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HISTORICAL PERSPECTIVE

Hospital Universiti Sains Malaysia (HUSM):25 Years Of Excellent Service

Zaidun KamariDirector, Hospital Universiti Sains Malaysia, Jln Raja Perempuan Zainab II, 16150 Kubang Kerian, Kelantan, Malaysia

Submitted: 1 October 2008 Accepted: 30 December 2008

Abstract

OurHospitalUniversitySainsMalaysia(HUSM)wasgiventheCabinetapprovaltoexistundertheMinistryofEducationon23November1982.TheDeputyPrimeMinisterduringthatperiod,YangBerhormat TunMusaHitamannounced this after the cabinetmeetingwasheld togetherwith thepresenceof theYangBerhormatMinistersofHealth;andEducation,Directorof thePublicWorksDepartmentandtheImplementationandCoordinatingUnit,PrimeMinister’sDepartment.Thefirstpatientsmovedinon14March1983andtheinaugurationofHUSMwasdoneon26August1984bytheDuliYangMahaMuliaTuankuIsmailPetraIbniAl-MarhumSultanYahyaPetra,theSultanofKelantanDarulNaim.HUSMcelebratedit’s25thanniversaryattheDewanUtama,USMHealthCampusonthe15thDecember2008whichwasinauguratedbyYangBerhormat,MinisterofHigherEducationDato’SeriMohamedKhaledNordin.USM’sViceChancellorProfessorTanSriDato’DzulkifliAbdulRazak,ChairmanoftheUSMBoardofDirectorsTanSriDato’HajiDr.AnibinArope,HealthCampusDirectorProfessorDato’Dr.MafauzyMohamed, former CampusDirector,Dato’ ProfMohdRoslani AbdulMajid, thecurrentandpreviousHospitalDirectorsandDeputyDirectorssince1983werepresent.TheachievementsofHUSMsinceitsestablishmentanditsvisiontofulfiltheUniversity’sAcceleratedProgrammeforExcellence(APEX)areelaborated.

KelantanDarulNaim is oneof the 14 statesof Malaysia. It is located on the East Coast ofPeninsular Malaysia, facing the South ChinaSea, with an area of 14,922 square kilometres,representing 4.4% of the total area of the entirePeninsularMalaysia(Figure1). Historically, the state of Kelantan devoteditself to cultivating Islamic knowledge. Hugenumbersof‘Pondok’institutionswhichwerenearlysimilartothemadrasahestablishedincertainareasofthestate. This phenomenon led to the foundation offamous religious teachers or ulama that activelypromoted Islamic education. Because of theimportanceofIslamiclearningthere,KelantanwasnicknamedMalaysia’s“SerambiMekah”(Figure2). During that period, one Haji Mohd. YusoffAhmad, better known as “Tok Kenali” by many,wasborninKampongKenali,KubangKerianKotaBharu in 1870 (1287H). Kubang Kerian, then asmall village located six kilometres from KotaBharu, started to grow in 1983 when a federalgovernment project established a health campusthere.

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Figure1: KelantanDarulNaimonthemapofPeninsularMalaysia.

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Kubang Kerian became known when the HealthCampus of Universiti SainsMalaysia (USM) wasdevelopedin1983on72.84hectaresofpaddylandthathadbeenpreviouslyownedbypoor farmers.This led to the beginning of a new era of healthsciences in Kelantan. It gradually came to be arealityoveraperiodoftwenty-fiveyears. The Health Campus of Universiti SainsMalaysia (USM), an establishment of higherlearninginmedicalscience,becameknownastheHospital Universiti Sains Malaysia (HUSM) in1983(Figure3).HUSMhasbeenheadedbyseveraldirectors,namedasfollows(Figure4to6): i.Dr.KamaruzamanWanSu(1983to1992) ii.Dr.HajiRamliSaad(1992to2005) iii.Dr.ZaidunKamari(2005topresent) The director is assisted by three deputydirectorsandtheheadsofthevariousdepartmentsandunits.Atpresent,2,672staffmembersworkatHUSMinmanagementandclinicaldisciplines.Arecord of excellent community service has made

thenameofHUSMbetterrecognised in the localcommunity.Basedonthisfact,HUSMisregardedasoneofthebestteachinghospitalsinKelantanandtheEastCoast.Furthermore,withnewapproachesto improve services, new specialist clinics havebeendevelopedtoprovidebettertreatmenttotheEastCoastcommunity. The mission of Hospital University ScienceMalaysia,“toprovidenewpatientservicesandthusbecomeafull-fledgedmedicalcentrethatprovidesonly excellent services using the latest medicaltechnology breakthroughs”, will become a realitysoon. To achieve this goal, HUSM (Figure 7) hastakenproactivestepsinordertobeknownas:

1) A referral hospital that provides a higherlevel of medical science, dentistry andgeneralhealthservicestothepublic.

2)Ateachinghospitalthatprovideslearningand research facilities in the fields ofmedical science, dentistry and generalhealth.

Figure2: ThecentreofKotaBharu,Kelantan,orbetterknowastheIstanaBalaiBesarsquare

Figure 4: First director of HUSM (1983-1992)Prof.Dr.KamaruzamanWanSu

Figure5: SeconddirectorofHUSM(1992-2005)Dr.HajiRamliSaad

Figure3: ThecentreofKotaBharu,Kelantan,orbetterknowastheIstanaBalaiBesarsquare

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is headed by both cardiac medical and surgicalspecialists and is supported by paramedicalstaff.At thismoment there are2perfusionists, 5surgical nurses and 21 CICU nurses (10 cardiac-trainednursesand11nursesundergoingin-housetraining).Inaddition,HUSMhadaMemorandumof Understanding (MoU) with the NationalCardiology Institute (IJN) regarding technicalequipment as well as progressive paramedicaltrainingandexpertisetraining. The first three patients who underwentsuccessfulcardiothoracicoperationswere:

HUSM provides treatment services to itspatients based on dedicated administration andmanagement approaches using high qualityservices,acommitmenttoteachingandresearch,optimalfinancialstrategies,corehumanresourcesvalues, and sensitivity to the social needs of theEastCoastcommunity. Inordertocompeteattheinternationallevel,HUSM has initiated a few centre of excellenceprojects, such as Cardiology and CardiothoracicSurgery, Burn and Reconstructive Surgery,Neurosciences,andTissueBanking. TheCardiothoracicserviceswereestablishedto help the patients who needed heart and lungsurgery,aswellastofunctionasacardiothoracicsurgicalresourcecentreontheEastCoastofWestMalaysia. It also provides an invaluable learningexposuretoheartandlungsurgerytothemedicalfraternity (undergraduates and post graduatesstudents in biomedical sciences) and the nursingstudents in line with HUSM’s functions as ateachinghospital. Theservicesthatareavailableinthisunitareopen-heart surgery (such as closure of septaldefects), valve replacement and coronary arterybypassgrafting,closed-heartsurgerywithligationof patent ductus arteriosus, pericardectomy,lung surgery, and mediastinum growth removal.HUSM provides invasive and non-invasivecardiology services such as echo cardiogram andcardiac+angiogram in the Invasive CardiologyLaboratorywherecardiologistsareabletoperforminvasiveprocedures like coronary angiogramandcoronary angioplasty (Figure 8). HUSM has alsoestablished special units to cater patients withheart problems: the Cardiac Intensive Care unit(CICU), providing intensive care post surgery,andtheCardiacHighDependencyUnit.TheCICU

Figure6: DirectorofHUSM(2005-present)Dr.ZaidunKamari

Figure 7: Officiation of the Hospital UniversitiSainsMalaysiaon26thofAugust1984bytheDuliYang Maha Mulia Tuanku Ismail Petra Ibni Al-MarhumSultanYahyaPetra.

Figure 8: Officiation of the Hospital UniversitiSainsMalaysiaon26thofAugust1984bytheDuliYang Maha Mulia Tuanku Ismail Petra Ibni Al-MarhumSultanYahyaPetra.

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1) Aten Gemok, 19 years old, and PuanHamidahMat,37yearsold,forclosureofarterialseptaldefects

2) EncikAzahariZakaria,47yearsold, forcoronaryarterybypasssurgery.

The operations were headed by a cardiacsurgeon from IJN and HUSM’S cardiothoracicsurgeon, Prof Madya Dr Mohamad Ziyadi HajiGhazali.ThesesuccessstoriesstartedaneweraofsurgeryforlocalpatientsfromtheEastCoast.Thecurrenttypesofsurgeryperformedare:

i. Coronaryarterybypassgraftingii. Valvereplacementiii. Closureofseptaldefectiv. Closed-heartsurgeryv. Open-heartsurgeryvi. Thoracicandmediastinalsurgeryvii. Trauma(Heart/Lung)viii.Ligationofpatentductusarteriosus

HUSM hopes that these services will maketheir mark and that HUSM will thus become areferral centre for thosewhoneed experthelp inheartandlungsurgery,aswellasbeingoneofthetraining centres for cardiothoracic surgeons inMalaysia.

Neurosciences

This project was initiated in early 1984and became a second project with the followingobjectivesforHUSM:

1) Tobe the centreof academic excellenceinthefieldofNeurosciences.

2) To be a resource centre offering high-level, neuroscience-based medical andsurgicalservices.

3) Tobe a leader inneuroscience researchand innovations at the national andinternationallevels.

4) Tobeatrainingcentreinvariousbiohealthsciencefieldssuchasbasic,appliedandclinicalneurosciencesincludingpainandspinalsurgery(neurology,neurosurgery,neuropsychology and neurosciences)(Figure9to10).

WiththeestablishmentoftheNeuroscienceUnitin2001,whichbecameadepartmentin2004,HUSMhasmadehistorybybecomingthefirstlocaluniversity to offer a Masters in Surgery(Neurosurgery)programin2001andanAdvancedMastersofInternalMedicine(Neurology)in2007with thecooperationof theMinistryofHealthofMalaysia and other local universities. It has also

offeredMScandPhDprogramsinNeurosciencessince2004.Thisdepartmenthasbeenrecognisedas themost active unit in research, especially inthefieldofTraumaticBrainInjury,HaemorrhagicStrokeandNeuroncologyinSoutheastAsia. As an active department in internationalresearch, it has contributed to studies such asCRASH, STICH, VITATOPS, ENOS, HAMLET,PERFORM,PROFESSandRescueICPstudy. Majlis KanserNegara (MAKNA) has chosenthe Department of Neuroscience as a place toconduct research for a new brain cancer vaccinewiththecollaborationofUniversityPutraMalaysia.Inaddition, theDepartmentofNeurosciencewasassignedasconsultantsfortheDewanBahasadanPustaka, a body responsible and advancementof the Malay language in Malaysia, regardingneurosciencesterminology. Another project that proves HUSM tobe an excellent hospital is the development ofthe Burn Injury Treatment Unit, under theReconstructive Science Unit (Figure 11). This

Figure9: Neurosciencespatientsbeingmanagedbymultimodalitymonitoring

Figure10: NeurosciencesIntensiveCareUnit

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servicewasestablishedwiththeobjectivetocreateacomprehensivehealingprogramforburnvictimsandtoreturnthesevictimstotheircommunitiesinthehighestpossiblephysically,psychologicallyandsociallyfunctionalstate. TheseserviceswereincorporatedintotheBurnUnit.

1)Treatment forburnvictimsfromtheearlystagesofinjury.

2) Continuous treatment by developing anetwork of long-term support, includingrehabilitation.

3)Atrainingcentreforburnvictimtreatment procedures.4)Preparingtrainingandeducationfor

paramedicsandthecommunityinvariousaspects such as prevention, first aid,treatment,andrecoveryprocedures.

5)Researchintomedicaltechnologyrelatedtothemanagementofburncases.

6)Supportingactivities forburnvictimsandtheir close relatives such as “BurnCamp”and“BurnSupportGroup”.

7)Establishmentofoutreachservicesprogramandeducationforthecommunitythroughfire prevention programs, fire treatmentprogramsandfireawarenessprograms inschools.

The actions of PETRONAS have made HUSMproud. They sponsored the travel of patientZawardyAbdulLatiff,whohadseriousthirddegreeburninjuries,fromTexasintheUnitedStatesforfollow-uptreatments. In its effort to create a successful unit, thestaffhasbeensenttovariousotherinstitutionstoimprovetheirskillsandknowledgeregardingburnvictims’treatmentandmanagement(Figure12).

Theseinitiativesinclude:1)RequestsforfiretreatmentprotocolsfromHospitalUniversitiKebangsaanMalaysia2)AttachmentofHUSMstaffattheFireBurn TreatmentCentreinHKL3)Astudy-visitprogramtoBeverwijkBurnCentre,Amsterdam

4)LearningfromtheexperiencedstaffattheCentre of Fire Burn and ReconstructiveSurgeryinSingaporeGeneralHospital.

StereotacticRadiosurgeryisanotherstrengthof HUSM, and it has a multimodality treatmentgroup which make it one of the better cancertreatmentcentresinthecountrytoday. InMay2002,HUSMmadehistoryagainwhenit successfully performed radiosurgery on “HeadandNeckCancer”usingaminimultileafcollimatorforthefirsttimeinMalaysia. ThisexcellentworkbytheHUSMunitsallowsustolookforwardtonewlevelofserviceonparwithotherinternationalmedicalcentresthroughouttheworld. HUSMalsooffersanOut-PatientServicewhichconsistsof:

1)ACommunityMedicineClinicthatisopenonallworkingdaysfrom8:30a.m.until4:30p.m.

2)ASpecialistClinicopenfromSaturdaytoWednesdaywherepatientsareseenbyreferralsandappointments

3) An Accident and Emergency Unit that isopenaroundtheclocktoattendtoallkindsofurgentcases

Figure11: ReconstructiveproceduredoneinHUSM

Figure12: BurnWard

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Asateachinghospitalandareferralcentre,HUSMhasundertakenthechallengetoprovidethebest in-patient services possible. Relevantspecialists who are also lecturers in the SchoolofMedical Sciences, Dental Sciences andHealthSciencesareappointedasconsultantsonallcasesbeingtreatedinHUSM(Figure13).

HUSM has numerous important supportservicessuchastheDepartmentofRadiology,theDepartmentofNuclearMedicine,andthedifferentDiagnosticLaboratoriesandClinicalDepartments.The Blood Bank supplies blood and bloodcomponentsaswellasotherhaematological testsand screening. The Physiotherapy Unit and theHaemodialysis Unit provide necessary therapiesfor certain patients. The Dietetics Unit preparesfoodforallin-patientsandoffersdietcounsellingservices. The Laundry Unit ensures a constantsupplyoflinentothewardswhiletheHousekeepingUnitisresponsibleforthecleanlinessofallgeneralareasinthehospital. The Department of Pharmacy at HUSMis one-of-a-kind in Malaysia (Figure 14). Itsservices go beyond dispensing and therapeuticdrug monitoring services. The department isalso involved in the clinicalpharmacy trainingofthe pharmacy students in their final year at theuniversity. The Medical Records Unit handles theregistration of all patients that seek treatment.(Figure 15). It also provides research facilitieswhere access to patients’medical records for thedoctors andmedical undergraduates is provided.ThisunitisauthorisedbytheNationalRegistrationDepartment to issue birth certificates for babiesborn in HUSM as well as death certificates.Moreover, medical reports for legal proceedings

arealsodealtwithbythisunit. In addition, there are several facilities forpatientsandtheirfamilies,(Figure16and17)suchas:

1)DesaRakyat-Accommodationforpatients’relatives/familiesatreasonablerates

2)Asportscomplexespeciallyforthecampuscommunity,butavailabletothepubliconrequest

3) A bank and post office that provide bothcounterandautomatedservices.

4)Agolfcoursewheremembershipisopentoallhealthcampusstaff.

Figure13: HospitalUniversitiSainsMalaysiain2009

Figure14: Out-patientPharmacy

Figure15: MedicalRecordsUnit

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5) Town bus and taxi service – town busesservice the campuswhile a taxi station issituatedoutsidetheHUSMmaingate.

Conclusion

Hospital USM beganwith a 36-bed in 1983andnowprovidesa747-bedservice.Overthepast25years, ithasachievedexcellencedespitebeingsituatedintheEastCoastofPeninsularMalaysia.Over the courseof thepast fewMalaysianPlans,HUSM has managed to be both a service andclinical research centre of excellence with theestablishmentofnewbuildings,servicesandunitsin the 9thMalaysian Plan. USMwas selected asanAPEXUniversity on September 3, 2008, thusgiving HUSM more responsibility for the healthcampusandUSMasawholetoincreaseitsimpactand presence in the national and internationalfieldsofresearchandpublication.

Correspondence

Dr.ZaidunKamariP.S.K.,MBBCh(Mansourah),M.S.Opthal.(UKM),A.M.(Malaysia)DirectorHospitalUniversitiSainsMalaysia,HealthCampus,JalanSultanahZainabII,16150KubangKerian,Kelantan,MalaysiaTel:+609-7642133Fax:+609-7652198Email:zaidun@kb.usm.my

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