During my final year of medical school, I spent four weeks at Hospital Kuala Lumpur (HKL), where I gained first-hand experience of paediatric ophthalmology, observed a wide range of ophthalmic surgery and developed a greater appreciation of how healthcare delivery is shaped by local resources and patient needs.
I had the opportunity to shadow clinics, observe surgical lists and witness a wide spectrum of ophthalmic conditions. It was an invaluable chance to compare Ophthalmology services, patient presentations and treatment pathways with those in the UK.
Hospital Kuala Lumpur is the largest public, government-owned hospital in Malaysia, located in the capital city of Kuala Lumpur [1]. The ophthalmology department comprises of seven subspecialty teams: cornea and glaucoma, oculoplasty, medical retina, vitreoretinal, paediatric ophthalmology and strabismus and neuro-ophthalmology [2].
Organising the elective
Arranging the placement at HKL was relatively straightforward, with clear communication and helpful administrative staff. The application process is outlined on the HKL website, where an application form can be downloaded and submitted via email [3]. Responses typically arrive within 8–10 weeks, after which a supervisor is assigned for the duration of the placement.
On the first day, I attended the general office to complete the necessary paperwork and collected the identification badge before being introduced to the ophthalmology department. I then met my supervising consultant for an introductory discussion about my learning objectives and what I hoped to achieve during the elective, including opportunities to be involved in audits, research, etc.
The placement ran from Monday to Friday, with weekends free. I was attached to a paediatric ophthalmology consultant although there were opportunities to observe a range of ophthalmic subspeciality clinics and theatre lists. On average, I spent one to two days each week in theatre, including dedicated cataract surgery lists and glaucoma, vitreoretinal and other subspecialty procedures. I was able to scrub into theatres. The remaining time was spent in consultant-led outpatient clinics, which typically began at 10:00am and ended at 3pm.
Figure 1: UNHCR has increased refugee access to healthcare in Malaysia.
Although my role was primarily observational, I was encouraged to examine patients under supervision, practice slit lamp examination and discuss clinical findings and management plans with consultants and trainees. This hands-on supervision significantly improved my confidence in slit lamp examination over the course of the four-week placement. English was widely spoken within the department, making it easy to participate in teaching sessions and clinical discussions. The combination of outpatient clinics, operating theatres and informal bedside teaching provided a comprehensive overview of ophthalmology within a large tertiary referral centre.
Figure 2: Ophthalmology Clinic Based in Hospital Kuala Lumpur Hospital.
Figure 3: Picture of myself scrubbing in for Cataract Surgery.
A memorable case: congenital glaucoma in a refugee child
One case that left a lasting impression was that of a 10-year-old boy who presented to the paediatric ophthalmology clinic with a protruding enlarged left eye, extreme photophobia, excessive tearing and persistent blinking with eyelid squeezing. He was diagnosed with congenital glaucoma for which he would require urgent surgical intervention to preserve his vision. However, his status as a refugee from Myanmar living in Malaysia added a distressing layer of complexity.
Unlike Malaysian nationals, refugees are not entitled to the same level of subsidised healthcare. At government hospitals, foreign nationals (including refugees) are required to pay full fees unless they are registered with the United Nations High Commissioner for Refugees [4]. Registration allows for a 50% reduction in fees, but the process can be time-consuming and, in this case, posed a significant barrier to timely care.
As a result, the child’s surgery was delayed due to administrative processes and funding requirements. Witnessing this first hand highlighted the complex ethical considerations that can arise when access to care is influenced by financial and administrative factors opposed to clinical need alone. This case demonstrated how healthcare systems must balance finite resources with the needs of diverse patient populations. Guidance from the Malaysian Medical Council emphases that ‘the right to health should be upheld without discrimination based on race, ethnicity or other factors, and that doctors should be mindful of patients’ financial limitations’ [5]. Observing these challenges in practice provided valuable insight into the difficult decisions faced by healthcare professionals working within different healthcare systems.
Although initiatives exist to improve access for refugee populations, this experience highlighted the importance of continued collaboration between healthcare providers, government agencies and charitable organisations. Partnerships with organisations such as Orbis International [6] have the potential to expand access to essential ophthalmic care and reduce avoidable visual impairment among vulnerable communities.
Patient confidentiality
Another interesting observation was how patient confidentiality was managed within a busy, high-volume clinic. In paediatric ophthalmology, several patients and their families were placed within the same clinical space by multiple clinicians. I found this to be different to my experience in the UK and I learnt the need to balance patient privacy with efficiency in an environment managing many patients each day. This was attributed to factors such as limited clinical areas, and a very busy service with many patients needed to be seen.
Observing this approach encouraged me to reflect on how healthcare systems adapt their clinical practice according to available space, staffing and patient demand. It reinforced that delivering patient-centred care often requires balancing competing priorities, and that approaches to confidentiality may vary according to the local clinical context while remaining guided by the principles of professional practice.
Comparative view of healthcare systems: UK and Malaysia
Experiencing ophthalmology in Malaysia provided a valuable opportunity to compare two healthcare systems with different funding models, patient populations and resource settings. The NHS provides healthcare free at the point of use [7], whereas Malaysia operates a dual public-private system, in which Government hospitals provide subsided care for Malaysian while non-citizens contribute a greater proportion of treatment costs [8].
There were key differences I observed that were closely linked to patient volume, resource availability and local models of healthcare delivery. A dilemma I did face was the language barrier, however this did encourage me to rely more heavily on non-verbal communication and careful observation during patient interactions. It also encouraged me to play an active role while observing such as asking questions to my supervisor as well as the supervising doctors who were more than happy to answer and explain when I did not understand. This helped me become integrated into the team.
There were noticeable differences particularly in ward layout and infection control. This highlighted to me how healthcare delivery is influenced by local priorities, available resources and cultural context. Experiencing these different approaches broadened my understanding of global ophthalmology and reinforced the importance of adaptability, cultural sensitivity and open mindedness when working in international healthcare settings.
Exploring Malaysia beyond the hospital
Outside of my time in clinic, I explored different parts of Malaysia, including Penang and Langkawi. In Kuala Lumpur, I visited the Batu Caves, admired the architecture of the Putra Mosque, and sampled a wide variety of local dishes at the lively Jalan Alor night food market. I thoroughly enjoyed Penang, experiencing its vibrant street art and visiting the Penang Peranakan Mansion, where I learnt about the Baba Nyonya heritage and explored a beautifully preserved family residence. Langkawi offered a welcome escape from the pace of city life, with pristine beaches and unforgettable sunsets shared with my peers.
Figure 4: Exploring Jalan Alor Food Market.
Figure 5: Sightseeing Petronas Towers.
These experiences deepened my appreciation for Malaysian culture and its diversity. They reminded me that electives are not only an opportunity to experience a different healthcare system, but also a chance to immerse oneself in a new culture, try new foods and discover new surroundings.
Conclusion
My elective in Malaysia offered far more than clinical exposure. I witnessed both excellent paediatric ophthalmology care and the challenges faced by refugees in accessing timely treatment. Comparing the Malaysian system with the NHS highlighted differences in funding, patient access and clinical practice, reinforcing the importance of adaptability, cultural sensitivity and advocacy in medicine. The lessons I learned, both in clinic and beyond, will stay with me as I begin my ophthalmology career, shaping not only how I practise medicine but also how I connect with patients.
TAKE HOME MESSAGES
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Be prepared to encounter language barriers. You may need to ask more questions in clinic, and although this can feel daunting, it is important to clarify when you do not understand the local language to maximise your learning.
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Try to pick up on non-verbal communication and learn basic local phrases, particularly key clinical terms such as ‘pain’, ‘redness’, or ‘cataract’. This can greatly enhance patient interaction and engagement.
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Take initiative and seek opportunities to get involved, whether by scrubbing into theatre, assisting in clinics or participating in research activities.
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Use the elective as an opportunity to explore your interest in a specialty. Engage actively in clinics – for example, by learning practical skills such as slit lamp examination.
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Make use of accessible learning resources. I found Lecture Notes: Ophthalmology (2024) particularly helpful for quick reference when reviewing cases or consolidating knowledge between patients.
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Finally, embrace the experience beyond the hospital – take time to explore the local area and culture, including trying the local cuisine.
References
1. https://en.wikipedia.org/wiki/
Kuala_Lumpur_Hospital
2. https://hkl.moh.gov.my/en/about-us/
department/medical-ii/surgical-directorate/
ophthalmology
3. https://hkl.moh.gov.my/en/component/
content/article/student-elective
-posting?catid=30&Itemid=195
4. https://www.unhcr.org/uk/
5. https://mmc.gov.my/wp-content/uploads/
2019/11/Confidentiality-guidelines.pdf
6. https://gbr.orbis.org/en/about-us
7. https://www.commonwealthfund.org/international
-health-policy-center/countries/england
8. https://apo.who.int/publications/9789290615842
[All links last accessed October 2026]
Declaration of competing interests: None declared.
