Electricity For Life 2024
26 September – 27 September 2024
A Sarawak Heart Foundation Initiative in collaboration with:
- Sarawak State Health Department
- Sarawak Heart Centre
- Medtronic International (Malaysia)
Report by Dr Esteban Chin, Clinical Cardiologist, Sarawak Heart Centre on behalf of the travel team for Electricity for Life Initiative
Introduction
The Sarawak Heart Foundation and the Sarawak Heart Centre have a long-standing tradition of organizing the annual Electricity For Life (EFL) initiative in conjunction with World Heart Day since 2015. However, like many initiatives, it was placed onhold during the COVID-19 pandemic, with the last event held in 2019. This year, we are proud to resume the program with a renewed focus, and our mission is to reach some of Sarawak’s most remote communities, specifically Sungai Asap and Bakun.
Sarawak is an incredibly vast state, the largest in Malaysia, covering 124,451 km², which accounts for 37.5% of the country’s total land area. For many communities deep within the interior, accessing specialized care at the Sarawak Heart Centre can take days of travel. The logistical difficulties posed by these geographical challenges is almost unthinkable.
As the only government tertiary referral centre for cardiology in Sarawak, we understand the importance of raising public and healthcare provider awareness about the latest advancements in heart disease management. Equally crucial is the introduction of new services available at the Sarawak Heart Centre. While our centre continues to advance and provide cutting-edge treatments for heart disease, we remain mindful of the healthcare needs in district hospitals and rural areas.
A core theme of Electricity for Life is “Closing the Gaps.” Our goal is to strengthen the connection between Sarawak Heart Centre and all district healthcare providers across the state. This tour is not only about delivering continuing medical education but also about listening to and understanding the healthcare needs of rural communities. With this in mind, we strive to enhance the accessibility of cardiology services throughout Sarawak, bridging the gap between urban and rural healthcare.
As we embark on the Electricity for Life 2024 journey, we extend our heartfelt gratitude to Dr. Ong Ting Kiam, Head of the Department of Cardiology, SarawakHeart Centre; Dr. Alan Fong, Senior Consultant Cardiologist, Sarawak Heart Centre; Dr. Veronica Lugah from the Sarawak Health Department; and Ms. Susan Lim from Medtronic International (Malaysia), for their invaluable support in organizing this event.
Day 1: Sungai Asap and Bakun
Our first day of the Electricity For Life (EFL) initiative took us to Sungai Asap and Bakun. They are both located in the Belaga district. One of the more accessible ways to reach these remote areas is by road from Bintulu, a journey of about 184 km. While The Pan Borneo Highway has improved access, only one-third of the journey benefits from this highway. The remaining two-thirds are narrow trunk roads. We set off fromBintulu in a 4-wheel drive at 8 a.m. and arrived at Klinik Kesihatan Sungai Asap around 10:30 a.m.
Sungai Asap is a resettlement area for indigenous communities displaced by the construction of the Bakun Hydropower Dam. The Klinik Kesihatan Sungai Asap is the only clinic in the area equipped with a family medicine specialist, providing essential healthcare to the surrounding communities. I had the privilege of meeting Dr. Allen Chai, the clinic’s first in-house family medicine specialist, who has been serving there since 2022. There are also 6 medical officers currently serving in the clinic.
During our brief tour of the clinic, I was deeply impressed by the range of healthcare services provided. From performing emergency deliveries to administering thrombolysis for heart attack patients, the clinic had to take on the role to handle emergencies with limited resources. This is especially remarkable given that the nearest hospital is at least 2.5 hours away. I was in awe of the dedication and sacrifices made by the healthcare professionals who choose to work in such a remote location, committed to serving the communities here.
We conducted a brief lecture on interpreting ECGs for cardiac emergencies, focusing on identifying life-threatening conditions and managing them in resource-limited settings. The staff shared the logistical challenges they face, particularly in handling emergencies. One key issue is the shortage of ambulances. With only one available to transport critically ill patients, they face serious challenges if multiple emergencies arise simultaneously. The round-trip journey to Bintulu Hospital alone takes five hours, leaving little room for error in such critical situations.
After our session at Klinik Kesihatan Sungai Asap, we continued to Bakun, an hour’s drive away. Bakun Dam, one of the tallest concrete-faced rockfill dams in the world, was a breathtaking sight. The Bakun Lake, formed by the dam, is now Malaysia’s largest by storage volume and surface area. The dam, which began operations in 2010, is currently managed by Sarawak Energy.
We were welcomed by Mr. Alvin and Mdm Juliana, the team running Klinik Bakun. Mr. Alvin, a Medical Assistant originally from Sibu, has been at the clinic since 2014, while Mdm Juliana joined in 2019. Initially, the clinic was intended to serve dam employees, but it has since expanded its services to the surrounding communities due to the lack of nearby healthcare facilities.
Mr. Alvin gave us a tour of the dam and the lake, and I was struck by the immense engineering accomplishment, made all the more remarkable by its location in one of Sarawak’s most isolated areas. He also explained the significant logistical challenges faced by people in the region in accessing healthcare, a situation further compounded by an unreliable communication network that frequently breaks down.
As we wrapped up our visit and began the bumpy ride back to Bintulu before dusk, my thoughts lingered on the profound difficulties faced by both the communities and healthcare workers in these remote regions. Their resilience, despite these hardships, left a lasting impression on me.
Day 2: Bintulu Hospital
Bintulu Hospital is the main secondary referral center, covering a vast area from the Mukah region to Belaga, serving a population of about 350,000 residents. This hospital holds a special place in my heart, as I served as a medical specialist here from2021 to 2023, during the height of the COVID-19 pandemic. Since then, Bintulu Hospital has evolved significantly. During my tenure as the head of the medical department, we established a new medical high-dependency unit. Now, the hospital is exploring the possibility of starting an invasive cardiology catheterization lab service. The Sarawak state government is also considering developing cardiology unit in Bintulu Hospital to extend cardiology service for the central region of Sarawak.
Our day began with a Continuing Medical Education (CME) lecture on the electrocardiogram in cardiac emergencies. The CME session also covered implantable cardioverter-defibrillators, pacemakers, and temporary transvenous pacing for bradyarrhythmias. We focused on the diagnostic and management challenges of cardiac emergencies in the absence of a catheterization lab. It was a rewarding experience, reconnecting with my former colleagues and engaging in a fruitful exchange of knowledge. We concluded the visit at 10 AM and flew back to Kuching shortly after.
This two-day initiative gave me firsthand experience of the arduous journey many people must undertake to access cardiology services in Sarawak. It reinforced the vastness of Sarawak and the pressing need to improve healthcare access for people in the district and rural areas. These visits enabled us to build stronger relationships with the communities and facilitated discussions on how to enhance cardiology services in Sarawak. We are also deeply grateful to Medtronic International (Malaysia) for supporting our travel to some of the most remote areas of Sarawak.
In summary, Electricity for Life 2024 has been a rewarding journey, and we hope to continue this initiative in 2025, reaching other parts of Sarawak.
