20th, this number had spiralled into a raging epidemic with 19,644 cases of infection and a staggering 1,433 deaths. This spike in Covid-19 cases occurred towards Nowruz as there was mass movement of people and families back to their hometowns for the celebrations. In fact, more than 1.2 million Iranians were recorded taking to the roads, despite pleas by the Iranian government for citizens to stay at home. Not helped by a lack of manpower to enforce the MCO and compounded by the government’s lack of resources to provide welfare payments to low-income workers the virus was thus spread to all parts of the country. Northern Iran, a more rural area with less medical facilities and a more elderly population, has been hit particularly severely by a pileup of cases at the hospitals. A similar scenario of human calamity is likely to occur in Malaysia should the government relax MCO restrictions prior to our traditional ‘balik kampung’ period during Ramadan and Hari Raya. Just try and imagine the tragic effects should urban dwellers in Covid-19 red zones like Lembah Pantai and Cheras disregard advisories and drive across the country to visit elderly relatives in states to the north and east of Malaysia, bringing with them the Covid-19 virus that is particularly lethal to those above the age of 65. However, we must also acknowledge that the continuation of the MCO in its current form is not without consequences either. There are many tales of woe regarding daily wage earners and SMEs that are unable to sustain their daily existence due to a lack of revenue. This does not even take into consideration the homeless, the stateless and the refugees who are very dependent on the largesse of society. With the above in mind, it becomes increasingly clear that although the MCO should continue for public health reasons it should be done in a less constricting fashion in order to minimise the socioeconomic repercussions. Social distancing must continue and be strictly enforced by security forces. This includes a ban on non essential interstate travel leading up and beyond Hari Raya. It may be heartbreaking to not visit elderly relatives during the festive season, but it will be more heartbreaking if the virus you transmit prevents your elderly relatives from living to celebrate Raya next year. The Ministry of Health can also work closely with the Ministry of Communications and Multimedia and the security forces under the centralised monitoring and management by the National Security Council to utilise location-based services to identify and track Covid-19 cases and their contacts. Identification of red zones based on live data and big data predictive analysis will allow for flexibility in imposing enhanced MCOs appropriately. Red zones can be targeted for increased levels of screening as well as more stringent restrictions on travelling and business operations. Conversely, green zones should be allowed greater freedom of movement and choice. The technology for real time adjustments already exists – it is a question of implementing it in a dynamic fashion that works across silos without being hampered by bureaucratic red tape. Mass congregations must continue to be prohibited – from religious activities such as tarawih prayers at mosques to retail such as Ramadan bazaars to cinemas, fitness classes, hedonistic nightclubs. More creative solutions can be tried and tested out to increase social distancing such as online digital Ramadan bazaars and online platforms for teleconferencing religious sermons. The public health and economic impact of the Covid-19 pandemic are two sides of the same coin, and must be managed concurrently. As the government moves to ease restrictions on businesses to ensure that supply chains are up and running and revenue streams are not exhausted, it is worth remembering that a study of the economic impact of the 1918 Spanish Flu in the United States found that cities that implemented early and extensive social distancing measures suffered less adverse economic effects over the medium term. The government must continue active measures of social distancing, including the MCO albeit in a more relaxed fashion. We have to accept that our social lives will have to change for the long haul and continue to be vigilant. Removing the MCO or falsely believing that the worst is behind us will likely lead to an overturning of all that we have achieved so far, and any future government stimulus will be used up for medical and funerary expenses. This article was originally published in The Malay Mail Online.
Lockdown Yang Perlu
Helmy Haja Mydin Tatkala Malaysia meneruskan pertempuran dengan pandemik yang tampaknya semakin berada di luar kawalan, kita berhadapan dengan dua pilihan yang amat sukar – menguatkuasakan satu ‘lockdown’ kebangsaan secara penuh, atau berisiko meruntuhkan sebuah sistem kesihatan dan pasukan barisan hadapannya yang kini sudahpun terlebih beban. Pakar kesihatan awam tidak mempunyai keraguan bahawa sebuah ‘lockdown’ yang menyeluruh, dengan bantuan sokongan sosial yang mencukupi, adalah amat perlu untuk memberhentikan penularan virus yang amat cepat ini. ‘Lockdown’ ini juga perlu dilaksanakan untuk satu tempoh yang akan membolehkan sistem kesihatan negara untuk mula dipulihkan. 18 hari pertama bulan Mei 2021 sahaja telah menyaksikan lebih 500 kematian yang berkaitan dengan Covid-19, iaitu bilangan kematian yang sama atas sebab tersebut untuk keseluruhan tahun 2020. Di lapangan juga, terdapat hospital yang telah melebihi kapasiti 100% dengan penggunaan hampir kesemua katil wad jagaan rapi (ICU). Terdapat kos ekonomi yang langsung serta tidak langsung apabila sesebuah sistem kesihatan itu telah runtuh. Berdasarkan demografi semasa, majoriti yang terkena jangkitan kini datangnya dari golongan umur bekerja. Setiap jangkitan itu akan menyebabkan pengasingan individu terkesan untuk sekurang-kurangnya 14 hari, dengan akibat fizikal serta psikologi untuk kontak rapat mereka di tempat kerja dan di rumah. Apabila digandakan dengan tempoh pandemik yang berterusan, kita akan dapat melihat bahawa gangguan yang berlaku tidak terhad kepada ekonomi dan kesihatan semata-mata, tetapi kepada persekolahan dan kehidupan peribadi. Namun, keputusan untuk melaksanakan ‘lockdown’ secara penuh kini dilengahkan atas sebab melindungi ekonomi. Negara-negara termaju dunia pun dilihat melaksanakan ‘lockdown’ penuh, walaupun mengetahui yang pandemik ini akan menggugat sumber-sumber fizikal dan manusianya. Di Malaysia, perintah kawalan pergerakan yang berubah-ubah – dan kini dalam edisi ketiga – hanya telah menyumbang kepada kekeliruan, dan boleh membawa kepada jurang kepercayaan yang semakin membesar sekiranya sekatan dilaksanakan tanpa mengutamakan pertimbangan saintifik dan kesihatan awam. Impak Sosioekonomi Kesan negatif sosioekonomi yang bakal terhasil dari pelaksanaan ‘lockdown’ ini tidak dapat dinafikan. Kebarangkalian untuk golongan berpendapatan rendah untuk melaksanakan kerja dari rumah adalah amat rendah, dan mendedahkan mereka kepada kehilangan pendapatan serta berisiko tinggi untuk dijangkiti Covid-19 semasa bekerja. Di dalam sebuah kajian yang difokuskan kepada impak Covid-19 pada tahun 2020, Tabung Kanak-kanak Antarabangsa Pertubuhan Bangsa-Bangsa Bersatu (UNICEF) dan Tabung Populasi PBB (UNFPA) telah mendapati yang berikut untuk Malaysia: > Sembilan daripada 10 orang miskin bandar bekerja sendiri tanpa liputan penggajian, > Empat daripada 10 ketua isi rumah wanita bergantung kepada bantuan kerajaan, > Enam daripada 10 isi rumah tidak mampu memberikan makanan yang mencukupi untuk kesemua ahli keluarga, > Satu daripada dua isi rumah tidak mampu membayar bil utiliti, pinjaman perumahan atau sewa mengikut masa yang ditetapkan, > Satu daripada empat isi rumah telah terpaksa mengurangkan pemakanan, > Satu daripada tiga isi rumah tidak mampu memberikan wang mencukupi untuk anakanak membeli makanan di sekolah. Bantuan tunai dan bakul makanan Rakyat sudahpun menanggung beban kesusahan ini dengan mengambil pendahuluan daripada simpanan Kumpulan Wang Simpanan Pekerja (KWSP) mereka, yang melihat pengeluaran wang persaraan peribadi sebanyak RM 78 bilion setakat ini. Namun, data menunjukkan bahawa golongan rentan masih tidak dapat memanfaatkan pengeluaran ini, apabila mengambilkira hampir 2.6 juta pencarum KWSP yang mempunyai kurang daripada RM 1,000 di dalam Akaun 1 mereka. Justeru, skim ini hanya akan bertindak sebagai bantuan kecemasan untuk golongan tertentu sahaja, dan tidak membantu mereka yang paling memerlukan. Apabila perniagaan tidak boleh dijalankan sepenuhnya, mereka tidak mempunyai pilihan melainkan bergantung kepada bantuan kerajaan untuk memastikan kelangsungan hidup. Tanggungjawab untuk melaksanakan ‘lockdown’ ini adalah berkait rapat dengan tanggungjawab untuk mengurus kesan sosioekonomi yang bakal terhasil. Kerajaan haruslah memastikan pemberian bantuan yang secukupnya kepada golongan paling terkesan tanpa mengira kawasan, termasuklah bantuan kewangan tunai dan juga bakul makanan. Pengurusan keperluan asas ini akan membantu memitigasi kesan ekonomi untuk jangka pendek dan sederhana. Golongan lain juga akan mendapat manfaat daripada moratorium pembayaran balik pinjaman ataupun intervensi mudah yang lain, seperti subsidi penuh bil utiliti yang dilakukan di Hong Kong. Pendidikan dan Prasarana Pelbagai kajian telah menunjukkan yang kemiskinan itu mempunyai pelbagai dimensi. Bantuan tunai secara terus akan membantu dari segi jangka pendek, tetapi dimensi kemiskinan yang lain juga perlu diberi perhatian, termasuklah akses kepada penjagaan kesihatan, pendidikan (khususnya apabila pengajaran dan pembelajaran dijalankan di rumah secara maya) dan/atau akses kepada infrastruktur awam. Kita tidak lagi boleh mengambil pendekatan seolah-olah terdapat hanya dua pilihan – iaitu memberi bantuan secara langsung atau bantuan secara tidak langsung kepada individu terkesan – tanpa mengambil kira faktor mempengaruhi kemiskinan yang sebenarnya sistemik dan fundamental. Dengan penutupan sekolah yang berterusan buat masa terdekat ini, penyediaan infrastruktur digital untuk pengajaran dan pembelajaran menjadi kritikal demi memastikan kesinambungan pendidikan. Kerajaan perlu mempercepatkan dan memperluaskan pengedaran peranti kepada pelajar-pelajar yang tidak mampu, dan seterusnya memastikan capaian Internet secara percuma serta stabil untuk seramai mungkin. Covid-19 telah menyebabkan kemudaratan yang amat signifikan kepada pendidikan, perkembangan kognitif, gizi pemakanan dan kesejahteraan am untuk kanak-kanak. Maka apa-apa langkah yang boleh diambil untuk menghentikan regresi ini perlulah dibuat dengan segera. Penjagaan Kesihatan Walaupun diyakinkan dengan kenyataan Jawatankuasa Khas Jaminan Akses Bekalan Vaksin Covid-19 (JKJAV) yang kadar vaksinasi harian kini menghampiri 100,000 dos (setakat penulisan ini), impak penuh hasil vaksinasi ini akan hanya ketara dalam beberapa minggu dari sekarang. Sementara itu, intervensi lain yang penting masih diperlukan untuk menghentikan kenaikan bilangan kes jangkitan. Ini termasuklah: > Menyokong usaha-usaha Kementerian Kesihatan dan Kementerian Pertahanan untuk mewujudkan katil-katil ‘ICU lapangan’, > Meningkatkan kapasiti pengesanan Covid-19 (khususnya proses pengesanan kontak rapat yang lebih cekap dan pelaburan di dalam teknologi membangun seperti kit ujian diagnostik sendiri di rumah yang akan membolehkan pengesanan kes yang lebih awal), > Mengutamakan SOP yang menitikberatkan pengudaraan ruang, memandangkan pengiktirafan badan seperti Pertubuhan Kesihatan Sedunia bahawa virus SARS-CoV2 merebak melalui udara, > Menyokong dasar bekerja dari rumah (BDR) bagi semua syarikat dan entiti yang berkemampuan bagi jangka masa terdekat, dan > Meningkatkan sokongan untuk perkhidmatan kesihatan mental, termasuklah menambahbaik perkhidmatan atas talian berkait. Peningkatan defisit fiskal Perbelanjaan tambahan adalah diperlukan untuk merealisasikan mekanismemekanisme yang disebut ini. Kementerian Kewangan tidak seharusnya mengutamakan kebimbangan tentang peningkatan defisit fiskal memandangkan keruncingan krisis kesihatan awam kali ini. Adalah menjadi sesuatu yang tidak beretika dan tidak bertanggungjawab untuk membiarkan krisis ini berlanjutan, lebihlebih lagi kerana jumlah rangsangan fiskal sebenar Malaysia hanyalah 4.7% daripada Keluaran Dalam Negara Kasar (KDNK), dan merupakan antara yang nisbah terkecil di rantau ASEAN ini. Satu jangkaan konservatif mengunjurkan bahawa kerajaan boleh mendapatkan sekurang-kurangnya RM 35 bilion melalui penerbitan sekuriti hutang untuk membiayai perbelanjaan ini, kerana kadar faedah yang masih menarik. Peningkatan perbelanjaan semata-mata adalah diakui bukan penyelesaian bersifat mutlak, malah ia mungkin menjejaskan taraf Malaysia di kalangan agensi penarafan antarabangsa sekiranya tidak diikuti dengan perancangan yang telus dan terperinci berhubung keutamaan perbelanjaan, serta strategi keluar yang jelas. Ini pula hanya boleh dicapai sekiranya Parlimen dibenarkan untuk bersidang secepat mungkin bagi memainkan peranannya sebagai semak dan imbang kepada cabang Eksekutif. Ahli falsafah dan sejarah Yuval Noah Hariri baru-baru ini ada menyatakan bahawa “Hari ini umat manusia mempunyai peralatan saintifik untuk mengalahkan Covid-19. Beberapa negara, dari Vietnam ke Australia, telah membuktikan bahawa walaupun tanpa vaksin, peralatan sedia ada mampu menghentikan epidemik ini. Namun, peralatan ini mempunyai kos ekonomi dan sosial yang cukup tinggi. Kita boleh mengalahkan virus ini – tetapi kita tidak pasti samada kita bersedia untuk membayar harga bagi kemenangan tersebut. Itulah sebab pencapaian saintifik meletakkan satu tanggungjawab yang cukup besar di atas bahu golongan ahli politik.” Sememangnya tidak ada syak bahawa kita berhadapan dengan satu situasi yang sangat kompleks dengan pilihan-pilihan yang cukup sukar. Ia merupakan satu situasi yang memerlukan semua pemegang taruh – khususnya ahli politik dari semua belah – untuk fokus kepada kesusahan yang sedang melanda rakyat. Ciri keunggulan kepimpinan ialah membuat keputusan yang sukar bagi pihak yang dipimpin, sambil memitigasi secara bertanggungjawab segala implikasi keputusan tersebut.
Malaysia is at a crossroads, of fear and hope of reform
Helmy Haja Mydin THE most potent paralytic agent is fear. In medicine, there are times for in-depth contemplation and there are moments when time is of the essence – a second's delay may result in death or permanent damage. In the latter scenarios, the key is to take in all relevant facts, analyse the data and make a decision that helps achieve our goals (in an emergency, it's the "simple" goal of keeping the patient alive). There is literally no time to be afraid as fear leads to a complete cessation of thought. In worst case scenarios, this can lead to a downward spiral resulting in the patient's deterioration. This, in turn, can prompt panicky interventions that ironically worsen matters. It would appear that Malaysia is coming to a standstill as a result of fear. Enough people voted for change during the watershed elections of May 2018. This was a time of hope and excitement, of high expectations that were not tampered by reality. Unfortunately these sentiments have since trundled down to fear and anxiety. Take our civil servants, the bedrock of the country. Many fear a witch-hunt, many are afraid of saying anything for fear of backlash. Career PTD officers have told me that they are reluctant to share their opinions – if they are seen as being too critical, the response can be directed at their individual persons rather than at the issue at hand. Some senior civil servants delay making any significant policy decisions for fear of upsetting their political masters. Some of these political masters (read: ministers) themselves are afraid of committing a faux pas and making fools of themselves. Some fear for their position, focusing on cementing their political strength instead of governing. Even as the civil service looks to them for direction, they defer decision-making to the Cabinet; oft-times even to our nonagenarian Prime Minister who undoubtedly has more than enough on his plate. Within the community, an increasing segment of Malays are afraid that their rights are eroding, while non-Malays fear increasing conservatism and extremism. Voices demanding a re-think of the social contract grow louder with each passing by-election. Everyone shares a common bond in their concern of the stagnating economy. Local businessmen are fearful for their future, lamenting the lack of direction and growth. GLCs (government-linked companies) fear making wrong moves, as many are unclear of their mandate. Foreign investors are not keen for fear of inconsistent policies. When people feel desperate, with no hope in sight, some will feel that the only option left is to pursue more divisive and dangerous routes, including increasing tribalism and ethnocentrism. The pattern throughout history and across the world is plain to see: when there is a struggle to put food on the table, altercations with "the Other" that would have previously been shrugged off, may spark outrage and fuel dissent. Such incidences may panic the state into intervening by either appealing to sentiment or imposing authoritarian measures, ostensibly for the good of society. When a doctor starts panicking, the patient usually ends up dead. Prevention, as they say, is better than cure. It is far better to address issues before they turn malignant. Most of us do not care about who holds what position or where, nor do we care about which politician is most popular on social media. The rakyat care about the cost of living, the opportunity to thrive, the reformation of our august institutions, and measures to improve our education, healthcare and social services. When leaders fail, it is sometimes up to the citizens to create a third force that can drive a national agenda. When the powers that be are too busy playing politics, we must make our voices heard and ensure that they are kept in line, just as when we should voice our support for each other when these same individuals attempt to revive the tired old tactics of racial politics. It is high time we separate the wheat from chaff, and get our leaders to take responsibility for their actions AND inaction. It is also time that we have some sense of hope and direction of where the country is heading; otherwise we will be left in a bloody mess from which there is no turning back. This article was originally published in The Star Online.
Measures needed to take care of our mental health
Helmy Haja Mydin
The Covid-19 pandemic has highlighted the global importance, as well as the lack of investment, in issues related to public health. Ensuring a fair and sustainable healthcare service is a goal that all countries must achieve in order to improve the well-being of their citizens. This monthly column, Health Matters, seeks to highlight how healthcare should not be viewed in isolation, as outcomes are very much dependent on socioeconomic issues and systems that are in place. One could even go so far as to say that your health and death is very much a function of your wealth. As today is National Day (Aug 31,2020), it would be fitting to start off the column on the theme for this year’s Merdeka and Malaysia Day celebrations: Malaysia Prihatin. When launched by Prime Minister Tan Sri Muhyiddin Yassin, he said that the theme emphasised the spirit of patriotism, unity and love for the country. “Prihatin” in Bahasa Malaysia also means “paying attention”. In the context of the Covid-19 pandemic, it is about paying attention to those who have unduly suffered from the impact of the SARS-CoV-2 virus. From Australia to Mexico, New York City to Kuala Lumpur, the events of the past few months have upended lives and disrupted not only our daily activities, but also the manner in which we view our present and future. While public health and economic disruptions have been obvious for all to see, there are other more pernicious issues that have developed since the start of the pandemic. Few have been more impactful than that of our mental health. Unseen effects Mental health disorders have been on the rise even before the Covid-19 pandemic. The 2019 National Health and Morbidity Survey (NHMS) reported that half a million Malaysians suffer from depression, with the highest numbers recorded in Putrajaya, Negri Sembilan and Perlis. Children were not excluded – a total of 424,000 children were reported to have mental health problems. These were mainly caused by interaction issues with peers, and behavioural, emotional and hyperactive-related problems. The rate of suicide is also a surrogate marker of underlying mental health disorders. More than 90% of those who attempt to commit suicide suffer from major psychiatric illnesses such as bipolar disorder and clinical depression. Even if you do not have an underlying mental health disease, the changes we are experiencing have a profound effect on our psyche, e.g. anxiety about contracting Covid-19, worry about placing food on the table for the family, the loneliness of social isolation and the guilt of possibly passing on the SARS-CoV-2 virus to an elderly loved one, to name just a few. Those in cramped spaces may also end up lashing out at one another, both verbally and physically. The consequence for adults may be obvious, but less so on children. Recently published research has demonstrated that even witnessing abuse carries the same risk of harm to a child’s mental health and learning as being abused directly. Children were also affected as a consequence of schools being shut and a change in their normal interactions with friends and peers. In fact, while we are busy dealing with the immediate consequences of these changes, nobody really knows how our psychological and social growth will be affected in the long term. Suggested measures There are many options when it comes to treating and improving mental health, but these require acknowledgement of the scale of the issue, as well as improving access for those who require treatment. Although local data is not available, it is very likely that the pandemic has delayed access to treatment for many who require the services of psychologists, counsellors and psychiatrists. This is as a consequence of both the physical lockdown, as well as the diversion of healthcare resources required to address the pandemic. There are three things that I would urge the government to address in order to help alleviate the suffering of those with mental health disorders: > Decriminalise suicide Section 309 of the Penal Code states “whoever attempts to commit suicide, and does any act towards the commission of such offence, shall be punished with imprisonment for a term which may extend to one year or with fine or with both”. This is an archaic approach to individuals who are suffering from a disease. A Magistrate’s Court recently fined an unemployed man RM3,000 for attempting to commit suicide. A few months ago, a 42-year-old man who attempted suicide by stabbing himself with fragments from a broken glass window was sentenced to one month in prison. A recent paper by science communication PhD student Eudora Ribeiro highlighted how severe global recession and substantial increases in unemployment and indebtedness are important risk factors for suicide. The paper highlighted examples from past crises, e.g. the 1997-1998 economic crisis saw more than 10,000 excess suicides in Japan, Hong Kong and Korea, and similar figures were associated with the 2007-2008 recession. Individuals who attempt to commit suicide are often at the end of their tether.They should be given prompt access and treatment to the care that they need, not be burdened by further punitive action.There should also be more effort to highlight the availability of suicide prevention services, e.g. Befrienders Malaysia. > Ringfence the budget for mental health services With the economic crisis we are facing, the temptation to reduce funding is likely lurking at every corner of the government.However, any Bill or supplementary/annual Budget that addresses the impact of Covid-19 on the rakyat should be done in a holistic fashion, and this includes ensuring that the mental health of our citizens is well looked after. Ensuring the availability of appropriate treatment involves not only the purchase of medication, but also a budget to train more psychologists, counsellors and psychiatrists. These are services that can be made more readily available online, as the need for physical examination is less, compared to physical ailments. These initial costs will translate to larger long-term savings. For example, there will be a decline in physical healthcare needs when individuals improve from mental illnesses. It is also worth noting that mental health disorders are a major cause of death among those of working age. With recovery, there will not only be improved productivity, but also reduced absenteeism. Just as with physical ailments, those who recover well will work better, thereby playing a more active role in the recovery of the economy. > Improve digital connectivity The pandemic has inadvertently brought digital disruption to the fore, including increased utilisation of digital technology in addressing mental health challenges. Telemedicine provides access to professionals based on a patient’s needs. Anecdotally, companies that provide telemedicine have seen a higher rate of use among those with mental health problems, as it provides more convenience and privacy. There are apps that not only monitor symptoms, but can also predict impending psychological breakdown. However, not everyone has the same level of digital access. There are significant financial and resource disparities within and between communities, and this can lead to significant gaps. I will address this in more detail in my next column (available online Sept 28,2020). It is unlikely that the changes forced upon us by the pandemic will dissipate anytime soon. The term “new normal” is being thrown about all the time, but it really is an apt description of how the manner in which we interact will not return to how it was even a year ago. Malaysia Prihatin appears to be a fitting theme for this year’s National Day and Malaysia Day celebrations. as we should not only be more aware of the disruptions our loved ones and neighbours are facing, but also be more empathetic towards them. This empathy should extend to not only those facing physical and socioeconomic challenges, but also those struggling psychologically, oftentimes in silence. This article was originally published in The Star Online.
Medicine for the economy
Prepared by Helmy Haja Mydin, Arif Astaman and Intan Nadia Jalil
MALAYSIA has just implemented a movement control order (MCO), a drastic but necessary social distancing measure to “flatten the curve” of the Covid-19 outbreak. The aim is to decelerate infection rates, thus preventing our healthcare facilities from being overwhelmed. However, the MCO will exert a toll on our economy. If prior to it, voluntary self-distancing and cross-border measures had led to a drastic drop in revenue for the tourism and hospitality sectors, the MCO will see a domino effect on almost all economic sectors. Economists expect production to at least halve in March. Micro and small businesses are on the brink of closure with disruptions to supply chains. In short, efforts to flatten the curve will lead to flattening the economy as well. This outcome is not inevitable. Other countries are demonstrating that it is possible to execute a plan that addresses the public health crisis while mitigating the effects of an economic recession and laying the groundwork for recovery. Using a medical metaphor, this action plan has three phases – triage, treatment and recovery. Given the urgency of the situation, we will focus on triage and treatment measures. A. Triage: Immediate measuresAs necessary as the MCO is, its abrupt and confusing implementation has led to significant disruptions to income streams and supply chains. The impact of these disruptions must be addressed urgently so that this temporary measure does not inflict permanent damage. Priorities include: > Ramping up the provision of personal protective equipment (PPE) and medical equipment. Supply chain disruptions have ranged from a drop in medical glove production to plastic factories being unable to supply plastic covers for patients. In a time of medical crisis, some key sectors should be ramping up production. For example, Malaysia produces 60% of the world’s rubber gloves; we should be asking our factories to scale up production in a time of global need. > Addressing loss of income: For the rakyat, cash transfers on top of existing cost of living assistance should be at the top of the agenda. Such measures have already been implemented in some form in Japan and Hong Kong. It provides rapid response to the loss of income suffered by all and its universal application minimises bureaucratic hurdles. For small businesses, there needs to be more in terms of support to keep them in business. Moratoriums on payments, assistance to pay for workers’ wages or government guaranteed loans to help businesses rebuild can go a long way in helping businesses to stay afloat. B. Treatment (now to month nine) and recovery (month 10 to 24) Most projections estimate that it will take 12 to 18 months for the Covid-19 pandemic to pass. In this period, the domestic and global economy will suffer. Unlike a typical recession caused by either a demand or supply shock, the pandemic means that the government will need to address both declines in demand and a drastic reduction in global capacity. We can expect the global economy in 2020 to resemble that of the 1929 recession and global financial crisis (2007-2008) combined. Given that it will take time for households and the private sector to recover, the government will need to cushion the impact of a likely recession and ensure that it is not unnecessarily protracted. This means that a comprehensive, sustained and substantive fiscal and economic survival and recovery package is needed to significantly ramp up the capacity of our health system in terms of test kits, medical equipment, infrastructure and human resources, rebuild domestic supply chains in essential goods and services to compensate for global disruptions, as well as incentives to ensure that businesses remain open and are able to take advantage of global economic recovery in the longer term. In short, we need to “flatten the curve” on the negative impacts of an economic recession in the medium term to support economic growth in the long term. The successful execution of such an action plan requires the following: > A Covid-19 task force that plans for, coordinates and implements these measures across all functions of the government, avoiding the silo effect and ongoing bureaucratic inefficiencies. The task force will also enable the action plan to be based on a set of common assumptions and projections. > A large-scale economic survival and recovery plan. The government released a RM67bil package to fight the global financial crisis. Given that the Covid-19 induced recession is likely to exact longer-lasting damage of higher magnitude, we call for a plan that is double this amount, financed by monetary expansion. This will require Parliament to be convened earlier than the planned date of May 18. This should be done as soon as possible, without politicians from either side of the aisle taking advantage of the situation. Our government must act quickly. Make no mistake, we are at war. The time for decisive action is now. This article was originally published in The Star Online.
More can be done for the visually impaired
Nabila Hussain In this age of digital communications, Braille is more relevant than ever as it is vital to the lives of tens of millions of blind, deafblind and visually-impaired people worldwide. Available in virtually every language, Braille provides endless possibilities for education, achievement and independence through literacy. Braille is one of the first forms of assistive technology, developed in 1829 by 15-year-old Louis Braille, a tactile representation of alphabetical and numerical symbols using raised dots to represent each letter and number. It can also depict musical, mathematical and scientific symbols. Braille is used by blind and partially-sighted people to read the same books and print materials as those published in a visual font. Braille allows people with low vision or visual impairments to have access to education, employment, information and cultural life. However, many establishments — restaurants, banks, hospitals and income tax offices — are not equipped with Braille menus, signs, financial statements or receipts. So people with blindness or vision impairment often do not have the freedom to choose their own meal or to keep their finances private. There are one billion people with visible disabilities worldwide. Globally, 39 million people are blind and 253 million have some form of vision impairment. In Malaysia, approximately 1.2 per cent of the population experience blindness. Life during the pandemic has highlighted issues of independence and isolation, especially for people who rely on the use of touch to communicate their needs and access information. People with disabilities could face a higher risk of infection due to a lack of access to guidelines and precautions. Up to 95 per cent of blind children do not attend school. This is primarily due to the lack of skilled teachers and limited access to Braille materials or equipment. For adults, Braille skills dramatically increase opportunities for entrepreneurship and employment, but employers are often unaware of the need for basics such as Braille paper or keyboards. Imagine a blind child trying to navigate online lessons, a newly-hired blind employee familiarising herself with online materials, or a blind business owner applying for government assistance during the pandemic. While there continues to be stigma and lack of awareness, we must realise that technology has changed the way we live, work and play, especially for people with disabilities. People with vision impairments can do just as much as people with sight, and often surpass their achievements. There are now blind engineers, blind chefs and even blind footballers. In fact, Malaysia's National Blind Football Team ranks top five in Asia and top 20 globally. Covid-19 has emphasised the need to intensify all activities related to digital accessibility and assistive technology to ensure social and economic inclusion of people of all abilities. Although technology has offered numerous alternatives to Braille in the form of audiobooks and screen readers, Braille literacy remains of paramount importance as it offers a building block for language skills and a means to teach spelling, grammar and punctuation. Learning Braille from a young age helps with literacy as Braille is a much better way to understand syntax and the rules of language compared to audio content. Technology should be seen as complementary to Braille; it plays an important role in amplifying human ability. However, we must remember it is not a substitute for Braille, enabling and empowering policies, or purposeful vision, action and inclusion. World Braille Day on Jan 4 (Louis Braille's birthday) is observed to raise awareness on the importance of Braille as a means of communication in the full realisation of the human rights for blind and partially-sighted people. The year 2021 marks the third global celebration of World Braille Day. This article was originally published in New Straits Times.
Poverty and Human Trafficking in Malaysia
Srre Vaishnavi Palanisamy During a recent search on 9th August 2022 at Kampung Sungai Udang, Klang, police freed six victims of human trafficking who were all migrants from forced labour. The case is now being examined under Section 44 of the Anti-Trafficking in Persons and Anti-Smuggling of Migrants Act 2007. This raises concerns about how prevalent human trafficking is in Malaysia and the level of its awareness among the general population. When considering crime often we typically think of murder, rape and theft. Not many of us are aware of human trafficking, a grave offence that occurs when someone is compelled into service. With 165 cases reported in 2020 compared to only 17 cases in 2008, human trafficking cases appear to be on the rise in Malaysia. From April 2020 to March 2021, the Malaysian government found and verified 119 victims of human trafficking out of 487 possible victims. Human trafficking and poverty Human trafficking is often referred to as a modern-day slavery for a variety of different purposes such as for forced labour, criminal activities, sexual exploitation or torgan removal. One of the primary causes of human trafficking is poverty. Malaysians as a whole have been let down by the current economic system in terms of wages, jobs, and wealth generation: 5.6% of Malaysian households are reportedly living in absolute poverty as of July 2020 when the country's national poverty line was most recently amended. Traffickers tend to target and exploit this group of people, promising them a means to make money. A lack of education may result in less prospects to find work that provides a living wage, alongside a potential lesser awareness of one's rights. According to Dr. Maszlee Malik, former education minister and Member of Parliament (MP), over a million Malaysian-born children are not in school. Besides, more than 30% of Malaysia's labour pool consists of migrant workers who are also at risk of falling victim to human or labour trafficking. These point at the weaknesses in our labour law that has the potential to lead to human trafficking. Additionally, Datuk Dr Madeline Berma, who is a human right activist and a member of Academy of Sciences Malaysia, claimed that probably one of the reasons Malaysia had become a primary focus for human trafficking networks was because the system had flaws that could be exploited. The loopholes through corruption are considered an obvious weakness. She added that the occurrence of widespread human trafficking activities at the nation's borders is unexpected, provided that they are well-guarded by law enforcement organisations with the necessary resources and training. It is speculated that multiple transit stations have been established by international human trafficking groups in the southern region of the neighbouring country to hold illegal immigrants, particularly those from Myanmar. According to Superintendent Mat Shukor Yusof, the commanding officer of the General Operations Force (GOF) Eighth battalion, the transit areas are utilised by human traffickers as temporary camps before the illegal immigrants are transported to Malaysia through the Kelantan border. In a recent incident, 13 people from Myanmar were apprehended on March 16, 2022 for unlawfully entering the country. When GOF members arrested the 13, which included two women, they were hiding behind bushes in Kampung Bakong. Addressing concerns The Anti-Trafficking in Persons and Anti-Smuggling of Migrants Act, often known as ATIPSOM(2007), was put into effect in 2008 by the Malaysian government in order to curtail the spread of this crime. The Council for Anti-Trafficking in Persons and Anti-Smuggling of Migrants (MAPO) was set up by the government in line with the ATIPSOM Act to coordinate the Act's implementation. Moreover, MAPO is entrusted with creating policies and initiatives to deter and combat Malaysia's migrant smuggling and human trafficking crimes. Since the council is made up of a number of ministries, law enforcement agencies, and other organisations including relevant NGOs, it also functions and behaves in an inclusive manner. Although a number of methods were initiated by the authorities, according to the US' Trafficking in Persons (TIP) report for 2022, Malaysia has still remained at Tier 3 with US authorities saying Putrajaya is not making considerable efforts to eradicate trafficking. It must be noted however that according to Putrajaya, a five-year national action plan against forced labour had also been adopted, which also emphasised that it had sentenced more traffickers to prison time than it had during the previous reporting period and had given out more freedom of movement passes to victims who had been recognised and were staying in government-funded shelters. To keep the nation from becoming a target of international human trafficking syndicates, border control procedures must be strengthened and flaws fixed, particularly those related to corruption. Governmental organisations need to take the issue more seriously by enacting stronger policies and laws. Local media has a significant obligation to inform the public about relevant issues and to cover incidents or problems regarding human trafficking. In order to raise public knowledge of the problem, community-level awareness campaigns against human trafficking and corruption need to be strengthened. The English politician and founder of the fight to abolish the slave trade, William Wilberforce, once said, "You may choose to look the other way, but you can never say again that you did not know”. Undoubtedly, human trafficking is a vile and cruel crime which is humiliating for humanity and a clear violation of human rights, such as the right to not be held in slavery or servitude as well as the right to freedom of movement and residence. More people are trafficked annually, with a growing number here in Malaysia, yet the response from authorities continues to fall short.
Recovered, but still suffering from long Covid
Helmy Haja Mydin Death is not the only bad outcome for those who contract COVID-19. Although there is a tendency to focus on the daily total numbers and the number of deaths, these figures do not paint the entire picture. There are many other consequences of the pandemic that are not made readily apparent by the daily statistics. One example is the impact of hospitals filled up with COVID-19 cases on the management and outcome of other diseases. Each occupied bed displaces another case, just as each case reviewed by a doctor takes away time from another case. This has implications on the manner and timing in which other conditions are diagnosed and treated. Although the vast majority of patients infected with the SARS-CoV-2 virus remain thankfully asymptomatic, those who do develop symptoms and survive do not always get away Scot-free. Long-COVID-19 Syndrome The level of severity and risk of complications from COVID-19 are higher in the elderly and those with comorbidities such as diabetes, kidney disease, heart failure, cancer and obesity. Symptoms related to COVID-19 manifest in different ways, and the duration differs between individuals. These do not always correlate with the level of severity or presence of complications. Prolonged symptoms that persist beyond 12 weeks of the start of the disease are part of the so-called Long-COVID-19 Syndrome, which is more common amongst those with complicated or severe illness. They can be classified into a number of subgroups: Respiratory - breathlessness, coughing and need for supplemental oxygen. Symptoms and impact on the quality of life are higher in those who have significant damage to the lung tissue especially scarring of the lungs (fibrosis). Mental Health - anxiety, depression, sleep disturbances, post-traumatic stress disorder, headaches and a disturbance or slowing down cognitive function (known as ‘brain fog’) Cardiac - palpitations, chest pain Blood clots Miscellaneous - fatigue, muscle ache, generalised weakness, joint ache, hair loss. Studies from China, the United States and Europe have shown that the most common symptoms are breathlessness, fatigue and anxiety/depression. A study in Italy found that 87.4% of patients discharged from hospital who recovered from COVID-19 still had symptoms at day 60. More than 50% complained of fatigue, approximately 40% had breathlessness and 44.1% felt that they had a decline in their quality of life. A study published in the latest edition of the journal The Lancet Psychiatry found that one in three COVID-19 survivors was diagnosed with a neurological or psychiatric ailment within six months of infection with the SARS-CoV-2 virus. The study, which looked at 230 000 patient health records, identified the most common mental health conditions as anxiety disorders, mood disorders (such as depression), substance misuse disorders and insomnia. The neurological conditions included diagnoses such as strokes and dementia. Long-term care As symptoms present themselves in a variety of ways, it is only logical that long-term care is ideally handled by a multidisciplinary team that not only assesses and manages the physical aspects of rehabilitation, but the mental health aspects as well. Besides doctors, there is a need to rope in psychiatrists, psychologists, physiotherapists and occupational therapists. Besides specifically addressing the above, nutritional and rehabilitation needs must be taken into account and appropriate intervention introduced early. All long-term COVID-19 follow-up studies have noted significant declines in quality of life and function. Severe COVID-19 can cause muscle wasting and feeding difficulties, which when combined with malnutrition can worsen both physical and psychological outcomes. Globally, there are increasing numbers of patient advocacy and support groups. Many of these are on social media platforms such as Facebook. They provide a space for patients to share their struggles, which may prove to be cathartic. For some, it is an avenue to learn from the experiences of others and to be more aware of the stories behind the numbers. Healthcare workers need to remind themselves that care does not conclude at discharge. From a management perspective, we must proactively identify those at higher risk of long-term complications, and to screen for the conditions listed above, especially mental health. These can be done in person, or with increasingly available telemedicine tools. Future needs As we see the number of active cases go up, it is inevitable that we will have more patients with long COVID-19 syndrome. Policymakers will need to provide the necessary funding as services will need to be rejigged in anticipation of increasing needs. The public has a more important role - we are at the frontline of the disease, and many of us need to be less nonchalant regarding the ongoing risks of the SARS-CoV-2 virus. The more cases there are, the more complications there will be. It is imperative that we continue to adhere to the SOPs in place, especially the use of masks, physical distancing and avoiding closed, crowded and poorly ventilated areas. Last but not least, we must take advantage of the blessing that we have in the form of COVID-19 vaccines. Many countries are still without access, and as we increase momentum in Phase 2 of the national vaccination programme, it is worth reminding ourselves that this modern miracle of science has been proven time and again to decrease the incidence of severe COVID-19 disease. Dr Helmy Haja Mydin is a respiratory physician and the head of the Lung Centre at Pantai Hospital Kuala Lumpur. This article was originally published in The Star Online.