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On the ground in Segamat

12 August 2008

A Monash project based in a small Malaysian town is at the centre of public health efforts to improve the prevention and management of chronic 'lifestyle-related' diseases like diabetes, hypertension and heart disease.

Like much of the world, Malaysia's greatest public health problems stem from lifestyle choices – diseases caused by sedentary routines, a national hankering for fast-food, and a shift away from the traditional diet. And while Malaysia's residents enjoy a well-developed rural health system based on a World Health Organisation model, attempts to tackle these emerging, long-term diseases face a unique problem.

"Using a western model, which is very highly individualistic, to deal with these problems requires huge resources and highly-trained people," says Associate Professor Shajahan Yasin of Malaysia's Sunway Campus.

"The western model works. It has been tested. It's very costly. And where that model isn't available, we have to say: we don't have that, it's not going to work, we can't treat these conditions well. Can there be another, alternative way?"

This affordability dilemma pushed a team of Monash public health experts to devise the Segamat Project. Funded by the Faculty of Medicine, Nursing and Health Sciences, and led by Associate Professor Yasin and Professor Brian Oldenburg from the school of Public Health and Preventive Medicine, the researchers aim to build capacity within the existing workforce of Malaysia's highly-efficient health system to address chronic diseases at low cost.

Associate Professor Yasin hopes that in three to five years' time up to 50 healthcare professionals, researchers and medical students will help contribute to the project, hopefully also attracting funding support from international agencies as well as the support of the Malaysian government to apply its results nationally. Hopefully, this new model will also be applicable and can be transferred to other low and middle income countries in Asia and Africa.

"When people say that there is a problem in Africa that needs to be handled, developed countries generally produce some aid.... People come in and bring their aid and money and they do a good job, but they eventually leave and the money runs out, and the project is orphaned. If we [in Malaysia] actually do a project in a different way where the healthcare workers of the country study the problem and realise it's important to take responsibility for it, and the local people and government are involved, it is more likely to be generalised to the rest of the world."

Named after the small city in the state of Johor where much of the work is currently concentrated, the Segamat Project brings together doctors, nurses and other health professionals from local hospitals and clinics at a series of workshops. Project leaders raise awareness about lifestyle illnesses, and then encourage the participants to identify their own research questions. The participants will attend subsequent workshops every six to eight weeks to develop their research methodologies and to reflect with leaders on their progress and activity.

The project also studies the methods that other middle-income countries and health systems with WHO models use to deal with non-communicable diseases.

"We are here. We are part of the community. We do want to build this up and we think this may be something from which the country will benefit and we are working together with the community to develop this problem. We are building a capacity which will be there for a long period of time," says Associate Professor Yasin.

Sunway campus entrance

The Monash Sunway Campus in Malaysia