Madam Tai, 89, never thought she’d end up in bed all day.
A slim woman with keen eyes and sharp hearing, Madam Tai came from a family with great genes. Her brother still drives his car in Ipoh at the age of 94. Her sister is a sprightly octogenarian. Madam Tai herself was as strong as her 69-year-old daughter.
But days before celebrating her ninetieth birthday, Madam Tai fell and snapped her right femur. She lay in hospital for two months where her bedsore grew to the size of a pancake. Her distraught family members ambulanced her into a nursing home where her wounds were tended daily.
But Madam Tai still couldn’t walk. She lay in bed all day staring at the expanse of gray ceiling. “What do we do?” thought her daughter and two grandsons as they visited their bedridden matriarch. “Who can help us?”
The plight of Madam Tai (not her real name) and her family members could easily be retold in many different ways in Malaysian households today. Throughout the 1980s, Asia boasted a young workforce that propelled the region’s economic success. But Asia has been rapidly aging – bringing about upheavals for families, societies and governments.
There are currently 2.3 million Malaysians above the age of sixty. By 2020, there will be 4 million. The numbers are massive compared to the meager numbers of nurses, therapists and geriatricians who are skilled in handling aging-related diseases, including diabetes, which already affects 2.6 million Malaysians.
There are also not enough facilities for the aged. A 2012 Ministry of Health report said that public hospitals provide only 41,000 beds. And while there are thousands of unregulated nursing homes, the number of government-registered nursing homes is only twelve.
Addressing the care of the aged is a monumental leadership challenge. You need courage to tackle an area that’s often neglected by the private sector and underserved by the public sector. You also need compassion and business acumen to devise meaningful solutions that make a genuine difference.
That’s why I found myself intrigued when PEMANDU convened a six-week-long “Seniors Living Lab” in September – made up of developers, healthcare providers, financial institutions, foreign experts and government officials – to focus on holistic care for the aged. During my visit, Fabian Bigar, the lab facilitator and associate director at PEMANDU, explained what they were doing: “In this lab, we brought the private and public sector to identify problems faced by an aging population. We’re now brainstorming solutions. Soon we’ll generate detailed action plans that will kick off high-impact projects called entry-point projects, or EPP.”
That’s when Fabian introduced me to Mohan Kumar, 58, CEO of Love on Wheels Healthcare Services. At the Lab, Love on Wheels was a potential candidate for an EPP. Mohan told me why it is necessary for the government to provide healthcare for patients in homes, not merely hospitals.
“There are countless Malaysians above the age of sixty who can’t afford to go to hospitals. How can we help them? We can’t ignore them,” Mohan said. “In this lab, I really hope the government will adopt our proposal to make mobile healthcare part of the national healthcare system.”
Mohan’s three-year-old company offers physiotherapy and occupational therapy services for patients with stroke, diabetes, accidents, back problems, osteoarthritis, Alzheimer’s and Parkinson’s. These services are usually provided in patients’ homes. Called “home care” in the United States, Australia and Western countries, this concept is relatively unknown in Malaysia.
“We are seeking to bridge the gap between hospitals and homes. When you’re discharged from hospital, you may still need therapy. We have a mobile healthcare team will come to your house or office and provide that service,” Mohan said.
In a follow-up interview, he added: “We’re like a simple hospital. The only difference is that the patient’s home is the hospital. People recover best at home. If they can reduce a prolonged stay in hospital, that will free up hospital beds for acute care.”
Everyday, Love on Wheels sends out 15-20 nurses and physiotherapists – who travel by car or motorbike – into homes for a typical 45-minute physiotherapy session or sometimes an eight-hour respite care session.
In March this year, Madam Tai’s grandson, an airline pilot, contacted Love on Wheels after googling for home healthcare services. “I want to get my grandmother off the bed and back on her feet,” he told the center’s clinical director, Dr Premala Thambirajah.
On a late October morning, Mohd Faizol Ezran bin Sulaiman, 25, a physiotherapist, rode his 110-cc Suzuki bike to Madam Tai’s nursing home in Damansara Utama. Faizol carried a pedal cycle and a Thera-Band with him.
“My goal today is to exercise Madam Tai’s arms and legs, get her off bed, and move her into a sitting position in a wheelchair,” Faizol, a physiotherapy graduate from UiTM, told me as we entered the nursing home. He has been treating Madam Tai for the past two months.
Madam Tai lay on a bed at the back of the house. She wore a pink blouse. A batik sarong covered her like a blanket. She gazed alertly as Faizol entered her field of vision. He raised her bed.
“Bring your right hand here,” he told the old woman, guiding her stiff arm across her chest.
“Bend your knee,” he said. He placed a pillow under her bent knee. “Some more. Some more, some more.”
Madam Tai grimaced. But she cooperated with Faizol.
“How’s my mother, Faizol?” said Ms Tan May Lee, Madam Tai’s 69-year-old daughter, who visited that morning.
“She’s feeling pain because she’s been sleeping in one position,” Faizol told Ms Tan. “The bed’s raised too high.”
“Faizol is really patient with my mum,” said Ms Tan, turning to me. “I’m so thankful for Faizol. I have trouble walking myself. I wouldn’t be able to look after mum at home.”
“You’re a good man,” Ms Tan called out to Faizol, as she leaned on a cane.
The inspiration for Mohan to start Love on Wheels came while he was caring for his ailing mother, aged 84. At that time, she had difficulty breathing. The whole process of going to hospital to see a therapist –waking up early, dressing, getting into the car, being wheeled around, waiting – was arduous. “I’m so very tired,” she’d groan. Her pain broke Mohan’s heart. But that pain also became the avenue for a great idea. “Why can’t we provide healthcare services at home?” he asked himself.
After both his parents passed away, Mohan, a former oil executive, threw himself into the startup with intensity. In less than three years, Love on Wheels has grown to a staff of 40 accredited nurses and therapists. They’re profitable. Demand for their services outstrip the supply of quality nurses and therapists they’re able to hire.
Mohan and Dr Premala, who also happens to be his wife, have big dreams. They’re developing a proprietary software called SHIMA that integrates clinical reports, customer service and corporate data so that their business is scalable once they go nationwide and regional. They’re undergoing an international healthcare accreditation process. And they aim to provide mobile healthcare services from cradle to grave: infancy (neonatal care); childhood (autism); corporate life (physiotherapy in offices); and senior years (palliative care). “A lot of things we’re involved in comes from learning from life – by watching and learning,” Dr Premala said.
Their greatest leadership challenge continues to be credibility – persuading hospitals, companies, clinicians, therapists and nursing schools that their company is a serious player in the healthcare field. Love on Wheels was given a big boost on November 16, when Prime Minister Dato’ Sri Najib Tun Razak announced 11 new ETP projects worth RM6.68 billion.
The project mooted by Love on Wheels, called K.A.S.I.H. (Kasih Atas Sumbangan Ikhlas dan Hemat), was adopted as an entry-point project. Mohan was ecstatic.
“We created history. For the first time, the government recognised mobile healthcare,” Mohan told me in a phone interview after the prime minister’s announcement. Mohan estimated that Love On Wheels will invest around RM68.5 million over the next eight years to provide mobile healthcare services for senior citizens, including 600,000 pensioners. “In most countries, the government pays for home healthcare. When that happens, that will be fantastic for the rakyat,” he added.
Meanwhile, back in the nursing home, far from the media spotlight in Putrajaya, Faizal has successfully moved Madam Tai from the bed into a wheelchair.
He props her up. She sways from side to side. He balances her. She salivates from the effort. Faizol wipes spittle from her mouth.
On the wheelchair, he tells her to pull the Thera-Band with her left hand, ten times. And then the right hand, ten times. Madam Tai complies.
“Are you tired?” he asks. She nods.
Faizol massages her shoulder. He turns her head, back and forth, and massages her neck.
“Are you comfortable?” he asks Madam Tai.
“Yes,” she says.
He takes her blood pressure. The 45-minute session has stretched to more than an hour. It will take many more sessions before she can walk. But compared to where she was lying prone all day and night, to witness Madam Tai sitting on a wheelchair is a minor miracle.
Faizol ends the session with her still seated in the wheelchair. He bids her goodbye. He looks at her eyes. She looks at him. They lock eyes for a long time. No words are exchanged. None are required.
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