Orientation Course for New Local Doctors

Every year since 1999, the Ministry of Health have been organizing Orientation Course for the new Officers in the Ministry of Health. These usually include new doctors that have recently join the ministry and include all levels including specialist.

Unfortunately due to work commitments only 7 doctors were able to join this years orientation course. Amongst those were Dr Jackson Tan (Renal Specialist), Dr Pg Siti Rafidah (SMO-ENT), Dr Rozzy Idros, Dr Firdaus, Dr Nora, Dr Caroline (MO) and Dr Hidayati (Dental MO).

The course which usually runs for 2 weeks usually includes lectures about the General Order (G.O.), briefing from all the various departments under the Ministry Of Health, visits to the 4 district hospitals and labs. But the highlight of the course have always been the overnight trips to Sukang and Temburong. This year however the Sukang trip have been cancelled due to the difficulties in acquiring transport.

But this year the venue was changed to the Outward Bound Temburong. We've heard from our previous predecessors their 'unique' experience of the Orientation.. (no names mentioned) but ofcourse the tradition continues... and what happens on the final night remains in the camp ofcourse..

The course designed to build a spirit of teamwork within the ministry of health has always been a success solely due to the hardwork by the main organizers, Malai Abdullah, Hjh Norsiah and the Gang. This year is no different, I'm sure everyone had a great time in Temburong. Let's hope Malai and the gang will continue to organize this very enjoyable course for the docs.

The Outward Bound Temburong

Team 'RAJAIR' presenting their proposal Healthy Lifestyle

Malai Abdullah (a.k.a. President of SMARTER BRUNEI)

Team 'PADIAN' posing

Dr Firdaus explaining their team Objectives

Dr Jackson Tan

Dr Caroline helping her teammate back on the kayak

Dr Rozzy Idros .... floating down river Temburong to Bangar

Activities continues on at night

Relaxing after completing the Tent building

Dr Hidayati posing after the Flying Fox experience

Two Thumbs up for the Flying Fox

The Flying Doctor

Falling backwards onto a stretched cloth.. requires trusting your teamates

Dr Pg Siti Rafidah

Ok guys... hold it together now!

Eeeek!

Ooops...

Another x-ray

42 year old male, a weapon specialist in the military complaining of 2 week history of pain in the wrist. No recent acute trauma apart from usual day-to-day testing of weapons. 1 year ago had a fall on an outstrectched hand.

Spot diagnosis?

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.