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Allied Health Professions in Brunei – Where East Meets West

In my role as an educator and a researcher, there are times when I am fortunate enough to travel around the world to meet and collaborate with a range of allied health professionals. One such opportunity presented recently. Earlier this year, I was invited by the Interim Committee for Brunei Allied Health Professions Council as the keynote speaker for the Advancing Allied Health in Evidence Based Practice Seminar which was held on the 6th and 7th of June 2014. The theme of the seminar was Finding and Evaluating Evidence with a particular focus on incorporating evidence into clinical practice. I accepted this invitation and I was hosted by the Interim Committee for Brunei Allied Health Professions Council from the 5th – 8th of June 2015. Brunei is a sovereign state located on the north coast of the island of Borneo in Southeast Asia. Since its independence from United Kingdom in 1984, Brunei has continued to transform into a newly industrialised country with extensive petroleum and natural gas fields. Brunei has a population of just over 400,000 and its capital is Bandar Seri Begawan. All Bruneians have equitable access to universal health care, with a nominal amount of B$1 for the citizens of Brunei. Furthermore the Government of Brunei ensures that in case appropriate health care is not available in Brunei, Bruneians have the opportunity to travel overseas to seek health care, the cost of which is borne by the Government of Brunei.

During my visit to Brunei, I was able to interact with a range of allied health professionals in Brunei and immediately upon arrival I was struck by how unique health care in Brunei was. Given the unique geography of Brunei and its population, Brunei has a relatively small but highly competent and committed allied health workforce. Many of the allied health professionals were trained in overseas (mainly in western countries) before returning home to contribute to the health and well-being of Bruneians. I was pleasantly surprised to meet many allied health professionals who were trained in overseas (including some who were trained in Australia) and their passion and commitment to best practices. Like their overseas counterparts, allied health professionals in Brunei were eager to gain access to the knowledge and skills in effective and efficient translation of evidence into clinical practice. Not surprisingly, similar to their overseas counterparts, allied health professionals in Brunei were also confronted with similar barriers to transplanting evidence into practice such as time, competing clinical demands, and access to resources.

Another interesting dichotomy that I observed in Brunei, adding to its uniqueness, was the blending of issues that is commonly observed in western and eastern countries. As is commonly observed in developed countries, Brunei too was confronted with chronic conditions such as obesity. Recognising these challenges posed by non-communicable diseases, the Government of Brunei responded by formulating a multi-sectorial strategy, which brings together community members, policymakers, administrators, and a number of health professions, including allied health professions, that play a prominent role. Building on the universal access to health care in Brunei, there has been a concerted push by the Government of Brunei to engage with the general public and consumers of health to take ownership of their own health, and in this context, allied health professions have contributed by creating awareness, providing education, and spreading the message about general health and wellbeing.

However, as is observed in developing countries, Brunei too was confronted with small number of allied health professionals to cater for burgeoning health care needs, challenges in timely access to and application of best evidence in the care of patients and populations, integrating emerging technologies and advanced and extended scope of practice for its allied health professionals, and ensuring equitable access to professional development for its allied health workforce.

While this dichotomy was unique to Brunei, the challenges faced by Brunei’s health system and its allied health professionals are not unique per se. For example, only last week, in my home state of South Australia, the Government of South Australia released a discussion paper called “Transforming Health” (http://transforminghealth.sa.gov.au/). This discussion paper, developed in consultation with a range of health care stakeholders in South Australia, aims to explore opportunities to transform the South Australian health system in order to meet the challenges of the 21st century health care while delivering consistent and quality care in the future.

It is in this context that we need to consider what role allied health professions can play in addressing these challenges. I am reminded of the saying that “for every complex problem, there is a solution that is plain, simple, and wrong.” Therefore, as the first starting point, we need to acknowledge that this is a complex issue and one that can only be addressed by bringing together stakeholders across health. This includes health care professionals, consumers, funders, policymakers, administrators, and the community overall. As allied health professionals, we need to work in partnership with other health professionals and health care stakeholders to identify how best as a team (through interdisciplinary and multi-disciplinary) we can achieve the best outcome for our patients. By working as a collaborative team over time and with adequate training and governance in place, there may be opportunities for allied health professionals to work in trans-disciplinary model in areas where there is recognised need but has limited number of allied health professionals because of workforce issues.

Rapid technological advances also provide opportunities for allied health professions to positively impact upon heath care needs of the 21st century. From an educational and professional development perspective, using online technologies and blended learning models, allied health professionals, irrespective of their geographical location, can get ready access to ongoing training, supervision, and mentoring. This is important for the development of the allied health workforce as it may then lead into advanced and extended scope of practice. This will have a system wide positive effect as it will benefit patients (access to health care in time and areas of need), allied health professionals (job satisfaction, recruitment, and retention) and health system (best use of infrastructure, human resources, technology and communication). From a health service delivery perspective, using technologies such as videoconferencing can assist in bridging gaps in services that may result due to geographical and/or pragmatic reasons (such as access to travel).

There is consistent evidence to indicate persistent evidence-practice gaps in many health systems around the world. Likewise, there is a considerable body of evidence which sheds light on why these evidence-practice gaps occur and how best to address these gaps. Allied health professionals, working in collaboration with other health care stakeholders, can play a critical role in closing these gaps by identifying barriers to and enablers of best practice. Given many allied health professionals, especially in recent times, have been exposed to, and are positive about evidence based practice, this could be an achievable goal.

According to our sources, Albert Einstein once said “Insanity is doing the same thing over and over again and expecting different results.” Fortunately, 21st century health care challenges bring opportunities for allied health professions to transform the way we provide health care. In order to achieve this, allied health professions need to take a systems-wide approach and work in close collaboration with a range of health care stakeholders. Allied health professions in Brunei, while unique in some ways, are also confronted by similar challenges that face all of us. Together, through mutual learning and support, we can positively impact health care that is provided to our patients.

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