BONE DENSITOMETRY SOON IN RIPAS

Bone Scan will soon be available in RIPAS!

As recently announced by the Department of Radiology RIPAS Hospital, Bone Densitometry service will be available in RIPAS as of May 2009. At last.. no longer will we be guessing whether is this osteopenic bone actually osteoporotic, confirming bony metastases, suspected hot spots for infections etc.etc..

We not sure yet whether it will be able to do Renal DEXA scans, but I'm sure with time the service will extend. This news will certainly be good news to Rheumatologists, Oncologists, Orthopods and many more.

This service will start in May 2009 and will be available only once a week to begin with. Every wednesday and only via appointment requests.. 6 per day. Requests forms will be distributed by the Deparment of Rheumatology soon.

Update on On-Call Allowances

We have received information that our proposal for on-call allowances have been approved. Unfortunately this does not include the Accident & Emergency & ICU doctors due to the fact that they operate on a shift system. According to a reliable resource, the department concerns are coming up with a new proposal to compensate for their work and it may come as some special critical care allowance.

As for the rest of the medical personel who are on full 24 hour rota system and are resident (i.e. on-site during on-calls), they should be entitled to claim for on-call allowances soon. For those who are non-resident on-calls, (this includes the specialists) they will only get paid when they come in to hospital during on-call period. This means after office hours and weekends only. The ministry is currently working out a system where this can be implemented and monitored easily and not be abused by others.

We have not received any confirmation as to the rates of the oncall allowances yet, but we hope the implementation of this system will not be to long ahead. Something to look forward to..

Proposed New Hospital Block for Mother & Child

These pictures were taken during the recent World Health Day 2009 exhibition. We manage to speak to one of the architects from the 'awarded' consultants Arkitek Idriss, and he said that the project is estimated to cost around $BND 60 million and if all goes well (i.e. budget approved) is due to start end of 2009 (Need to verify this information).

It is suppose to accomadate the Obstetrics & Gynae, Paediatrics, Accident & Emergency and the RIPAS Administration... hey what about Doctors Mess! We put that question forward too and still awaiting answers.

After doing a bit of asking around amongst the doctors, two very common comments were forwarded. One is that... it's quite an impressive and nice building... but secondly is that the worry about congestion it will create to an already congested Hopital area. Relevant issues considering we have just undergone a workshop for ensuring safe hospitals, and that one of the indicators of a structural risk is that the location of the the hospital... in this case right at the hill. I'm sure the professionals would have already thought about it, but we are not sure if the congestion problem can be minimized. Something to ponder...

In the following posts we will elaborate on another project that RIPAS is planning to undertake, which is renovation of the 4th floor (where the doctors mess is) and converting it into 2 full wards, the coverage on World Health Day 2009, and the update on On-Call Allowances...

Major Disaster in Brunei??

At approximately 8.35am the ambulance service received a distressing 991 call, a 6 storey business building has collapsed in the capital city. Following this, Major Medical Event was immediately activated and before long RIPAS A&E Department was already receiving some of the 50+ casualties that was trapped within the rubbles.


















Ok...ok maybe the scenario was little drammatic, but it could happen right. Eversince a series of 'man-made' and natural disasters that has hit the country in quick successions, the Accident & Emergency department with co-operation from various other specialties are preparing ourselves for the worst case scenario. One of the objectives is to ensure that the medical services are prepared and able to cope if a Major Medical Event (MME) was to happen.

This mini-drill was just to demonstrate the chain command during such an activation, the role of allied professional like radiographers, labs, security, paramedics, nurses and the deloyment of medical personels to the disaster area. The casualties are professional actors... ok ok we borrowed the staff nurse that was working later that day in the afternoon duty, but thanks Norazli.

Doctors Mess Club along with it's NEW committee members participated in this exercise that was organised earlier today and with support from the military made the casualties look more realistic. Well done boys & girls, and special thanks to Act SSN Hjh Nora, Dr Ang (HoD A&E), SN Norazli for their big role in todays exercise.

The Doctors Mess Team winding down after the exercise from Left to Right
Front - Azmi, Ady, Nurul & Athai
Back - Munir, Ezam

The man himself Dr Ang (HoD A&E)

Update on the Scheme of Service & On-Call Allowances

We heard the Jawatankuasa Tanggagaji (JTG) resided on the 18th December 2008 to discuss an urgent issue, the doctors proposal for improved salary. The proposal consisted of three main issues, the revised scheme of service (i.e. basic pay), the on-call allowance & a proposal for professional allowance.

We don't know exactly what went on in the meeting because no doctors were allowed to be represented in it. However from a very senior doctor in the ministry the JTG has concluded that they will only approve resident and non-resident on call. Extended hours duty at On sum ping, medical cover and shift duty at A&E and CCM will not be considered as 'on call'.

According to a member of the team that represented our paper in the meeting, if MOH wants to compensate us for the extended hours, medical cover or shift duty, we should call it something else but not oncall allowances because he said JTG says it is not really oncall.

So if we want to be compensated, we have to prepare another paper? Hmm... basically it's up to our executives what would be the next step of plan. Either accept the deal from JTG where only resident & non-resident on-call will be given, i.e. medics, surgeons and any doctor who is on the oncall rota at RIPAS with exception of A&E and ICU doctors because they work shift duties or prepare another paper and start back again. Or maybe there is another solution...

What's your view??

We await the decision from the executive meeting and update us with the other issues with regards to the Scheme of Service proposal.

Reporting for Doctors Mess.

More Skin Lesions

Lesion 1

This is a 70 year old male, presented with a 2 month history of skin lesion on his anterior shin. He has a past medical history of COPD and still a smoker with a 40 pack year history. The lesion initially started as a small itchy lesion which developed into the size you see now on the picture above over 2 mths.

What is your diagnosis of this skin lesion? How would you confirm your diagnosis and what is your treatment plan?

Lesion 2

This is a 45 year old diabetic female with lesions on her lower limb. She was referred to a specialist clinic with a non-healing ulcer on the medial gaiter area. What is the diagnosis of her skin lesion?


Answers: Posted on 27th December 2008

Lesion 1: Squamous Cell Carcinoma

Lesion 2: Diabetic Dermatopathy

A persistent Wrist sprain

A 35 year old male attended casualty after falling onto his dominant outstretched hand. He was tender all over the wrist joint but more so medial to the scaphoid area with an obvious deformity. There was no neurovascular deficit. The above xray was done and patient was sent home with a diagnoses of soft tissue injury and follow up appt in clinic.

4 days later in clinic his pain is no better so he was given more analgesia and a high arm sling. There was no neurovascular deficit noted.

2 weeks later patient requested to be seen again after complaining of un-abating pain on his wrist and swelling which has not subsided since his initial injury. He also complains of numbness over the medial 3 and half fingers.

What is the diagnoses based on the x-ray?
What is the cause of the neurological findings?
What is the preferred option for treatment?


Answer: (posted on the 20/12/2008)

It is a Perilunate dislocation, with scapho-lunate dissociation.
The Neurology is a median nerve compression
The treatment is immediate MUA (closed reduction), however with a 2 week old injury it can be difficult (almost impossible)

Well done to those who got it right!
In this case we attempted initially closed reduction but was unsuccessful. So we went for open reduction. After open reduction, under image intensifier the scapho-lunate dissociation was very obvious so k-wire fixation was necessary to maintain reduction. These are the post-operative xrays.

Good Luck Dr Lim Kian Soon

The Head of Diagnostic Division and also our only practising local Radiologist Dr Lim Kian Soon has recently left RIPAS Hospital to join his wife who was also a practising Breast Surgeon Miss Hani Trasil to work in Singapore.

Dr Lim was well known to all the doctors working at RIPAS for his work in improving the services at department of radiology, and of of his many achievements was to obtain the 64 slice CT scanner for RIPAS Hospital which had tremendously improve our imaging capability. We are now able to diagnose diseases with better precision, do 3-D CT Reconstruction, Cardiac CT Imaging and perform interventional radiology procedures with better precision and outcome. We are definitely going to miss having somebody of his calibre around, but nonetheless wish him all the very best in his future career abroad.

Send us a postcard Dr Lim!

THE LAUNCHING OF BRUNEI MEDICAL ASSOCIATION

Finally the day has almost arrived! The Association that will represent the voice of us will be be launched soon..

The date: Sunday, 2nd of November 2008

The time: 8.30 AM

The place: RIZQUN hotel, 4th Floor

Guest of Honour: The Honourable Minister of Health

All medical professionals in Brunei are invited (locals & expatriates).

Hari Raya with MoH

Assalamualaikum, hello guys. Recently the Public Health Services held a Hari Raya celebration for all the MoH staffs at RIZQUN Hotel. I have to say the organization is much better than last year celebration because I think almost everyone who bought the tickets actually got seats! The food was good, but the highlight of the evening was the entertainment ofcourse.

We had a couple of performances from the districts, but the best must have been from Tutong with Rashidah belting out her voice and her 'associate' rapping.. yeah yeah aha aha.. Dr Wadi and Dr Rizal made the doctors proud with their unplug version of Aizat's Hanya kau yang mampu.

But the highlight of the evening was saved for the last... a very sporting participation of our minister and datin during what I can only describe as salsa/cha-cha/aerobic dance towards the end of the evening, led by the one and only Dr Anie Rahman... go girl!

It was definitely worth my $15, coz you will never see the minister, deputy minister and our perm secrectary dance again till hopefully next year hehe. Plus I also won a hot water dispenser! Which I have donated to our department :-) Look forward to next years Hari Raya Celebration

For those not in Brunei or did not manage to get tickets to that evening, doc mess shares some pictures taken that night.

Dr Anie leading the group...

Our minister, Deputy minister and Permenant Secretary

The Deputy Permenant Secretary (middle) singing along to Hari Raya song

Rashidah and the Gang, performance from Tutong

$100 if you can guess who this is?

Wadi a.k.a superwoman - Doctor / Emcee / Singer / many more....

Getting the chords right... Dr Rizal

Now this guy can really shoot photos... :-)

Update on the Scheme of Service

Efforts to improve the welfare of doctors working in Brunei has long been around. Pensions, On-Call Allowances and Scheme of Services has been the talk of many, but like myself many of us didn't know what was going on in terms of effort done to address these very important issues pertaining our welfare.

From a reliable source eversince 1997 (this might be slightly off) when our then DG proposed for on-call allowances to be implemented, the paperwork has gone through various hands and gone through several revisions until now. Alhamdulillah the final version of the proposal has now been agreed by everyone (Medical & Health services) and in the process of submission for approval to the Jawatankuasa Tanggagaji at JPM. The proposal package now consists of On-call allowances, a new Scheme of Service and 'special allowances' for doctors working in the Ministry of Health.

For everyone's information, prior to the proposal for the revised scheme of service, a proposal for pensions to be returned to the doctors was submitted. Unfortunately the proposal was unsuccessful.

Going back slightly it was since early 2007, Our Minister of Health agreed to form a committee to look into the current scheme of service. The committee is headed by a very senior member of the health ministry and were represented by Hospital doctors, GPs, and Public health to come up with a scheme of service which would be in line with the current international trends, competitive and career progressive. About 2 months ago this committee met with senior representatives from JPM and members of the Jawatankuasa Tanggagaji to discuss the proposal and a few amendments to the proposal was recommended.

Just to highlight some of the challenges that we face are that

1) The number of doctors we produce is still not meeting our demands. As of 2007 our ratio of doctors to population is around 1:900 (that includes ALL the doctors working in the Ministry of Health). Singapore has 1:600 and are still lacking and actively head-hunting qualified doctors to work there. According to OEDC the figure that we should aim for is 1 : 350.

2) The number of doctors leaving the service is increasing. Doctors are highly marketable professionals and continuously poached by agencies with attractive renumerations.

3) Medicine is not an attractive career choice for students. Lengthy undergraduate period, Health-risking career, Stressful & Long-hours of work appeals only to the very few. There are now many other career options that provides a better lifestyle and a better renumeration for the 'cream of the cream'.

In brief the committee want this package to achieve 3 things

1) Attract - Attractive to students to want to do medicine, attractive to qualified experts and doctors to come and work in Brunei.

2) Retain - retention of doctors who are currently working in Brunei to continue working with the Ministry of Health

3) Possess - For the country to possess talented, skillful, knowledgeble Clinicians, GPs, Public health, Scientists, Researchers and propel the quality of health service forward.


Where are we now? This process is certainly not as straightforward as we think. It has to go through to so many levels before approval. Then when approved it will take a while before implementation can take place. How long? I'm not sure if anyone can answer that.. but at least we know that the ball is rolling.. and insyallah hopefully not too long.

Medical Superintendant

Assalamualaikum w. w.

First of all Doctors Mess would like to wish all our muslim readers in welcoming the month of Ramadhan. Hopefully we will all be blessed during this holy month and our 'amal ibadat' be accepted Amin.

Secondly, we'd also like to congratulate Dr Hjh Norlila (ex-CEO of RIPAS) on being promoted as the new Director General in the Ministry of Health. We all wish the best for her, and we'll promise to try and make her life the least miserable as possible...hehe... kidding.. (ops there goes my promotion). We all know it's a very tough and challenging post and we will try to support her as much possible, and I think it's fair to say that the majority of the doctors are very happy with the appointment made so far. All the best to Dr Hjh Norlila and congratulations again.

Now back to business. I'm sure most of us have heard and if not been to the recent meeting that was held between our DG and the RIPAS doctors at the lecture hall in RIPAS Hospital. For those who couldn't make it, the outcome of the meeting was to nominate a medical superintendant.

What would be the task of the medical superintendant? Unfortunately we don't have the official job description yet... however from the talk that our DG gave we gather that the person that will be appointed will be tasked MAINLY to look after the welfare of the doctors working in the medical services. This means he/she will ensure that issues pertaining salary, allowances, housing, and others that is within the realms of welfare for the doctors are taken care of. The medical superintendant is suppose to be the link between the doctors and the DG, and is responsible to ensure that there is minimal delay in addressing these welfare issues. As for promotion, we not sure if the medical superintendant has authority to promote doctors but I'm sure the M.S. can recommend them to the DG.

The DG also conveyed the message that our ministry is seriously looking into this welfare issue and is working very hard to ensure that our welfare is looked after. The ministry would like to make sure our doctors are happy working in Brunei and will continue to stay working here.

The medical superintendant will be chosen from amongst the Local Specialists and will be working directly with DG, thereby bypassing the CEO of RIPAS. And will receive a certain amount of allowances which we are not sure yet of the figure. Apparently this post is not something new. Before there was CEO and Director General, the medical superintendant post had already existed, but after the Ministry of Health was reorganized, the medical superintendant post was replaced with CEO, and since was left vacant until now.

So who has been nominated? That we don't know but we've heard a few names being mentioned several times. Perhaps it's too soon to mention. However that person will have a busy task ahead because as well as performing their responsibility as a medical superintendant, he/she would have to perform their normal clinical duties. Whoever it is we wish them the best. May god mercy on their soul coz these bunch of doctors are quite feisty! Kidding.. ofcourse we are very nice people aren't we ;-) Aammton that includes you, behave yourself!

Next post insyallah we will give an update on the current efforts made by the ministry of health to improve our welfare. This involves On-Call Allowances, proposed salary scale and other allowances. Happy Fasting!

More locals passing their Membership exams

Congratulations to Dr Ady Adillah (General Surgery) and Dr Helinie (ENT) for having passed their Membership exams from the Royal College of Surgeons, and to Dr Rosmonaliza (Internal Medicine) another fresh graduate from the Royal College of Physician (UK).

Well Done guys, this means there will be more SMOs in RIPAS... keep it coming! And ofcourse we hope to hear an invite for lunch soon ;-)

Dr Ady Adillah (MRCS)

Dr Helenie (MRCS)

The Bowling Doctors of Brunei!

Dr Aziman, Dr Azmi, Dr Athaai, Dr Natalie & Dr Norwani

Today Doctors Mess marks it's 4th Anniversary by bowling it's way through Charity!

45 bowlers comprising of 9 teams from various departments in RIPAS Hospital and Public Health took part in the Doctors Mess RIPAS Charity Bowling Tournament 2008 which took place at Utama Bowling at 2.30pm.

This Charity event raised BND $1,000 which will be donated towards the 'Tabung Kebajikan Pesakit RIPAS" di Kementerian Kesihatan and at hand to receive the donation on behalf of the charity fund was the Guest of Honour Dato Seri Laila Jasa Dr Md Arif b Abdullah receiving the mock cheque from Dr Azmi Mohammad on behalf of the Doctors Mess.

The tournament began with an opening throw from DSLJ Dr Md Arif who was also the team captain for 'Gutter Balls 1' representing Internal Medicine 1.

The Public Health team "Healthy Sihat" led by Dr Fakhri did not waste any balls and commanded superiority throughout the tournament dwarfing other teams with score of 684 - 710 - 658 and collected 31 strikes and a total score of 2052 to be crowned champion of the tournament.

Following at 2nd place was the team representing the Lab Services "Mighty BAMLS" led by Hjh Aishah collecting the score of 616 - 578 - 667 (21 strikes) and a total score of 1861. 3rd place went to the team representing the Department of Radiology "T.N.T - tarik nafas tahan" which scored 548 - 590 -581 (15 strikes) with a total of 1719.

Highest Score went to Hj Shamsul (Public Health) and Hjh Aishah (Lab Services) in their respective categories, each receiving 6 month free membership to Fitness Zone.

The most Stylo-Mylo player for the tournament was awarded to Dk Herny Sharnie (Radiology) for her stylish kick at the end of each throw, and to Pg Ya'akob (Admin) for his verbal & physical antiques.

Prizes were also given to the player with the lowest score (hehe..) and we're proud to say Dr Aammton secured that prize without any difficulty. Well done Aamton! Dr Norainun was disqualified from receiving the prize because she had to leave early... tsk tsk tsk...

Anyhow everyone appeared to have enjoyed the afternoon. There were lots of cheering.. shouting... jumping... and cupcakes (thanx Wadi!) Thank you to the sponsors for making it possible to organize such an event. And special thanks to our docs Dr Athaai & Dr Aziman for getting the sponsors. Dr Norwani & Dr Natalie for their lightening mathematical calculations of the scores and setting up the tournament. Dr Ayu & Dr Rizal for the prizes & deco & Dr Ady our treasurer. And to the rest of the Doctors Mess Committee... Thank you all and well done!

These are the final scores.



p.s. more pictures of the tournament will be posted once we get the pics from our un-0fficial photographers that were scattered everywhere.. tune in..

Bowl for charity

Hello everyone! It's time again for our annual sporting event. Last year during the pool tournament we saw Herry Zul triumphed over Dr Ang, Dr Amalinda beat Dr Dk Norzieda and our Minister demonstrated his skills to defeat DGMS in their respective categories.

This year we would like to see who amongst us health professionals are top kegglers! Personally I'm terrible at bowling... only averaging 180 or so hahaha.. I wish! However the idea of this event is just for us health professionals and other allied health professionals to get out from our stressful working environment and trash it out at the bowling alley... Kidding... just have some fun alright and at the same time do some charity work lah.

And of course since we are all very nice people.. and we like to help others (sincerely)... why not give some to the less fortunate aye. So we are also inviting kind individuals, groups, companies, anybody to donate money towards the 'Tabung Kebajikan Pesakit Hospital RIPAS' which was officiated by our honourable Minsiter not so long ago, to help boost their funds.

This will enable the Social Welfare Unit at RIPAS to channel the funds into buying essential household equipment, food, clothings & blankets, and alleviate some of the burder faced by our less than fortunate patients.

This year insyallah, we will see 2 teams from internal medicine, 1 team from surgery, 2 orthopaedics, radiology, lab services, administration, operating room & public health. There is still room for 2 more teams who ever is interested. Sponsors are always welcome!

See you guys at the alley!