Malaysia’s experience in promoting Traditional & Complementary Dr.Teo Chiah Shean, MD Traditional & Complementary Medicine (T&CM) : Medicine Division Ministry of Health Malaysia Malay Postnatal 31st May 2015 Massage in Beijing State Presentation Flow . Development of T&CM in Malaysia Traditional & . Classification of T&CM 1. Overview of Traditional . T&CM services in integrated hospitals Complementaryand Complementary Medicine in Malaysia Medicine 2. Malay Postnatal TraditionalMassage & Complementary in the MedicineIntegrated Division Hospital & MinistryHealth of Health Clinic Malaysia in Johor State

The Definition

Practice of traditional and complementary medicine means a form of health-related practice designed to prevent, treat or manage ailment or illness or preserve the mental and physical well-being of an individual and includes such practices as traditional Malay medicine, traditional Chinese medicine, traditional Indian medicine and complementary therapies, but excludes medical and dental practices used by a medical and dental practitioner respectively.

Traditional and Complementary Medicine Act 2013 Important milestone in the development of T&CM in Malaysia 1987 Preparation of proposal for research in alternative 2000 medicine Launch of Herbal Medical Research Centre 1996 Formation of the Traditional & 2002 Complementary Medicine (TC&M) unit under the Family Establishment of Global Health Development Division Information Hub and National Committee in R&D on Herbal Medicine

1990 1995 2000 2005

1998 2004 Establishment of TC&M Establishment of the TC&M standing committee division in Ministry of Health

2001 1999 Launch of National Policy Formation of five umbrella on TC&M bodies for TC&M 2013 2007 MAWIP Kepala Batas Hospital 2010 Likas Hospital Sultanah Bahiyah 2008 Hospital National Cancer Putrajaya Institute Hospital Port Dickson Hospital 2011 T&CM Act 2013 Sultan Ismail Sultanah Hajjah was gazetted Hospital Sarawak General Kalsom Hospital 2012 Hospital Cheras Strategy of T&CM 2009 Raja Perempuan Rehabilitation in Primary Health 2015 Sultanah Nur T&CM Branch Zainab II Hospital Hospital Care was T&CM Zahirah Hospital Offices in north, launched Branch south, east zones T&CM Branch T&CM Bill 2012 2014 Office in Duchess of Kent and Sarawak Office in Sabah was passed in Masai Health Jasin Perak was Hospital were established was established Parliament Clinic Hospital established

2005 2010 2011 2012 2013 2014 2015

Important milestones in the development of T&CM in Malaysia National Policy of Traditional and Complementary Medicine

Traditional &complementary system (T&CM) shall be an important component of the healthcare system. It will co- exist with modern medicine and contribute towards enhancing the health and quality of life of all Malaysians.

National Policy of Traditional and Complementary Medicine Ministry of Health Malaysia 2007

Classification of Traditional & Complementary Medicine

Traditional & Complementary Medicine

Traditional Homeopathy Islamic Medicine Complementary

Chinese

Indian

Malay Regulate the practice of T&CM practitioners

Facilitate and as a collaborator for Ensure all T&CM research and practitioners undergo scientific evaluation formalized system of of T&CM education and training

Regulation and monitoring of accredited learning Establish a registry of all centers, setting the quality T&CM practitioners and standards of T&CM programmes

Facilitate the development of standards and criteria in T&CM

Roles and functions of T&CM Division Divisions related to the Traditional and Complementary Medicine sector in Malaysia

Products Practice Practitioners Research

Sales of Drugs Act Traditional & National Poison Act Complementary Act 2013 Committee on Dangerous Drugs Act Research and Development of Medicinal Herbs Drug Control T&CM Authority Council

National Traditional & Complementary Institute of Medical Pharmaceutical Medicine Division Research Control Bureau http://tcm.moh.gov.my/v4 T&CMD Website New Branch Office PERAK

Tel: 088-237602/ 088-237603 Fax: 088-237609

Jalan Tun Abang Haji Openg 93590 KUCHING Tel : 6082-233 346 Fax : 6082-233 341

T&CM Branch Offices in Malaysia Practising Integrative Medicine Cover Story Fit4Life, The Star 27 July 2008 T&CM Units in Public Health Care Facilities under the Ministry of Health 2015

11. CHERAS REHABILITATION HOSPITAL 12. PUSAT BERSALIN BERISIKO RENDAH MAIWP 13. NATIONAL CANCER INSTITUTE PUTRAJAYA 14. LIKAS HOSPITAL SABAH 15. MASAI HEALTH CLINIC JOHOR 16. JASIN HOSPITAL MALACCA

Patient Referral System

Hospital Specialist / Medical Officer

Medical Officer in charge of T&CM unit hospital

Practitioners

* Referred patient must be under supervision of hospital Specialist / medical officer T&CM Services in Government Hospitals

Herbal Traditional Therapy as Malay Malay Adjunct Acupuncture Shirodhara massage Postnatal Treatment for Massage Cancer Patients

Kepala Batas Hospital Kepala Batas Hospital Sultan Ismail Hospital

Sultan Ismail Hospital Sultan Ismail Hospital Kepala Batas Hospital Putrajaya Hospital Putrajaya Hospital Port Dickson Hospital Sultanah Nur Zahirah Sultanah Nur Zahirah Hospital Hospital Sultanah Nur Zahirah Duchess of Kent Hospital Hospital Sarawak General Hospital Duchess of Kent Sultan Ismail Hospital Sultanah Bahiyah Sultanah Bahiyah Hospital Hospital Hospital

Port Dickson Hospital Port Dickson Hospital Sultanah Bahiyah Hospital Sultanah Hajjah Sultanah Hajjah Kalsom Hospital Kalsom Hospital Cheras Raja Perempuan Raja Perempuan Raja Perempuan Rehabilitation Zainab II Hospital Hospital Zainab II Hospital Zainab II Hospital Putrajaya Hospital Cheras Rehabilitation Cheras Rehabilitation Hospital Hospital National Cancer MAIWP Likas Hospital Institute Number of Patients Receiving Treatment in T&CM Units

Modality 2010 2011 2012 2013 2014

Malay Massage 9,654 13682 14922 15112 17842

Acupuncture 12,589 17458 19989 24766 29722

Herbal Oncology As An Adjunct Treatment To 1,995 2446 2356 2713 3457 Cancer Patients Traditional Malay 887 1936 3145 4499 5100 Postnatal Massage Shirodhara 0 46 473 0 1094

Increasing trend Presentation Flow

Traditional1. Overview of Traditional & Complementaryand Complementary Medicine in Malaysia Medicine . Postnatal service in the 2. Malay Postnatal Massage in the Integrated Hospital integrated hospital Traditional & Complementary & Health Clinic in Johor . Postnatal service in the health Medicine Division MinistryState of Health Malaysia clinic

CONCEPT OF TRADITONAL MALAY PRACTICES IN POSTNATAL CARE

 The confinement period lasts for 40- 44 days (6 weeks).

 There are three (3) major features in Malay postnatal care : 1. The use of herbs 2. The use of heat 3. Malay postnatal massage. The use of Herbs

1. Oral use : • In the form of decoction, capsule or grounded and cooked with honey (makjun).

2. External use : • Herbal bath, extracts added to ointment, herbal paste etc. The use of Heat

1. Direct exposure :  Bertungku (heated river stone)  Warm herbal bath

2. Indirect exposure:  Consuming “hot food” during confinement.

Malay Postnatal Massage  Malay Postnatal massage includes 1. Whole body massage 2. Hot compression (bertungku) 3. Body wrapping (barut)

MALAY POSTNATAL CARE PRACTICE IN HOSPITAL SETTING

Ministry of Health, Malaysia (MOH) has taken a stand to: 1) Promote safe practices in the Malay postpartum care 2) Provide information to discourage any potentially harmful beliefs that may affect the morbidity and mortality of new mothers. MALAY POSTNATAL CARE PRACTICE IN HOSPITAL SETTING

Wellness Postnatal Massage Postnatal Care • To relief muscle cramps / • Early detection of fatigue which occurred after postpartum complications. labor • To give awareness and • To promote a safe and good promote safe practices of practice of Malay postnatal traditional postnatal care care.

• To promote compliance in • To give awareness of the breastfeeding program. safe usage of herbal concoction during confinement period. Malay postnatal care Wellness Postnatal Massage Postnatal Care

Time of 24 jam after being 3 days after normal treatment discharged from the ward delivery Massage Treatment Massage + Breast care + Hot Compression + Body Wrapping

Regime Once First and last week of confinement ( at least 3 days)

Items None Barut cloth/ bengkung required Batik cloth Sirih leaf / mengkedu Wellness Postnatal Massage Divided into 2 components: 1. Massage 2. Breast Care Wellness massage

Definition It is a soft, superficial massage of the limbs and neck region that promote relaxation to the new mothers after a strenuous delivery.

Aims 1. To relief muscle cramp/fatigue which occurred after labor. 2. To improve the quality of sleep. 3. To elevate mood. Criteria for Well discharge within 24 hours from postnatal ward Wellness in the hospital and with vaginal delivery mothers.

Criteria for Lower segment Caesarian section exclusion Duration 15-30 minutes Location T&CM Unit in Integrated hospital Breast Care

Concept Breast care involves breast massage and teaching the techniques to mothers in performing the massage at home.

This is to help mothers to gain confidence and compliance in breastfeeding their infants.

Aims 1. To increase breast milk flow. 2. To increase the production of breast milk. 3. To prevent breast engorgement.

Criteria All mothers Duration 30 minutes Location T&CM Unit Flow chart of postnatal massage in hospital Malay Postnatal Care Clerking Form Mass Media

Free Postnatal Massage in Hospital

Promotional activities in the Hospital Sultan Ismail, Johor Promotional activities at community level in Johor State Consumers Guide to Safe and Effective T&CM Services

MAL19976399T

Postnatal massage service in health clinic MASAI HEALTH CLINIC, JOHOR STATE Monitoring of postnatal care service by Family Medicine Physician in Health Clinic Free Trial in Health Clinic

Free for 2O Minutes Home visit by registered T&CM practitioners Home visit includes newborn care Important factors in promoting Malay Postnatal Massage at the national and community level:

1. T&CM National Policy 2001 2. T&CM Act (Act 756) 2013 3. T&CM Practice Guideline for T&CM practitioners in the hospital 4. Good Practice Guideline for T&CM practitioners in the private sector 5. Consumer guide to safe practice 6. Mass Media ( internet, newspaper and radio) 7. Postnatal care service monitored by modern medicine doctors 8. Postnatal massage service led by Chief Nurse from the Obstetric department 9. Promotional activities in the hospital 10.Promotional activities at community level 11.Free T&CM services in the hospital 12.Free for trial of postnatal care in the health clinic 13.Home visits by registered T&CM practitioners

Thank you Traditional and Complementary Medicine Division Ministry of Health Malaysia Block E, Cenderasari Road 50590 Kuala Lumpur Tel : +603 2698 5077 Fax : +603 2691 1259 Email : [email protected] Web : http://tcm.moh.gov.my