What happen to our On-Call Allowance?

6 months ago JPA (Department of Public Service) approved the doctors On-Call Allowances, through its memo to our ministry dated March 2009.

About three months ago a form for applying the on-call allowances were released by the Finance department at the Ministry of Health via our CEO's office. It was claims for the month of March, April and May. The forms was filled and handed in.... 3 months later we're left wondering what happened to our claims...

March On-Call Allowance form

Doctors Mess approach a senior officer at the Ministry to ask some questions and Here's our answer my dear doctor friends....

Apparently NO on-call allowances will be given yet, because there are no allocated budget for it .... as yet. Yes the oncall allowances have been approved by the highest authority, and permission has been granted through JPA for the ministry to proceed with the on-call allowances... however the Finance department is still figuring how to 'correctly' award the on-call allowances to the doctors.

So what about the forms that were filled in 3 months ago for the month of March, April and May? Well it turns out it was only a "PILOT" study to gauge how much the ministry will be spending on On-Call claims. So who's idea was this pilot study... BDMC found out it was the Finance Department..

Before I elaborate on some of the querries brought forward from the "Pilot" study that was done where None of us were told about, let me just elaborate on the different type of On call allowances that you are entitled to claim.

There are 3 types of on-call allowances, Resident On-Call, Non-Resident On-Call and Consultant On-Call.

1) Resident On-Call are given to those who stay in-hospital during the 24hr On-call period, mainly Medics, Surgeons, Orthopods, Anaesthetist, Gynae, Paeds & ICU. The rate depends on their grade whether it's Medical officer or Senior Medical Officer.

M.O. - $11/hr

SMO - $14/hr

2) Non-resident On-call are given to those who are on-call from home. e.g. OMFs, ENTs, Opthalmology, Neurosurgeons. These doctors will have to claim the hours they come to hospital only and attend patients. Calls taken from home are not counted apparently. The rates are similar to the above.

3) Consultants/Specialists Oncall are given only to specialist. Its fixed amount of $1,250/mth. However If you are Acting Specialist, you will only be entitled SMO rate and you get paid only when you come to hospital.

We overheard Several querries were brought forth, I thought we'd share with you some of them:

1. Some doctors were claiming to be on-site when they are not.

2. How do we know if the doctor claiming for 3 hours duty, actually came for 3 hours?

3. Some specialists were claiming on-site oncall allowances, although their on-calls are fixed.

Well, firstly we think the Pilot study was a bit on the unfair side. It's fine to do a pilot, but at least let us know so that everyone understands there will be a long delay.

Secondly, the doctors claiming wrongly, would probably have been avoided if there was a proper briefing held by the Finance department on How to Fill in these forms.. If you have a look at those forms, there is no way to differentiate between who is on-site and who is not. How do you expect the doctors to fill in the forms correctly.... if no body actually tell them how to? It is not surprising that some of the doctors would have filled them incorrectly..

Thirdly, the claiming of correct hours can be overcome by using 'thumb finger-print' recognition technology. You just 'thumb in' and 'thumb out' when your done. I'm sure the money used to acquire this technology is much less than the money some of the doctors would try to claim wrongly... right?

Or have somebody in each ward and department to log in the doctors that were on-call everytime they see a patient... including at 3 am when a Neurosugeon gets called in for a Road Traffic Accident.

Or alternatively, trust the doctors who really should be professional, honest and trustworthy. I prefer the later. I think $14/hr versus a sleepless night when you have to wake up at 2am to put a Cardiac Pacemaker or help your junior put a central line in is well justified.. Plus on top of this they are yet expected to work the next day from 7.30am till 4.30pm. You do the maths...

So what now... BDMC heard that we'd have to wait for an official letter from DGMS to officially allow us to claim... then there will be another form - 'The Official one' where we can start claiming.

There is going to be some delay as well, because the current on-call allowance does not include those who are 'daily-paid'. This include our newly appointed Pre-registration House Officers and some of the new Medical Officers. Fortunately our DGMS are already looking into this matter and is in the process of getting this approved by JPA.

Finally on behalf of all the doctors, we'd like to say thank you to all those who have continuously given support to improving the medical profession in Brunei. We hope this profession will continue to strive, and continuously contribute to the society, religion and country. May Allah bless you.

Comparing Doctors pay

Due to popular request, we have compiled a table that summarizes and compares the salary of doctors within 4 countries, Brunei, Singapore, UK and Australia. We have chosen these countries for comparison because most of our trainees either graduated from these countries or usually chose these countries to further their training into specialty areas, as recommended by the Post Graduate Training Advisory Board.

However in comparing these figures, we have to bear in mind that our beloved country is blessed with other factors such as a peace, no income tax, heavily subsidized petrol price, excellent education facilities for the kids and one of the lowest inflation rate in the region.

Also these figures are the current figures when we collected them and of course other countries like Singapore changes very quickly (almost yearly) according to demand of health service. The figure from Brunei has remained the same.

We also apologize for the incomplete information for it is difficult for doctors (esp consultants) to disclose their total pay especially when it comes to their private practice. This is of course understandable. We can only assume that it is somewhat more substantial than their basic pay working with their government.

The salary stated above are starting salary for each grade, and can vary widely even within each grade depending on experience and qualifications.

In providing this information, we try to be as honest as possible with the figures. The information also came from various sources such as websites, journals and individuals who have been very kind to share their information with us.

Holiday Allowances & 10 years service allowances

To most perhaps the above subject is very familiar, but to most of us who have worked less than 3 years in the government service, a holiday allowance after every 3 years of service and a 10 year service allowance is very much welcomed.

For those who have not come back to Brunei yet and medical students abroad, we are entitled to the allowances below:

1. 3 year holiday allowance of $2,500 each for you and your wife and up to 4 children below 18yrs old
2. For children below 12yrs old it's $1,250
3. 10 years service allowance of up to $21,700 (husband & wife) and if your single it's $10,850. Pls note this one is one-off allowance.
   

Don't forget to apply for these allowances well in advance (at least a month) before your due date i.e. your appointment date as medical officer.

To apply, first go to Ministry of Health, 1st floor and ask for the Allowance section. Then ask for a form to apply for the above respective allowances. Go back and fill it up. You need a copy of your appointment letter, Identity Card & Bank Card or statement (if your married I suppose you need the marriage certificate and your wife's details). At the time of writing this article, only male government officers are entitled to apply for their wives and not vice versa. Then hand in this form to RIPAS administrative department at the CEO's office - claims section (it's room 1).

The CEO then will draft a minute to confirm you are entitled to the above allowances. Once the minute is ready 2 days later, I have been advice by the Finance dept to hand this minute back to the Ministry of Health my self. Because as we all know, letters easily get lost on the way causing you to get delayed allowances. Hand it in to where you got the form from, 1st Floor MoH.

Simple right!

Other allowances that you are also entitled to are:-

1. Overnight allowance. e.g. if you are posted to Temburong - $40-45 / night
   
2. Moving to a new workplace allowance - $350 / one off
3. Mileage allowance from home to RIPAS - $29/mth if within 9.5km etc...
4. Ad hoc mileage allowance if your posted to KB or Tutong and you use your own vehicle - $0.45 / km (to and from)
5. Interest free car loan up to $15,000 (repay within 4 years)
   
6. Interest Free Housing Load up to 4 years basic pay (repay within 30 years)
7. Free Haj package worth $3,500/per person after 15 yrs of service
   
8. Education allowance for your kids

• $800/mth for overseas education
• $120/mth for local schools
• $800 / mth if you send them to JIS (Jerudong international school) Year 7 (?up till or from)

Happy Applying!

Are we ready for a Disaster?

Following the recent disaster drill which was organised by the Royal Brunei Police Force, it left us thinking and wondering, do we really have the ability to respond to such a disaster call. Police Force, Firemen and Army usually take central role in managing these disasters which leaves us medical personel on the sidelines... treating the wounded...

What happens during a disaster from the medical point of view?... How is our response to a disaster call?... Do we have enough personnel and equipments...? Is our protocol for disaster management solid...? The experience from the recent disaster drill raised these issues that I think we have to look closely and try to solve. We can never be ready 100% for a disaster but we can at least be prepared for it.

The scenario painted, albeit a little bit on the un-realistic side (An anthrax bomb, followed by hostage taking at sheraton, followed by another bomb blast in BSB, and ended with a stand-off between the police and terrorist at a house in Kg Bebuloh) which went on from 2pm till 3am (13hrs!) was nevertheless ..... Exhausting!

Although we failed (bomb squad) initially to identify the anthrax powder in the beginning of drill...in other words the containment procedure were somewhat 'delayed'... because Everyone was already exposed to the anthrax! Tq... in theory ofcourse we all will eventually succumb to Acute Respiratory Distress Syndrome and die!. The rest of the disaster drill was pretty much the Police show really... The police rounded the 'terrorist' at Sheraton, the Special Police Squad i.e. 'Brunei S.W.A.T. team'... (aseh..) stormed in and caught the bad guys. then The police bomb squad diffuse the bombs in the Capital city... and the rest I fell asleep....

The medics... well the 1st scenario (anthrax bomb) we responded really fast.. did our job and went.. The second scenario...again faster response... but the waiting was almost unbearable.. altho the S.W.A.T. team put on a good show for us...plenty of shooting and bombs.... the 3rd scenario at midnight we realized that we were just there for the show... then the 4th scenario at 3am... we were not involved coz most of us decided to go to bed. I suppose if it was a real disaster or the medics were actually given task we would be busier of course.

Was it a good drill? For Police yes... for us yes and no. Yes because we exercised our response time to the scene and despatch our 4 Rescue teams within 5 mins. Yes because we identified that food for our teams on the site is equally important as sending teams there. No food and drinks.. No efficient team working on site. Yes because We identified that we don't have facility to build 'Field' medical area, which we need. Yes because we have identified our Disaster Alert Response Team personnel which are a solid bunch of people! I really enjoyed working with them.

No.. because the full Major Medical Event protocol was not exercised yet.

Unfortunately or Fortunately.. the drill was exercised for 'on the site management' only.. i.e. once the patients were brought to RIPAS, it ended there. The problem with this is that we will never know how our own hospital team will manage and respond if a disaster as such were to happen. Do we have enough manpower and logistics to handle a disaster of such scale in the hospital?...Can we handle the traffice in and out of RIPAS?.. do we have enough space and beds? some questions for 'us' to answer there...

But my opinion our MME (emergency) plan is pretty solid, on paper ofcourse. But exercising this plan by playing it out on a drill is equally important, because a good plan is only as good as it is on paper.

After this drill...I think I can see a full-scale disaster drill coming up soon.. like a plane crash drill... hint hint... hopefully after raya...stay tune for more updates

In the meantime let us entertain you with a video clip of the 'MME Activation'. This clip was done in collaboration with Doctors Mess & Accident Emergency Dept. Also special Thanks to Dr Ang (HoD) Hj Lamat (Cameraman), and Army personnels (make-up).

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.