Confirmed Minutes of the 10th Conference of the Medical Association of South East Asian Nations (MASEAN) held from 15 - 18 November 2001 at the Hotel Cambodiana, Phnom Penh, Cambodia
PARTICIPANTS AT THE 10TH MASEAN CONFERENCE MASEAN COUNTRIES Ministry of Health, Bandar Seri Begawan (Official Observer, MASEAN) Cambodia Medical Association (MASEAN Member) DELEGATES Dr Kenneth Kok
Prof Sau Sok Khonn Prof Sea Huong Dr Touch Sareth Prof Mom Choth Dr Hu Bun Kim Prof Seang Tharith Dr Dok Chan Ly Dr Ouk Saphay Dr Chou Pin Dr Sar Polin Dr Keo Sokun
Indonesian Medical Association (MASEAN Member) Medical Association of LAO PDR (Official Observer, MASEAN)
Prof Dr Farid A. Moeloek, President Elect Dr Fachmi Idris, M. Kes, Secretary General Dr Kongsap Akkhavong Dr Bovakhan Phakounthong
Malaysia Medical Association (MASEAN Member)
Datuk Dr N. Athimulam, President Dr A. Radhakrishna S., Vice Chairman, MMA Negeri Sembilan Branch Dr Davaraj Balasingh, Honorary Deputy General Secretary (1) Dr P Vythilingam, Honorary Deputy General Secretary (2)
Myanmar Medical Association (MASEAN Member)
Prof Kyaw Myint Naing, Vice President Dr Sein Thaung, Joint Secretary General Prof Daw Myint Myint Khin, Member Dr. Myo Thant, Member No Delegate
Philippines Medical Association (MASEAN Member)
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Singapore Medical Association (MASEAN Member)
Dr Wong Chiang Yin, 2nd Vice President Dr Yue Wai Mun, Honorary Secretary Dr Tan Sze Wee, Honorary Asst Treasurer Dr T Thirumoorthy, Director, Centre for Medical Ethics & Professionalism Dr Kachit Choopanya, Past President Dr Supachai Ratamamaneechat, Committee Member Dr Sakesom Suvarnakara, Committee Member
Medical Association of Thailand (MASEAN Member)
Vietnam General Association of Medicine & Pharmacy (MASEAN Member)
Prof Dang Duc Trach, President Prof Nguyen Duy Cuong, Vice President Dr Tran Huu Thang, Secretary General Prof Duong Thi Cuong, Executive Member Dr Nguyen Quoc Trung, Deputy Director Permanent Bureau
NON-MASEAN COUNTRY OBSERVERS Australian College of Rural and Remote Medicine (ACRRM) (Observer NGO) MASEAN SECRETARIAT MASEAN Secretariat hosted by the Singapore Medical Association Prof Cheong Pak Yean, Secretary General, MASEAN Ms Regina Chin, MASEAN Secretariat Officer (Web Administrator) Mr Phil Heffeman, Project Manager Mr John Grundy, Public Health Advisor
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FRIDAY – 16TH NOVEMBER 2001 1.0 OPENING CEREMONY 1.1 The ceremony commenced with the National Anthem of the Kingdom of Cambodia. In the opening speech by Outgoing Chairman of MASEAN Prof Dang Duc Trach, President of VGAMP sent the warmest greetings to the Guest of Honour, Samdech HUN SEN, Prime Minister of the Kingdom of Cambodia and all the distinguished guests and representatives of doctors in the ASEAN countries. He said that in the past year, members of VGAMP and the Chairman of MASEAN paid working visits to the medical associations of Singapore, Malaysia, Myanmar and Cambodia. He commended the choice of the themes of the four symposiums chosen for this conference and was confident that in the spirit of unity and development, the active contribution of all the participants will make the conference a success. He then handed over the Medallion of Office of Chairman of MASEAN to Prof Sau Sokkhonn of the Cambodian Medical Association. 1.2 The Senior Minister and Minister of Health, H.E. HONG SUN HUOT indicated his strong support to all activities of the Cambodian Medical Association. In particular, he mentioned Continuing Medical Education and the strengthening of health laws and regulation (ethics and professionalism to improve the quality of healthcare. 1.3 Samdech HUN SEN said that this meeting is taking place at a crucial junction in both regional and national context. As the topic of this conference suggests, ASEAN‟s health system is in transition, and affected by the financial turmoil in 1997 and the tragic events of September 2001 in the USA. New challenges also need to be confronted, such as HIV, AIDS, and Tuberculosis. At the national level, Cambodia has embarked on a far-reaching health sector reform including the introduction of fiscal decentralisation to improve health delivery at the grassroots level. He said that Cambodia is ready to cooperate with other MASEAN Members to raise the health status of the people in the region in general. In particular, he hoped that the cooperation would lead to more training to improve healthcare in Cambodia to meet the regional healthcare standards. He went on to inform the conference of the organisational and financial reforms implemented since 1996 to strengthen the healthcare system in Cambodia. He was proud that Cambodia has made significant success in some areas, such as a steady decline of the prevalence of HIV/ AIDS among adults from 3.9% in 1997 to 2.8% in 2001. He was very pleased to note that the conference has focused on important healthcare issues and wished the conference every success. He then declared the 10th MASEAN Conference open. The traditional group photo of the Head of Delegations with the VIPs was then taken. 2.0 BUSINESS MEETING 1 2.1 Business Meeting 1 was chaired by the Secretary General, A/Prof Cheong Pak Yean. He invited one representative from each MASEAN member country to present their country report. This was done according to alphabetical order, beginning with Cambodia Medical Association. Member countries, with the exception of Philippines which was not present, took turn to report on their association‟s activities and their country‟s recent healthcare developments. The full reports are posted on the MASEAN Website at http://www.masean.org.
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2.2 Cambodia Report delivered by Dr Touch Sareth The Cambodian Medical Association (CMA) participated in various international and regional medical meetings in 2000/01. The Medical Council of Cambodia was established in 6th July 2001 with the active participation of the CMA. CMA looks towards further developing the association by co-operating with NGO in development of health services, advising members on ethical matters, extending and promoting CMA branches at the central and provincial levels and assisting in the working group for establishing a process for election to the Medical Council. 2.3 Indonesia Report by Dr. Fachmi Idris Uncertainty in global and regional economic situation has affect healthcare delivery in Indonesia. A national conference was held in Nov 2000 to restructure IMA. At the central level, aside from the central executive board, there are two other structures, namely the Academy of Medicine and the Honorary Board of Medical Ethics. In response to a question about malpractice insurance, Dr. Fachmi Idris said that IMA co-ordinates with third parties such as insurance companies and encourages its members to take up such coverage. Internal activities in 2001 include planning and co-ordinating events in Medical Ethics and medical professional education in close working relationship with the MOH and MoF. A task force for Family Medicine was formed and a new website www.idionline.org was launched on August 24 2001. Malpractice issues, the use of methadone to combat heroin addiction and CME point system are also looked into. IMA has collaborated with the Ministry of Health in a draft for establishing a National Medical Council what will oversee good medical practices in Indonesia. It has also worked with the Association of Pharmaceutical Companies to declare a joint statement regarding the ethical sales and promotion of medicine. 2.4 Laos Report presented by Dr Kongsap Akkhavong Laos is still in the process of forming a national medical association for doctors. In 1999, experts from Vietnam assisted in the formulation of a document for setting up the Laos Medical Association. The Ministry of Justice has since proposed revision and adjustments of some articles in line with the real situation in the country. Dr.Kongsap is confident that in one or two years, the Laos Medical Association would be set up. Dr Kongsap also gave an overview of the healthcare system, medical education and health expenditure of Laos and mentioned problems due to the different systems of medical education in his country. 2.5 Malaysia report presented by Datuk Dr Athimulam Medical students are actively encouraged to join MMA. MMA has negotiated with the British Medical Association to provide free student edition of BMJ to these student members. It has liaised with government agencies on various programmes for example on equitable managed care system. Advertisement of traditional medicine in the media is a problem and the MMA stand is that such alternative practitioners should be registered and that traditional medical practice should not be merged with western (allopathic) medicine. The health of foreign medical workers is also of concern and medical examinations done by doctors (FOMEMA) for M$60 are mandatory for them. An on-line system of reporting and monitoring of these examinations has been set up and a diploma of occupational safety and health has been started. Private hospitals have been active in promoting “medical tourism” and the number of foreigners treated has increased from 33,000 (1993) to 70,000 (2000). The MMA stand is that such hospitals while provided specialist and in-patient services should not also provide primary health care to compete with general practitioners. Regular meetings with pharmaceutical trades about the escalating cost of medicine have been started. Schemes for government doctors to have limited private practice would be brought up with the government. As to issue of compulsory HIV testing for young adults applying for marriage
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license advocated by a Muslim group, the MMA supported by the Malaysian AIDS Council successfully opposed that on ethical and professional grounds. 2.6 Myanmar report presented by Prof Kyaw Myint Naing Prof Kyaw gave an overview of the structure and activities of the MyMA. Representatives attended various international meeting such as the annual conference of the Australian Medical Association. Projects with NGO such as UNICEF, UNDP-UNFPA and Family Planning Assistance (USA) have been carried out. It also participated in many national public health programmes such as national health plan activities, and organized social activities for its members. Prizes in memory of Dr San Baw, Dr, Pe Thien, Dr Khin Maung Win and the microbiology prize were inaugurated. 2.7 Singapore report presented by Dr Yue Wai Mun A strategic planning session was held to discuss the work-plan and the budget for the year and how SMA could collaborate with various sister bodies. Under the Centre for Medical Ethics and Professionalism, SMA organized the Annual Ethics Convention in Nov 2001 to discuss maid employments, Bolam‟s test and ethical issues regarding informed consent. Other educational activities are monthly sessions on Bioethics and health law and other practice management issues. Singapore introduced the Faculty Practice Plan which allows public sector doctors to do some private practice and also the schemes which allow private doctors to work part-time in public system. A CCCP scheme (chronic continuing care partnership) scheme was introduced to enable general practitioners to provide subsidized care for indigent elderly patients. Two statutory boards, the Health Promotion Board and the Health Science Authorities were set up. The Traditional Chinese Medicine Practitioner Act 2000 was passed which provided for eventual registration of all such practitioners starting with acupuncturists. 2.8 Thailand report presented by Dr Sakesom Suvarnakara Dr Sakesom Suvarnakara said that the Thai Medical Association (MAT) is organising a review course in basic medical science and clinical practice for graduates from abroad who are preparing for the medical license examinations. The course is held in Siriraj hospital and medical school. The Council Members of the association visited neighbouring medical associations. Scholarships and awards for Thai doctors to extend their studies abroad and in Thailand were given. MAT also had a number of publications and events to celebrate the 80th anniversary of MAT. The 45th Annual Scientific Meeting was held in Oct/ Nov 2001. MAT is also involved in CME, which doctors have to participate in. 2.9 Vietnam by Dr Tran Huu Thang The VGAMP has developed good working relationship with many national medical associations such as that of Malaysia, Myanmar, Singapore and Thailand. It has also developed good relationships with the Chinese Medical Association and with CMMAO. 3.0 DISCUSSION OF COUNTRY REPORTS 3.1 During the panel discussion that followed the country reports, the regulation of Traditional Medicine was discussed. MMA felt that proper training certification from China, Indonesia or India respectively is necessary as there are actually three systems of traditional medical practice in Malaysia. MMA also believes that later nationally organized courses are necessary. It felt that the practice of traditional medicine should be subjected to same rules and annual certification applied to registered medical practitioners and that traditional practitioners must not be allowed to use the term „doctor‟. 3.2 Dr Wong Chiang Yin from Singapore said that the practice of Traditional Chinese Medicine in Singapore should be governed by training, standards and not permitting
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misrepresentation. The Singapore standard is pecked to a 3-year diploma standard for TCM as practiced in China- this standard applies to all new TCM Practitioners. Existing practitioners are automatically registered if they are in full-time in practice for ten years or more while those with less than ten years must go through interviews and/or examinations. Unlike the practice as in China where traditional Chinese medicine is allowed to practise side by side with allopathic medicine, Singapore does not allow this practice for example the use of antibiotics by traditional Chinese physicians. 3.3 The question of who has the authority of awarding CME points was raised.. Both Thailand and Singapore said that their national medical councils are the authorities. Malaysia at present issues its own CME points though CME is not compulsory. When it becomes compulsory, it would ask the government to allow it to issue CME points even when it is compulsory. Indonesia Medical Association issues the CME points which are needed for Indonesian doctors to get re-registration. Dr Fachmi of IMA asked the SMA about the relation with Consumer organizations. In reply, Dr Wong CY said that in Singapore, CASE which is the consumer watchdog has a close working relationship with SMA and has worked together on matters such as unsubstantiated beauty claims. 4.0 BUSINESS MEETING 2 4.1 Minutes of MASEAN Mid-Term Conference in Yangon, Myanmar, Nov 2000 The minutes were proposed to be passed by Malaysian Medical Association and was seconded by the Singapore Medical Association. 4.2 Report of the MASEAN Secretariat
A/Prof Cheong Pak Yean read out the secretariat report (see appendix 1). Prof Moeloek commended the Secretariat for the work done and enquired about the funding of the Secretariat. Dr Yue Wai Mun of SMA said that secretariat is wholly funded and staff is provided by SMA with A/Prof Cheong providing his service in an honorary position. Prof. Cheong gave a historical perspective about how MASEAN meetings were not held for many years prior to the 7th MASEAN Conference in Singapore in April 1995 because of an inactive secretariat. It was unable to obtain information about the accounts kept. The former Secretary General Dr Primitivo Chua though elected when he held office in the Filipino Medical Association was no longer with it. It was felt that because of this bad experience, that the Secretary General should be designated by the national medical association elected to host the secretariat so that the officer bearer would be accountable to MASEAN through the MMA. It was then felt that if a national medical association is prepared to fund the expenditure, no membership fee need be collected. Dr Yue Wai Mun, Hon Gen Sec of SMA said that his current Council will support the secretariat for its present term ending 2003. The meeting decided that when the secretariat hosting is up for consideration again in 2003, the matter of collecting annual subscription fee and the funding of the secretariat should be brought up for discussion. Ms Regina Chin then gave a demonstration of the MASEAN website.
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Discussion on Proposed Amendments to MASEAN By-Laws Dr Yue Wai Mun for the Singapore Medical Association brought up for discussion proposed changes in the by-laws (see appendix 2). The consensus is to accept the proposals but it would be brought up again for affirmation as the constitution specify that three months‟ notice must be given for amendments. However the meeting felt that the spirit of these amendments can be put into effect immediately. 4.4 Report by Chairman of Task Force on GATS & AFAS
Dr S. Radhakrisha reported on behalf of Datuk Dr P. Krishnan (see appendix 3). The report of the task force was accepted -proposal by Thailand and seconded by Myanmar. A/Prof Cheong Pak Yean proposed that Dr. Radhakrisha for MMA be the author of a MASEAN position paper on this subject based on the report of the task force. Dr Athimulam President of the MMA accepted the project. 4.5 Mid-Term MASEAN Meeting The Secretary invited members present to host the next mid-term MASEAN Meeting in 2002. SMA was affirmed as the host. 11th MASEAN Conference Meeting in Indonesia 2003
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The Indonesian Medical Association accepted with acclamation to be the host of the 11th MASEAN meeting. 4.7 Presentation by observer from Australian College of Rural and Remote Medicine Mr Phil Heffeman project officer of ACRRM gave a brief presentation on his organisation.
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SATURDAY – 17TH NOVEMBER 2001 5.0 SYMPOSIUMS The topics of the four symposiums, which were decided at the last MASEAN meeting, were held in conjunction with the 10th MASEAN Conference. The topics were: 1. Integration & Harmonisation of the Medical Organisations 2. Telehealth 3. Medical Ethics & Professionalism 4. Continuing Medical Education
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5.2 SYMPOSIUM 1: “INTEGRATION & HARMONISATION OF THE MEDICAL ORGANISATIONS” Keynote by Indonesia Medical Association F.A Moeloek of Indonesia presented the keynote (see appendix 4)
5.3 SYMPOSIUM 2: “TELEHEALTH” Dr Davaraj Balasingh gave a presentation on Telehealth in Malaysia (see appendix 5). Dr Wong Chiang Yin gave a presentation on Telehealth in Singapore (see appendix 5A). 5.4 SYMPOSIUM 3: “MEDICAL ETHICS & PROFESSIONALISM” Dr T. Thirumoorthy gave the keynote presentation on ethics and professionalism (see appendix 6). Other panel members were from: 1. Cambodian Medical Association 2. Medical Association of Thailand 3. Vietnam General Association of Medicine & Pharmacy 4. Indonesian Medical Association 5. Myanmar Medical Association 5.5 SYMPOSIUM 4: “CONTINUING MEDICAL EDUCATION” Prof Kyaw Myint Naing, Vice President from Myanmar Medical Association, gave the keynote address (see appendix 7). Other panel members were from: 1. Cambodian Medical Association 2. Malaysian Medical Association 3. Singapore Medical Association 4. Vietnam General Association of Medicine & Pharmacy
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6.0 Closing Ceremony The Chairman of MASEAN Prof. Sok Khonn thanks all the participants for contributing to the successful conference and read out the MASEAN resolutions for affirmation 6.1 MASEAN Resolutions MASEAN Resolution Number One 2001 Arising from the consensus reached in the symposium on “INTEGRATION & HARMONISATION OF THE MEDICAL ORGANISATIONS”, and recognising the important contribution of Family Physicians to the healthcare of the people of ASEAN, The 10th MASEAN Conference hereby resolves to Adopt as the theme of the 11th MASEAN Conference to be held in Indonesia the training, financing system and delivery structure of family medicine and primary care in the context of the whole healthcare system. Proposed by Indonesian Medical Association, and seconded by Singapore Medical Association.
MASEAN Resolution Number Two 2001 Recognising the critical role of mutual trust and respect as the basic ingredient in a doctor patient relationship and the importance of medical professionalism, ethics, and health law in achieving the Goals of Medicine and building trust between the medical profession, patient, and society. The 10th MASEAN Conference Resolves To Promote the development of medical professionalism, ethics, and health law on a long-term basis. It should do so immediately by organising seminars during the MASEAN Mid-term Meeting in 2002 in Singapore. MASEAN members and doctors from ASEAN countries would be invited to participate in these educational activities; Include in future MASEAN Conference a meeting of Chairman and Members of Ethics Committees of member associations for exchange of experience in resolving ethical dilemmas; and Exchange information and provide links to websites relating to medical ethics and professionalism
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Proposed by Malaysia Medical Association and seconded by Indonesia Medical Association.
6.2 Thank You Speeches & Presentation of Mementoes by Delegations 6.3 The MASEAN Flag was handed by Prof Sau Sok Khonn to Dr Wong Chiang Yin, head of the Singapore delegation which would host the mid-term meeting in the year 2002 in Singapore.
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7.0 The Office Bearers of MASEAN Council 2001-2003 MASEAN Council 2001-2003 Chairman : Prof Sau Sokkhonn (Cambodia) Vice Chairman : Prof A. Moeloek (Indonesia) Secretary General : Assoc. Prof Cheong Pak Yean (Singapore) Deputy Secretary General : Dr Seang Tharith (Cambodia) MASEAN Council Members (Two from each member country, one of which must be the incumbent President of the National Medical Association, unless he is already one of the Office Bearers) Cambodian Medical Association Dr Touch Sareth Prof Sea Houng Indonesian Medical Association Prof Ahmad (President) Dr Fachmi Idris, M. Kes Malaysian Medical Association Dr N Athimulam (President) Dr P Vythilingam Myanmar Medical Association Prof Myo Myint (President) Prof Kyaw Myint Naing Singapore Medical Association Prof Low Cheng Hock (President) Dr Wong Chiang Yin Medical Association of Thailand To be given later. Vietnam General Association of Medicine and Pharmacy Pr. Dang Duc Trach (President) Dr. Tran Huu Thang MASEAN Secretariat (1999-2003) Assoc. Prof Cheong Pak Yean Secretary-General, MASEAN Ms Krysania Tan Secretariat Officer Ms Regina Tan Information Officer c/o Singapore Medical Association No. 2 College Road Singapore 169850 Tel: 65-2231264 Fax: 65-2247827 E-mail: masean@masean.org MASEAN Website : www.masean.org
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