Vacancies for doctors to work in Brunei

We have received a lot of requests on how to apply for work in Brunei. I'm not sure what is the official requirements for doctors in Brunei, but having worked here for almost 2 years, I can say that we are still short of doctors both in the Health Services (GPs) and in the Medical Services (Hospitals).

We have about 460 doctors working with the government of which 2/3 are expatriates. We serve a population of about 300,000 people at 4 different districts, Brunei Muara, Tutong, Kuala Belait & Temburong. So the ratio of doctors to population is about 1 to 800 not taking into account the attrition rate.

If you are interested to work in Brunei, below are information regarding on how to apply

This information has been extracted from the official MoH Website

Vacancies are follows:

• Department of Medical Services
• Department of Health Services

Requirements

• Recognized basic medical degree
• Relevant post-graduate qualification
• At least 5 years of post-registration working experience
• Working in a job relevant to the post being applied for

Salary and level of appointment will be determined by qualifications and experience.

Benefits:

• Tax-Free salary
• Passage to Brunei Darussalam for you, your wife and up to four children under the age of 18 years.
• Heavily-subsidized housing, charged only at BND130 per month.
• Education allowance of up to BND800 per month for up to four children.
• Free treatment at government facilities for you and your wife, and your children under the age of 18 years who are resident in Brunei.
• 48 days of paid annual leave.
• Shipment of personnel effects.
• 25% gratuity on successful completion of contract.

How to apply:

• Download and print application form (SPA 1).
• Send completed form with required documents to relevant Department (Medical or Health).
• Required documents:

a. Up-to-date CV giving details about the work you are doing now and have been doing in the last 5 years, and your clinical skills and responsibilities, as well as information about the hospital or clinic you are working at size, workload etc.

b. Proof of registration after completion of medical training.

c. Copies of your certificates

d. A copy of a letter/certificate of Good Standing from your present Medical licensing board (under which you are currently practicing) which should be less than
6 months old.

e. The names, full postal addresses and other contact details (and preferably email addresses) of at least three referees.

Please also provide an email address for ease of contact.

Applicants considered suitable will be invited by the Public Service Commission to attend an interview. Successful applicants will normally be given 3-year contracts. In exceptional circumstances two year contracts will be considered.

Applicants must be prepared to work in any of the four Districts of Brunei Darussalam.

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Department of Medical Services

Vacancies for Doctors In Department of Medical Services

Specialty	Specialist	Senior Medical Officer	Medical Officer
A&E Medicine			Yes
Anesthesia	Yes		Yes
Cardiology	Yes	Yes	Yes
Respiratory Medicine		Yes	Yes
Critical Care Medicine			Yes
Dermatology			Yes
Infectious Diseases/Tropical Medicine	Yes	Yes	Yes
Internal Medicine (Endocrinology)		Yes	Yes
General Medicine		Yes	Yes
Neurosurgery			Yes
Obstetrics & Gynecology	Yes	Yes	Yes
Oto-Rhino-Laryngology			Yes
Renal Medicine			Yes

Applications should be sent to the Director-General of Medical Services at:

Director-General of Medical Services

Department of Medical Services
Ministry of Health
Commonwealth Drive
Bandar Seri Begawan BB3910
Brunei Darussalam

Or by email to moh_dgms@hotmail.com

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Department of Health Services

Specialty	Specialist	Senior Medical Officer	Medical Officer
Maternal and Child Health Services			Yes
Primary Care Services + School Health Services			Yes

Applications should be sent to the Director-General of Health Services at:

Director-General of Health Services

Department of Health Services
Ministry of Health
Commonwealth Drive
Bandar Seri Begawan BB3910
Brunei Darussalam

Or by email to phc_moh@hotmail.com

An Interesting Chest X-Ray

A busy ICU

ok, first photo is of some of busy people in Surgical ICU. Note our hardworking nurses, Dr. Izzati & Dr. Nurul (surgical).

Anyway, the Chest Xray I've got here is of a 50 plus year old lady who has had a prosthetic metallic mitral valve replacement. She's basically come in with severe breathless. A&E saw this Chest Xray and thought she was in severe pulmonary oedema, gave her frusemide and intubated her & admitted to SICU.

On initial history taking from her relatives, she has been unwell for the past 5 months, easily irritated, not eating well, having chronic dry cough WITH on average once weekly haemoptysis. She has no previous history or contact of pulmonary TB. She normally takes warfarin for her metallic mitral valve replacement.

What's her INR or clotting profile ?

It was so high, it was beyond the scale readable to the machine !! & yes, she was having pulmonary haemorrhage visible in the endotracheal tube.

She was very unwell & went into Acute Respiratory Distress Syndrome (ARDS) and we managed her to improve her lungs or rather her ventilation after a couple of days. Magic, isn't it ?

At this point, it has to be Tuberculosis until proven otherwise. We sent 3 sputum samples and so far negative, and the PCR AFB is negative. We note that she has a hard enlargened left supraclavicular node.

Her ventilation requirements have improved and right now she is awake, and we are continuing to keep her on heparin infusion for her MVR.

What's our working diagnosis....

Could this be Wegner's granulomatosis, SLE, some other vasculitis, malignancy ?

We're still waiting for the autoimmune screen / profile to come back and she's not stable enough for a CT everything (thorax, abdomen, pelvis)

If the autoimmune screen and the CT comes back negative, what else could it be ?
Was it a warfarin overdose of the massive kind ?

Will let you know when we have the answers.

Ero Sennin

The Temburong One Week Duty

I’m back! Phew… just got back from Temburong duty last week and still recovering haha… not from the travelling but from catching up with my post-poned outpatient appointments in RIPAS. I thought I might write something about Temburong Hospital for the benefit of future doctors who will be posted there, unfortunately I could not dig out much information from the web, so had to do a bit of research. The information provided below is based on the 2007 Temburong hospital statistics and my observation during my one-week stay there. Enjoy…

Introduction:

The Pengiran Isteri Hajah Mariam Temburong (PIHM) Hospital is one of the smallest district general hospitals in Brunei Darussalam and supposedly houses no more than 50 beds with two main wards (Male + Children & Female), 1 isolation ward (converted into doctors on-call room and a multi-function area) and a newly furbished day-care renal dialysis ward. The hospital provides general medical services to a population of around 9,000 people in its district.

On average Temburong hospital sees around 123.5 patients per day in it’s Out patient Department (General & Specialists). The ratio of doctors to population in Temburong is approximately 1: 3000 with only 3 permanent doctors to serve the whole district.

Amongst the services that it is able to provide includes Outpatient & Inpatient services, Outpatient specialists clinics, Pharmacy & dispensary, X-ray, Accident & Emergency, Dental Care, Physiotherapy, Laboratory services and until recently a Day care Dialysis centre for 11 of it’s patients requiring Haemodialysis. 3 permanent medical officers have been dedicated to this hospital; one of them is a female doctor with experience in Obstetrics & Gynaecology. There are no local doctors posted permanently here as yet.

Doctors’ duties in Temburong

During a regular working day, the doctor who has been on-call for 24 hours the night before will be responsible to do a ward round in the morning before going Off Duty for the rest of the day. This leaves the other 2 doctors to run the general outpatient clinic, which regularly sees around 85 patients a day, and admits around 2-3 patients per day during their on-call period. Majority of the cases they see in clinic are mainly cases you would see in a typical General Practice, and for those requiring admission to hospital 70% are medically related, 13.3% Paediatrics, 11.8% Obstetrics & Gynaecology and only 4.7% Surgically related.

Since March 2008 the Department of Medical Services through RIPAS Hospital initiated a new move to support the medical services in Temburong. It offers a separate paediatric service every working day and sends one local medical officer from RIPAS hospital to spend 1 week working in PIHM Temburong Hospital. These extra doctors were incorporated into the on-call rota and will also be doing clinic sessions during their time in the hospital.

With the new initiative Temburong Hospital Medical Service can now operate with a 1 in 5 rota and relieves some of the burden in managing paediatric cases in the outpatient. However if a paediatrician is doing the on-call, there will be no next day paediatric cover, and if a RIPAS junior medical officer is on-call, there should be a senior person to be 2nd on call as well.



After completing a week’s duty in Temburong hospital, several observations has been made and are as follows:

1) The majority of the cases seen in the outpatient are very much cases you will see in a general practice.
E.g. Cough & Cold, Headache, General Obstetrics & Gynaecology, Management of Diabetes & Hypertension.

2) Despite Paediatric Cover, there will be a day in the week when the Paediatric On Call will be off the next day, leaving you and the other doctor to deal with Paediatric Cases. (NB Paediatric admissions accounts for 13.3% of total admissions, the majority are medically related adult admissions).

3) Hesitation in management of Paediatric & Medical Emergencies for the surgeons and expecting a paediatrician/medic to handle an Adult trauma case is sometimes a concern.

4) Certain important drugs are not available and some were found to be out of date
E.g. Intravenous Phenytoin for management of prolonged seizure (not available during one of the RIPAS doctors week of duty)

5) There were actually only 27 beds available & functioning (instead of 50 beds)


6) The person On-Call is supposed to do the next day Ward Round alone. The problem arises because the M.O. is sometimes quite junior and inexperience in certain specialty cases like Gynaecology and Paediatrics, but most importantly there is an issue of Continuity of Care.

7) No CME Activity listed or planned for the month

However there are some positive feedbacks about this hospital service

1) There is 24 hour Lab Service & X-ray Service
2) All round pharmacy service
3) The On-Call Room is decent & Clean
4) Good food provided by the hospital (apparently this is not a common phenomenon, if you are nice to the nurses and attendants you might get it I guess)
5) Dr Elangovan, the Senior medical officer is very helpful
6) Small Hospital, therefore very friendly environment
7) Hospital Drivers are helpful in transporting us to wherever needed (very useful when you need to get some food for dinner when you are on-call)
8) Helicopter transportation is prompt and almost 24hrs weather permitting


Taking into consideration that it is a small and fairly remote hospital, it is quite impressive that this hospital is still able to provide a fairly good all round medical service.

Suprisingly although the doctors’ population ratio is huge (5x of Singapore) the in-patient activity only accounts for 2.85% of its total activity, the majority of which is medically related. Below are several issues that have been highlighted and followed by suggested recommendations.

Suggested Recommendations:

1) To incorporate Local General Practitioners into the Temburong Hospital Initiative. This would definitely be beneficial for the population of Temburong. Not only it fulfils the objective of exposing our local doctors to Temburong, but also the added benefit that the majority of illness treated are very familiar to their expertise.

2) Incorporate a period of 1-2 month compulsory placement to Temburong Hospital for all Basic Specialty Trainee (GPs, Surgeon’s and Medics) during their A&E placement, perhaps the last 2 months of their rotation in A&E. However a permanent senior A&E staff (specialist preferably) should be placed in Temburong to ensure training continues for the trainees.

3) To give a Special Allowances for any Health Staff working in remote areas, especially in Temburong district in this case. This is to act as an incentive and appreciate the hardship our staffs have to go through to work at remote places where many facilities are limited, and to recognize that some of them have to leave their family behind to work at these places. Not only will this promote good morale but may even attract health professionals to work in the rural community. The allowances should be awarded to temporary, visiting and permanent staffs at the particular hospital/health centre. The ministry of health can help ratify the rates, so that it is appropriate and always-in line with the standard of living.

4) Provide a simple guideline handbook to management of common Paediatric, Medical & Surgical outpatient & Emergencies.

5) The morning ward rounds should be led by the Temburong doctors every day, to ensure good continuity of care and provide a potential teaching session for the junior MOs. It also promotes the sense of teamwork amongst the Temburong doctors. A timetable should be set to do ward rounds and all MOs should make an effort to come to the ward rounds.

6) Regular update of important emergency drugs.

7) The more experienced visiting MOs can do teaching sessions during their week stay for the Temburong health professionals. This not only gives the opportunity for the permanent staff to score CME points, but also encourages a teaching & learning environment for every health professional.



Conclusion:

In general approximately 97% of the activities in Temburong Hospital are outpatient based and only 2.85% are inpatient work, of which the majority of the cases are medically related followed by O&G and paediatrics.

This raises two important issues, firstly is the proportion big enough to justify having a hospital in Temburong. If it is, then should we allocate more money to ensure that it has adequate expertise, facilities, drugs and equipments. Perhaps we can start by placing a A&E specialist there. I could suggest Dr I.... from RIPAS for a start. Alternatively if it’s not, then we should concentrate on making it a better equipped health centre, with the current facilities that it already has.

However I think the general picture is quite clear from the figures mentioned earlier (derived from Temburong Hospital Statistics 2007) Temburong hospital would benefit from having more generalist clinician around to support the population’s demand of healthcare provisions.

The one-week experience of working in Temburong Hospital has highlighted several issues on how we can better improve the quality of medical services to a small population district general hospital like Temburong. It has also given us the 1st hand experience of working in a hospital environment where facilities, manpower, and expertise are sometimes of limited supply.

The objective to expose our local doctors to our people is most probably a very good step forward not just enriching the doctor’s experience as an individual but also in identifying & highlighting issues for improving our medical services in the future as a whole. After all it is our own people that we are looking after and it is our Health Service that we want to better. My last comment would be, the choice of doctors sent could be better.. ahem.


Btw .. Don't forget to:

1) Be at the RIPAS Jetty by 7.00am for a boat to go to Temburong
2) See the Temburong CEO (Pg Sabtu) on your last day there and ask for the overnight form to claim for your allowances working there

More future Budding Specialists

Congratulations to our latest graduates Membership of the Royal College of Surgeons, Dr Amalinda Suyoi and Dr Amy Thien who recently sailed through (hehe... nda kan?)the final part of the gruelling 3 part MRCS exams at Edinburgh, UK. Both Miss Amalinda (graduated from Nottingham) and Miss Amy (graduated from Southampton) are currently working in the Department of General Surgery, RIPAS Hospital and will be pursuing Higher Specialty Training abroad in their respective field of interest.

Miss Amalinda Suyoi
MRCS (Edinburgh)

Miss Amy Thien
MRCS (Edinburgh)

Also who recently passed their membership exams are Dr Anas Naomi Hj Harun, Dr Yong Chee Kuang (I may get the spelling wrong) & Dr Dk Hjh Norzieda who have successfully completed their PACES of the Membership of the Royal College of Physician Exams last year. Dr Naomi & Norzieda are pursuing a career as Neurology Specialist and Dr Chee Kuang will be training to become an Endocrine Specialists in Singapore soon.

Dr Chee Kuang
MRCP (United Kingdom)

Dr Dk Hjh Norzieda
MRCP (United Kingdom)

So congratulations again to these guys for achieving their exams.. I was just thinking as I'm writing this article, the question why do we need to get our membership exams? Is it absolutely necessary? What is our motivation to achieve this exam? After all it is very very tough... and expensive! Doing the final part of MRCS exam can cost you easily $5,000 bnd! and usually it takes 2 to 3 try to pass.. Is there an alternative around it?

Hmmm....it's quite controversial issue since membership exams only apply to UK recognised Health Care System. What about Malaysia, USA, Australia... does having membership exam offer an advantage there?

In Brunei we have a scheme of service for the doctors and we follow a certain set of criterion advised by the Post Graduate Training Advisory Body. And most of these criterion has been set quite a while ago during our predecessor time. So within the guidelines already set we will see that MRCS, MRCP, MRCGP, MRCOG etc. exams play an important aspect in deciding that a doctor will be entitled to

1) Senior Medical Officer Post & Pay!

2) Ticket to Higher Specialty Training sponsored by the Government

It was one established method of deciding that a doctor has undergone sufficient amount of basic specialty training and are now ready for Higher Specialty Training with more responsibility.

But as training in medicine evolves, newer method of training & assessment has been developed and perhaps the days where Membership Exams will be over and replaced with SEAMLESS training like in Singapore where trainees are chosen right from the start of their post graduate period and undergo a 5 to 6 year period of training straight into a specialty.

In Malaysia the system is slightly different, where you can become a specialist after completing 4 years Masters programme in a particular specialty. What about USA, Germany, Australia, India, Pakistan.. ? I'm not sure how the training is like there but certainly the requirements for training will also be different.

As we get many doctors local and also our expatriate friends coming to work in Brunei, it's necessary that we are able to recognize these qualifications that they come back with and allocate them a post that they deserve and of course the correct pay. Something like a Specialist Accreditation Body like the one they have in Singapore is good start, comprising of local and invited oversea specialist with no conflict of interest, that can recognize and filter the right person for the right job.

Next topic we will discuss the pay of doctors in Brunei, the exact figures according to the current scheme of service according to your qualifications. If you are interested to find out the payscale of the doctors in Brunei from Medical Officer level up to specialist, please tune in next week, after I return from my 1 week duty in Temburong. We will also try to update on the latest with our ON-CALL Allowances...

The Real 'Mat Kilau'

Do you remember the time quite a while ago when Brunei army recruits on some hill in Tutong were struck by multiple lightning strikes ? I think this was last year in March or February. Violent lightning storm it was. I was told that a few soldiers were hit directly by lightning and died on the spot. Many were 'electrified' through water or direct body contact.

About a 4-5 soldiers were admitted to ICU as there were 'bradycardic' but this was a misinterpretation of their normal physiological state. These are fit fighting soldiers hence you would expect them to have a normal low heart rate.

One of the patients there was struck by lightning directly. Note the picture of this patient's chest, right nipple on the left, and white 3^rd degree burn marks into this skin of the chest (gauze is covering the burn area) like a fingers of lightning protruding and burning into the chest. The lightning went into his chest, and somehow did NOT defibrillate his heart and went out the exit wound ie. Left thigh. Note the 3^rd degree burn on the thigh. He was intubated and observed in Surgical Intensive Care Unit for a few days.

Miraculously, this man survived with no internal organ damage. He must have had a low 'resistance' to electricity. Unfortunately, I was told that his colleagues who were next to him died instantly.

This man must be Mat Kilau.

3^rd degree burn on the thigh

patient's chest

Article contributed by Dr Doom

Finger Trauma

These are actually two different patients with what I would call 'Avoidable' trauma to their hands! The reason why we choose to post it this week is to highlight some important lessons that can be learnt from these cases.

The first picture is a 35 year old male who had this infected little finger 2 weeks before presenting to A&E RIPAS. If you were a casualty officer apart from giving him a good telling off for not coming earlier what would be your next treatment plan? By the way it's a ring on the little finger just incase some people are wondering.



This should be an easy one too. What is wrong with this hand x-ray? This is a result of someone trying to escape from the 2nd floor of a house using a rope... tsk.. tsk.. tsk.. Bad Rope!

AED for the public

About 2 months ago we posted a story of a male patient who suffered a cardiac arrest whilst performing friday prayers, but was revived because 3 doctors happened to be around and a Defibrillating machine was available in time.

AED (Automatic External Defibrillator) is a life-saver and should not just be available by the paramedics and hospital, but should also be available at all peripheral clinics and even public areas, such as the mosque, shopping malls, stadiums & popular recreational parks. You never know when this handy little machine can save someone's lives... it could be your beloved ones.

Our neighbouring countries like singapore have already taken steps to ensure this. If you've been to Singapore you may have seen this machine at the shopping malls.

AED machine in Takashimaya

AED machine in ISETAN

Swelling at the Wrist

This is an interesting case of a 64 yr old male who presented with a Four year history of swelling at his wrist. Apparently in some parts of the world this is quite a common and significant sign of a serious illness, which has gradually reduced over the years. Nevertheless if you see this in your clinic there should be 2 important diagnoses that comes to mind.. What are they? What is the name given to this particular swelling?

The above is a radiograph of the affected wrist. If you were thinking along the correct path, you probably would have asked for a chest x-ray. What do you think?

Answers will be posted next week.


ANSWERS:

1. The two commonest differential diagnosis are Tuberculosis & Rheumatoid Arthritis

2. The name given to this swelling is Compound Palmar Ganglion

'The Culprit'

Immediately post-op
Surgeon: Dr Phillip, Assisstant: Dr Herry Zul

The histopathology came back as Tuberculosis and it turns out that he actually had this swelling and cough for more than 4 years already.... suffice to say that he is currently on anti-TB medication.

BMA Roadshow

The Brunei Medical Association (BMA) aims to represent the voices of the Doctors working in Brunei Darussalam and will strive to unite all the doctors from various specialties including the Dentist. One of it's first main priority is help improve the welfare and wellbeing of the doctors here by addressing certain issues at heart, one of which is the On Call Allowances that has been in air for sometime. This was echoed by the interim President Dr Hjh Susalnoor when briefing the doctors at the BMA roadshow held at RIPAS Hospital recently.

Dr Hjh Susalnoor

The talk was also attended by Dato Paduka Dr Hj Abd Latif (Special Duties Officer at the Ministers office), Datin Paduka Lim Meng Keang (Specialist Paediatrician), various heads of department from RIPAS Hospital, Dentists and trainee doctors.

Some of the doctors attending the talk

The first step after recruiting new members would be to hold an election and elect the 8 members of the Executive Committee which includes the President and Vice-President. These committee will bear the tough responsibility to unite it's members and address the issues concerning them. Only members are allowed to nominate and vote who will sit at the executive committee. These include all GPs (government & private), Dentists, public health and hospital doctors. Doctors holding administrative role (HOD and above, including DG) will not be eligible to be nominated according to the current BMA constitution. Every members will be updated via e-mail regarding the nomination and the date of election which would be in the next couple of months.

If you are interested to become a member a copy of the registration form can be e-mailed to you.

p.s. Special Thanks to Tracey of GSK for sponsoring food that afternoon, but next time it would help to deliver the food at the right location... like RIPAS and not JPMC! Yep a few stomachs were growling towards the end... :-)

BRUNEI MEDICAL ASSOCIATION LAUNCHING SOON!

A group of doctors from various specialties have began efforts to re-launch the Brunei Medical Association (BMA), which will act as an independant body that can represent the voice of doctors working in Brunei.

Currently led by the Interim President Dr Hjh Susalnoor, the interim committee will begin to distribute information and for ALL doctors and dentists who are interested to know more about BMA there will be a briefing done on the 13th of March at RIPAS Hospital, 2nd Floor Lecture Theatre during Lunch time.

The objectives, role and details of it's constitution will be elaborated more in detail during the briefing, so do come along if you are free this Thursday Lunch time.

Application forms to join the BMA will be distributed then, or alternatively via e-mail.

Medical Officers to be sent to Temburong

The latest news on the block is that ALL local RIPAS doctors (medical officers only) will be ordered to go to Temburong hospital and take turns to work there for a week. A schedule beginning march 1st has been distributed and every department are suppose to take turns and nominate their MOs who will be sent to Temburong that week.

The objective of this 'exercise' is to allow local Junior doctors to be exposed to working in a hospital environment apart from RIPAS, and allow oppurtunity for the junior doctors to be interacting with patients from other districts closer. It is hoped that after this exposure, some doctors would be more attracted to work at other districts hospital apart from RIPAS.

Since it's announcement on the 19th February, the move has not been met very favourably amongst many of the junior doctors. Though the objective of this mission is understandbly noble and necessary, as it is quite apparent the lack of local doctors working not just in Temburong, but also in Tutong and KB.

However some of the doctors believe that the decision to send the doctors away for a week is a little bit on the hasty side, and some even voiced concerns about doctors looking after other specialties at which they are not trained for and there are no specialists mentor at the hospital site (Temburong), to guide them.

Others mention concerns about doctors who have been trained in their specialty field for so long and not seen an ischaemic ECG for many years to correctly diagnose one, or doctors who will be asked to examine patients of a different age group than the one that they are routinely used to.

All these are valid concerns, but nevertheless the objective of the 'exercise' is also equally important. Further discussions between the doctors and the administrators are to be planned this week. What is your say?

Well Done Docs!

It was only moments before the friday prayers sermon, a 72 year old male collapsed following a cardiac arrest at the Serusop Mosque in Berakas.

Thanks to the quick response from 3 good samaritans, prompt resuscitation was delivered which saved the man's life. We would like to acknowledge these 3 fantastic young local doctors for their heroic effort, and convey huge gratitude from the patient and his family.

Well done Dr Nirwan (Navy), Dr Fakhruddin (RIPAS A&E) & Dr Ahmad Fakhri (Public Health)!

Dr Fakhruddin

Dr Ahmad Fakhri

The story unfolds...

Mr I was a 72 year old male with a history of Hypertension and Hypercholesterolaemia. As usual he was about to perform his friday prayers at his local mosque when suddenly he felt unwell and collapse. He was brought aside and help was called upon. Dr Nirwan, who was about to join the prayers was first to arrive at the scene and assessed the situation, quickly followed by Dr Fakhruddin. After confirming it was a cardiac arrest, CPR was initiated immediately. Dr Fakhri arrived at the scene moments later to lend assistance and the paramedics arrived bringing with them the defibrillator, soon proven to be another life saver.

As soon as the leads were connected, Ventricular Fibrillation (VF) arrest was diagnosed and shock was delivered immediately. Normal Sinus Rhythm was regained but Mr I was still apnoeic. Manual ventilatory assistant was continued as Mr I was transferred to RIPAS Hospital by the paramedic team.

Upon arrival, Mr I was intubated and admitted to Intensive Care Unit where again he had another VF arrest which reverted back to Sinus rhythm after receiving another shock.

Grave prognosis was feared for Mr I, as the survival rate for out of hospital cardiac arrest is low. It is estimated that less than 60% of cardiac arrest will survive hospital admission and only about 12% will regain full neurological recovery, if resuscitated on the scene.

Alhamdulillah, praise to god almighty, within a week Mr I was extubated and 2 weeks after his admission, Mr I was discharge from RIPAS with full Neurological Recovery.

In the most recent literature, it is estimated that the survival rate of Out of Hospital Cardiac arrest event which did not received CPR on site was 7%. This is improved to 9% with good CPR.

However the rate is significantly increased up to 30%, if the patient received a shock with an Automated External Defibrillator (AED), (Hallstrom AP et al. N Engl J Med. 2004;351:637-646).

Having AED and equiping the public about using the machine and performing CPR do save lives as demonstrated in this particular event.

We support the idea of having AED machine in public areas such as the mosque, shopping malls, stadiums and recreational park. This paired with increase awareness and knowledge of the public on how to perform CPR may help save another life in the future.

Finally well done to the paramedics, Accident & Emergency staff, the Intensive Care Unit and the 3 doctors on site, Dr Nirwan, Dr Fakhruddin & Dr Ahmad Fakhri, for their outstanding work.

The Peril of Drink & Driving

The Peril of Drink & Driving

A 30 year old Thai worker was involved in Road Traffic Accident along Jalan Telanai which involved 3 other vehicle. He was unrestrained driver and was under the influence of alcohol. When the paramedics arrived on the scene, it took 20 minutes to free the patient from the vehicle.

Upon arrival to the A&E at RIPAS he was agitated and confused. His BP was 80/40 and pulse 120. He had deep laceration on the occiput, bruising around the flank and an open fracture dislocation of the ankle. There was some movement of both his upper limbs, but he was not moving his lower limbs.


After primary survey was done the trauma panel x-rays revealed this x-ray.


Question:

1. Give two abnormality on this x-ray?

2. How does it correlate with the clinical findings?

3. After stabilizing his vitals, what would be your next investigation of choice?

ORL UPDATE 2008

ORL UPDATE 2008
ON ALERGIC RHINITIS &
OBSTRUCTIVE SLEEP APNEA

DATE: 19TH JANUARY, 2008

VENUE: RIZQUN HOTEL

TIME: 19:00HRS

Limited Seats, Please RSVP before 16th January 2008 to
SN Hjh Noraini / SN Tai Mei Lian
2232111 ext 4114

JPMC organised Osteoporosis CME

OSTEOPOROSIS CME

The Organising Committee with Guest Speakers

Dr Wang explaining the pathogenesis of Osteoporosis

Dr Hjh Haslinda (Endocrinology Specialist)

Mr Ketan Pande from Orthopaedics sharing his knowledge

The Special Guest Speaker from Singapore

HSBC brings magic to children's Ward

HSBC brings magic to Children's Ward

27th October 2007

HSBC once again brought smile all around the paediatric ward at RIPAS hospital by doing its charity rounds and bringing gifts and prizes to the children's ward. The group led by the Manager of Kiulap Branch Hjh Rohani and her crew from various branches kept the children entertained and even brought in a magician to liven up the day. Thank you HSBC for your continuous charity work, perhaps one day you will visit the Doctors Mess as well :-)

When doctors wed..

Congratulations to Dr Norlenny & Dr Taufique!

21st October 2007

To those who attended the Akad & Nikah Ceremony between Dr Norlenny (Radiology) & Dr Taufique (Intensive Care Unit) it was one to be remembered. Not only because it was the first time I saw Taufique, whom I have known since med school wear a traditional malay costume, which by the way you look good dude... keep it up hehe..!

But also it was the first time we've heard the akad & nikah ceremony done in English! Well done to the brave Khadi who managed to translate the whole khutbah into english and performed the ceremony smoothly indeed for the first time! Well ofcourse the choice of verbs and nouns could have been better (Who am I to comment ofcourse), but I'm sure perhaps words like 'sexual intercourse' could have been avoided in the khutbah... :-D Hmm well I could say there were several smiling faces in the crowd for a moment then.

Well done to Taufique for being able to perform the akad at One Go! I met him a few minutes before the ceremony and he was well nervous (who wouldn't aye) but Taufique was a cool as ever. Of course not stressful and nerve wrecking like saving people's lives everyday in the ICU unit, but someone's got to do it dude ;-).

Lenny was beautiful in her nikah dress as expected.. a few tears was shed, ofcourse from both the parents and bride.. but she manage to whole her make-up very well indeed.

Finally Congratulations to the newly weds, and a big warm welcome to Dr Taufique Ahmed (from UK) whom we will see more of in the near future.

DOCTORS HARI RAYA-ING

SELAMAT HARI RAYA AIDLFITIRI
to All our Families, Friends & Colleagues

from

BRUNEIAN DOCTORS, RIPAS Hospital

At Azmi's House
L to R: Dr Azmiman, Dr Azmi, Dr Hj Amri (Back)
Dr Wadi, Dr Ariff, Dr Sofi & Hubby (Si) (Front)

Celebrating Raya at RIPAS
(Can't you tell the happy faces!!! erm..)

Dr Herry's crew (2nd from left)

The Eligible Bachelors
(except the one sitting on the far right! Sorry Mrs Ady!)

Ofcourse there are still more pics that should be posted, but I haven't had the time to steal them from their facebook accounts :-) Will post it as it comes ok!

SELAMAT HARI RAYA FROM THE DOCTORS MESS COMMITTEE!!

LIVE 'Keyhole' Spinal Surgery in Brunei

1st International Endoscopic Lumbar Spine Workshop in Brunei

5th October 2007

RIPAS Hospital was once again host to an international meet, when a world renowned Neurosurgeon from France Prof Jean Destandau was invited to Brunei Darussalam to demonstrate 'live' the most recent advancement in treatment of Lumbar Disc Prolapse (Backpain) to 20 surgeons from Brunei, Malaysia, Singapore, Indonesia, India and the UAE.

Present to watch for the 1st time in Brunei Live Surgery telecasted from the Main Operating Theatre at RIPAS to the Lecture Hall was the Honourable Minister of Health Pehin Orang Kaya Indera Pahlawan Dato Seri Setia Hj Suyoi who also earlier officiated the endoscopic workshop.

Prof Jean Destandau explaining his technique

Amongst the guests that attend the Live Surgery Demonstration

The patient being prepared for surgery

Over 2 days Prof Jean Destandau performed live surgery on 4 Bruneian patients who had been troubled with backpain for several years and found to have a Lumbar Disc Problem. The 2 days workshop was held at RIPAS 2nd Floor Lecture Hall and the visual was telecast from the Operating Theatre. Prof Jean Destandau has been using this special technique which he innovated to correct disc herniation since 1993 and since then has operated over 5000 patients worldwide with back problems. The advantage of his technique over the traditional 'open' procedure is reduction in hospital stay to just 2-3 nights, reduction in infection rate and improved visual capability.

It was impressive to watch Prof Destandau in action, live as he smoothly carved his way through the lamina (cartilage at the spine) and release the bulging contents of the Lumbar spinal canal. It was very much a different story when the rest of the participating surgeons was given the oppurtunity to try this technique on dummies the next day... hmmm.. let's just say some will take a lot more practice before they should be doing it on real people... However there were others who were quite keen already to try on this technique on their patients back home.

One of the Bruneian surgeons trying his skills with the dummy... what can i say.. hmm

Well done again Department of Neurosurgery for organising and Thank you to Misti Jaya & STORZ for sponsoring.


Lumbar Discectomy

What is the diagnosis?

This is an 18 year old female who presented with a pelvic fracture after having fallen from the bed. She also has a history of recurrent fractures of her wrists and ankles. Despite her recurrent admissions no body spotted the spot diagnosis of her eyes.

What is the abnormalities on her eyes?

What is the differential diagnosis of this abnormality?

With her clinical presentation, what is her likely diagnosis?

4th Surgical Forum

The 4th Surgical Forum in Conjunction with the
1st Annual Surgical Scientific Conference

The Organising Committee
Front (L to R): Mr V Matthew, Mr Tan, Mr Kok, Dato Yapp, Mr Chua, Mr William, Hjh Rumput
Back (L to R): Dr Nourul, Mr Yusri, Mr Mackie, Dr Ak Azmi, Ms Zue, Mr Tin.

9th September 2007.

For the 4th consecutive year the Department of General Surgery successfully held it's annual surgical forum with this year's theme ‘Management of the Trauma Patient – Working Towards Better Survival’.

In the morning sessions, we had interesting talks about the current trend in trauma and the statistics by Dr Da of Accident & Emergency. Dr Ang presented on Fluid management in the Trauma patient, Mr Paw talked about cardiothoracic injuries and Mr Tan shared his experience in management of abdominal injuries.

We also lucky when we had a guest speaker from Singapore who was also a Specialist Trauma Surgeon who spoke of his experience as a Trauma surgeon in singapore and advised our surgeons on current standard management for trauma patients.

Dr Ang giving his talk

Mr Zul & Dr Vui Heng amongst the guests

For the first time this year, the organising committee also held it's first annual Scientific Conference and invited scientific papers from all the surgeons working in Brunei to present their study, research or interesting cases of which top 10 papers were presented in the afternoon. The Best Scientific Paper was awarded to Mr Yusri Yahya a General Surgeon, who's paper triggered an interesting remark from one of our guests, Dr Hjh Roslina. Mr Yusri's Paper was an interesting case report of a male patient who injected his genitalia with foreign substance to make it ... well 'bigger' however it ended up all wrong (as usual) and the patient had to end up having surgery to make it 'smaller'! And oh yes.. when Dr Hjh Roslina said what is that.... the whole room just burst into laughter... who wouldnt aye.. Anyway due to certain restrictions we are not allowed to show the gruesome pics of the surgery however it's enough for us to deter anyone from having any one of these nasty injections. Well done Mr Yusri!

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-Complete set given with the original box..refer to the attached pics

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Inmates Version of Thriller.. just for laugh

contributed by sCalpel