In December 2016, as part of a medical facility survey in the ASEAN countries, I visited Bandar Seri Begawan, the capital of Brunei, the last country on our list. This article recounts that visit, which served as a catalyst for further exploration of healthcare institutions in ASEAN.

"The Kingdom of Brunei, an Islamic microstate with a population of about 460,000 people, is located in the northern part of Borneo Island, shared by Malaysia and Indonesia. Brunei is a member of the ASEAN 10 and is part of the maritime ASEAN 5 along with Singapore, Malaysia, Indonesia, and the Philippines.

Our first visit was to the royal family-established national hospital, Raja Isteri Pengiran Anak Saleha Hospital (RIPAS), which is equipped with facilities comparable to an average Japanese hospital (see top photo). The hospital had recently added a new ward and also constructed a maternity and pediatric center in collaboration with the Japanese firm Tobishima Corporation. Despite being well-equipped and spacious, the hospital lacked a website and brochures, an indication that patient information disclosure was not prioritized.

In 2013, RIPAS implemented the BruHIMS (Brunei Darussalam Healthcare Information and Management System), an electronic health record system that handles the same data across all national hospitals and clinics. This inclusion of an image system, locally referred to as PACS, streamlined patient information management, although, according to our guide, it initially slowed down data entry and increased waiting times.

Brunei, where the sale of alcohol and tobacco is prohibited, faces challenges with diet-related health issues like obesity, diabetes, and hypertension, with heart disease being the leading cause of death, not cancer. Discussions about obesity were a common sight.

Next, we visited the Jerudong Park Medical Centre (JPMC), a 110-bed hospital (see middle photo), which is part of the Parkway Group and accredited by the Joint Commission International (JCI). Unlike the national hospital, JPMC was open to marketing manager contacts.

Parkway Holdings, the largest hospital group in Singapore and part of Integrated Healthcare Holdings under the ownership of Malaysia's sovereign wealth fund Khazanah Nasional, is expanding, including a new hospital in Yangon. This expansion into Myanmar was unexpected as the country had not previously allowed foreign hospital investment.

The adjacent JPMC Heart Centre, a 40-bed facility (thumbnail photo), is staffed by seven doctors (including part-timers) and caters to the increasing incidence of heart disease.

Brunei has four districts, each with a hospital. We did not visit the Pengiran Muda Mahkota Pengiran Muda Haji Al-Muhtadee Billah Hospital (183 beds) in Kuala Belait and a 50-bed hospital in Temburong. The former was too far from the capital, and the latter, offering primary care services, was deemed unnecessary for our visit.

The Tutong Hospital (138 beds) is a comparatively small facility, offering various specialties. It's expanding its bed capacity and seems lively, though it lacks a comprehensive emergency system, functioning more as a 1.5-tier facility. The medical level is said to be comparable to Japan's for non-major surgeries.

The exact number of doctors working in Brunei's healthcare system is unclear, but given the country's reliance on foreign medical professionals, who make up nearly half of the physician workforce, the total could be around 1,200.

Brunei's healthcare system, supported by its rich oil resources, covers all medical expenses incurred overseas for a nominal fee of 1 Brunei Dollar, including family travel costs. We visited the under-construction Brunei Cancer Centre (TBCC) (bed number unspecified, see bottom photo), established to reduce the need for patients to seek treatment abroad. Unfortunately, we couldn't tour the inside as it wasn't officially open yet.

While the University of Brunei Darussalam's PAPRSB Institute of Health Sciences fulfills the role of a medical school, doctors are trained in the UK and return home to practice. The healthcare level is still developing, and the country depends on foreign doctors. Foreign physicians can work in Brunei based on an interview with the Ministry of Health, not necessarily passing a national exam. There are no Japanese doctors currently, but it could be an opportunity for some.

Brunei's healthcare facilities are impressive, situated near the sea, providing an ideal treatment environment. The connection between PJMC and TBCC might be due to Parkway's consulting, reminiscent of my experience supporting the Japan Desk at Shanghai International Medical Center.

Our 4-night, 5-day whirlwind trip from Kuala Lumpur via Royal Brunei Airlines was enlightening, offering a comprehensive understanding of the healthcare landscape in Brunei." (Written by: Yuji Ishii)

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