Condolences to the families involved

Yesterday, as we are preparing to celebrate one of the most Auspicious occasion in our Islamic calendar a disaster struck right in the middle of our beloved capital city. A total of 4 cardiac arrests on-site most likely due to Crushed injuries and Asphyxiation and many others with injuries requiring admission to RIPAS. It was a very very sad day.

The pre-event incident occured around 1015am as thousands (as many as 4,000) of women rushed into the gates of the garden. An eye-witness account from one of the doctors attending the medical cover at that time, Dr Herry Zul said the victims were piled up on top of each other and situation worsen by the crowd pushing and shoving and even stampeding over the fallen ones. At this point it was evident that there was going to be a high number of casualties.

A major disaster call was activated immediately. With the help of the authorities, Dr Herryzul's team manage to retrieve the victims and prevented what would have been a bigger number of fatalities. Within 5 minutes more ambulances arrived and more back-up doctors and nurses arrived on the scene.

Out of the 4 cardiac arrest, one was revived on the scene by the medical team, but only to succumb later in ICU last night. The 4th victim was revived in A&E and is still in ICU, so 3 fatalities in total. Around 27 patients were admitted with sprains and minor injuries.

Our Deepest condolonces to the victims family who lost their loved ones.... Al-Fatihah..

INTERVIEW WITH DATO YAPP

INTERVIEW WITH DATO YAPP

Q: When did you start medical school?
A: 1961, Leeds Medical School

Q: Were you a Government Scholar?
A: Yes, fortunately

Q: You must have passed with flying colours?
A: No, I happened to be a citizen. In fact we were the first batch to take the exam, at that time the citizenship were just introduced. I was among the first to sit for the citizenship exam.

Q: At what age did you start medical school?
A: 19 years old, but I sat for the Higher School Certs in Brunei, and that was also the first batch ever to take Higher School Certs. There were six of us.

Q: Who were the rest of the six Dato?
A: There was one doing engineering, three doing science and another one doing microbiology. Another two on the art side, one doing law, another one don’t know what happened to her.

Q: When did you graduate, Dato?
A: In Leeds, I must have started in 1962. It’s a six years course. I qualified in June ’68.

Q: And you work there for how many years?
A: I work in Leeds in St. James’s hospital for a year. I was in the professorial unit doing a medical job because at first I wanted to do medicine. After that job I changed my mind to do Surgery

Q: That leads me to my next question, why did you choose surgery?
A: At that time, the surgery was in two parts, one three months each.Three months in urology and three months in general surgery. It seems to be a good job for me, and after that I went to Glasgow and the job was anatomy demonstrator, but the actual job title was assistant lecturer in anatomy.

Q: Was it a full time job? And being a doctor too?
A: Yes, it was a full time job and being a doctor too because at that time at Glasgow university in fact one of the biggest medical school with 250 students. 1968 to 1969, I did one year. After that I passed my primary, then I came back to Brunei. At that time actually we should come back after our house job. It was a compulsory three years, you must come back but because I took up this anatomy demonstrator job, I came back a year later. I started working in Brunei in October 1970 and work under Mr Harris for three years as a surgical trainee.

Q: How many doctors were there in Brunei?
A: You mean, in the whole hospital or the locals? We were the first group of local doctors, there were five of us; Dato Joe Lim, Dato Sherlock Chin, myself, Dato Johar, later became the Minister of Health, and Dato Hussin Daud, who was later became the Director of Medical services. After the first group, there was a vacuum of 13 years before Datin Intan and Datin Lim Ming King came back. When we came back, our salary was exactly the same as any graduates either arts or science, that means not only it is more difficult for us to get into the university but we spent a much longer time in University, so at that time our salary was only $1100 when we came back. Because of that, Dato Hussin and myself wrote in to get our salary revised. The two of us wrote in and they reconsider, that’s why the “M” scale came in.

Q: What other changes in term of health care in Brunei do you see?
A: For a start, previously there was only a Director of Medical Services. There was no Perm Sect, there was no Minister. So the Director General, in fact was the head of Medical Services. He controls or runs the service. Now, you have perm sect, in fact you have two Director Generals, one for the Medical Services and the other one for public health. The other thing that was introduced during these years was decentralisation for the clinics in the periphery. So as to make the Hospital less congested. Also an increase in the numbers of doctors. During our time in the old general hospital, the specialist, there were only four. A gynaecologist, which is Dr Datin Lapru, there were two phycians, Pehin Dato Dr Hart, and Dato Sinatambi. Dato Hart was in charge of the general services and Dato Sinatambi runs the chest clinic and Tuberculosis. And surgeons, at that time there was only one general surgeon, Mr Harris later become Pehin and under him, at that time was Dato Joe Lim and myself. When Dato Joe Lim was away, I was alone for little while, until Dr Gouse came in 1974. And there was an eye surgeon, Pehin Frank, he was also the Director of Medical Services. And later on, Dr Nayan’s (Eye spiecialist) father, Pehin Joshi came. So at that time in the Medical Services, there were four Pehins. That’s another change, from four Pehins to two Pehins today (laughing).

Q: How about in terms of working conditions?
A: Working conditions are better, because it’s so small, it’s like a family. So you almost know all the doctors working in the hospital. Infact you often make referral on the corridor or when you see each other. It a lot less formal and more intimate (smiling).

Q: In terms of investigative machine like x-rays, CT scan?
A: We didn’t have any CT, in fact to begin with, we didn’t have any radiologist. There were two radiographers, Hj Ismail and Pg Mohidin. And often say like IVP (Intravenous Pyelogram) we have to do our own injection and we tell them what pictures we want and then we read our x-rays. If we want to have barium meal, the technician would do the x-ray and we do the interpretation, so our investigations were fairly basic. The CT scan didn’t come in until we moved into this hospital (RIPAS Hospital) in 1984. And there were two radiologists who came, Dr Tony Jones and his deputy Dr Robinson. They came in the 70’ but they didn’t stay for a long time, I think only one or two contracts. I think it was during their senior register time they came to Brunei and then they went back and became consultants. Dr Jones was in Cardiff and Dr Robinson went to North Wales I think.

Q: How about the changes in surgery, Dato?
A: Surgery at that time, Mr Harris was doing all the major surgery. He was a very good all round surgeon and he was thoracic trained as well. He was able to do General Surgery and Orthopaedics. I went back to UK again in 1974 for another five years. I came back to Brunei in 1979. So when I came back I took over most of the General Surgical work, Urology and Paediatrics. Mr Harris still do Thoracic and Orhopaedics. We had two wards, one for General Surgery and one for Orthoaedics. He retired in 1987 and then Mr Wie came. Mr Wie graduated from Leeds and he was orthopaedic and neurosurgical trained. So he took over the neurosurgery and orthopaedics, and because he was also trained in plastic surgery, he took over the burn’s as well. That’s why Burns Unit came under Orthopaedics.


Interviewer: We, that all we have time for now Dato, thank you for spending time doing this interview.
Dato: My pleasure, thank you.


Thank you Ady, Amalinda & Khairul for doing the interview

DERMATOLOGY QUIZ

This is a skin lesion found on the medial aspect of the right thigh. A 16 year old male who has had this for the last 13 years. It was initially excised when he was 3 years old. He presented to A&E with pain and limping of his right Leg because the area surrounding the lesion got swollen. The lesion to begin was not as bad as it is now according the the patient, only recently exacerbated after playing bouncer!

Any guesses?

The SICU story continues.... from Ero Sennin

Last time, I was telling about our 50plus year old lady with a prosthetic metallic mitral valve who came in breathlessness & later on pulmonary haemorrhage. Check the link: http://doctorsbrunei.blogspot.com/2008/05/interesting-chest-x-ray.html

Her pulmonary haemorrhage settled, whilst on heparin & her ventilation requirements did seem to improve. We did a battery of blood tests on her, autoimmune screen turned out negative, and yes, sputum AFBs and PCR AFB turned out negative too. We even did tumour markers, yes a shot in the dark and debated about the relevance of a high CEA. We did however notice her going into obstructive jaundice.

Eventually, she became stable enough for a CT chest, abdomen & pelvis. We were expecting to find lung metastasis. The only thing that was reported from our radiologist was that she had a dilated common bile duct and some narrowing near the ampulla. (I'm recalling this from memory sorry)

After the CT, she proceeded to have a tracheostomy as she had been intubated all this time and we felt it would improve her chances of being weaned off ventilation.

Our friendly gastroenterologist reviewed the CT film and suggested an ERCP, which unfortunately, she was not fit for. She actually deterioated post tracheostomy (acute lung injury) & required a higher ventilation requirement. I thought she wouldn't make here at that time, but she weathered round.

Surprise

It was time to tell the family what we found & what the options were. When we discussed with her husband regarding the CT Abdomen findings, he asked if the 'stricture' in the billary tract was a result of her previous radiotherapy or chemotherapy ! This completely knocked us off our feet, coz' this was not mentioned before and there was nothing in the medical notes to say that she had cervical carcinoma a few years ago !!

We traced the Obs&Gynae notes, which were completely separate to her normal medical notes, to find the cervical carcinoma with NO mets diagnosed in 2006, this was however treated 'conservatively', to summarise a complicated story, at family request. She did however go to KL for chemotherapy and radiotherapy.
Later on, she had a cervical lymph node biopsy which confirmed metastasis, but it is unclear on whether her or her family were informed about this as they refused follow up from then onwards.

With that in mind, we formed a definitive treatment plan with the family, to continue her on artificial ventilation, but not for aggressive cardiopulmonary resuscitation in the event of cardiac arrest.

She slowly continued to deterioate, and died within 1 week after the discussion.

May she rest in peace.

Coolbrunei Weblog

What's hot in RIPAS at the moment?

Even officials at the ministry are talking about it...

It's a website.... not any ordinary one... A very interesting weblog which discusses many issues that involves the doctors. Although the sources can be controversial, it has so far manage to 'un-earth' issues that has been quite difficult to discuss openly, like pay, promotion, brain-drain etc.

Comments:

At last ... a place where you can just let it out...
A recommended site to visit..

http://coolbrunei.wordpress.com/