Dr. Elise Monerasinghe
Dr. Elise Monerasinghe was previously the Deputy Director of the Oral Health Division under Ministry of Oral Health, Malaysia. She has worked in the Ministry of Health for about 20 years and she is currently working as a lecturer at SEGi University.
‘Doctor, can you please briefly introduce yourself and share with us your background?’
I was born and had my schooling in Penang which was a lovely island and I really enjoyed myself there. I went to university in University Malaya and did my postgraduate at the University of Michigan, in the US. I served in Segamat, in Penang, and then with the Ministry of Health in Kuala Lumpur and then Putrajaya. I have two grown-up children who are working and one little granddaughter. Now, I have been in KL for the past 20 years, so I suppose I am a KL person now.
‘Doctor, how did you decide to pursue Dental Public Health, and what led to your position in the Ministry of Health? ‘
It is a combination of things. I love clinical work, but I also like data and I have always been the person who likes the nitty-gritty and things like that and when it came to that point in my career, I had two young children, so thinking of life as a clinical specialist would have been a little bit difficult with two young children. I was a single mother, so I decided to go for Public Health. When I came back from the US, we were asked to do a presentation because four of us went to the US to do Public Health. We were asked to do a presentation because we were the first ones to go to the US. Previously, people went to England to do their DDPH. Ours was a 2-year program in Masters. So after I did my presentation, they asked me if I would join the Ministry of Health as the Assistant Secretary of the Council. I thought, okay, I will try it for a while. Sounds interesting! Well, ‘the while’ went on for 20 years.
‘Can you share with us your roles in the Ministry of Health?‘
As I said, I started as the Assistant Secretary of the Council, and at that time because the role of Assistant Secretary wasn’t that heavy at that time, so I was also in charge of the Fluoridation Project and the Fissure Sealant Program that we had. Later I became the Secretary of Council, after about 3 years and I was Secretary for 5 years. Then, I was asked to head the new Legislation and Enforcement Unit. That one, of course, we were in charge of amending the Dental Act, the enforcement of the Private Healthcare which was actually the heaviest burden at that time.
‘Doctor, part of your job included handling complaints related to dental malpractice, can you share with us what kind of complaints you receive?’
Okay, I am assuming you are asking about…you see there are two Acts, the Dental Act & the Private Healthcare, Facilities & Services Act. So under the Dental Act, it is mostly ethical issues, so patients will complain about negligence, fees, whether they were not informed about the fees, whether the doctor is overcharging them, and things like that. They do sometimes, quite often complain about negligence, in the sense of substandard work, alright, but this usually involves implants, orthodontics, and root canal treatment. Those are the ones we have the most problems with at the moment. The other thing is advertising, when you are not supposed to advertise and you do, you don’t follow the guidelines. There are quite a number of complaints, they were on the rise. Those are the ones under the Dental Act. We also have got a few complaints of molesting, well, unfortunately, they were all proved to be true. That’s one thing we must be careful about. There was one complaint of drug abuse, not that the doctor was abusing the drugs but he was selling the drugs, so there is that. Not paying their bills, we had that. One doctor was not paying the lab for the work they were doing for him. Of course, the lab complained to us because he was bringing the profession into disrepute. So the respect that people have for a dental surgeon was dropping on the lab. So that was one and we do have somewhere the practitioner is rude to the patient and says things that should not be said in a dental clinic. Under the Private Healthcare, the bulk of our complaints were not against the practitioners, it was against illegal practice, so that was a different matter.
‘So sometimes the dentist can be innocent. What do you think can be the preventive measures for the dentist to safeguard themself and avoid such situations?‘
Sometimes when we use the word innocent, it sounds like it’s a criminal charge and that does happen under the Private Healthcare, though, then you have the issue of innocence and guilt but under the Dental Act which is more problematic, because it’s ethical issues. When it’s a law, it’s very easy, just read the law, you should have read the Private Healthcare before you go into Private Practice and then, you just follow. But when it comes to an ethical issue, it’s sometimes a grey area. So the whole thing is that, you must practice with integrity and do what is best for the patient, not best for you or easiest for you or even best for your pocket. You must always think, the patient comes first and you must be able to convey that to the patient, that whatever you’re doing is for his benefit. Sometimes of course they don’t want to listen to you but never mind, be that as it may. The other thing is don’t practice beyond your training and skills. Remember that whatever you learned in dental school, you are expected to know, anything above that, you should get extra training or whatever. If you feel you are not competent, don’t try and be a hero. Alright, and we have CPGs and we have guidelines. Please read them and follow them. Many people when they come for a complaint, they really haven’t read it and if you should have a complaint against you and you appear before the Council, please do not depend solely on your lawyer to have read the law or to understand it. Because we would understand our laws better than your lawyer, so please make sure you have read it and you understand all the CPGs and the guidelines.
‘Doctor, what was your role in drafting the Dental Act 2018?’
I was Secretary to the committee, so for more than 10 years, we sat in the committee. I took over from Dr. Husna and it fell to me to put it through Parliament. Well, a lot of it fell to me to write the Dental Act actually because we discussed concepts and things at the committee meeting and then it falls to the Secretary to actually write the Act together with the legal fraternity, so that was my contribution to the Dental Act.
‘Doctor, what are your thoughts on illegal dentists or fake dentists, and do you have any advice to the public about this?’
I can’t have any thoughts on illegal or fake dentists. I mean they are illegal. There is nothing to say but to me, I can’t say wasted but there was a lot of time the enforcement unit, not only in Putrajaya but in the states, we had to spend a lot of time on this illegal practice of dentistry. You know there’s the problem of investigating it, trying to send in someone, find out where they are practicing, get someone to help us to inform on those things. All these take a lot of time and energy out of the enforcement unit and once we have actually raided the premises, then we have to prepare the investigation papers, we have to go to court. It takes a lot of time. But to me, if you don’t go to an illegal dentist, then they will not offer the service. Why are so many people going to illegal dentists? We have them in KL. We have some in KL, who actually offer basic dentistry, making dentures, fillings, extractions even on the side of the road in Pudu and I don’t want to say that all their clientele are foreign workers or whatever but the majority of the clientele would be. We still do not agree, we still try and stop them but in a way, I can try to understand that because it is cheaper maybe, you know whatever, but when it comes to fake braces, that’s the majority of our work and I cannot understand it. So, what I advise the public is that none of us, I am sure you and me, we haven’t gone, we haven’t had orthodontic treatment. The majority of girls have not and we look fine. Are we having a problem with our looks? So why does beauty become such…or being perfect become such a…why they envision to become perfect? Why does that become such a big thing now? Why do people feel they need to do that? So actually my advice to the public is to educate your children, to think of yourself as what is inside is more important not what you have on the outside and if you really need orthodontic treatment, there are practitioners around. Let me tell you, fake dentists are not cheap. It is a one- time visit and it costs you about RM 800, could cost you RM 1000. So that is not cheap for 1 visit and you never see them again while an orthodontist may charge you RM 3000-RM 4000. It is over a 2-year span. You get treatment for 2 years, almost every month to every 6 weeks, so work it out, it is much cheaper. So I think the important thing is we must break this chain of them actually having clients. If they didn’t have clients, they won’t be practicing, so that’s my advice to the public. Think why are we doing this? Is it a fashion, is it a fad? Do I really think I need to improve on my looks? So, yeah.
‘Doctor, for example, for the patients, when they want to go seek an orthodontist, is there a way to find out if the dentist is actually licensed or not?’
Yes, that’s very easy because all the dental clinics are registered, so when you go into a dental clinic, the registration under the Ministry of Health of that clinic is actually by law, it is to be displayed. That means it will be on the wall somewhere or it will be displayed somewhere in the clinic. The second thing is every practitioner must have his practicing certificate displayed in the clinic and we are unique in that if a practitioner has 3 practicing addresses on his APC, he will be given 3 identical APCs so that he can display one in each clinic. You don’t even have to make a photostat of it. You are given 3 for those 3 clinics. The 3 addresses will appear in all 3 clinics. It will be exactly the same, but the council gives you 3 copies. So there is no problem. So, when the patient goes in, you can see the clinic is registered, you can see the practitioner has an APC. In the future, when we have the specialist registered, your specialty will be listed on the APC. So you can compare who is your doctor, is his APC here? If the APC is not in the clinic, he is not supposed to be there at all. But generally in the clinics, if it is registered, we don’t have much problem with that. We still do, there are some practitioners who are a bit irresponsible and they hire people who are not registered to their clinic but barring that, we don’t have that much problem. So it is easy to identify a legal clinic and a legal practitioner.
‘Okay doctor, so while working in the Ministry of Health or pursuing Dental Public Health, did you face any challenges, and how did you overcome them?’
When I was working in the MOH, actually not many challenges but one thing that is different from the MOH and the private sector is that you can’t hire and fire your own staff. You are given the staff and generally, I would say I enjoyed myself before I went to the Ministry of Health, one of my ex-bosses actually warned me. He said, “Oh dear, you know, you go to the Ministry of Health, it is full of these ladies and they will be having all their little gossips”. I can tell you my tenure in the Ministry of Health was peaceful and a wonderful experience and I made really good friends and when you think of it, the people in the Ministry of Health are like you and me. Why should they be different? They were very cooperative. I didn’t have any problems in the Ministry of Health. Thank God! But as far as challenges, working no, but as I said, for me I set a standard. I expect my colleagues and staff to maintain that standard. If they don’t, I will tell them, straight to their face. This is what I expect and so generally almost all of my staff came up to that standard. There were a few that maybe didn’t quite come up to my standard and got the sharp end of my tongue but I have met them subsequently and they have actually thanked me because they have gone to other units and moved on and they have actually come up to me and thanked me for you know, what I have, well, corrected them, let’s say. I think it helps. So to me, I would say, set a standard and make sure everyone follows it. I had a happy time at the Ministry of Health.
‘Okay doctor, can you share with us your happiest memory working in the Ministry of Health?’
Oh dear, I don’t know what they would say is the happiest. I can’t but I would say what I am happiest about, is many people feel it is the Dental Act because it was something that we took a lot of trouble to put the Dental Act through Parliament and my team was the main movers in putting it through but I won’t say that because that is something technical and if you know the law and if you know how it works, you can put the Dental Act through Parliament. There is nothing so difficult about it, but what I am most satisfied with is the Enforcement team. I took over enforcement before it was really a unit. It became a unit under me. Then we formed a team in the sense of Enforcement Officers in every state including Labuan and Perlis, we had enforcement officers and I am most proud of them because they work as a team. They work very well together. They are brave. They are honest. They work with integrity and that is something that I really appreciate in them. It is nothing like the Dental Act which is dry but that is what brought me the greatest pleasure working in the Ministry of Health and they are the ones I miss the most when I left Ministry of Health. My team.
‘Doctor, do you think Dental Public Health in Malaysia needs any improvements, and what are your suggestions on it?’
Malaysia is one of the countries that has quite a good public health programme, both medical and dental, and during this COVID Pandemic, Public Health has of course come to the fore because everything relates to Public Health but to me, I have found that public in Malaysia, this is my opinion, of course, don’t really value their health. The first thing is health is pretty cheap in Malaysia. There is nothing much you can buy for RM 1 except for a whole medical check-up in the Ministry of Health facility. Okay, so people don’t really value maintaining their health. I am not saying we should put a monetary value to health but at the same time when it comes so easily, we are proud of the fact that we have health centres everywhere even in the most remote regions, we have health centres and that is a very good thing for this country. It is something that not many countries can say and even I studied in the US, I did my Masters there and I can say our health services are much better at a general level than America, you may say they have high- end, they have things like that. They have big hospitals. Yes, I agree with you but for the man in the street, for the poor man on the street, we are much better. So you must look at it in different ways...the Ministry of Health is actually for everybody, not for the high end. Okay, so that’s one thing but when it is not difficult to come by, somehow the Malaysian mentality is that, “Oh well, if anything happens, the government will take care of it, so my teeth would be taken care of”. And we also go into the schools and we treat the children in the schools, parents don’t even have to make the effort of taking them to a clinic or worrying about their health. So, it’s unfortunate but maybe what we should do is have incentives. I am not saying change our programme and make it more expensive or difficult but we should have incentives for good health. I think now some of the insurance schemes are doing that. If you don’t claim, you actually get a rebate or your monthly payments are less or some things like that. Maybe that would be an idea that people who see health as if they maintain their health, there is a benefit to it. The other thing is, in Malaysia, people feel the health is the responsibility of the Ministry of Health. We are supposed to provide health for them. You will not find this in other countries, you have to maintain your own health but maybe that is something…I don’t know whether that is good or otherwise but people have to be taught, people have to be educated that they have to maintain their health, not… So, that is our biggest public health problem.
‘What is your advice to the dental students in Malaysia?’
One thing I want to tell is I have just joined a dental school for 1 year. Previously I just came, I gave lectures to students and I left. So I didn’t really know the students but one thing I find which I suppose I was a student too many years ago but there is a lot of preoccupation with getting your minimal clinical requirements, with getting your percentages here and there, passing your exams, of course that is essential, passing the exam, but you must focus, students must focus on their life after the dental school. Okay, that is why you are there. You are there so that patients will feel confident, you will feel confident. So I hope that all dental students love their work. They didn’t come in because dentistry is a money-making project or it gives them the title doctor or whatever it may be, you must love your work. You must love your patients. That is something that will really make your life so much easier. And number 2, you must know your work, so all those lectures that you missed, that you thought were not coming out for the exam, please read up those notes. Please know them because when the patient is sitting on the chair in front of you, he asks you something, he gives you some weird symptoms and signs, what are you going to do if you have missed that lecture? That’s not the time to say excuse me I’ll google it, of course the answer may be on Google but you know, to instill confidence in a patient, you have won half the battle. They will hardly make any complaints or argue with you when they have confidence in you and to get that confidence, you must be confident in yourself. You must know what is happening. So the most important thing is that. Then you must practice with honesty and integrity. You must do only what is best for the patient even whether the patient can pay you or not pay you is tomorrow’s problem. So there is compulsory government service. I would like it to be 3 years but not because I think you don’t know your work but to inculcate that government service attitude that we will treat everybody. If you can’t pay it is okay, even the RM 1, it is okay, we can sign it off. You know that attitude that we are providers of health, not a money- making project or a private concern or we are thinking of how much this treatment will cost which is a concern when you are in private practice but most important is the patient’s health and we have to have that attitude, so while you are chasing your MCE and while you are chasing to pass the exam, keep that in mind.