Brief history of Brunei's health services

Brief history of Brunei's health services


Then and now: Brunei's first hospital in 1925 (above) and today's Ripas hospital (bottom).Rozan Yunos
BANDAR SERI BEGAWAN


Sunday, November 4, 2007


AT THE turn of the 20th century, Brunei suffered two major epidemics. The first was cholera, which took many lives. Peter Blundell in his book, City of Many Waters, described it as "a dreadful time for Brunei, and most of the huts had to mourn the loss of one or two of their inhabitants".

The next epidemic was smallpox and, like cholera, "the disease spread with great rapidity". The death toll was said to be as great as during the cholera epidemic. In the palace itself, those who died included Sultan Hashim's two elder sons, his grandson and the Bendahara's daughter. During both epidemics, Brunei had no doctors and had to rely on medical services from Labuan.

By the time the British Residency was established in Brunei in 1906, there were still no medical institutions established in the country. There was also little in the way of sanitary measures in the country.

Peter Blundell decried the main inhabited area of Brunei, Kampong Ayer, for the "cramped conditions under which the inhabitants lived. The damp, the lack of exercise, and the germs in the filth and mud under the huts could not but affect unfavourably the health of all the inhabitants. The infant mortality was great, the constitutions of many of the adults extremely weak."

As a result, one of the earliest policies indicated under the British Residency was to advocate a move from Kampong Ayer towards Brunei Town on dry land.

But by the first decade of the 20th century, medical and health services in Brunei were still rudimentary. Any required medical aid was provided in Labuan by the Colonial Surgeon. The British Assistant Resident, among other duties, also provided simple medical care and treated minor ailments.

The British Assistant Resident kept a stock of simple medicaments. Blundell also described his role as providing medical and health care.

It was in 1911 that a government dresser was appointed. Leong Ah Ng, the Government Dresser, was also the Government Postmaster running the postal services. Part of the postal office was even used as a health centre.

Two problems faced Brunei then. One was the cost of upkeeping a medical service and the other was to convince Bruneians of the need for a modern medical service. The former was almost unimaginable in today's country of free medical and health care services. Back then, Brunei's government had too little funding to even provide for a medical doctor.

The government met with some success in the latter endeavour. In 1914, another smallpox epidemic broke out but it was contained with the existence of that health centre. Vaccination was also widely accepted by then.

In 1918, a second dresser was appointed to provide services to the outlying areas. It was then a vaccination program started in Brunei with satisfactory results. A doctor from Labuan was also assigned to visit Brunei from time to time.

In 1921, a Sanitary Board (the forerunner to the Municipal Council) was formed for Brunei Town. Despite those efforts, in 1922, a cholera epidemic hit Brunei and a number of children died.

The first Brunei hospital was built in 1925 by the British Malayan Petroleum Company (BMPC), the company that was prospecting for oil in the Belait District. That hospital was built in Kuala Belait. It was a very small hospital but, at the time, it was considered the best in Brunei.

It was not until 1929 that Brunei Town had its own hospital. It too was a small hospital with an 18-bed ward, an operating room, a laboratory and a pharmacy. Brunei's first medical doctor with the grand title of Residential Medical Officer was also appointed in February of that year.

In 1932, the Government and BMPC collaborated to build a second hospital with better facilities in Kuala Belait. BMPC also embarked on an anti-malaria spraying campaign throughout Kuala Belait.

Infant mortality rate in Brunei was still high. By June 1933, a government bidan (midwife) was also appointed. A Maternity and Children's Clinic was also started to help lower the mortality rate.

Hospitals in Tutong and Temburong were built in 1933 and 1934. The rubber estates in Brunei then also provided medical services in their estates. In 1934, the Gadong Estate had its own dispensary and the Labu Estate in Temburong also had a small hospital. By 1937, the Brunei Town Hospital was also enlarged with the addition of several second class wards.

By the outbreak of the Second World War, Brunei's medical and health conditions had improved tremendously compared to the 40 years prior to that. All the districts had hospitals, mobile clinics operated throughout the country, the large rubber estates had their own medical services and on top of that regular anti-malaria sprayings were done in all the major towns in Brunei.

All that, however, was undone during the Japanese occupation. On top of it, massive Allied Forces bombings, all the hospitals in all the districts were destroyed. Of particular concern was the one at Kuala Belait which, before the war, was equipped with an X-Ray machine.

Immediately after the war, medical services were provided by the Australian Army through a temporary hospital. The government report at that time indicated that in 1946 it was a struggle to provide basic medical services, with shortages of almost all medical supplies.

The 1950s was a revival period. A new hospital said to be the best in Borneo was built in 1952 with 150 beds. Several clinics in Kampong Ayer and the outlying areas were also built. Local nurses were trained by a World Health Organisation nurse brought in to help.

By 1954, there were as many as five doctors in the country and 18 operational clinics. An anti-tuberculosis vaccination program was also introduced.

One major policy was the introduction of the feeding scheme. This scheme, organised by the Health Department together with the Education Department, provided food to about 11 schools, feeding around 800 students by 1953. The feeding scheme introduced better and healthier eating habits to Bruneians.

The first school to provide midwifery and nursing education was opened in 1957. At the same time, many were also sent abroad for training. However, it was 1958 before the first Brunei Malay was appointed as a nurse and midwife.

Since then, Brunei has not looked back. Its medical and health services are probably among the best of the region today. Through the National Health Care Plan 2000-2010, launched in June 2000, the directions, vision, mission and priorities in the strategic and instrumental goals were made more transparent and clear.

The Health Ministry is now able to implement well-coordinated programmes and projects appropriately to achieve a common goal that is to enhance and improve the quality of health and well-being in Brunei Darussalam.

With a current annual health budget of half a billion dollars a year for a population of less than 400,000 people, no expense has been spared by the Government in providing the country with a medical and health service that is second to none. Currently there are around 400 doctors and 1,800 nurses in the country with about 1,200 hospital beds. It is indeed a far cry from just 100 years ago when Brunei had no doctor and no hospital.

The writer runs a website on Brunei at bruneiresources.com

The Brunei Times