Coronavirus: Malaysia up in arms over Indonesian medical ‘tourists’

Women queue at a bus station in Kuala Lumpur, Malaysia. Photo: ReutersWomen queue at a bus station in Kuala Lumpur, Malaysia. Photo: Reuters

Malaysia’s medical tourism council has moved to ease public fears following an uproar triggered by the arrival of three Indonesian patients in Penang state.

The arrival of the Indonesians last Friday had prompted anger among many Malaysians because of Indonesia’s high coronavirus rates. Indonesia, the worst affected country in Southeast Asia, on Tuesday reported 1,673 new infections to bring its total number of cases to 143,043 with 6,277 deaths.

The three Indonesians, accompanied by two companions, had arrived on a chartered AirAsia flight from Medan. Another Air Asia flight from Indonesia due to arrive in Kuala Lumpur on August 24, had since been delayed, said the Malaysia Healthcare Travel Council.

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On Tuesday the Academy of Medicine Malaysia expressed concern over allowing medical tourists from neighbouring Indonesia, saying the risk of importing Covid-19 cases was high.

“The hidden economic cost of managing even one case cannot be properly estimated if one thinks of care providers who will be exposed and bring the infection home to their family,” said the academy’s master professor Dr Rosmawati Mohamed. “When the frontliners do it for the country, it is an obligation but we should not risk a third wave or overwhelming our health care system.”

The academy is a registered body representing all medical specialists in Malaysia.

Emeritus Professor Dr Lam Sai Kit, a research consultant and virologist at the University of Malaya warned that since medical tourism brought in foreign patients, Malaysia ran “the risk of having more new strains introduced into the country”.

Malaysia Healthcare Travel Council CEO Sherene Azli on Tuesday said all medical tourists were subject to strict procedures on arrival in Malaysia, including 14-day quarantine periods and two polymerase chain reaction (PCR) tests. Patients also had to undergo PCR tests at accredited Indonesian facilities before boarding their flights.

Health care workers at a mobile Covid-19 testing facility in Jakarta, Indonesia. Photo: Bloomberg
Health care workers at a mobile Covid-19 testing facility in Jakarta, Indonesia. Photo: Bloomberg

“Once the patients have recovered, they will go home,” said Sherene, adding that each patient was allowed just one companion who had to undergo the same tests and quarantine period.

She said the patients were being allowed in on “humanitarian grounds” as they were in need of treatment for conditions including cardiovascular and oncological problems.

Since July 1, 16 medical tourists had visited Malaysia and three had since returned home, said Sherene.

The intervention by the medical council comes after the Facebook page of Penang Chief Minister Chow Kon Yeow was flooded with angry comments after he claimed to have no knowledge of the tourists’ arrival.

“Why is the state favouring or assisting a commercial consideration specific to private hospital business entities? It only brings profit to these certain companies putting the entire matrix of frontliners at risks,” wrote one user, Sian H Ooi.

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The resumption of medical tourism comes as Indonesian police investigate the sale of fake medical certificates that are used to “prove” patients have tested negative for Covid-19.

Health experts warn these fake certificates are helping to spread the virus, as Indonesians need to produce a negative Covid-19 medical certificate to travel.

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Indonesian police spokesman Awi Setiono said seven suspects had been arrested in connection with the certificates. The arrests had been made in Jakarta at the Soekarno-Hatta airport, Tanjung Priok port; north Sumatra, east Kalimantan and West Papua.

In 2019, 1.3 million medical tourists visited Malaysia with half of them coming from Indonesia and the next highest number coming from China.

“Since a high percentage of foreign patients are from Indonesia, the news that fake medical certificates are being used to circumvent Covid-19 travel curbs in Indonesia is worrying,” said Lam at the University of Malaya.

Lam said there had been reports of fraudulent medical certificates being bought for between 50,000 and 300,000 rupiah (roughly US$4 to US$20) each.

“Fake certificates are available online at market places, blogs and social media,” he said.

Dr Lam Sai Kit, a research consultant and virologist at the University of Malaya. Photo: Handout
Dr Lam Sai Kit, a research consultant and virologist at the University of Malaya. Photo: Handout

Lam said the Indonesian government’s reluctance to impose a blanket ban on travel “for economic reasons” would “lead to people selling and buying forged documents”.

The Academy of Medicine Malaysia shared Lam’s concerns, warning that testing patients before their flights was not “foolproof”.

“Quarantine and Covid-19 testing should be mandatory upon entry, and should be the same for everyone, without regional exceptions,” said Rosmawati.

She said the receiving hospital should be responsible for picking up the patient directly from the airport and taking them into quarantine. If the patient returned a positive test, the hospital should have the “expertise to manage the patient” and the cost should be borne by the patient or their insurance company.

Medical tourism had generated 6-7 billion ringgit (US$1.4-1.6 billion) annually for the economy over the past five years, said the Medical Healthcare Travel Council. Foreign medical tourists made up 30 per cent of patients in private hospitals in Penang, 10-20 per cent in Kuala Lumpur and up to 40 per cent in Melaka state, it added.

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Dr Christopher Lee, former National Advisor for Infectious Diseases at the Ministry of Health, said screening procedures for incoming travellers needed to be “thorough and accurate” if a third wave of the disease were to be averted.

“Every cluster is of concern, especially now, because [relaxed domestic restrictions] mean there are a lot more people moving around and interacting.”

He warned against a sense of complacency and “Covid fatigue”, noting that a more infectious variation known as

D614G was now circulating.

The mutation, thought to be 10 times as infectious as more regular strands, was discovered at the weekend by the Malaysian Institute of Medical Research.

“[All these] reasons may facilitate a faster and wider spread of the virus within the community, making control of Covid-19 more challenging,” Lee said.

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