How Safe are our Children in Nurseries?

In the present generation, where both parents often tend to be employed, many parents send their young children to nurseries or other child care services. When we entrust our much loved children into the care of others, we need to ask how competent are these individuals to look after our children when emergencies occur.

The Clinical Research Centre (CRC) at Perak recently audited 42 registered nurseries as to their knowledge in managing emergencies. This study tested the knowledge of Kinta district nursery teachers on paediatric emergencies. We included 6 common emergencies: choking, poisoning, seizures, drowning, head injuries and simple fractures. We had approached 81 registered nurseries and 42 consented to participate in the study. The most senior teacher from each nursery was approached to participate. They were given 6 different scenarios and were asked to identify the emergency and outline the first aid steps that they would perform to help the child.

The results were not encouraging. Remember that this evaluation is based on the most senior/experienced person in the centre and that 69% of participants had prior first aid training. Although teachers were good in identifying the emergencies, none of them (0%) possessed good or average knowledge in managing common emergencies (see info-graphic attached). The majority knew less that 70% of the right steps to take and were often out of sequence. Only 4 nurseries had first aid algorithms to refer to during an emergency and these teachers tended to faired better in the assessment


Current policies require registered nurses to have some minimum safety standards. These include making available a first aid kit (all but one nursery audited had first aid kits available) and having some training in handling emergencies (69% had prior first aid training). But our study shows that these are insufficient to support our young children.

We would like to thank these nurseries for the courage to allow us to audit them. This offered them opportunities to improve the quality of care at their centre. Participating nurseries were given a copy of the algorithms to serve as a reference guide in case of an emergency.

We are certain that teachers working at nurseries would like to have the knowledge and skills to support children when faced with an emergency. Calling for help, while useful, may take too long to help a child. We recommend that all nurseries have:
1. Display important first aid algorithms to aid action during emergencies (available from this link: or ).
2. A complete first aid kit that is checked periodically.
3. Have all teachers trained in first aid. This should include a formal Paediatric Basic Life Support (BLS) course for at least one staff member.
4. We also strongly encourage parents to evaluate the safety profile of nurseries before enrolling their children.

If this study showed the limited safety capacity of registered nurseries, imagine the situation in the numerous unregistered child care providers and nurseries in our country! We need to work together as a society to improve the quality and safety of child care providers and nurseries in our country.

Thank you.

Dr Arvinder Singh HS, Research Officer
Dato’ Dr Amar-Singh HSS, Head
Clinical Research Centre Perak

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The tragedy in Hospital Sultanah Aminah JB

By now you would have read about the tragic news of the fire in the ICU of Hospital Sulatanah Aminah in Johor Baru. Lives were lost but there were heroic acts too.

Here’s an account we came across in our Doctors forums

A house officer from HSA recounts his personal experience .

Today is a dark day for us. We’re hit by the worse tragedy that can ever happened to a hospital. I thanked all of people who called or dropped a message to check on me. The thoughts that you gave me are really appreciated.

I would like to thank all people who have helped us throughout the day. Special thanks to :

1) Allah for keeping all my babies safe. No words can I put if the flame went to my paediatric blocks

2)The Colleagues & MO

To all my colleagues especially the female colleagues in my ward today. When the fire started they selflessly told all the male House Officer “You guys go and save the patients. Do what you need to do. They need manpower to lift the patients. We’ll take care of the babies”. My MO today gave me a look during ward round and say ” You can’t focus in round today don’t you Muhaimin? You want to go there and help. Go lah. Be safe.”
And that’s how all of us managed to come and help in ED and other parts of the hospital

3) The PPK, Nurses and MA

All my PPK. You have no idea the part they played today. Some of them carry oxygen tanks from place to place, with sweats dripping from their foreheads to make sure everyone is safe. I knew some of them have osteoathritis but they were so strong today. Nurses and MAs are so efficient today that some orders are carried out without words. Everyone know what they should do and where they should be. Some of them sacrifices their lunch hours just to make sure patients are not left alone in new wards.

4) The Fireman.

They are the bravest soul who ran into the fire to try to save our patients. Some of them looked so tired in their heavy gears. They are the unsung heroes of today.

5) NGOs

Tzu Chi, Jabatan Amal, ARIF, and many more. Thank you for the water and food. Even Mc Donalds came and provide burgers to everybody. In less than 3 hours, aids came in non stop that we have to redistribute the supplies to other departments.

6) The off duty officers

A lot of my House Officer friends and nurses, MA and PPK alike who are on their off days came to the hospital, in their sport attires and helped. You know how much off days meant to us. I managed to get a break to drink water today after my friend who was post night came and substitute for me. Some came with red eyes and tired faces. May Allah repay you for your kindness.

7) The Specialist

I put this at the end because I think they deserved one of the greatest thank you of all. Can you imagine organising a ward that is built for medical patients, but in less than 30 minutes they are full of patients from ICU, Ortho, Surgical, Neuro and many more? The specialists are the calmest in ward. They rally the House Officers and MOs, gave a perfect orders and positioned everyone at the right station so that everything goes smoothly. From ordering a House Officer to take blood, till ordering ward Sisters to make a check list and head counts, they managed to complete and turn a chaotic day to an ordered one. Thank you for showing us a good leadership.

Let’s pray for the deceased one. May their souls rest in peace.

Today I was reminded why we Malaysians are the best.

Our deepest condolences to the family and loved ones of those who lost their lives.
May those seriously ill get well soon.
Our thoughts and prayers are with all of them and the brave staff of Hospital Sultanah Aminah.

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Contract posts only for junior medical doctors


As we predicted in December last year (The changing landscape of junior doctor jobs in Malaysia IV), junior doctors will no longer start off with permanent jobs, and instead be hired on contract basis only.

Malaysiakini reports

The Health Ministry will appoint 2,600 medical, dental and pharmacy graduates to serve in the government sector on contractual basis from December.

Its minister Dr S Subramaniam said in line with the Budget 2017 announced by Prime Minister Najib Abdul Razak yesterday, the government will introduce a contract system to them as well as to solve the problems of graduates who waited too long for placements.

“With the announcement yesterday, all the posts in this category (doctors, dentists and pharmacists) will be selected through contract system and we will suggest that doctors work for the government for at least four years while dentists and pharmacists can work up for three years under the contract,” he told a press conference at the Penang MIC office today.

Subramaniam said the move could provide flexibility in recruitment in the future due to the number of contracts can be increased based on the need.

“So with this move, waiting period for doctors to get the placements will also be reduced.

“All of them will be given training according to their respective fields and we will provide sufficient time so that graduates acquire adequate experience and knowledge to assist them when leaving to work for the private sector or setting up their own practices,” he said.

It seems those who perform will be be offered permanent posts, and as the DG has posted in his Facebook page, there is the possibility that under performing doctors may not be continued after completing their compulsory service and “will have to join the private sector”


If these “rejects” wish to continue to serve as doctors, it is unfortunate as the private sector is competitive and private hospitals and clinics will want to hire only good medical officers.

In the long run, we believe it will be better for the overall standards. It will be a survival of the fittest (I know, some of you will be cynical and think otherwise) .

We wish junior doctors all the best and you all are invited to join the hot discussion on this topic in our Malaysian doctors community, DOBBS, the pioneer and largest forum with now about 13,000 doctors in all platforms combined. For more information on how to join, see

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