A Burmese lunch in Brunei

I made a wonderful friend in Brunei. Despite being from two totally different cultures (Yin is from Burma), we seemed to have a lot in common! Yin made Brunei feel like home. I loved spending time with Yin and her daughter, Thin Kyi. The week before I left Brunei, they invited me over for a traditional Burmese lunch. It was wonderful! Of course I ate too much—I’m blaming Yin’s mother for that since she insisted I have seconds of everything. Yin’s beautiful niece lives with her and did all the preparation. I’m really hoping they can visit the US so I can return the hospitality! The photos below were taken in Yin's house and her neighborhood.

A Day in Brunei's Temburong National Park

Last Friday I got to join a group of other doctors, nurses and public health types on a trip to the Ulu Temburong National Park. It was a full day experience with pick up at my residence at 7 am and return at 5 pm. We had a great international group including: two visiting pediatricians from Oxford, England; a pediatrician and his wife from Japan; a child community health expert from Japan; plus three other Brunei doctors and a nurse.









The easternmost part of Brunei is the Temburong District, which is separated from the capital and the three other Bruneian provinces by the Malaysian state of Sarawak. The Temburong District includes the Ulu Temburong National Park (formerly the Batu Apoi Forest Reserve). The rain forest occupies a significant portion of the country. The park can only be accessed by the river, which is great experience in itself.







Upon departure from the capital city, Bandar Seri Begawan, we left in sort of "taxi" boats for the main Temburong city. This took about 45 minutes, but was beautiful and cool in the morning. I could see monkeys on the shore looking for breakfast. After arriving in the main Temburong city, we stopped for tea and snacks. Tea Teka is sort of like a tea cappuccino and one of my favorite drinks here. It always comes with sugar! After tea, we loaded into vans that took us to the river leading to the park. Four to five occupied one long boat. These are like wooden canoes with motors. We then motored upstream, often over class II white water. Most of the river was shallow and our wooden boats often bumped the bottom.






We stopped for a break at the rain forest's only resort for a little break then continued up river to the park. Once we stepped off the boat it was about a 45 minute uphill climb to the canopy walk. The sounds were amazing. Unfortunately, the wildlife here is pretty shy, but the scenery is beautiful.

After our hike to the canopy walk, we boarded our boats and headed to a picnic spot along the river. Our guides made a great lunch with a sweet and sour fish, curried chicken (I only heard that was good), braised greens, rice (of course!) and fresh-cut melon. Needless to say, it was hot and humid by lunch time. We were instructed to bring bathing suits and a change of clothes, so after lunch most of us went swimming in the Temburong River. I was told there were no crocodiles, so the swim was refreshing AND relaxing.

We then headed back the way we came, with an afternoon tea break, of course. We were all pretty wiped by the sun, but it was a fabulous trip. I especially enjoyed getting to know so many genuinely interesting and friendly people. Dr. Mawarni, one of the Brunein pediatricians on the trip organized the day and I want to give her a big THANK YOU!

Just a foot note: The only hat I could find with a brim was this obnoxious cowboy hat. Why not look like a typical American?

A Little Brunei Culture

Last week the Brunei Ministry of Health held a free walkathon to create awareness about kidney disease. First, as I mentioned, the event was free. Bruneiens found it a little unbelievable that people in the US actually pay money to participate in such an event. They even gave out free workout towels! Secondly, the humidity was about 90% and no one wore shorts. And per custom in Brunei, most women had a on long sleeves and a head scarf. Pardon the quality of my video taping, but this is a snapshot of the warm-up before the 3.5K walk. I was pretty entertained.


After the walk I met a few Brunei health officials (Dr. Balalla is far left). There was also a special breakfast gathering with the Minister of Health (sort of like the US equivalent of the Secretary of Health and Human Services). I got to attend with Dr. Balalla (notice my sweat-drenched shirt) and have pictures taken with the minister (far right) and other officials. I was quite honored!


After the walk (and a shower) I spent the rest of the day in the capital city, Bandar Seri Begawan. I've included some photos of one of the older mosques, The Sultan Omar Ali Saifuddin mosque - built in 1958, and the streets of Bandar.


The Brunei river boarders the city and is home to a large water village.

Clinic Activities

Clinic starts at 7:45 am everyday, except Friday and Sunday, which are the government "holidays." The morning is usually the most busy with patients scheduled between 8 am and 12 pm. Usually there's a tea break around 10 am--very civilized! Patients are scheduled in the afternoon from 1:30 until about 3:30 pm and we're finished with work by 4;30. Many days include other activities such as employer site visits, training activities or meetings with other departments.

During my 2nd week I gave a general CME (continuing medical education) talk on Occupational Exposures and Women's Reproductive Health. There was a reception before so I got to meet physicians from other departments (general medicine and OBGYN).








I've also been busy with a portable cholinesterase test kit I brought with me, which is good for testing people who work with pesticides to see if they have been over exposed to organophosphates. Normally, obtaining blood results from a lab can take a few weeks in Brunei--the test kit I brought can check blood cholinesterase levels in less than five minutes.

It just so happens there was a small outbreak of Dengue Fever in early March so the Ministry of Health decided to increase pesticide spraying throughout the country. Dr. Balalla arranged to have all the spraymen (and they are men) come to our clinic for testing. We're checking to see if the test kit I brought gives the same results as the blood we send off to the central lab. So far, I've tested about 25 workers.











The best part about bringing the kit with me was teaching the nursing staff how to use it. They are fantastic! I took a few pictures of them practicing on each other. They are quick, enthusiastic learners and I love working with them.







Below is a picture of the most the nursing and physician staff. As soon as I learn how to spell everyone's name I'll include them!

A Day Off

We have "split weekends" here with Friday and Sunday off, so I spent the first one catching up on sleep, laundry and grocery shopping. And I joined a gym for the month—who would of thought I could continue to do spin classes in Brunei!?! I also went to a yoga studio with Dr. Yin (with me in photo below) on Saturday evening after work—it was great!

Sunday was also a holiday, but I spent about half the day at an orthopedic conference with Drs. Yin and Khin. It was held at this enormous hotel and country club, The Empire, situated on the South China Sea. The conference was interesting and the surroundings and food made it well worth the $20.

The Empire Hotel and Country Club is located near a large park, Bukit Shahbandar Recreational Park, so I packed a change of clothes and headed there for the afternoon. The 7 km hike was really challenging—partially due to the heat and high humidity. I kept wondering why so few people were on the trail. When I arrived the parking lot was almost empty. When I got to my car at 5:30 pm the parking lot was full. I realized it was because everyone else is smart enough to wait until it cools down.

The few people I did run into on the trail were friendly and curious—probably because I look foreign and I’m a female traveling alone. I’m frequently asked why I’m visiting Brunei. I don't see westerners very often. Most folks I meet (if not from Brunei) are from Malaysia, China, Singapore, India, Bhutan or the Philippines.

I'm looking forward to more exploring. This is a fairly easy country to navigate, even though I can't read the road signs. I guess that's one advantage to driving in Seattle...

Monkeys at the Market!

My favorite part of the day is lunch. Not only because we actually close clinic for an hour and half and I get to eat, but because I get to go to the closest market--Supa Save. This is a very special place. There is a family of monkeys living in the trees next to the parking lot! I'm fascinated by this. Bruneins are unphased. Anyway, they are super cute--especially the babies.


The doctors in clinic tell great stories about them. Like the two monkeys that tore a license plate off a car. They were carrying it away (each holding one side) when the car owner caught them in the act. Apparently, their endurance is not too great--while being chased up hill the monkeys got tired of running and carrying the plate so they turned around and threw it at the car owner. They are like mischievous little children.

If you can zoom in on the photos (above) you'll notice the mama monkey with a little newborn. I'm sure you'll see more monkey pictures from me in the future.

The Many Jobs of Occupational Medicine in Brueni

Occupational Medicine physicians in Brunei have a tough job. In the US, we have the luxury of having industrial hygienist who do work site and environmental assessments.Physicians will go along if time/motivation permits. We have a state department of Labor and Industry (as imperfect as they may be) that will perform an ergonomics evaluation for a patient if needed. And we have medical assistants who take vitals... I could go on.

Every week, Dr. Balalla and his staff do site visits for public and private industry. Currently, there is no requirement for the companies to comply with recommendations, but recently passed legislation will change that. Last week I went on site visit to the Butra Heidelberg Cement factory in Maura (Eastern Brunei), which is about a 30 min drive from Bandar Seri Bagawan (the Capitol). They import about 4500 tons of clinker and 1500 tons of gympsum per day. In case you were wondering, clinker is a pebbly rock-like substance that is made by heating limestone and other raw materials to a very high temperature in a kiln. Limestone is the primary material used to make it. I love Wikipedia! Anyway, construction is a major industry in Brueni and employs more people than any other industry.

I was impressed by the health and safety promotion within the plant, however a very dusty job and not everyone working in all this dust wore a respirator. It was a really hot day to walk around a cement factory in long pants/sleeves with a hardhat and face mask!


The inspection started at the dock where the clinker and gypsum is unloaded from the ship then transported into super large grinders. Eventually, it's bagged and shipped off to distributors.