Malaysia – The Recurrent Themes and Challenges Nurses Face

I land in Kuala Lumpur at midnight, after a 22-hour journey from San Francisco, via Tokyo, and I enjoy a warm reception from a faculty member and an undergraduate student, who escort me in a University car for the hour drive to my hotel, which is close to the UKM Medical Center and University. New, modern and still under construction, my hotel has a well-equipped gym, an absolute must when I travel, and a magnificent pool overlooking the city.

The reason for this trip, and for most trips I make to many corners of the world, is to honor invitations, to inspire women, to empower nurses, to dialogue with colleagues and to learn about the progress and the challenges affecting nursing and health care. Another reason for my travels is to consider together, with my international colleagues, the progress made toward achieving the Sustainable Development Goals. In particular, how well are we progressing toward universal health care access, lower maternal and infant mortality rates, reduced disparities, the elimination of violence against women and equal participation of women, nurses and midwives in policy and decision making arenas. Thus begins my mission in each country, organization, conference and workshop I visit. I use this blog to share what I learn from my global colleagues, culturally, socially and intellectually.

On my first morning, while feasting my eyes on panoramic views of the high-rise buildings dotting the Kuala Lumpur skyline, I enjoy breakfast, where I listen to many conversations in Malaysian, Cantonese, English, Arabic and many Indian languages. It is here that I realize rice and noodles are staples for all meals of the day. It makes me wonder how rice affects health outcomes. I may ask my colleagues. But of course fruits and vegetables are also plentiful in this tropical climate.

Kuala Lumpur has well paved streets and highways, with close to 7 million inhabitants. It boasts traffic jams at all times of the day – not much different from the I-76 Schuylkill Expressway in Philadelphia, Route 101 in San Francisco or Abou Kir in Alexandria. The patience and enthusiasm of my hosts wipes away any of my frustrations about slow moving traffic and my fears of motorcycles zipping between cars (even though they all wear helmets).

The issues confronting nurses in Malaysia are similar to what I hear from colleagues in most other countries. The timing might be different, as these issues challenged U.S. nurses in the 70’s, and more countries may have identified them in the 80’s. Other countries, like Malaysia, face them in the present. Here are my top observations regarding the themes and challenges Malaysian nurses face:

• Diploma and degree graduates are divided by a sense of superiority of one group over the other, because of a confrontation between experience verses education. Haven’t we already lived through these internal oppressions???
• Salary classification reflects hospital preparation and educational advancement does not augment salary.
• Leadership positions are given to hospital graduates.
• There is a rift between hospital and university graduates, which is cultivating an environment that may stall progress in the nursing profession.
• The Board of Nursing, which creates and implements policies related to nurses and nursing, is chaired by physicians and is populated by hospital graduates – a powerful board that does not seem to value university education for nurses.
• Public universities formed a council consisting of two representatives from each university school of nursing. The council develops policies that the board reviews, accepts or ignores.
• Participants in the conference, who came from Malaysian universities, expressed frustration concerning the stagnant state of nursing education, practice and research.
• There are increasing numbers of university graduates, as well as Ph.D. graduates. Most of these graduates obtained their education in Malaysia and are ready to make a difference; however, they do not feel valued or appropriately compensated.
• The Minister of Health and Vice Chancellor of the University were very supportive and complimentary of nursing education. It was intriguing to hear them speak about the importance of nursing theory and scholarship.

Each of my global experiences reinforces for me how nurses continue to excel and struggle to improve health care for all. Nurses are resilient and never surrender their values for equitable education and quality health care. I raise all my hats to them. 

My Acceptance and Gratitude Speech for the Princess Srinagarindra Award

I am truly humbled and honored to receive the Princess Srinagarindra Award and to be here in the presence of her beloved granddaughter, Princess Maha Chakri Sirindhorn. It is a double honor for me to have Princess Sirindhorn presiding over the ceremony this afternoon. I know how much Princess Sirindhorn was influenced by her grandmother, and I know she was a role model to her and to all in this country and beyond. There are many similarities between both princesses.

But first, let me acknowledge the role of the trustees of the Princess Srinagarindra Award Foundation for selecting me. And a special expression of gratitude to Professor Tassana Boontang for her leadership in nursing and to Professor Somchit for creating an impactful journal that has become a leading journal in South East Asia.

Now, let me share my views of how Her Royal Highness Princess Srinagarindra and Her Royal Highness Princess Sirindhorn are alike.

The Princess's Grandmother, Srinagarindra, served the Country with love, loyalty, dignity, and with a focus on alleviating the suffering of many, particularly the underserved. She established schools, insured access to health care and instituted many preventative health programs. She worked on improving the life of the rural Thais. Her love for her country extended to rehabilitating the forests, and in that, she was a visionary and ahead of her time in thinking about the sustainability of our planet. She was a dedicated role model, who I know has inspired many to emulate her actions. She was honored by UNESCO as a distinguished leader in public service in the fields of education, applied science and human, social and environmental development.

Following in her footsteps, Her Royal Highness Princess Maha Chakri Sirindhorn realized the difficulty villagers faced in accessing health care, education and quality living, so she helped over 200 schools to improve education and health care access for children. Her work makes health care a right, not a luxury. Princess Sirindhorn is able to speak with children and the elderly and make them feel valued and cared for. She is invested in cultivating their best capacities to live quality lives and to succeed.

We know her in the USA as the “Angel Princess,” as she brings everyone humility and genuine caring, instilling hope in their lives - whether in times of peace, turmoil, disaster or conflict - just like her grandmother, Princess Srinagarindra. She continues to build on her grandmother’s vison and goals for the health and the education of the vulnerable among us. 

The love between them reminds me of my own grandmother, whose accomplishments were limited to her immediate family. A farmer from a small village in Egypt, she was never educated in a school - but she was educated by life experiences. She managed to raise a daughter, my mother, who achieved the highest education and the top leadership positions in the nursing profession, not only in Egypt, but in many parts of the Middle East. As a farmer, my grandmother delivered her own babies while in the field, losing many of them along the way. In spite of limited resources and no formal education, she instilled in me a love for education and a work ethic to care for other people, all of which propelled me to receive this incredible award. She would be so proud to know I am receiving an award that reflects the love between a grandmother and a granddaughter.  

Receiving this award would not have been possible if I had not been involved in working with and learning from my many Thai colleagues and mentees. That being said, my involvement and love for Thailand developed because of the incredible leadership of Dr. Tassana Boontong. I met Dr. Boontong over 25 years ago, and her charismatic leadership and strategic vision for Thai nursing instantly struck me. Some people have a vision, but they do not follow up with proactive leadership and action. Dr. Boontong understood the connection between vision and action, and knew that without proper education, nurses would not be able to make a difference in health care. Through the Thai Parliament, she insured that nurses could get scholarship and fellowship support to obtain the highest education. She ventured even farther, establishing a pioneer doctoral program in collaboration with other schools of nursing in Thailand - a model program that benefitted from the teaching and expertise of the best minds from several Universities. I had the distinct honor to be invited to teach in that program. And now, as we look around, many of the movers and shakers in nursing in Thailand are a direct result of Dr. Boontong’s efforts.

It is also because of Dr. Boontong that I have enjoyed the good fortune of developing mentoring relationships with my many mentees here. To all of these mentees, I extend my deep appreciation for their diligent work and outstanding leadership in health care.  

I am genuinely grateful to receive the Princess Srinagarindra Award, and I would like to extend my appreciation to the Trustee Committee and to all who supported my nomination and selection. It is truly an honor to receive an award that reflects committed valuation of nursing contributions, not only in Thailand, but all over the world. So I thank you Princess Sirindhorn, on behalf of all nurses worldwide.

2018 Princess Srinagarindra Award Ceremony

Four hundred Thai dignitaries, including 50 representatives from 40 embassies, ministers of health, education and welfare, leaders in health care and nursing, and senators gathered on October 17, 2018 to celebrate a global nurse leader who received the Princess Srinagarindra Award. Attendees gathered under enormous, shimmering chandeliers surrounded by countless fragrant flowers, all while enjoying an exquisite and delectable high tea, presided over by Her Royal Highness Princess Maha Chakri Siridhorn, the beloved princess of Thailand and granddaughter of Her Royal Highness Princess Srinagarindra Mahidol.

This gathering followed an elaborate royal ceremony involving the giving and receiving of a plague and certificate, which required two rehearsals and the guidance of about one hundred palace protocol custodians. In a noble room, with dignitaries lined up on both sides, the awardee marched slowly, escorted by Dr. Somchit Hanucharurnkul, a nursing leader from Mahidol University, and the U.S.A. interim ambassador to Thailand, and curtsied twice before Her Royal Highness. After heartwarming citations were read by the President of the National Nursing Council, Dr. Tassana Boontong, and Her Royal Highness, the Princess presented the awardee with a stunning plaque, a certificate and a silver plate, all inscribed with both of their names. 

In my view, this memorable and once in a lifetime award has three purposes.

First, it celebrates and honors the life and the memory of the Princess's grandmother, Her Royal Highness Princess Srinagarindra Mahidol, for her unprecedented contributions to the Thai people. She understood the suffering of vulnerable populations, the need for access to health care and education, and she traveled throughout Thailand to provide it. She treated the young and the old with dignity, compassion and humanism. And, ahead of her time, she advocated for and led efforts pertaining to environmental sustainability. UNESCO gave her an award for her impactful contributions to human, social and cultural development.

The second purpose for this gathering is to affirm Princess Siridhorn’s continued and expanded support of her grandmother’s vision and goals. In many ways, it is a celebration of Princess Siridhorn as well. She brought education and health care to children in over 800 schools. She too insures that vulnerable populations receive the education and care that they need. She does so with dignity, respect, kindheartedness and incredible generosity of spirit.

The third outcome of this gathering, which honors the life achievements of one global nurse, is honoring ALL nurses globally. By televising the elegant and elaborate ceremony on all Thai news channels, and by taking the time to attend the celebration, all of these leaders in the government, embassies, health and education are acknowledging the centrality of nurses in insuring population’s health and wellbeing. The message is loud and clear - nurses as a major workforce matter to global health, and celebrating nursing royally affirms the discipline’s value and importance. By celebrating one nurse, they celebrate all nurses.

Having been humbled and honored by receiving this award, I understand and interpret its significance not in terms of my achievements. To me the award is an affirmation of the accomplishments and the impact of nurses all over the world. I accepted the award, basked in the celebration rituals and I will cherish the memory because it is embedded in the namesake of a late beloved Princess Srinagarindra, who was also a NURSE. I accepted it with pride because her granddaughter, Princess Siridhorn, supports and values women and nurses. Moreover, I accepted it with a great deal of humility and gratitude because my Thai colleagues, mentees and the global community chose me to receive it. The award’s significance was obvious to the nurses of Thailand and to the attendees who celebrated with me with joy and a great deal of pride.

And finally, I believe that the recommended color of yellow for the occasion’s attire, a royal color, added a sunny, bright and joyful note to the celebration.

Like many in the Thailand nursing community, I am most grateful to Dr. Tassana Boontong, Dean Emerita of Mahidol University and President of the Thailand Nursing Council, for her leadership in obtaining government funds to support nurses getting PhDs from national and international universities. I am convinced that I would not have received this tremendous honor if I had not had the privilege of mentoring many of those who pursued their PhD education due to the availability of those funds. Many of these mentees became leaders in their own right, including my dear friends, Dr. Siriorn Sindhu and Dr. Ameporn Ratinthorn. I also believe that this award was another visionary initiative by Dr. Boontong to acknowledge nursing and nurses worldwide.