Malaysia Health Promotion for Stroke
- Introduction
Stroke is caused by a blood clot forming on one of the arteries to the brain (Anon, 2014). The resulting blockage interferes with brain function and the body loses optimum function. There are degrees of severity, ranging from impaired speech to major disability or death. Early detection improves recovery.
Malaysia is experiencing increases in incidences of stroke related to lifestyle. Approximately 11.6% of all deaths each year are attributed to stroke (WorldLifeExpectancy, 2004). It is the second leading cause of death and in the top five causes of disability in the country. Malaysia is a low-to-middle income country, but the government allots only 4% of its gross domestic product budget on healthcare (Who.int, 2014)).
Chinese immigrants are the second-largest ethnic group in Malaysia, comprising 24.6% of the population (Cia.gov, 2014). The influence of traditional Asian medical treatment is seen in acceptance of methods such as acupuncture and herbs in integrative care with Western medicine (Wellness, 2013).
The environmental causes for stroke are alcohol and tobacco consumption, obesity, and high blood pressure. Government and non-government organizations have become actively involved in programs for stroke prevention. A pro-active program of public education, improvement of treatment in medical centers, and legislative motions addressing curtailment of contributing factors will result in decreased incidences of stroke and improvement in recovery following episodes.
2. Major Contributing Factors to Hypertension
The major factor influencing stroke is hypertension. The Mayo Clinic defines hypertension as high blood pressure. Statistically, the numbers of patients with hypertension in Malaysia increase daily. Rampal (2008) states that although there are high numbers of patients suffering from hypertension in Malaysia, the general population is relatively ignorant of opportunities for control and treatment. He felt it was crucial to establish an intervention health program that was population-based; it was important the program be comprehensive to the risks, treatment, and rehabilitation aspects of hypertension and stroke. Ahmad (2014) states lowering a person’s blood pressure reduces the chance of stroke by 35–40%. He goes on to show that in Malaysia 27% of the population suffers from hypertension. The statement translates to 1 in 4 adults betweenthe ages of 25 and 64 have the disease. There are 1.4 million know patients and 1.7 million newly diagnosed. In terms of race, Chinese comprised the largest group of patient, follow by Malays at 23.4% and Indians at 21.6%.
The average age of a Malaysian stroke patient is between 54.5 and 62.6 years of age (Statistics.gov, 2014). Although there is a shortage of surveys and studies recently, The Star newspaper reported there were 11 new stroke cases every hour in the country (Killer, 2007). In 2007, Health Minister Datuk Seri Dr Chua Soi Lek stated 30% of Malaysia adult population suffered from hypertension (Cruez, 2007). High cholesterol, diabetes, and obesity also contribute to hypertension. In Malaysia, 3 million people have high cholesterol levels in their blood and 2.1 million suffer from diabetes. Twenty-five percent of the citizens of Malaysia suffer from obesity, the highest in Asia. Hypertension is treated with drugs for lowering blood pressure and diuretics and regular visits to a physician. The office visits give the doctor the opportunity to adjust medication if needed and look for symptoms of possible stroke or heart attack.
Loo (2012) conducted a small study in Malaysia and stated that although reports previously did not link hyperlipidemia (Beltina.org, 2104) to stroke, he found most of his patients had the condition. Loo feels the high amounts of fatty substances in the blood is a risk factor for patients in Malaysia for stroke.The major risk factors for stroke are considered to be poor diet, smoking, and lack of exercise (Cruez, 2007). In addition older people, men, and heredity factors contribute to the disease.
3. Health Promotion
Using Beattie’s Model of Health Promotion, there are four ways to improve the statistics on stroke for Malaysia (Garside, 2014).
Legislative action.
The government in Malaysia needs to contribute more to the prevention of stroke. There are some agencies functioning for care after discharge. Non-profit organization such as the National Stroke Association of Malaysia have strong programs for rehabilitation after stroke. However, in 2007, only 10% recovered fully (Cruez, 2007). That year, Health Minister Datuk Seri Dr Chua Soi Lek stated the ministry had developed a number of methods to reduce the incidence of stroke in the country. He felt the best strategy included educating the public on recognizing early symptoms and their causes. The Ninth Malaysia Plan established the Health Promotion Board for activities related to that goal. To provide funding, the ministry set aside RM37 million. Dr. Chua also donated RM100,000 for the National Stroke Association of Malaysia to increase its programs. However, Stuart and Thomas (2005) stated that government intervention alone does not produce the desired results for a health promotion program because receivers of assistance develop a “victim” attitude. For that reason, the other three components of the model are used.
The Malaysian population is lacking in resources for medical care. In 2009, there were only 63 neurosurgeons and 64 neurologists available in the country for the treatment of stroke patients (Loo, 2012). Due to the influence of a large number of Chinese immigrants in the country, traditional treatment is performed in some of the hospitals (Nuar, 2010). These treatments include herbs, scalp and body massage, and acupuncture. As study conducted by the Kansas college of Chinese medicine and Wesley Rehabilitation Hospital determined patients receiving conventional western rehabilitation programs from multiple disciplines improved more when acupuncture was included (Wellness, 2013). Measurements included ability for self-care, cognition, mobility, and placement after discharge (home or facility). Traditional Asian therapy is more readily available to the typically low-income Malayan than Western technology.
Personal counseling.
Using a health professional, personal counseling works to empower the person recovering from stroke to set his own goals and develop a plan to achieve them. Rather than a program teaching the patient ways to change, personal counseling allows him to change himself. However, it is possible for this to take place inside a government program.
Community Development.
Community development activities function in a manner similar to personal counseling but address groups rather than individuals (Naidoo and Wills, 2008). An example of this is community groups. These reach out to Malayan people who cannot come to a medical center or enroll with a professional for individual counseling. These can be funded by the government, but some work apart. Also, a facilitator may bring his own opinions to the training, and there have been instances of resources being diverted from their intended purpose (Stuart and Thomas, 2005).
Health persuasion techniques.
There are a number of ways to start the process of health persuasion. One is to contact the health professionals, reinforcing patient education. Legislation by the government or medical facilities has the opportunity to mandate patient teaching, also. Public information dispersed in the media through agencies or the government takes the form of print, radio, and television. Health instruction is effective with the next generation by incorporating the health education into the school system for children; the students take the information back to their families in the form of oral presentation and/or printed material.
Several factors enter into the ability of programs to influence the individual. Wills and Earle (2007) discuss how an individual’s basic health information, how motivated they are, general concepts for rehabilitation, and how confident they are in their ability to recover influence reception to the training.
4. Ethics
When introducing a health program as expansive as addressing stroke in the Malayan population, it is important to judge when the methods begin to incorporate coercion. The objectives of the organization or individual should be based on the good of the patient(s) and not on personal gain. Power in organizations or individuals should be monitored to prevent intervention not approved by the majority. Individuals should never feel they are being forced into compliance.
Respect for Autonomy
Individuals have the right to choose their behavior when it comes to their health. If they are capable of rational thought and do not want to use the information offered, they have the freedom to do so. When assistance is offered to the public, a person should have the option to refuse the help. But the government and other organizations have the responsibility to inform Malayans of their health risks and assist them whenever possible.
Beneficence
Acts that are beneficial and that remove harm are for the good of the population. Smoking in America is restricted to certain areas and the practice is expensive. Movies no longer depict smoking as attractive or elegant. It is illegal for children to buy tobacco or use it. These types of legislation are for the good of the citizens, but some feel it is intruding on their autonomy.
Non-Maleficience
Above all, the health promotion program should not bring harm to any member of the community. There is a responsibility to be sure information is accurate and conveyed in a fashion that is respectful to the individual. Assistance is optional and available as much as resources allow; it is structured and monitored to avoid the possibility of graft or incompetence.
Justice
There is no member of the population that should be denied assistance and information for any reason. Race, age, gender, income or education level, or any other categorization is not a reason to deny services. Services should be distributed equally by the organizations and their leaders.
5. Effectiveness of Promotion
It is difficult to perceive long-term effectives of programs outside the area of science due to the lack of ability to precisely define content. Therefore, it is important to watch for evaluation designs that incorporate different types of research methodologies. By using a wide range of data and its sources, results provide more information relevant to the program. It may be necessary to create methodologies specific to certain aspects of the health program, individualizing them for individual circumstances.
6. The Malayan National Health Program Against Stroke (MNHPAS)
The national health initiative for the prevention and treatment of stroke has begun in 2007 when Health Minister Datuk Seri Dr Chua Soi Lek pledged government support. Since then, programs have floundered for lack of management under a central agency. In that light, the Malayan National Health Program Against Stroke is granted permission by the ministry to coordinate the activities of the various agencies dedicated to the effort. Director Sam Bishop began the impetus by forming committees from the government and non-profit agencies on record. Gathering information from the public and private sectors, he appointed a staff to address issues in each division.
Mary Poppins, Head of Community Coordination, is listing the various community programs throughout Malaysia and contacting their facilitators. While many centers are focused on rehabilitation efforts, clinics also need to include anti-smoking and nutrition classes. Madelyn Lee is a certified nutritionist and is in charge of developing a curriculum and collection of healthy recipes for free distribution through the public relations department. The curriculum will be encouraged in the centers for continuing education and cooking classes will be opened to the public. Since approximately one-fifth of the population of Malaysia is of Chinese descent, Mary has appointed Christian Dingerman to investigate the Chinese community for acupuncturists, massage therapist, and herbalists willing work with the health centers in their communities to incorporate traditional medicine into the classes. In addition to obtaining schedules, class content, and instructor credentials Mary is planning to visit as many sites as possible to evaluate the impact on the community. Records have been loosely kept, and Mary is developing a list of criteria for the centers. She also is attempting to determine how each center is being funded. She is assisted by a staff of assistants assigned to the major cities to facilitate activities.
Chester Hall is Head of Information Technology. He and his team have begun to coordinate data entry into a system to keep information at the fingertips of the staff. He is also in charge of developing and evaluating the measurement methodologies for the program. It is essential a baseline of results is quickly gathered for comparison after the program has been in place for a period of time.
Cassandra Nelson is Head of Institutional Coordination. She has the vast responsibility of evaluating current practices at the major medical centers. Ahmad (2014) found patients were non-compliant, physicians were not trained when to treat hypertension or what the goals should be. They do not use correct pharmaceuticals and patients with secondary hypertension are escaping detection. Armed with this information, Cassandra has a formidable task ahead with a physician education initiative. After consultation with representatives from the facilities, she and her team will produce a list of mandated responsibilities for teaching patients risks of stroke and how to avoid them. Ultimately, one of her responsibilities is to create a department within each facility of over five doctors to maintain a standard of teaching and treating stroke patients.
As Head of Public Relations, Mathew Johnson works with a group of talented media technicians to produce informational material for distribution. Working with the television stations, he is obtaining public service announcements to instruct the public about the risks of strokes and encourage them to attend training at centers in their area. In addition, he is gathering the names of healthcare professionals willing to volunteer for individual counseling for patients determined to respond best to this type of intervention. Mathew is currently working with Malayan celebrities for radio and television informational spots.
The staff of MNHPAS is optimistic that within two years, the steady increase in the incidence of stroke in Malaysia will halt. Within five years, after evaluating the programs and making adjustments where needed, the statistics on stroke will begin to decrease.
7. Conclusion
The population of Malaysia suffers from the economic and social impact of high incidences of stroke. Officials in the government are advised to promote development of healthcare; providing efficient prevention and treatment aids the economy and the populace. It is crucial to take steps focusing on prevention which costs much less than treatment. In the case of stroke and the accompanying health factors, properly managed care reduces severity and the subsequent associated costs. Government officials require persuasion to allocate more of the national budget to the prevention and treatment of stroke for the benefit of the country and its citizens. Through the planning and implementation of programs addressing the risk factors of stroke, treatment, and rehabilitation, incidences of stroke in Malaysia will decrease.
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