- 7 months ago
- #thefutureisfemale
On this episode of #TheFutureIsFemale Melisa Idris speaks with Nurse Maheswari Jaganathan, Deputy Head of Community Outreach at Cancer Research Malaysia. She was recently named Top 10 Finalist for Aster Guardians Global Nursing Award 2025, one of the world’s most prestigious recognitions for nurses. Selected out of over 100,000 applicants globally, Maheswari is an oncology nurse who created Malaysia’s Patient Navigation Programme, transforming breast cancer care for thousands of women by addressing both medical and systemic barriers. Her model is now adopted in multiple hospitals across the country and recognized by the World Health Organization.
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NewsTranscript
00:00Hello and good evening. I'm Melissa Idris. Welcome to The Future is Female. This is the
00:16show where we find the extraordinary in every woman. I am delighted to introduce my guest
00:22today, Nurse Maheswari Jaganathan, who is Deputy Head of Community Outreach at Cancer
00:28Research Malaysia. She was named one of the top 10 finalists for Esther Guardian's Global Nursing
00:36Awards 2025. Welcome to the show, Mahes. It's good of you to join me. I mean, this is such a remarkable
00:43achievement. Congratulations, I would have to say first and foremost. Thank you so much. So, I mean,
00:49clearly this is a global recognition of your work and your journey, your contribution. Maybe you can
00:57share a little bit with us what your journey has been. Maybe tell us a bit about yourself and your
01:01journey and what drew you to nursing. Nursing, okay. I've been in the nursing field now, about 24 years
01:09now. And started, I mean, where I started was actually in an accounting school. Okay. That was
01:19done. Oh, so you never, like, were you, did you picture yourself as a nurse as a little child? No.
01:23No. No. No. But there was a lot of drive for me to go and work with you, I mean, like with people.
01:30And at the time, you know, after Form 5, family preference was to go into accounting because family
01:36was doing business and they wanted somebody to really know how to keep money. And so, because
01:42being eldest, then you've been dragged into that. But of course, that, I don't feel, I mean, I truly
01:48don't feel like it's something that I really wanted because I hate accounting anyway, when I was in Form 5.
01:53So, it didn't fit with you, didn't you? Yeah. I always feel like a numbers drives me crazy. And I don't like
02:00numbers. It was just about like eight months in the, in the whole course. And then I was walking back in
02:07one of the night class. In the cafeteria, there was a newspaper left behind in the, in the cafeteria.
02:14So, I brought that back. And there was a nursing scholarship then. Yeah. So, that's how I went into
02:20the nursing field. But what kept you in the nursing field for 24, 25 years? Yes. I think it's the, it's how
02:29you use your identity, your skill and your knowledge to be able to help people at the most vulnerable
02:36time. And not everyone is being gifted in that kind of nature or maybe to be in a situation to see
02:46people in suffering. But at the same time, you have to really act and be the person who will actually
02:53lead them to the betterment. Yeah. Okay. So, so you've, you clearly love this, this work that you feel
03:00that they recognized. So, as the guardian is looking into legacy of nurse, the future nurses, right? So, in my 23 years, for the past 15 years is the
03:16the time that I have spent into coming out from bedside nursing. I mean, nurses are really great when it comes to bedside nursing and it's just invaluable and no doubt. But, you know, sometimes nurses are only given the chances or maybe there is a
03:32coming out from bedside nursing i mean nurses are really great when it comes to bedside nursing and
03:39it's just invaluable and no doubt but you know sometimes nurses are only given the
03:44the chances or maybe there is only opportunity to be where they need but not where they lead
03:51so i was looking into how can i use this experience the knowledge and also the skill
03:59to come out and do something different in system change making so most probably what i was working
04:06on and when i joined right after coming back from middle east after five years of experience i came
04:14back to malaysia and i joined cancer research malaysia that's when the opportunity came
04:19to start a project called the patient navigation program and at that time the survivorship of
04:26our breast cancer patient in 2010 was at 47 and we were actually one of the poorest in southeast
04:32asia and at that time um my knowledge uh while i'm working in the middle east uh was very helpful
04:40to map out and start doing uh the the the mapping out of patient journey when they are going into
04:50breast cancer care the pathway the pathway okay yes the pathway so you're absolutely right i think
04:56that sometimes nurses are often seen as frontline caregivers but not at so much as system changes
05:03right um but you you really flipped that on its head you you decided that you could do more than just
05:10care for patients you could actually change the system itself talk to me about the patient navigation
05:14program what was it that you saw that made you that frustrated you that made you want to change the
05:21system right so when when you look at the the way that how usually any any newly diagnosed breast cancer
05:29patient okay they might be coming from the primary care clinic which is clinic in malaysia and most
05:34probably they would have been given a referral letter saying that something suspicious when they when they
05:39arrive to the hospital right there's more complex or more complicated journey uh in the hospital but
05:45many of the women might not know about it and feel intimidated yes and sometimes when people say go to
05:52the when they refer to the bigger hospital right hospital besar and they always think like hospital
05:56besar means right so when they when they arrive at the hospital the entire journey from uh the suspicious to
06:06the diagnosis until they get the breaking of the news and then the doctor talks to them whether they go for
06:12surgery or if it's not operable they will go for chemotherapy to shrink the tumor it's a long process
06:20but i was looking at what is the strength of a nurse in this right like i can actually watch literally watch
06:27them uh and i know what can i do okay and while you are in the ward in in inpatient you'll work work on
06:36shift basis most probably you will see patient when they come for treatment or maybe go for surgery and
06:42all of that but it's a very short time but what uh patient navigation does is that you'll tag with them
06:49along until they complete the treatment so patient navigation the patient navigation program which you
06:55you created essentially is you you is it partnering a nurse with a patient is that what so it's it's
07:01a tagging a tagging tagging a program where is a patient we introduced a patient centered program
07:07that can actually guide newly diagnosed breast cancer patient to complete the treatment and overcome the
07:13challenges so that their life-saving treatment is not disrupted okay you you noticed that without without
07:21having someone navigate them through the system they would fall out of the system yes because
07:27because the journey for breast cancer are based on our observation study if let's say they come very
07:31early it's about eight months but if they are not coming in early stage it can go into two and a half
07:38years so it's a very long process process and it's a long time and if you look at um the another reason
07:48how did cancer research malaysia brought the patient navigation program is also when i came back from
07:53middle east i was having this knowledge of how to navigate patient in the ward uh so i'm coming from
07:59really bedside and bringing up all the excellence for patient care and uh i was our past chief scientific
08:07officer uh doctor uh professor uh dr tiosu huang was also she won a eastern howell fellowship and she
08:15wanted to understand how did women in the western country improve their survivorship and at that
08:22time uh dr harold freeman was already pioneering patient navigation program in 1990s in hallam new york
08:28oh wow and that particular program was also started with uh breast cancer okay so she brought back the
08:37aspiration and uh with the aspiration from there uh uh we we had and because we are part of the research
08:45organization uh the aspiration the research background and at the time we also had a funding
08:51coming to us uh through the ladies professional golfers uh yes and saim dhabi okay and then so
08:58everything happened at the same time yeah but at the same time right even though we have all of this
09:05because we don't have patient or the pool of patients so we need to go and pitch okay and we were actually
09:11walking to the nearest hospital which is hospital the compound rahima in klang so we were walking and
09:19trying to convince them and talking to them direct directly to patients uh to to to the hospital
09:25to the hospital administrators about like you know if you take patient navigation program uh to the breast
09:32cancer patient management it will improve so you were trying to convince them to take on the patient
09:37navigation navigation program because we need patient and we we need to integrate them to the breast
09:42cancer management so it was a long walk four years but was all worthwhile and uh there was after four
09:51years one uh one of the uh retiring uh director i think the third director of the hospital uh actually
09:57gave us a 290 square feet uh room underused a quality meeting room said prove yourself and that's where we
10:07started and where we built the demonstration model was the same hospital where i lost my grandmother
10:14who had a cervical cancer so uh i used i always believed that you know the hospital has something
10:21to do uh when i was 10 years old going to the hospital watching her waiting downstairs for children
10:28you know young children were not allowed so i used to hate the hospital so much because you know took away
10:34uh somebody that you love and uh when i went into the posting as well i went back to the hospital
10:40hospital same hospital for my uh uh nursing diploma and then i did some specialization in midwifery after
10:48that again another one more year and then i left to the middle east for five years that's where i went
10:53into specialization of patient navigation program and all of that very little i know that i will come back
10:59and i will build back the demonstration model in the same hospital my goodness what a full circle moment
11:05yes this hospital must be very special to you very very special so so was that the turning point uh when
11:12people really started to listen to you that this program can work when somebody gave you a chance and say
11:18here's a room prove yourself yes yes because we okay the whole idea was from us okay so it was just about
11:26implementing it here in malaysia and what um nuances did you have to adapt it to a malaysian context
11:33because you can't copy paste a us program to malaysia program yes was there some changes you need to
11:39make for malaysia so for malaysia we really need needed to map out uh what is the patient's journey her
11:46experience their challenges at the same time we also really needed to really understand what is the gap in the
11:54system healthcare professional that is working with the breast cancer patients so holistically so for
11:59the past four years of us waiting we were also trying to be more alert aware what is the current need of
12:08the real breast cancer could you maybe illustrate it with an example so when you think about some of the
12:14patients what are would what would you say are some of the biggest non-medical factors that keep them from
12:23moving through the pathway okay so when uh most of the referral centers so when they come with
12:30suspicious finding they need to get to a facility that may have mammogram so uh if they don't have uh
12:37they i mean the healthcare system the ministry of health healthcare system is they will always refer you
12:42to the nearest and sometimes for women who are coming from the rural area it's not equipped that that
12:47yeah that clinic is not so equipped or something yeah so the sometimes they have to go to the bigger
12:52facility in the center of the town uh so first of all is the transportation uh for them to go beyond the
13:00clinic to go for the diagnosis uh when they arrive right because the the process is not only going through
13:09one diagnosis to get a diagnosis for breast cancer they need to go for a mammogram followed by an ultrasound
13:15and then followed by a biopsy so yes and sometimes women can go for three different days to do all these
13:24three but what we as the navigation team have actually negotiated together with the ministry of health is
13:30having it on the same day on the arrival so we try to cut a lot of time that we can actually save
13:39so you come in and you do it all and then you go back and then after that is health literacy
13:45uh a lot of women may not know exactly what is the sign and symptom of breast cancer it can be something
13:52normal uh and sometimes we we also found in our uh study women who find any suspicious finding if they
14:01are not telling that out to anyone they have no one checking on them and these are the people who can
14:06actually become a patient with delay presentation but if only they speak about this delay the the
14:14sign and symptom to somebody that can actually help you find a lump or there's an unusual you know
14:21something unusual about their breasts they tell somebody hey this is happening to me yes so yeah
14:27usually they don't if they say it then somebody is checking on them have you gone okay uh like like
14:32your accountability your accountability buddy buddy uh oh and uh if you're telling someone and this
14:39person if they say they are not telling the right information uh a lot of women might sometimes say
14:44that maybe it's breast uh milk engorgement uh maybe it was something else yeah it's not cancer somebody
14:51saying uh the people if they don't tell someone or the people who hear it and is is very very
14:58responsible to divert them just go to the hospital get it checked should be the right way of doing it
15:03but these are the two factors sometimes uh can bring patient uh to become a delay and then uh money money
15:13financially uh even though that malaysia have universal health coverage uh there's a lot of
15:19costs that can have to be buried by the patient the out of pocket paying for the travel sometimes you
15:25need to get grab something you take uh need to do parking you take a highway those are all out of
15:31pocket that's not even included in the um you know the the cost which is subsidized and it's at an
15:39affordable price in the ministry of health hospital but these are the things that they cannot uh it is
15:47something that they have to pay out and it adds up yes and and sometimes when they have to come for
15:52hospital who are there to care for their elderly at home child very young children and sometimes when
16:00they are going for work some of the work most probably if they don't have they are just maybe
16:06they are working on daily wages or they are working on contract so it is very difficult for them to just
16:12take a time sleep or a mc very different uh type of uh issue faced by women which is why it must have been so
16:24important and impactful for a simple thing like making sure the one trip and they get all the three
16:32procedures done at the one time instead of having to come back three separate times can i ask you
16:38um is what impact you're most proud of with this program okay so now uh the the partnership
16:46together with cancer research malaysia and the ministry of health uh since january 2015 uh we
16:52have navigated 10 years yes uh 2015 uh we have navigated almost about 5 000 women across uh hospital
17:01uh which was our demonstration model and then uh state referral hospital in uh coaching uh in kota
17:09kinabalu and also uh negeri sembilan okay do you see the potential for this being scaled up throughout the
17:15country yes uh currently ministry of health is uh i mean we have very good and uh high support from the
17:23ministry of health uh because this is a public and a private practice that we are doing this so we are
17:28scaling up uh starting from these four centers that i mentioned so last year we have uh signed an mou
17:37for a center in kedar uh hkl uh kelantan kota baru and also peraipo and um the and we are also going to
17:47establish an enhanced um navigation model in sabah and sarawak uh where it will consist of uh almost about
17:5518 hospital uh because in sarawak and sabah geographically patient have a lot of challenges
18:02the intensity do you think mahez that this model can be replicated for other diseases so beyond
18:10breast cancer then do you do you think that there could be an application for other diseases as well
18:16um definitely yes so we do have a lot of i mean like question do only breast cancer patient die and
18:23it's only breast cancer patient you know i mean we're not diminishing the everything but i'm sure
18:27it could be yes so while we are starting this with only breast cancer we if we have established the
18:33pathways in the way that we work with our breast cancer patient i think it'll be faster for us to
18:38establish for different cancer maybe we need to train uh team with the body of knowledge like now if
18:45somebody is taking care of breast cancer patient we need to know what to do before surgery after
18:49surgery during chemo radiotherapy so it's same goes to different type of cancer so the team has to be
18:55like team of excellence yeah oh wow so so was that difficult to build the capacity within the your team
19:04of excellence to make sure that they themselves are equipped to guide patients through the pathway so
19:10so currently the training is done uh in-house and i lead the training for uh two type of navigators one is
19:17nurse navigators who will be in charge of medical navigation so their medical navigation will be
19:24attached to all the clinical pathway decision making in going to all the uh medical decision with the
19:31doctors a second one we call them as community navigators so community navigators are social medical
19:38uh social welfare officers uh so in our uh model we have bring the social welfare officers so that they
19:47can actually use their uh skill and knowledge on how they want to navigate uh patient with disease
19:56at the same time uh due to their expertise right like you know social justice uh social they look
20:03they can navigate the welfare system as well yes uh due to the social determinants uh they can actually
20:09we have uh social welfare officers going to ardent office representing patient we have uh we even have
20:18gone to even court to uh represent patient so we we use two type of expertise and this two type of expertise
20:27were um actually choreographed based on the need assessment uh information that we found that these are the gap
20:38so in order to close this gap the the the solution is to uh convert that to a job description and the
20:46jobs job description fall into these two people nurse navigator and community i have to tell you mahes i can
20:53only imagine how reassuring and comforting it must be when somebody is going through probably the worst period
21:01of their lives getting a cancer diagnosis to have someone to be able to help and rely on i think is
21:07remarkable this is a wonderful program with the award uh with the recognition that came as top 10
21:14finalists for the global the esther guardians award can i ask you what that meant for you to be
21:20recognized on a global stage and i i wonder also if not just for you personally but for
21:27nurses everywhere for community navigators everywhere what do you think it means to them
21:34i think of course uh beyond personal recognition i always feel like um that you know all of us all of
21:40us have uh different strength um and uh we carry a different identity uh and when you carry those
21:47identity right at any any situation those identity is for others uh if let's say i'm i'm a nurse i'm
21:56sitting down and um talking to a patient and who is having this confusion about should i go for
22:02photoreal therapy or not but you know my knowledge will help and and and demystify all her confusion
22:09state and all of that nurses i think um well actually i should have asked you do you think that the
22:16emotional labor that nurses um undertaken nurses are mostly women um do you think that's undervalued in
22:25our healthcare system this immense emotional labor that nurses give i i think um i think at this point
22:35of time uh not i mean i think after covid a lot of uh constraint in healthcare uh especially human
22:42resource in healthcare but i think the nurses are doing wonderful job especially in the ministry of
22:47health they're doing wonderful job and additionally into a system that is actually trying to do the best
22:55for the malaysian women uh what cancer research malaysia because the project is being funded by
23:02donors uh so i will seek uh funding for the first four hospital came from yayasan saim darby and uh after
23:09that yayasan patronas has come over to help us to go far and establish more centers so beyond just looking
23:18at uh hospital uh when we say uh government hospital you know they are struggling and all that we are going in
23:25giving our strength we bring different strength into this entire uh solving the problem together i
23:30bring i i mean like for cancer research major we bring in uh we add the nurse navigator and community
23:37navigator their salary is paid by us but they are based in the hospital hospital and then we also
23:43through the donors we have financial reimbursement uh prepared for women so when for the patient for the
23:50patient so when they are coming in on arrival uh usually when you when you see a single mother with
23:56you know two children who are not even 12 years old who are traveling like 52 kilometers on uh only
24:05only depending on public transport right so today before she goes back the navigation team would do
24:11a profiling uh to see what will happen to this patient in 14 days if she is going to have cancer
24:18so the nurse navigator and the community navigator will actually uh do an interview and we already
24:23know the prediction and from there we will actually do a plan how will we bring her you know align her
24:31to the recommended treatment so on the day that the doctor will actually break the news to any women
24:37saying that is cancer on the other side the navigation team will say look we have all of this uh plan for
24:44you you're going to get a grab to come for all their hospital appointment your children while you are
24:49going for chemotherapy we will actually pay for you so that somebody else is looking after your children
24:54and if let's say that you are not working we try to help you to have groceries at home at least for the
25:01first two three months while doing that the community navigator will start looking at what are the
25:07initiative that is already available at the national level so like my salam peka b40 or we will even
25:15leverage on jabatan kebajikan masyarakat if they say she's a single mother they will start doing all of
25:21this planning but you know certain things will come later two to three months but now right if you want to
25:28get trust from women who are really vulnerable at the state you really need to show them that you care and
25:34you provide them immediately with the money because that will help them to come and listen and be in
25:40that recommended treatment plan mahez i'm so moved to hear this i think it's a wonderful program
25:48congratulations on being recognized for the work that you do and i wish you and your team all the
25:55success in the world i hope we get to scale up this program this wonderful program so it helps more women
26:01i hear thank you so much melissa thank you for talking to me about it today highlighting the
26:06patient navigation program we we hope that one day we have a centralized patient navigation program
26:13and it's a one-stop center so now itself the ministry of health is already providing us a space called the
26:20one-stop center called the pink ribbon center that's where the patient goes but we want it to be not only
26:27limited to breast cancer patient we want it to be more to different type of cancer one day we'll get
26:33there i have faith in you thank you so much for talking to me today i appreciate your time thank you
26:38thank you that's all we have for you in this episode of the future is female i'm melissa idris
26:43signing up for the evening thank you so much for watching and good night
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