Brunei sports needs physiotherapists

Physiotherapists are a rare breed in Brunei.

With injuries a common occurrence in sports but with only 14 physiotherapists at public hospitals, it is obvious the discipline is one that is largely overlooked in the Sultanate.

Of the 14, a dozen are stationed at the Raja Isteri Pengiran Anak Saleha (Ripas) Hospital in the capital while two work full-time in the Belait district at the Suri Seri Begawan Hospital. Tutong and Temburong are only fortunate enough to have their services on a rotational basis.

The Sports Medicine and Research Centre (SMRC) at the Hassanal Bolkiah National Stadium in Berakas which caters mostly to members of the sporting fraternity hires four physiotherapists, with three assistant physiotherapists and a massage therapist also on the payroll.

Though it is understood that the Jerudong Park Medical Centre has two, and though there are certain private clinics who offer physiotherapy, their numbers could not be verified.

But when it comes to the public sector healthcare, it is a simple case of supply failing to meet demand.

"It's definitely not enough," said Samuel Lim Sin Been, Head of the Physiotherapy Section at the SMRC.

"The demand is there. Just look at our appointment book it is always full. We have to provide physiotherapists to about 500 athletes in 31 disciplines and you know how it is in sports when athletes have to perform at a high level — there will be injuries, but minor ones hopefully."

The first local to graduate with a Degree in Physiotherapy in 1975, Lim has 30 years of experience in the field and has worked in England and Canada. Lim's counterpart at Ripas, Norhartina Hj Sharbini, agreed with him.

"Yes, we don't have enough," she said. "We only have 14 looking after a population of (more than) 300,000. We have got a waiting list but it is comparable to other countries."

"We provide services ranging from pediatrics to Intensive Care Unit (ICU), which tends to be respiratory illnesses. There are other private physiotherapists, but I have to say, I am doubtful whether they are really qualified or recognised by the government.

"If you look at private masseuses, some of them call themselves physiotherapists," she scoffed.

According to the World Confederation for Physical Therapy (WCPT), physiotherapists provide services to individuals and populations to develop, maintain and restore maximum movement and functional ability. The field of physical therapy is also concerned with identifying and maximising quality of life and movement potential within the spheres of promotion, prevention, treatment/intervention, habilitation and rehabilitation.

With a rising trend in health-awareness resulting in a surge of interest in physical exercise, Norhartina has every right to be concerned. Looking at demographics, the baby boomers are in their 50s or 60s and age-related problems like arthritis are increasingly common.

There are certain elements which contribute to the shortage of physiotherapi-sts in government hospitals, top of the list being the lack of training institutes in Brunei. Neighbouring countries such as Malaysia and Singapore have physiotherapist training centres, though they cater more to the domestic demand and places for foreign students are limited. What this means is that Bruneians interested in becoming physiotherapists have to look at Australia or England — where the cost is often prohibitive.

Cost is also equally problematic in starting a private practice in Brunei, where public healthcare comes for next to nothing and the services the government offers are often taken for granted.

"It is hard here (to set up a private practice) since the expectations are high because of the free medical services at public hospitals," said Lim.

"If in Australia you go to a private practice, part of the cost is paid for by insurance. We don't have such a thing like that here. By and far it can cost $30 to $50 per session. I think on average you would need five to six sessions. How many people can afford that?" he asked.

At JPMC it is about $90 per session, though they did have a recent promotion where it was about $39 per session. At Ripas, Bruneians get in for free and green IC holders have to pay only $5. Lim said the SMRC also accepts outpatients if they can be slotted in.

The cost of becoming a physiotherapist and maintaining private practice is not the only factor though, as it is well known that the qualifications required to become a physiotherapist are high. Comparing the entry level requirements in medicine and physiotherapy, there is not much difference. To get into a top-level institute, 2As and 1B is a must. Accreditation also plays an equally important role in landing a job in the Sultanate.

The responsibility of ensuring the quality of physiotherapists lies not with the Ministry of Health (MoH) but the Brunei Darussalam National Accreditation Council (BDAC). It goes without saying that a degree in Physiotherapy is what potential employers are looking for. However, it also depends on where the degree is pursued.

"Certain courses in certain institutions, the curriculum is not comprehensive," explained Norhartina.

"Sometimes if they specialise in children or sports medicine, they might not know much about other aspects, so it depends on which school you come from. The United Kingdom and Australia (are the norm) mainly because we have seen their curriculum, and they have institutes that are known around the world. We also do accept those from India or the United States . We are looking at quality, that is why we accept some and not others," she added.

Even then, those who are qualified and accredited might not want to practice in Brunei — regardless of whether in the public or private sector.

Salary is a big issue, and the lack of avenues to improve comes in at a close second.

"I think that if you look at it, the pay that you get here and abroad ... There is quite a big difference. In fact I know that local physiotherapists, once they graduate they don't come back, especially those not under scholarships," said Lim.

"If you look at a graduate, when they come back and work the salary here is $2,600 which is a B2 entry level pay scale. But for a graduate in Australia , you would be looking at $4,000. Of course there is the tax and the standard of living but if you are a graduate and are looking at it as a career path, there are a lot of opportunities to study there," said Lim. "Whatever fee you pay for your Masters or PhD, it is all tax-deductible. Most of the people who work in the government were on government scholarship. If you study on your own it costs a lot almost as much as studying to be a doctor. If you want to have some way of offsetting the cost you would be looking at a comparable pay.

"One of the things that is lacking here, if you graduate as a physiotherapist, there aren't any avenues or courses that you can take to upgrade your skills. In England and Australia, every week or every month there are a lot of different courses you can get into," Lim said.

There is a silver lining to the cloud though, with Norhartina insisting that physiotherapy in Brunei is on the right track.

Though Brunei might not possess the same opportunities for "experience expansion" as Norhartina put it, MoH has funded a few physiotherapists to symposiums and conferences in places such as Turkey, Singapore and Hong Kong.

The physiotherapists at Ripas attend at least one conference every year to keep them up to date, and they are expected to share their new-found knowledge once they return to Brunei.

To nurture the next generation, career expos and talks have been held in schools and students have been encouraged to come to Ripas on attachments to see what happens in the Physiotherapy Department.

The Institute of Medicine at UBD has been talking about starting a training centre, with Norhartina even approached to be one of the teachers.

There are three students on government scholarship who will hopefully graduate this year, giving the country a cause for optimism. Norhartina said that the students will have the chances to further their studies under scholarship, granted that they believe they are on the right career path.

"The future is bright in Brunei," assured Norhartina.

The Brunei Times