The Brief History of Medical Technology in Malaysia

Submitted by: Group 2 Orendain, Melissa Villa er, Stephanie !ap, "armel #eas, $mi %ngelica Galamiton, &omari Torres, '(ight Habana, "arolyn

Submitted to: Ma)am 'elos #eyes

History
*+ast ,pdated on -. May 2./20

Founding and Development of the Institute

The $nstitute for Medical #esearch *$M#0 began (ith a recommendation in /1.. from Sir 2ran3 %thelstane S(ettenham, the #esident4General of the 2ederated Malay States, to establish a 5athological $nstitute in Malaya to 6carry out scientific and sustained research into the causes, treatment and pre ention of such scourges as beri4beri and all forms of malaria fe ers67 This proposal (as made follo(ing the resolution of the "onference of Berlin held in 8urope in /99: to underta3e such acti ities so as 6to promote the moral and material (ell4being of the nati e population and to e;plore the great and un3no(n field of tropical medicine67 The 8uropean colonial po(ers at that time namely the 2rench, 'utch and 8nglish, mo ed almost simultaneously to establish ne( research institutions in the "olonies7 The 5athological $nstitute in British Malaya (as one such institution7 $t (as to ser e as a research outpost for the +ondon School of Tropical Medicine, established a year earlier in /911 at about the same time as that of the +i erpool School of Tropical Medicine7 <uala +umpur (as chosen as the site for the ne( $nstitute because of its central position in the Malay 5eninsula7 The time (as opportune as the country (as beset by not only tropical diseases such as beri-beri and malaria, but also bydysentery, small pox, cholera, plague, rabies and other endemic, sporadic, infectious and contagious diseases7 Sir 5atric3 Manson, (ho (as the Medical %d isor through the British "olonial Office at that time, appointed 'r7 Hamilton =right, a pathologist at the +ondon School of Tropical Medicine, to ser e as the $nstitute>s 2irst 'irector7 Much of =right>s time during the first year (as ta3en up (ith the planning of the ne( $nstitute7 =hen the buildings (ere completed, a formal opening ceremony (as held in 2ebruary /1./ and in %ugust of the same year, the 5athological $nstitute became 3no(n as the $nstitute for Medical #esearch7

1901 1905 !he "arly #ears$

8arly research (as carried out on:

malarial fe ers of Malaya ? the study of ta;onomy and ector biology *+eicester @ 'aniels0 and on malarial control *=atson0A beri4beri 4 its aetiology and pathology *Braddon, 2raser @ Stanton0A and the study of dysentery7

#eports (ere (ritten on cholera in #a(angA plague in <uala <ubu BharuA and rabies in Begeri Sembilan7

190% 191& 'efore the First (orld (ar$

2rom an independent 2ederal 'epartment, the $nstitute became a branch of the Medical 'epartment7 #outine pathological (or3 for the medical ser ices (as offered co ering chemical, to;icological, pathological, bacteriological and medico4legal ser ices7 The $nstitute>s contribution to(ards the solution of the beri4beri problem, and the (or3 done by 2raser and Stanton, are documented in the boo3 >The "ause and 5re ention of Beri4beri> by Braddon7 The classification of Malayan mosCuitoes (as carried out by +eicester and 'aniels, (hile =atson published a boo3 on Malarial "ontrol7

191&-19)* !he First (orld (ar and !hereafter$

$n4depth studies are conducted into the causes, transmission, treatment and pre ention of such diseases as cholera, small po;, leprosy, melioidosis, influenDa, dysentery, rabies, tuberculosis, typhoid, filariasis, leptospirosis, dengue and scrub typus7 #esearch into other aspects of malaria and beri4beri continued7 $n /1/9, the $M# contributed to the disco ery of the cause of beri4beri, i7e7, the disease (as caused by the deficiency of an essential nutrient that resulted from the consumption of rice (hich had been e;cessi ely milled7 $n /12E, a ne( series of $nstitute publications, the Bulletin series, (as started, in (hich (ere included shorter articles and progress reports of in estigationsA on completion of the research, these articles and reports (ould form a basis of monograph or study7

19)+ 19)9 ,eorganisation$

The $nstitute e;panded to accommodate a South Bloc3 for the %dministration, the 'i isions of 5athology, Bacteriology and a +ibrary7 The Borth Bloc3 (as ta3en up by the ne( 'i isions of 8ntomology and Malaria #esearch7 The "hemistry 'i ision ceased to e;ist to gi e (ay to the creation of the 'i ision of Biochemistry and the 'i ision of Butrition7 The $poh branch laboratory of the $nstitute came into being7

19)9 19&1 'et-een the (ars$

=ith the e;pansion and the reorganisation of the $nstitute, there (ere t(o appointments for research students7 $t (as a phase of acti e inCuiry in many fields *filariasis, tuberculosis, typhoid fe er, beri4beri0, (hile the focus remained in malaria research7 The +eague of Bations Malaria courses */1-:4/1-10, an international malaria course, (as organised in Singapore by the Health Organisation of the +eague of Bations7 The $nstitute contributed by pooling the e;perience7 The courses (ere partly di erted later to the $nstitute (here certain aspects of malariology could be studied to a better ad antage7 This opportunity for an international gathering of malaria (or3ers (as lost (ith the (ar7 The 2ifth $nternational "ongress in Malariology opened in <uala +umpur in /1-1 (ith delegates from most of the countries of the 2ar48ast7

19&1 19&5 (ar in .alaya$

The $M# $poh branch laboratory (as transferred to <uala +umpur and there (as the final e acuation of the $M# to Singapore (ith the recruitment of local and 8uropean $M# staff in the 'efence Ser ices *the details are illustrated in the original te;t of 2ield>s >:. !ears of Medical #esearch in Malaya>07 The period of &apanese Occupation in Malaya from /1E24/1E: (itnessed the brea3do(n of the high standards of disease control and a malaria epidemic bro3e out in <uala +umpur7 The $M# (as in ol ed mainly in the production of cholera and typhoid accines as (ell as the pro ision of some diagnostic ser ices7

19&5 1950s /ost-(ar #ears$

The $M# addressed the problems of (idespread malnutritionA smallpo; in <edahA rabies in 5ro ince =ellesley, <edah and <elantanA and sporadic cholera throughout the country7

#esearch into population nutrition, prophylactic trials (ith paludrine and other antimalarial drugs, penicillin sensiti ity testing and insecticide trials (ith ''T and BH" in malaria control, (ere also underta3en7 The British Scrub Typhus #esearch Team and the ,nited States %rmy Medical #esearch ,nit *,S%M#,0 researched into the problem of scrub typhus, a disease (hich (as first described by 2letcher in /12F7

19&+ 19%0 !he "mergency #ears$

$n /1E9, the 2ield Stain for the identification of malaria parasites (as de eloped by 'r 2ield, a director of $M#7 %lso in /1E9, a team of researchers from the ,S%M#, successfully demonstrated that the antibiotic chloramphenicol could be used to treat scrub typhus7 =ith the 8mergency and the threat of communism, the local defence forces (or3ed together (ith the troops from the colonies and other "ommon(ealth countries7 +eptospirosis (as studied in depth because it (as thought to pose a considerable health haDard to the security forces (hich operated in the Gungles of Malaya7 =ith the 8ast %frican troops operating in the Gungles of 5ahang, the introduction of schistosomiasis (as a great possibility7 +i3e(ise (ith 2iGian troops operating in the &ohore Gungles, the introduction of the non4periodic Bancroftian filariasis needed study7 The "entral Bloc3 (as added to the $nstitute>s Borth and South Bloc3s in /1:-7 This building housed the British "olonial Medical #esearch Team, the ,S%M#,, the 'i ision of Medical Hoology and Virus #esearch, the ne( +ibrary and a +ecture Theatre7 % year earlier, the 5enang laboratory became a branch laboratory of the $M# along the same lines as those of the $poh $M# branch laboratory7 'uring this period, three $nternational Scientific Meetings (ere held at the $M#, that is, the "onference on !ello( 2e er and other Viral 'iseases */1:E0A a symposium on +eptospirosis *&une /1::0A and the =orld Health Organisation *=HO0 organised a study group of 2ilariasis *'ecember /1::07

195* 19%5 Independence and /ost-Independence$

$n /1F., the Ministry of Health reCuested assistance from international organisations such as the =HO and the "olombo 5lanA at the same time, the ,S 5ublic Health and the Hooper 2oundation (ere permitted to underta3e medical research at the $M#7 The period mar3ed the disco ery of /2. ne( species of chiggers by the Medical Hoology

'i isionA rare blood types in Southeast %sia by the Haematology 'i isionA and the e;istence of haemorrhagic fe er in Malaya by the Virus 'i ision7 19%% 19%9

% School of Medical +aboratory Technology (as established to conduct a three4year course for Medical +aboratory Technologists and a one4year course for &unior +aboratory %ssistants7 Be( 'i isions of Oral 5athology, "ytology, and Helminthology and 5rotoDoology (ere established7 The 'i ision of 2ilariasis and Malaria #esearch split to become independent di isions7 +i3e(ise, the 'i ision of Medical Hoology, (hich earlier on had been independent of Virology ? also split into the 'i ision of Vertebrate Hoology and the 'i ision of %carology7 #esearch in the $M# carried out independently or in collaboration (ith the Hooper 2oundation and the ,S%M#, resulted in some 1.4/.. publications annually7 $n /1FI, the $M# (as declared Malaysia>s Bational "entre for Tropical Medicine under the Southeast %sian Ministers of 8ducation Organisation *S8%M8O07 % si;4month training course leading to the 'iploma in %pplied 5arasitology and 8ntomology *'%5@80 (as offered to graduates in science and medicine from the S8%M8O countries7

19*1 19*5 0econd .alaysia /lan$

The $M# (as further de eloped in t(o phases7 The first phase in ol ed the construction of a hostel for 2E. students, the School of Medical +aboratory Technology, 2 lecture theatres, stores, a maintenance (or3shop, a cafeteria and adeCuate facilities for +aboratory %nimal #esources7 The second phase in ol ed the construction of the %dministrati e bloc3, research and ser ice laboratories and an $nsectarium7 The main acti ities continued to be research, training, accine production and referral diagnostic laboratory ser ices7

19*5 19*9

The main thrusts of research (ere directed at in estigating rural health problemsA dengue, scrub typhus, leptospirosis and other iral diseasesA the ector biology of insect4 borne diseasesA the ecology of Doonotic diseases in small animalsA parasitic, bacterial and fungal infections including food and hygiene bacteriologyA community nutritional status, nutritional biochemistry and nutritional disordersA cancersA abnormal

haemoglobinopathies, GF5' deficiency diseases and genetic disordersA cell mediated immunity, population immunity status and se;ually transmitted diseases *ST'0A hormone disorders, clinical enDymology and to;icologyA and beha ioural science (ith particular reference to the study of the social, cultural and beha ioral factors affecting health7 19+0 19+&

'isease4orientated research approach continued to be the main strategy adopted by the $M# in its research endea ors7 Malaria, filariasis, dengue, scrub typhus, other parasitic diseases, leprosy, enteric diseases, respiratory infections, febrile illnesses, se;ually transmitted diseases, cancer, human nutrition, community health research, and reproducti e endocrinology (ere the main areas of research7 %dditional biomedical research and research aimed at updating methodologies (ere also underta3en7 $n /19/, a team at $M# succeeded in culturing in in itro, the human filarial parasite Brugia malayi from the infecti e lar al *+-0 stage to the fifth *+:0 stage7 Bet(een /19/4/19-, a ne( species of schistosome, called the Malaysian schistosome, (as described7 This schistosome (as found in the ri erine areas of <uala <oyan in 5ahang7 $n /19-, the $M# established the use of the common local species of 5resbytis mon3ey as a model for anti4filarial drug trials7 The opening of the $M# Sna3e 2arm in 5erlis on -rd March /19/ mar3ed another milestone in the gro(th of the $nstitute7 $n response to the high incidence of sna3e bites in the northern states of the country, the Sna3e 2arm (as e;pected to study the epidemiology, biology and ecology of sna3es and produce anti enom against the Malaysian pit iper, the Malaysian cobra and sea sna3es7 % rapid diagnostic 3it for sna3e bites (as de eloped in collaboration (ith the <angar General Hospital7 $n /192, the $M# "linical #esearch "entre (as established (hich began research into blood disorders, ST' and myelomas on an outpatient basis7 On E th &une /19-, the Biomedical Museum (as officially opened for the purpose of pro iding information to the scientific community on research acti ities and contributions of the $M#A the museum also has a aluable research reference collection dating bac3 to /1..7

2rom /st %pril /19E, the $M# has pro ided H+%4tissue typing and H+% cross4matching ser ices for renal transplant patientsA it has the first and only H+%4Tissue Typing +aboratory in Malaysia7 The enDyme lin3ed immunosorbent assay *8+$S%0 and the indirect fluorescent antibody *$2%0 test for malaria (ere de eloped as seroepidemiological tools7

19+5 19+*

Since /19E, a 'engue Sur eillance and "ohort Study (as initiated as a :4year Goined study (ith the ,ni ersity of Malaya and the <uala +umpur General Hospital7 =ith the emergence of the %cCuired $mmune 'eficiency Syndrome *%$'S0, the Ministry of Health *MOH0 formed an %$'S Tas3 2orce and the $M# irus laboratory (as designated as the Bational #eference +aboratory for %$'S 'iagnosis, (hich (ould screen sera from donors and high ris3 groups and help in the laboratory diagnosis of %$'S7 The 'i ision of Virology (as in ol ed (ith the MOH 5ilot Study on #ubella $mmunisation from May to September /19:7 % =HO "ollaborati e "entre for 8cology, Ta;onomy and "ontrol of Vectors of Malaria, 2ilariasis and 'engue (as established at the $M# in /19F7 % ne( di ision of Health Beha ioral #eseach (as set up at the $M# in &anuary /19I7 The Organisation of the $slamic "ountries *O$"0 designated the $M# as the $nter4$slamic Bet(or3 for Tropical Medicine *$BT#OM0 in /19I7 =ith the completion of the cobra anti enom proGect, the Sna3e 2arm (as fully functioning7

19++ 1990

$n /191, a local strain of Bacillus thuringiensis (as disco ered7 This strain has been sho(n to be more potent than the internationally accepted strain Bacillus thuringiensis israelenisis7 The change in direction from disease4oriented research to problem4sol ing research (as in line (ith the implementation of the MOH health programmes7 Thus, ne( research areas (ere included (ith emphasis on beha ioral and health systems research, non4 communicable diseases and community health7 On Eth &uly /191, the ,S%M#, officially closed its operation in Malaysia after E. years of collaborati e research into tropical diseases (ith the $M#7

T(o organisational changes too3 place in /11., and these include the closure of the Vaccine 5roduction ,nit and the discontinuation of the production of anti enom by the Sna3e 2arm7 The %llergy 5rogramme (as initiated in /11. (ith the increase in a(areness of morbidity and mortality due to allergies7

1991 1991

#esearch proGects (ere grouped into /: research programmes: %llergy, Beha ioural, Blood 'isorders, "ancer, "ardio ascular 'iseases, "ommunity Health, 'engue, 2ebrile $llnesses, 2ilariasis, Human Butrition, +eprosy, Malaria, Other 5arasitic 'iseases, Scrub Typhus and ST's7

199& )000

The $M# (as organised into : departments, namely, Tropical Medicine, "linical 5athology, "ommunity Medicine, Support Ser ices and %dministration7 The 'epartment of Tropical Medicine comprised the follo(ing 'i isions: %carology, Bacteriology, Medical 8ntomology, 5arasitology and Virology7 The 'epartment of "linical 5athology comprised the follo(ing 'i isions: Biochemistry, 8ndocrinology, Haematology, $mmunology, Molecular 5athology and Stomatology7 The 'epartment of "ommunity Medicine comprised the follo(ing 'i isions: 8pidemiology and Human Butrition7 The 'epartment of Support Ser ices comprised the follo(ing 'i isions: Biotechnology "entre, the "omputer ,nit, +aboratory %nimal #esources, the +ibrary, $nformation and 5ublication, 8n ironmental Health #esearch "entreJMedical Museum, 8lectron Microscopy ,nit, Medical 5hotography ,nit7 %dministration consisted of: the 2inance ,nit, the 5urchase and Supply ,nit, and the Ser ice and %dministration ,nit7 The $M# celebrated her /.. years of e;istence in the year 2...7 !ear4long acti ities comprising both scientific and social programs (ere organiDed and (ell attended to commemorate this auspicious occasion7 The main e ent of these celebrations (as the 6$M# Open 'ay6 (hich (as officiated by !ang %mat Berhormat 'ato> Seri %bdullah HaGi %hmad Bada(i, 'eputy 5rime Minister of Malaysia on 2E %ugust 2...7 % commemorati e plaCue (as un eiled and a set of - commemorati e stamps and a first4 day co er (ere launched7 Three products (ere commercialiDed namely MOSB%", an aCueous suspension formulation containing the spore crystal comple; of Bacillus thuringiensis, $M#4BT4/ for

the biological control of mosCuito lar ae and #48ST, a test 3it for the rapid detection of insecticide resistance7

Butri4"al, a nutrient analysis and food composition data management soft(are (as de eloped7

)001 !he /resent$

$n 2../, the $M# (as restructured (hereby the former 22 di isions (ere re4configured to form si; #esearch "entres and t(o support "entres7 =ithin each of these "entres, scientists from the arious disciplines collaborate to (or3 together, and (ith researchers outside the $M# on priority research proGects7 =ith this approach, research has become more focused (ith consolidation of resourcesA thus building on the strengths of the $M#7 The greater focus allo(s the $nstitute to enture into ne( gro(th areas and bring research closer to the cutting edge of science and technology7

The ne( structure of the $M# is as illustrated in the organisational structure7 The $M# officially came under the ambit of the Bational $nstitutes of Health Malaysia in 2..-7 The research focus of $M# e;tends beyond tropical diseases and penetrates into other areas of biomedical discipline such as cancer, herbal medicine, immunology and autoimmune diseases, diabetes and metabolic syndrome, stem cell research and en ironmental health, in line (ith the changing trend of health burden in the country and ad ancement of medical technologies7 % total of /I products or methods (ere patented or pending patent, fi e of these (ere commercialiDed7 The $M# de eloped >Globinmed> (((7globinmed7com (hich is a global information hub on integrated medicine7 The main function of this (ebsite is to pro ide information on all aspects of traditional medicine e7g7 safety, research, training, policy and trade for the layperson as (ell as for practitioners7 $M# continues to support the pathology ser ice of the country through continuous impro ement of the test methods or de elopment of ne( methods through research @ de elopment7 $M# became the only centre in the country that offers biochemical genetic testing for $nborn 8rror of Metabolism *$8M0, molecular diagnostics for genetic diseases and detection of trace elements and hea y metals in biological fluids7

The $M# laboratories ser e as the Bational #eference "entres for Transplantation, %llergy 'iagnosis, 5rimary $mmunodeficiencies, molecular diagnosis of leu3aemias, multiple myelomas and confirmatory diagnosis of infectious diseases7 The $M# established the Malaysian Marro( 'onor #egistry (ith M%<B%, for the purpose of tissue typing potential donors for patients (ho are in need of a bone marro( transplant7 $M# is elected as a Member of the Go erning Board of the =HO4,B'54=orld Ban3 Special 5rogramme on Tropical 'isease #esearch *=HO4T'#0, (hich is the highest policy decision body on tropical disease research of the =HO7 The =HO appointed $M# as one of the coordinating body for =5#$M *=estern 5acific #egion $nde; Medicus07 Bet(een 2...?2..E, $M#, through a research programme supported by the S8%M8O4 T#O5M8' #egional "entre and =HO, established the ector of malaria in +aos7 $M# is the "hair of the 5ublic Health Sector of the Second Bational "ommunication on "limate "hange, and a Member of the Technical =or3ing Group on "limate "hange, ODone 'epletion and 8co4system "hange of the #egional Ministerial 2orum on 8n ironment and Health7