The Much Improved RIPAS A&E

My mother had an unfortunate fall down a couple of steps the other night. It was a bad fall and her head bled profusely and that she also had bumps on her face. We rushed her to the Accident & Emergency at RIPAS. At first I was thinking whether we really should go to RIPAS as my previous experience with the A&E Unit is that you might be better off anywhere else but there.

My last experience was taking my son there about four years ago when he fell off from a stool and hit his head on the floor. When we arrived at the A&E at about 9 pm, it was like visiting a market of some sorts. People were all over the place and you didn't feel as if you are in an A&E, more like being in a general outpatient department where nobody has an appointment. It was that chaotic.

However when we took my mother there, the place I have to admit has transformed dramatically since the last time I went there. The place is better organised, the waiting area has increased and in a much better condition and the staff are very professional. The registration was fast and the triage was done quickly and even though my mother's condition was not very critical, relatively speaking, medical attention was quickly given. After given a few stitches, we accompanied her to the radiology department for a CT scan and two x-rays. For each of those, a duty specialist came over, the neurosurgeon for the CT scan, the orthopaedics specialist for the bones and the oral maxillo facial specialist for the face. And on top of that we also have the duty doctor at the A&E. He came over and explained to my father and me about my mother's condition and the treatments that were to be given.

During that four hour stay, I watched the other patients which seemed to be mostly babies and children suffering from asthma and breathing problems and a couple of other elderly people who had falls as well, being dealt with quickly and efficiently. The large crowd that used to be there the last time I came over was no longer there. Part of the reason is that there is now an evening clinic over at the Health Centre at Ong Sum Ping and probably people are getting the message that you should only go to A&E if you have an accident and it is an emergency. By dealing with less people, the staff were able to give better attention to medical emergencies. But of course the improvement of the overall environment has helped tremendously.

The only downside I noticed is that the signages are lacking. Most people who walked through the main door at the A&E would automatically go to the old counter. If there is someone there, the staff would be pointing to which door they have to go through for the registration and the triage. But they are not there all the time and these people would like stand around and not knowing what to do or where to go. The only sign for the direction that I saw was a faded printed piece of paper on the side of the wall which nobody would have seen unless you are sitting at the waiting area. My father and I were the unofficial information centre last night pointing to which door and counter these people should go to. Our good deeds of the night. Other than the signage problem, I really have no complaint about our visit.

Though my sister was a little trifle annoyed as each specialist would ask for a different set of x-ray and everytime, we would have to go trudging to the radiology department, but no complaint from me there. If this had been some other country or even at JPMC, the first thing they wanted to see was either your medical insurance policy or your credit card. In Brunei at RIPAS, they ask for nothing more than $1 registration fee. Each of those treatments would have cost a bomb. I am thankful to be in Brunei. I know that there are still other shortcomings that RIPAS need to overcome but for once I am grateful that the A&E has performed more than what I expected. Thank you to the Government and thank you to the staff at RIPAS and thank you to MOH for making all the changes possible.


AlaiMidget said…
There was a meeting with the Ministry of Health and co. sometime this year with doctors, medics and nurses in training in UK. They showed and told us of the new and improved health system. Havent been attached to RIPAS for quite some time but I have to say, was quite impressed with it. I was silently being a little cynical but reading your post, I'm glad that they have implemented the changes to practice .

Our healthcare system has had many criticisms in the past (and perhaps present) and I'm sure you're not the only one to doubt the efficiency of the system. Others might even doubt the capability of the doctors there. Our local doctors especially need the support and trust of the rest of the nation.

There are indeed many, many changes to be made and hopefully,improvements will be made in a good rate.
Anonymous said…
Mr BR,

I applaud you for giving such a positive review of the A&E services in RIPAS. After hearing so much negative things about our emergency department over the past few years, your comments are a welcome change.

There is however an error in your deduction of why the large crowd is was not there on that night. I presume you yourself went through the main entrance and after looking at your mother's injuries, the nurses must have put her to the trolley area. I don't think you saw what was going on outside whereby there is usually a large crowd of people with minor cases waiting to be seen by the doctor.

All that has happened is that the normal waiting area has been moved out to the waiting area in the dispensary area. This in effect has given the staff more room in which to work in and and are able to "to give better attention to medical emergencies"
Anonymous said…
Hope your mother is ok.
Anonymous said…
I thank you for giving us in RIPAS hospital your continuing support. As a local doctor, my colleagues and myself do and try our best to upgrade and promote our nation's health system.

It is important to emphasise that the A&E department is specifically for Accident and Emergencies, and not an outpatient centre. We have evening OPD centres elsewhere where minor medical treatment can be seeked. This will help the system run smoothly and effectively.

Overall, I feel RIPAS hosp has gone a long way to reach its status as it is at present, and agree with Alaimidget that there are many changes to be made and insyaAllah improvements will be made in time.
Anonymous said…
Wow.. I havent been to the A&E for a decade+ (thank God) so I cant comment on any improvements. But kusos to them!

Anyway I hope your mom gets better soon.
Anonymous said…
sometimes, you get what you pay for. glad to hear that it is improving tho.
Anonymous said…
my grandma had an operation yesterday. i was initially a little worried as i've heard horror stories about ripas hospital. but she's recovering well and the staff have been more profession than i remember from those days when i was an attachment. so, it's definitely heading in the right direction. well done, ripas!
Anonymous said…
Kudos A&E Dept of RIPAS Hospital.. But there's still other areas/dept that needs serious improvement. Such as the wards and the nurses. A very recent grumble I hear from a friend whose father's admitted into one of the wards there.

Let me just quote from what she has written:

"The patient in the bed next to my Dad was given medicine by one of the nurses yesterday. His wife took one look at it and called over the nurse (male-nurse, by the way) and asked what the extra 4 medicine were for? The male-nurse says "Ih bitamin (vitamins) bah bitamin untuk laki kita!" and starts to walk off.

The wifey calls him back and says, "tapi laki ku nda pernah makan nie ubat mcm ani, bulih ko tanya kan doktor wang, ubat untuk apa sabanarnya nie".

The male nurse looks at her in a way to suggest is this lady for real?! Coz she doesn't look like no doctor to me! But says through his teeth - "mbah!"

The male nurse didn't get back to the wifey. The next day, guess what happens? Her husband gets more medicine that don't look familiar. So again the wifey calls over the nurse to enquire. Again, the same response - "baik tah kita betanya arah doktor sendiri kalau biskita inda pecaya ani bitamin laki kita."

So luckily, the doctor on duty was around so the wifey being concerned for her husband's wellbeing calls over the doctor and asks him what the extra meds are for. The doctor (bless his soul) actually refers to a real honest-to-God chart. Yes! You know the kind right? The file that has patient's medical history. About what their sickness is all about, and about why they're in the hospital in the first place. Yes and wouldn't you know - there's also a small note in there detailing about the medicine that that patient is supposed to get.

So, what happens at the end of this story you might ask?

The doctor goes through the file with his doctor eyes. And declares that "These arre not yourr husband's medication!"

The doctor then checks my Dad's history and declares that the extra medication the other patient was getting was in fact my Dad's!!! And what happened to my Dad all this time? When his real medication was being given to some other patient? He was given only one lil itty bitty pill to swallow for his pains. My mom asked the nurses to check. And they realised they forgot oh about some 3-4 other pills my dad was supposed to get. The lil itty bitty pill my Dad was given to swallow wasn't even supposed to be his medication. Get this! It was only Panadol. Ya I spelt correctly - P A N A D O L! Imagine that. It's so unbelievable it's hilarious! I am just crying my eyes out coz it's so damn funny. I mean it's only a couple of lives we're talking about here.

Oh back to the other patient. The doctor was extremely upset about the intolerable negligence by the nurse who administered the medicine. He went off, found out who the lil inconsistent nurse was and gave him a stern warning about his carelessness.

The other nurses witnessing this mistake of their colleague surprisingly weren't too harsh on him. No, in fact, they not only NOT learn from their friend's mistake - they were 100% on their buddies side! Yes! They kinda gave the other patient and his wife the cold shoulder after that. One of the nurses even voiced out her disdain about the couple saying that the patient's wife was "C E R E W E T !!"

Ok, it's kind of a long story but that's the whole picture. I am not proud of this but being concerned, I hope someone with the right authority can look into this matter.
Anonymous said…
A&E Dept. of Ripas is doing a great job but what about the outpatient? They close at 1, an hour earlier than the usual ramadhan operating hours. And then ask us to just come back the next day.
Anonymous said…
I am not certain what anonymous meant by the outpatient closing one hour earlier. I was in one of the health centres yesterday and it definitely closed after 2pm.
DocMamau said…
I am one of the local doctors working in RIPAS. In A&E, we r continuously seeing patients and its just annoying when someone just suddenly banged on the door and demanded to b seen immediately as apparently they have been waiting for hours and apparently were dying only 2 find out all they have is batuk selesema.. whats the emergency there??? Strongly feel that A&E is being misused. Should consider charging more for A&E services instead of the standard $1. And whats the point of all the health centres if not to lessen the burden of A&E? WHY did A&E set up its on OPD??? Isnt this in itself telling the public that its okay to go to A&E for all those mundane problemS???
Anonymous said…
yeah. i think we are improving. yes, u might need 4 years to realize the change,definitely not overnight. probly a slow one, but insya-allah we will be there. (=


ps: to ppl, be patient eh. we are studying damn hard here, and we'll be home as quick as we can.. ;)

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