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.