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Neuroanaesthesia and Neurocritical Care in Brunei Darussalam

Zulaidi Latif, MB ChB, FRCA
Consultant Anaesthesiologist
Retired Deputy Permanent Secretary (Professional),
Ministry of Health, Brunei
President, Society of Anaesthesiologists, Brunei Darussalam

M N Chidananda Swamy, MD
Consultant and Head, Neurocritical Care Unit
Brunei Neuroscience Stroke and Rehabilitation Center (BNSRC)
Brunei Darussalam

M N Chidananda Swamy, MD
Zulaidi Latif, MB ChB, FRCA

Brunei Darussalam, the Abode of Peace, is located on the north-west coast of the island of Borneo in South East Asia. There are four districts in Brunei. The recent preliminary population census in  2021 showed that it has a population of  429,999, of which 72.3% live in Brunei-Muara district, and most of the population lives around the capitalBandar Seri Begawan. The male to female ratio is 52.6 and 47.4, respectively. By age distribution, 16.3% of the total population are below 12 years of age, 73.7% are between 12 to 59 years, and 10.1% are aged 60 years and over.

Brunei gained her independence from the United Kingdom on the 1st of January 1984. Economic growth during the 1990s and 2000s, with the GDP increasing 56% from 1999 to 2008, transformed Brunei into a modern and prosperous country. Brunei Darussalam’s economy has seen periods of rapid development, mainly driven by oil and gas activities.

 

Healthcare in Brunei

Brunei’s healthcare system is managed by the  Ministry of Health and funded by the Government of His Majesty the Sultan and Yang Di-Pertuan of Brunei Darussalam. It has four government hospitals, 14 health centers, six health clinics, and seven maternal and child clinics that provide a high standard of care to the population. The healthcare is free for the citizens of the country. The Raja Isteri Pengiran Anak Saleha Hospital (RIPAS Hospital) is the main tertiary referral and teaching hospital with about 1260 beds. In addition, there are three private medical centers: the Pantai Jerudong Specialist Centre (PJSC), Jerudong Park Medical Center (JPMC), and Gleneagles JPMC (GJPMC).

There is one medical school in Brunei that twins with well-established schools worldwide, including the UK and Australia, for clinical studies. Citizens interested in studying and becoming doctors must attend university overseas, either partly or entirely.

Neuroanesthesia and Neurocritical Care Services at Brunei

Neurosurgery services are available at the main referral hospital of the country, the RIPAS Hospital. Prior to 2018, all patients requiring neurosurgery, both elective and emergency, from all district hospitals and medical centers were referred to this hospital. The Anaesthesia department provides neuroanesthesia services, and neurocritical care has been provided by the Critical Care department at RIPAS Hospital. RIPAS hospital continues to provide neuroanesthesia and neurocritical care services for all neurotrauma cases and pediatric patients. After 2018, all adult patients necessitating Neurology, Stroke, Neurosurgery, and Rehabilitation care are referred to the newly established Brunei Neuroscience Stroke and Rehabilitation Center (BNSRC) at the PJSC.

The year 2010 was a milestone in treating neurological diseases with the establishment of an exclusive Neuroscience Stroke and Rehabilitation Center in association with JPMC and Nordwest Krankenhaus, Germany, to provide comprehensive stroke care in the country. The clinical and neurocritical care services were provided with a combined team of German and Bruneian doctors. The Center is comprised of an 8-bed stroke ICU. The anesthesia team from JPMC provided the anesthesia service for stroke-related procedures. In 2013, this Center was renamed as Brunei Neuroscience Stroke and Rehabilitation Center (BNSRC) and was independent of JPMC. In Jan 2017, the Center was moved to the present new location and facilities. In 2018 when Nordwest Krankenhaus, Germany, concluded their engagement, the Center was integrated with the Ministry of Health under the umbrella of the PJSC. It consists of three Centers of excellence, namely The Brunei Cancer Center, Brunei Neuroscience Stroke & Rehabilitation Center, and Maxillofacial, Facial Plastic and Reconstructive Surgery Center, that are equipped with state of the art medical and rehabilitative care facilities.

Brunei Neuroscience Stroke and Rehabilitation Center was established as the National Center of Excellence for Neurology, Neurosurgery, and Rehabilitation. The neurological, neurosurgical, and rehabilitation services were all shifted from RIPAS Hospital to the present Center to provide comprehensive care under one roof. It is an 86-bed exclusive neuroscience center that houses 13 bedded neurocritical care unit, 21 bedded high dependency unit (HDU), two operating rooms, and a hybrid operating room. All ICU beds, HDU beds, and operating rooms are equipped with state-of-the-art facilities to provide a complete spectrum of monitoring and therapeutic facilities.

The neurosurgical caseload has progressively increased to provide care for about 450 cases annually, which includes the complete spectrum of cases. Neurocritical care admissions include about 300 patients annually, including the complete spectrum of neurology and neurosurgical patients.

Neuroanaesthesia services for all elective, emergency, and interventional neuroradiology at BNSRC are being provided by the anesthesia team from JPMC. Neurocritical care services are provided by an in-house team headed by a consultant, three specialists, and two medical officers and supported by medical officers from neurology by rotation.

Challenges and Shortcomings

Sufficient manpower in neuroanesthesia and neurocritical care is challenging, especially with the growing demand for these services. As a small country, training facilities, particularly opportunities for specialist training, are limited. Comprehensive Neurological Care, including neurosurgery, neurocritical care, and rehabilitation services, is resource-intensive, and the financial outflow is also daunting. Strong leadership in training and organized research collaborations involving local neuroanesthesia and neurocritical care stakeholders is vital to meet the demands for current and future needs in neuroanesthesia and neurocritical care.

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