The Occupational Health clinic in the Universiti Malaya Medical Centre (UMMC) was opened in 2005 through the efforts of Associate Professor Dr. Retneswari Masilamani and Dr. Victor Hoe, and the strong support of Tan Sri Datuk Dr. Mohd Amin, the then Dean of the Faculty of Medicine and the Director of the UMMC. The clinic is the first occupational health referral clinic in a hospital in Malaysia.
The clinic has received continued support from the subsequent directors, Prof. Dr. Ikram Shah Ismail and Prof. Dr. Tunku Kamarul Zaman. Since its establishment, the occupational health clinic has been using other Department’s facilities, these include clinics in ENT, RUKA, O&G, and UMMC staff health facilities.
Under the leadership of Associate Professor Dr Marzuki Isahak as the Head of the Occupational Safety Health and Environmental Unit, UMMC, and support from Prof. Dr. Tungku Kamarul, the clinic was given its own space in 2019, which is situated on the ground floor of the UMMC main building (Menara Utama).
The clinic has its soft launch on 24 January 2020 and after the launch, we received our first patient. The clinic managed occupational diseases and injuries cases for Universiti Malaya (UM) and UMMC staff, and also the public. The clinic also conducts medical surveillance for UM and UM staff.
Objective of the Clinic
One of the aims of the establishment of the clinic was to allow postgraduate students from the Department of Social and Preventive Medicine, Faculty of Medicine, Universiti Malaya to practice occupational health and learn the related clinical skills. The clinic serves both the workers from the UMMC and workers from the surrounding communities.
The clinic was able to offer service to the community and a platform for our students to learn Occupational Medicine.
Occupational Disease Management
Occupational diseases are diseases arising from or out of activity in the workplace. It results from exposure to physical, chemical, biological, psychosocial or ergonomics factors in the workplace. The presence of these factors in the workplace is essential for occupational diseases to occur; e.g., exposure to lead in the workplace will lead to lead poisoning, and the presence of silica in the workplace will cause silicosis. It must be recognised, however, that other factors, such as individual susceptibility, characteristics of exposure to those substances (for example duration of exposure, the concentration of a substance, and condition of the substance) do have a role in the development of occupational diseases.
Occupational Health Physician does not only treat the patient who has occupational diseases or illnesses but also “treats” the workplace. The OH Physician will work with the employer and workers to improve the workplace condition in order to reduce the number of workers coming down with the same or similar occupational disease.
Compensation
In Malaysia, the worker in the private sector is protected by the Employee’s Social Security Act 1969 (ESSA 1969). They are covered under two insurance schemes; the Employees’ Injury Scheme and Invalidity Pension Scheme.
To qualify for compensation from the Employees’ Injury Scheme the workers must have been injured while commuting to and from work, commuting in the course of work, and while working, workers who develop Occupational Disease is also covered under this scheme. There is no age limit to this scheme, the insurance scheme will continue while the person is still working and contributing to the scheme.
The second scheme is the Invalidity Pension Scheme where the worker is qualified for an invalidity pension if he suffers from chronic diseases that make him unable to earn more than 1/3 of his usual wages. This scheme only covers workers up to 60 years old.
Other than the two schemes under ESSA 1969, individuals who is protected under another insurance scheme can also apply for compensation. In this case, the amount and quantum of payment will depend on the agreement between the insurance company and the insured party.
Quantum of Compensation:
The quantum of compensation to be paid to the insured person who was involved in an accident or from occupational disease depends on the degree of impairment. For the “Employees Injury Scheme” under the ESSA the quantum is given in the Second Schedule of the ESSA. The Social Security Organisation has come up with the “Guidelines on Impairment and Disability Assessment of Traumatic Injuries, Occupational Diseases and Invalidity” since the Second Schedule of the ESSA only contained a limited list of impairment. The main purpose of the guideline is to be used as a guide for evaluating medical issues, diseases and the estimation of invalidity especially on issues that are not stated in the Second Schedule of ESSA.
Under the ESSA, an insured person can submit a claim under the Employees’ Injury Scheme if he has been injured from activity due to work or in the course of work and while travelling to and from work, and also for occupational diseases. The amount to be paid depends on the assessment by an independent medical assessor appointed under the ESSA.
Notification
Occupational diseases is also a Notifiable Disease under the Occupational Safety and Health Act 1994 and the Notification of Accident, Dangerous Occurrence, Occupational Poisoning and Occupational Disease) Regulations 2004. The list of notifiable occupational diseases is listed in the Third Schedule of the Regulation.
Impariment Assessment
Impairment assessment conducted in this clinic is for workers involved in workplace injuries, commuting injuries and occupational diseases. Impairment can be defined as “any loss or abnormality of psychological, physiological or anatomical structure” (WHO). It can develop from an illness or injury. In evaluating impairment we will consider both structural and functional loss.
Impairment assessment is usually conducted after the injury or illness have reach Maximal Medical Improvement (MMI), which means it is well-stabilised and unlikely to change substantially in the next one year with or without medical or surgical treatment. Impairment Assessment is conducted for the purpose of compensation and return to work.
The impairment assessment for SOCSO cases will be conducted in accordance with the “Guidelines on Impairment and Disability Assessment of Traumatic Injuries, Occupational Diseases and Invalidity- 2nd Ed”, which is prepared by the Medical and Rehabilitation Division of the Social Security Organisation.