Letter from Malaysia

Hi all! Below is a letter published in one of Johns Hopkins’ magazine ‘Change’. Thought I’d share it here:

As the first year of Perdana University Graduate School of Medicine draws to an end, class president Malini Fonseka has collected her classmates’ thoughts on their life-changing plunge into a brand new institution and a different system of medical education.
Until now, Malaysia used only the British method of training physicians. It calls for students to begin a five-year program as undergraduates, usually at the age of 18 or 19, instead of waiting until they obtain the bachelor’s degree that is required in America. In this system, only half of the students who qualify for publicly-financed programs are admitted due to limited allocation, while private schools are beyond the financial reach of most. At the Hopkins–operated program, the country’s first graduate medical school, the government is supporting the Malaysian students in exchange for future service in government hospitals and clinics.
Fonseka, 27, holds a master’s degree in immunobiology. Like many members of the Class of 2015, she left a job she enjoyed to pursue the dream of becoming a doctor. The following letter provides insight into the students’ experience of that opportunity so far.

A second chance
Perdana University’s interim campus is in a rather isolated location in the suburbs of Kuala Lumpur. The campus is really just two huge halls converted into lecture halls, discussion rooms, library, anatomy lab, clinical skills unit and offices – all put together last year in the span of 42 days! We do not have student dorms here, so most of us stay with family or rent places together. We do not have our own research center or our own hospitals yet, and that sometimes removes us from the special energy and connection one might feel walking to class through hospital corridors.
However, the small size of our class has allowed us to grow very close to one another and to have a warm and meaningful relationship with the faculty members. There are only 24 of us – all Malaysians of different races except for one classmate who is from Bahrain.
For many of us, this is a second chance to pursue our dreams. Until now, pursuing a graduate medical school program after completing an undergraduate degree was almost unheard of in our country. Last June, during the application period, a number of us were already working fulltime jobs in such fields as nutrition, business development and pharmaceuticals.
When we received our admission letters, we were overjoyed, but anxiety about the next step – a scholarship — quickly replaced it. The tuition fees alone at PUGSOM cost RM 1 million, (roughly $320,800 U.S.) for four years and there is no way any of us can afford it. Our only hope was applying for a government scholarship that would cover all tuition fees, as well as provide us with a small stipend.
Because we did not get word about the scholarships until two days before registration, those of us who were working were forced to take the risk of quitting our jobs. Realizing that the faculty members also took huge risks in being part of PUGSOM gave us the courage for such a leap of faith.

New lessons
I went through my undergraduate degree hardly asking any questions at all. Our classes were not only very large, but also took the form of didactic lectures where faculty members were remote figures. Not only was there a fear of calling attention to yourself, but you weren’t really encouraged to ask questions. The cursory “Any questions?” at the end of class did not invite many.
When we first started classes here, the scenario was pretty much the same: pin-drop silence, eyes averted when asked if there were any questions. But, time and the persistence of the faculty members took care of that. Our entire class can easily fit into a medium-sized room, and that close space has facilitated the discussions. Because we are comfortable with one another, we no longer fear making mistakes or embarrassing ourselves. That’s largely due to the relationships that we have and the support we have been receiving. Having others believe in you really does wonders in helping you believe in yourself. We are given a lot of opportunity to speak up here, and we have provided honest feedback on what works for us and what does not.
Visiting lecturers have commented on how less critical we are than the students in Baltimore. They advise us to question more and not accept everything at face value. This is an area we need to work on, but it is not an easy habit to break. Although we have all learned to open up and be more vocal, we also face challenges in that regard. Being respectful and grateful is very much a part of our culture. We must learn how to strike a balance: question while maintaining respect, criticize without sounding ungrateful. We remain mindful that, at the end of the day, most of us are going to end up working in Malaysian hospitals with fellow Malaysian doctors. A junior doctor who’s too vocal and critical might not sit well with the rest.

Looking ahead
Considering that the medical school is less than a year old, it’s not surprising that most people are unaware it exists. But many of those who do know about it, including our country’s medical fraternity, have doubts. With such a steep tuition fee, they argue, it will be impossible for Malaysian students to enroll without government scholarships…and how long can the government continue spending such huge amounts to sponsor them? Some wonder why taxpayers’ money is spent on such an expensive education when the same number of students can be educated elsewhere for a fraction of the cost.
Currently, our medical system does not allow a direct transition from medical school to a residency program. (No residency program currently exists in Malaysia. If the law is not revised by the time we graduate, we will have to join the graduates trained under the British system in two years of housemanship before we undergo any specialty training (which is also very highly competitive due to limited allocation). Completing our residency program abroad would be a wonderful opportunity, but it is not presently an option because the scholarships we are receiving bind us to serve in government hospitals and clinics for ten years following medical school.
Despite the many uncertainties, we are really happy to be here and are hopeful for the future. Medical education in Malaysia is transforming. We realize what is happening with us has far-reaching impact on the education system and the country as whole. We take a certain pride in being the first class in PUGSOM and are determined not to shy away from the responsibilities that come with it. Late last year, the faculty made special T-shirts for our class that express that spirit. They read: “Once a pioneer, always a pioneer”.

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