When passion drives research: Greentown Health Clinic, Ipoh

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Dr. Sree Kantan Nayar is a Senior Medical Officer and Clinical Coordinator at Greentown Health Clinic, Ipoh, more popularly known as Klinik Kesihatan Greentown. He has over 20 years’ experience as a clinician with stints as a medical officer throughout the state of Perak and in Kuala Lumpur. He is involved in training medical students and housemen, running of a high risk clinic and conducting his own as well as industry sponsored research among others.

Even with his vast experience, clinical trials were not something that came naturally to him. He stumbled upon the idea of conducting trials when he worked with Dr. G.R. Letchuman, a renowned Consultant Physician and Endocrinologist. He was a medical officer at the clinic of the Medical Unit, Hospital Raja Permaisuri Bainun, Ipoh at the time.
In 2003, Dr. Letchuman had asked him if he was interested to participate in a clinical trial. He gave it a go and as they say, the rest is history. When the nascent team first embarked on a clinical trial, they found that research required a higher level of attention to details. Everything they did had to be scrutinized under a microscope. On reflection, Dr. Sree believed that his personality suited research, as he always had a keen eye for little details.

Initially, clinical trials were run at the outpatient clinic with Dr. Letchuman as the principal investigator and Dr. Sree assisting as co-investigator. But Dr. Letchuman had always intended to pass on the baton as he wanted to focus more of his time at Hospital Raja Permaisuri Bainun. Coincidentally the outpatient clinic was moved from the hospital to a brand new, separate facility nearby, Klinik Kesihatan Greentown. A few years after the move, Dr. Sree took over as principal investigator.

In 2004, Klinik Kesihatan Greentown was one of only a few government clinics to participate in industry-sponsored clinical trials. This surprised many doctors at investigator meetings. Many doctors had the idea that a government clinic is crowded, noisy and haphazard, and wondered how they managed to maintain the nice, tidy order required of a clinical trial. But against all odds, they persevered.

Investing in people

Dr. Sree credits the pioneering staff for getting the clinical trial ball rolling. Starting with a small crew comprising himself, Dr. Letchuman, and a retired nurse, Ms. Wong Kheng Chee, they rolled up their sleeves to set up the location and recruit patients. Dr. Sree commends Ms. Wong, who is still actively involved in his research team for her efficiency, dedication and her rapport with the patients. They also received support from a nurse sister, Sister Mariaman in the earlier stages of setting up the trial site.

When participating in a clinical trial, managing finances has to be done in a transparent manner and the team is held accountable for all money coming in and out of the account. Dr. Sree was thankful that they had help from the hospital to manage their accounts, in the earlier days. But he realized the need for a person dedicated to managing their accounts, and that was when Mrs Preet Kaur was roped into the team to do just that.

In its infancy, the Klinik Kesihatan (KK) did not have clinical specialists. It was only recently that family medicine specialists (FMS) were stationed at Klinik Kesihatan. The budding team was actually guided by physicians from the hospital. Dr. V. Paranthaman, an FMS from Jelapang was roped in because he had shown an interest in clinical trials. He is now a principal investigator for the Greentown site. Dr. Sree credits Dr. Amilia Hazreen, an FMS stationed at KK Greentown who is a sub-investigator for her hard work and professionalism. He also acknowledged Dr. Subashini Ambigapathy, who was a principal investigator for the site but has since moved on, and Dr. Lau Kin Mun, a sub-investigator. He could not have imagined achieving success without their efforts.

Part of the reason the Greentown site was successful was the large pool of diabetic and hypertensive patients from Klinik Kesihatan Greentown, Ipoh. The hospital had close to 10,000 patients that could participate in studies that involved diabetes, dyslipidaemia and hypertension. The proximity to the hospital allowed them access to this cohort of patients. Dr. Sree is proud of the fact that the Greentown site was one of a few sites in the world to participate in the phase 3 trial of the DPP-4 inhibitor drug, Januvia (sitagliptin). He said research kept the site at the cutting-edge of medicine.

Advice to young doctors

Dr. Sree said doctors should participate in clinical trials to give their patients access to the best possible treatment and management of their disease. Even within the constraints of government service, good quality treatment does not always involve a lot of money.

Young doctors who are keen to take part in clinical trials should have very good knowledge of their field of interest. Dr. Sree pointed out that clinical trials requires hard work and doctors must be willing to put in the hours. He shared that when he just started out, he used to go home around 8–9pm but he assures doctors that it gets easier with time.

Finally, Dr. Sree discussed the type of support that is important for a doctor who wants to conduct clinical trials. Having support from colleagues is important but most importantly is to have supportive superiors, which he did have throughout his years participating in clinical trials.

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