A beacon of light in Malaysia’s healthcare

THE Malaysian healthcare sector is riddled with challenges. While some underlying issues have existed long before the pandemic, Covid-19 brought the complexities of the healthcare sector to the forefront.

Years of underinvestment in public healthcare – only 2.2% of gross domestic product (GDP) compared to 4.1% of GDP for upper middle-income countries in 2021 (according to World Health Organisation data) – have strained an already unsustainable financing model, taking a toll on the entire system.

With Malaysia anticipated to become an aged nation by 2030 (when more than 15% of the population will be above 60 years old), the healthcare system will face even greater pressure.

While there is a lot to discuss on this issue, I would like to highlight a beacon of light within Malaysia’s healthcare sector – an individual who pushed boundaries despite systemic constraints, driven by skill, dedication, and passion.

His vision and contributions to the medical fraternity and the nation were profound.

His untimely passing last week has left many devastated.

Early years of sacrifice

Associate Professor Dr Yoong Boon Koon (pic, centre) was one of – if not the – most renowned liver surgeons in Malaysia. He was widely regarded for his extraordinary accomplishments in performing the country’s first adult right lobe living donor liver transplant, performed with his team on Jan 9, 2017.

He also established the liver transplantation programme at University Malaya Medical Centre (UMMC).

Dr Yoong served as the president of the Malaysian Society of Hepato-Pancreato-Biliary (HPB) Surgeons and chaired the Chapter of HPB Surgery under the Academy of Medicine of Malaysia.

In 2023, he joined Sunway Medical Centre (SMC) as a consultant HPB surgeon, following a 23-year career at the UMMC.

While he was widely regarded as the top specialist in his area of expertise, Dr Yoong faced many hurdles early in his career – challenges familiar to many medical practitioners in Malaysia today.

Notably, he had not taken the SPM examination and therefore lacked the required Bahasa Malaysia qualification for civil service entry.

Determined to pursue his calling, he sat for the Sijil Pelajaran Malaysia as a private candidate, passed with flying colours, and eventually secured confirmation in the civil service, allowing him to enrol in the Master of Surgery postgraduate course in 2003.

At one point, Dr Yoong even worked unpaid during his early training at UMMC – a testament to his perseverance and unwavering commitment to becoming a surgeon. Despite the roadblocks, he never wavered in his pursuit of excellence in medicine.

In 2009, he underwent his HPB fellowship and on-the-job training at Hong Kong’s Queen Mary Hospital, Hong Kong University (HKU), under Professor Dr Lo Chung-mau (the present secretary of health of Hong Kong).

Dr Yoong was always grateful for the opportunity and thankful to Datuk Professor Dr Wang Chew Yin, who was the consultant anaesthetist at UMMC at that time, who opened doors through her connection with HKU.

He spent one year in Hong Kong learning the skills in HPB surgery and liver transplantation, and made many friends, who are now top experts in this field.

When Dr Yoong returned in 2010, he realised our country’s liver transplantation rate was low and many patients were dependent on overseas centres for transplant.

After witnessing the living donor liver transplant (LDLT) progress in Hong Kong, it motivated him to build up a team in UMMC for LDLT surgery.

He submitted multiple proposals to set up the practice in the early days, which received support from UMMC but had challenges in securing funding and ensuring adequate human resources.

Finally, it was through the efforts of Professor Dr Lee Way Seah (paediatric gastroenterologist at UMMC) that Yayasan Sin Chew provided adequate funds to kickstart the programme at UMMC.

It began in 2017 for the adult LDLT programme, followed by the paediatric LDLT programme in 2019. He was grateful and indebted to the support for the adult programme provided by Queen Mary Hospital, HKU, and the paediatric programme provided by Renji Hospital, Shanghai Jiaotong University.

Pursuit of excellence

Helen Ng, senior general manager of Robotic Surgery and Minimally Invasive Surgery Services at SMC, has known Dr Yoong since 2018.

“To begin with, Dr Yoong was already an excellent surgeon and a strong advocate of minimally invasive surgery.

“However, with the introduction of robotics, he was able to further refine his techniques and apply robotic assistance to support complex cases such as pancreaticoduodenectomy, also known as the Whipple surgery.

“This procedure, which is the standard surgical treatment for cancers involving the head of the pancreas, is complex, lengthy, and highly demanding, and is regarded as one of the most challenging surgeries in hepatobiliary surgery.”

She said due to the complexity of the procedure, Whipple surgery is commonly performed via open surgery in Malaysia. With the aid of surgical robots, it can now be performed using a minimally invasive approach.

“Dr Yoong was the first surgeon in Malaysia to use the fourth generation Da Vinci system to perform a robotic Whipple procedure. Last week, he completed his 10th robotic Whipple surgery, a milestone that gave him a great sense of achievement.

“To date, no other surgeon in Malaysia has matched his expertise in performing this highly refined robotic procedure. Dr Yoong has always been open-minded in adopting new technologies to advance medical progress for the benefit of patients,” said Helen.

Associate Professor Dr Koh Peng Soon is Dr Yoong’s successor at UMMC, consultant general surgeon, HPB surgeon and the late doctor’s first recruit when he established the HPB and Liver Transplantation Unit at UMMC.

Dr Koh said: “He was a person who was kind, generous, always concerned for the welfare of others. He was like a father figure, always willing to guide you. As a lecturer and clinician at Universiti Malaya, many staff, patients and families were touched by his care for them.

“Along the way, he also mentored many Master of Surgery students, espousing good clinical practice and work ethics. I truly wish we had more time as there were many more years we could have achieved things together and looked back at our careers when we are older.

“To date, UMMC has completed 32 liver transplants and true to his word, Dr Yoong still returned to assist with the transplant surgeries even after joining the private sector.”

Mindset to contribute

Over the years, Dr Yoong has received many offers from various healthcare institutions. One local hospital even offered him shares to get him onboard.

His hesitance was because he believed he could contribute more at UMMC with the number of patients requiring his service.

Finally, when he decided to join SMC, he told me it was because the Da Vinci robotics machine and SMC, being a major hospital, could provide the resources he needs to do more multidisciplinary complex surgery.

It was always the mindset of contributing that remained his paramount consideration.

“I worked very closely with Dr Yoong for the best benefits of our patients. He was not only a highly skilled surgeon with high IQ, but he also had a wonderful character as a doctor that was a team player.

“He genuinely cared for his patients and whenever the team referred complex cases to him, he would always express gratitude and take it as a privilege that the patients were willing to entrust their health issues to him.

“ It is a big loss to the nation for patients who want to undergo complex surgeries without Dr Yoong with us,” said Dr Seow Vei Ken, chief executive officer of SMC.

Recognition of his legacy

It is my ardent hope that the Health Ministry recognises Dr Yoong for all his contributios made over the years to advance our nation’s healthcare development, especially in HPB surgery.

While there are many silent heroes in Malaysia’s healthcare sector, he not only embodied what a healthcare professional ought to be but a wholesome local talent who could have gone anywhere in the world yet chose to return home to contribute to our beloved country.

As Dr Yoong’s three young children grow up, in the years to come I am confident they will truly comprehend his legacy and have every reason to be proud of their father, who loved them dearly.