For most Malaysians – and many Singaporeans – the town of Mersing is best known as the place to get a ferry to the well-known tourist islands of Pulau Tioman and Pulau Rawa.
If you’re coming from Johor Baru, it can be a long, challenging drive, braving a winding road approximately 120 kilometres long.
Unfortunate collisions with wildlife have been known to occur while traversing the single-lane east coast roads.
Monkeys can often be seen on the road, and reports of motor vehicle accidents with other wildlife, such as wild boars, tigers and elephants have also been previously reported.
While it is likely that the animal would suffer more, the outcome for the humans involved in such accidents can also be serious.
These injuries may vary from trivial cuts and abrasions to serious injuries to the head, neck, chest and abdomen.
Such trauma cases are usually rushed to Mersing Hospital, the nearest emergency treatment and stabilisation centre, before being transferred to Sultan Ismail Hospital (HSI), a specialist tertiary hospital in Johor Baru.
Expanding surgical services
Mersing Hospital is a district hospital that was established in 1917 to cater for the health needs of the estimated 71,000 local residents.
As a district hospital, it is staffed by medical officers and does not currently have any medical or surgical specialists permanently assigned to it.
Prior to 2017, all patients that required surgery were referred to HSI, which serves eight districts (including Mersing) and over 700,000 citizens in the state of Johor.
However, the Health Ministry’s introduction and rollout of the Global Surgery initiative in 2015 now means that instead of patients going to the surgeon, the surgeon goes to the patients.
One of the five goals of Global Surgery is to provide safe, accessible and affordable surgical and anaesthesia care to all.
This is as the delivery of surgical services is crucial in saving lives and preventing patient disability.
Mersing Hospital, along with Kota Tinggi Hospital, was identified and grouped under Johor’s East Coast Cluster Hospitals, for this purpose.
In order to bring surgery to the district of Mersing, a new building with an operating theatre was constructed and opened in 2017.
From the beginning of 2019, surgeons from HSI travelled to Mersing Hospital every month to perform minor elective surgeries for the local residents.
This arrangement evolved into regular week-long stints starting in August (2022), with each of the eight general surgeons from HSI travelling to and staying for about a week each at Mersing as the resident surgeon.
This allows for a broader coverage of general surgical services, including running general surgery clinics and performing both emergency and elective surgeries.
A collaborative team effort is crucial to ensure the surgical services are streamlined and run smoothly.
Mersing Hospital’s primary healthcare team and HSI’s general surgery and anaesthesia departments work in tandem to ensure that patients get the best care during and after surgery.
This joint effort in bringing surgery right to the doorstep of local residents has helped reduce operation waiting times, and the hassle and burden of travel for patients.
All types of surgeries
Often, any necessary surgery can be performed by the team on the spot, especially for straightforward cases.
Among such procedures are appendicectomy (removal of the appendix); drainage of breast, peri-anal and skin abscesses; circumcision for infections of the penile foreskin; and saucerization of skin carbuncles (i.e. cutting out the diseased parts).
Certain cases however, still need to be referred to HSI.
These include cases that require certain diagnostic or investigative equipment unavailable in Hospital Mersing, such as a CT (computed tomography) scanner.
Most trauma cases are managed solely by the general surgery team in HSI, which is trained to deal with various traumatic injuries.
Other conditions that need to be referred to HSI include small/large intestinal blockage, stomach ulcer bleeds, small or large intestine perforations and severe gallbladder infections.
However, these are a small portion of the cases that are managed by both HSI and Mersing Hospital.
It is, of course, a daunting task for the team in Mersing to be on the frontline managing such a wide variety of emergency surgery cases.
But being able to offer immediate specialist surgical assessment and treatment has certainly helped in the recovery of many patients.
Being on the spot also allows surgeons to assess the need for, and conduct, elective surgeries.
Elective surgery usually refers to a condition requiring surgical consult or attention, but not urgently or immediately, depending on each case.
Such conditions can be divided into benign and malignant, of which suspected malignancy requires a more rapid investigative approach.
Examples of malignant cases include breast, colon, rectal, gastrointestinal and thyroid cancers.
Meanwhile, benign cases requiring surgery include abdominal wall hernias, non-cancerous breast lumps, skin and soft tissue lumps, gallbladder surgery and circumcision, among others.
Such cases that come into Mersing Hospital are screened first, then either scheduled for surgery or referred to HSI if necessary, e.g. for more complex cases or those needing further imaging.
The hospital routinely detects many such cases during health checks and screenings.
In addition, endoscopic procedures, comprising upper endoscopy and colonoscopy, are also being provided by HSI surgeons for Mersing residents.
These procedures play a pivotal role in screening for stomach and colon cancer, as well as detecting early pre-malignant growths (polyps) in the digestive system.
Upper endoscopy is also absolutely necessary when dealing with bleeding oesophageal, stomach (gastric) and small intestine (duodenum) ulcers.
This procedure has saved many lives by allowing surgeons to stop such bleeds.
After stabilisation by the primary healthcare team in Mersing, patients experiencing such bleeds are often rushed to HSI for emergency endoscopy.
Convenient and fast
Many patients have benefited from the ease and convenience of this arrangement.
For example, one of my patients, a 68-year-old housewife from Mersing, was diagnosed with breast cancer.
We were able to conduct her surgery at Mersing Hospital to remove the breast with the cancer, along with the lymph nodes in her underarm (i.e. a mastectomy and axillary clearance).
Her surgery was uneventful and she went home well.
A follow-up two weeks after her surgery showed that her wounds had healed well and that she was well enough to undergo systemic therapy to ensure all the cancer is cleared out.
She is expected to make a full recovery from her breast cancer upon completion of the cancer therapy.
Another patient is a 60-year-old rectal cancer survivor.
She too was able to have her surgery at Mersing Hospital to remove the cancer.
At that time, an opening of the small intestines (ileum) to the outside of the body was created to allow passage of digested food materials.
After recovering from the surgery and being certified cancer- free, her small intestines were scheduled to be closed up (reversal of ileostomy), also at Mersing Hospital.
She had an uneventful surgery and was discharged five days after her operation.
Both these cases illustrate how local access to surgery allows for reduced waiting time, which is especially important in cancer, and the convenience of having the procedure done closer to home.
Another case of mine involved a 40-year-old man who had a swelling in his underarm for almost six years.
It gradually grew in size, leading to significant discomfort in moving his arm.
Despite being large in size and close to the axilla (armpit), especially the axillary vein, the surgery was performed successfully without affecting any of the axillary structures.
The patient recovered well with no further problems.
The next patient is a 50-year-old man who works as a school janitor.
He developed a swelling in his chest over six years, which grew more prominent in size.
After feeling much discomfort and fear owing to the development of the growth from the initial size of a coin to its latest size of a ping pong ball, he finally decided to come and seek treatment at Mersing Hospital’s surgery clinic.
After careful assessment and examination, he was immediately scheduled for surgery the following day.
The operation to excise the swelling was performed as a daycare procedure, where patients are not required to stay overnight in the hospital.
The excision was performed successfully with just a small injection to cause numbness to the surrounding skin (local anaesthesia).
His recovery was uneventful and he was discharged on the same day as planned.
The patient never expected surgery to be performed so quickly, with the effect of six years of discomfort being relieved within 24 hours.
The satisfaction and relief he expressed after the surgery certainly gave me a great sense of fulfilment.
Dr Henry Tan Chor Lip is a general surgeon at Hospital Sultan Ismail, Johor Baru. For more information, email starhealth@thestar.com.my. The information provided is for educational and communication purposes only, and should not be considered as medical advice. The Star does not give any warranty on accuracy, completeness, functionality, usefulness or other assurances as to the content appearing in this article. The Star disclaims all responsibility for any losses, damage to property or personal injury suffered directly or indirectly from reliance on such information.
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