Bruneians receive best health care
By June Ong

The Health Minister presenting a gift to Dr John Dirks, professor emeritus from University of Toronto

The government of His Majesty the Sultan is totally committed to providing the highest quality of health care for its people, said Pehin Dato Seri Setia Haji Awang Abu Bakar bin Haji Apong, the Minister of Health. He spoke at the welcoming dinner for invited speakers and participants of the National Nephrology Conference. The Ministry of Health with other governmental and non-governmental agencies must look into new ways of promoting education programmes such as diet, and the management of diabetes, he said.

They are two most common factors that can affect the renal condition of patients, especially in the elderly.

To ensure that the patients get the best and most effective treatment, the first haemodialysis programme was established back at the old general hospital in 1968.

The nephrology department is one of the oldest established departments under the medical services, headed by Dato Dr Sherlock Chin. At that time there was only one patient on the haemodialysis programme.

Thirty-four years later, the programme is serving up to 336 patients last year. Some 281 are receiving renal replacement therapy while 55 are receiving Chronic ambulatory peritoneal dialysis. In 2020, the number of patients on dialysis will increase to 1,081, it is estimated.

For countries and healthcare providers globally, the challenge is the financial limitation and constrains that management of renal diseases posed.

In Brunei Darussalam, this can be equated to a minimum of $30,000 per patient per year. The real challenge for the Ministry of Health is the cost containment both the management of the dialysis centre and the prevention measures.

This may include looking for cheaper modalities of Renal Replacement Therapy, looking at criteria of selection for patients undergoing renal disease management or kidney donation and transplantation.

Some 13 invited and local speakers received gifts of appreciation from the Minister of Health. The chief guest received a token of appreciation from the Director General, Medical Services of the Ministry of Health, Dr. Haji Affendy and Dr. R. Dwarakanathan, Head and Specialist Nephrologist, Department of Renal Medicine, RIPAS Hospital cum Co-Chairman of the Conference's Organising Committee.

The welcoming address was given by Dr. Haji Affendy bin DSP Hj Abidin, Director, General Medical Services, Ministry of Health.

Dr. Lim Si Ching, Senior Medical Officer, Department of Renal Medicine, RIPAS Hospital cum secretary, organising committee, talked on "Incidence and prevalence of renal disease in Brunei".

Dr. Lim said there were 12 dialysis patients having post transplant in the year 2002, while one patient had a successful renal transplant.

The gender distribution of dialysis patients on haemodialysis programme has 144 males and 137 females, while 23 male dialysis patients are receiving peritoneal dialysis and 32 females.

The age distribution of dialysis patients last year were in the 50 to 60 age category, followed by 40 to 50 years, 60 to 70 years, 30 to 40 years with the least number in the 20 to 30 age group, 70 to 80 age group, over 80 years of age and those in the less than 20 age category.

There were 47 new patients taken on dialysis last year, 45 new patients on HD and two new patients on CAPD. Their ages range from 40 to 50 years being the highest, 50 to 60 years, 30 to 40 years and 60 to 70 years, 70 to 80 years and between 20 to 30 years.

The highest number of disease distribution in the new patients are in the diabetes mellitus category followed by those having hypertension, chronic glomerulonephritis, SLE and others. Some 25 chronic dialysis patients last year died.

Dr. John Dirks, Professor Emeritus of Medicine from University of Toronto, Canada cum Chairman, COMGAN, International Society of Nephrology, talked on "Global Mission on Kidney Diseases".

He said the cause of kidney failure has shifted more to diabetes and hypertension. It is predicted by 2020, there will be 300 million diabetic patients worldwide. One third of them will have kidney failure requiring dialysis, further increasing the healthcare costs dedicated to kidney disease. The increase in kidney failure due to diabetes and high blood pressure will increase in developing countries such as Asia, Africa and Latin America. As a result, resources will not be available to deal with the "diabetic epidemic".

Fortunately, new scientific evidence and clinical studies have shown that kidney failure can be prevented or at least largely stabilised. Studies that have shown up to 50% reduction in kidney failure depends on strict lifestyle of avoiding overweight and engaging regular physical activities and stopping smoking.

Courtesy of Sunday Bulletin