Report on the Ethical Response to COVID-19 in Malaysia

By Hui-Siu Tan.

One of the better things to come from social media during COVID-19 was Malaysia’s Ministry of Health’s (MOH) use of  Facebook (and FB Live), Twitter, and Telegram. These kept both the public and the news media updated at 5 pm every day. This good start, however, was subsequently tainted by a controversial public communication by the ministry: the open sharing of smiling photos of families who had been discharged from hospitals. Although it was frowned upon by several of us on the front-lines – citing privacy and the social implications of such actions – we decided to let it be. The photos were consented to and were meant as a risk communication strategy to calm down the public during the initial panic phase. 

In the footsteps of the director-general of health, healthcare front-liners also started sharing their own photos gowned up in PPEs holding signs of “#stayathome.” They pleaded with many who did not comply with the “Movement Control Order” (partial lockdown) enforced by the National Security Council. News media began sending the same messages too. Of course, medical heroism got the better of many front-liners too, who could not stop sharing every bit of our adventures (and pleas) since then. Lucky for us, no leader has put a gag order on that.

It was heartening to see that whistleblowing or advocacy regarding the lack of PPE was tolerated by the government. Perhaps it was wise for the ministry to embrace its limitations openly and to encourage a shared responsibility in the community. However, this did not come without harsh criticism that the responsibility of ensuring the adequacy of PPEs should be wholly borne by the ministry and the government. Nevertheless, fashion designers, tailors, living skills workshops, NGOs, individuals, corporate companies, and schools took heed of the needs of the front-liners and began making and securing PPEs for hospitals. This communal “shared hardship” spirit – “有难同担” – has yet to stop till this day.

I reflected upon ethicist Dr. John Lantos’s comments during our weekly long-distance Paediatric Bioethics class from Children’s Mercy Bioethics Centre in Kansas City: “Where does scurrilous unprofessionalism end and whistleblowing or advocacy begin? Is it in the eye of the beholder? I don’t have good answers to these questions – but the questions are what makes the whole new world of digital media so fascinating and ethically ambiguous.”

This sentiment summed up my feelings for the week as we entered MCO Day 45, and schools and many shops have not reopened. I believe our director-general of health, Dr. Noor Hisham, with his gentle persuasion and moral courage, has attempted to break down many of the unseen bureaucratic walls of governmental institutions. He resisted political pressure, allowed the disclosure on the shortcomings of the ministry, and engaged the public with the relevant facts. Many circulating fake news were countered with firm handlings and immediate clarification through official health portals under his leadership. As a small country, we as front-liners verified and attested to COVID-19 misinformation management. It was heartening to observe that individual voices were not dampened in the process, and narratives mushroomed through media platforms.

MCO has now been extended to mid of May with surprisingly calm acceptance as Ramadan sets off a month of of fasting and reflection. Roadblocks have been loosened up to make way for college students traveling back to their home towns in anticipation of the coming congestion during the Eid al-Fitr holidays.

At this time, some of us are still hopeful that the ministry will scrape the less meaningful #kitapastimenang “we must win” movement and the weekly international ranking of COVID-19 cases. Many are still wary of the reopening of restaurants and parts of the economic sectors as announced by the Prime Minister’s Office recently.  Eventually, we hope that the 120-paged “Ethical Reflections for Clinicians during COVID-19 pandemic” – which the Malaysian Bioethics Community have compiled – will see the light of the day. This project aims to assist local clinicians navigate through the challenges in clinical practice during COVID-19 and complements other COVID-19 ethical responses and initiatives. It is a fine time that clinicians’ needs and bioethicists’ voices be heard — fingers crossed with the caring leaders that we have.

 

Author: Hui-Siu Tan

Affiliations: HS is a general pediatrician serving at a public hospital in the city of Kuala Lumpur, Malaysia. She is currently leading the initiative to produce an ethical guide for clinicians.

Competing interests: None declared

 

 

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