In The Pink Of Health - National Healthcare Group

Transcription

WINNER
AWARD OF EXCELLENCE
APEX 2013
SEP/OCT 2013
ISSUE 47
HONOURABLE
MENTION
CONTENT MARKETING
AWARDS
An
End To
Suicide
Heed the
warning signs
and get help
Every
Breath
You Take
Why the air
inside your
home may
be harmful
In The Pink
Of Health
Dr Melanie Seah and Senior Nurse Clinician
Patmavathy spell out the B.R.E.A.S.T. issues
NHG AWARDS 2013
• FOOD FOR THE BRAIN • TECH TOOLS FOR SENIORS
Lifewise
CONTENTS
SEP-OCT ISSUE 47
features
08 COVER STORY
A CLEAN B.R.E.A.S.T.
Awareness is high,
but perhaps not high
enough. We look at
this deadly disease
and two women who are
dedicated to the cause.
15 BONE BATTLE
Given Singapore’s
rapidly-greying
population, here’s what
you need to know
about the age-related
disease, osteoporosis.
18 LET’S GET PHYSICAL
Learn more about
physiotherapy, an
integral component
of patient care today.
8
15
20
20 THE VALUE
OF LIFE
Suicide can be
prevented with
treatment and
counselling.
SEP - OCT 2013 LIFEWISE
1
Lifewise
CONTENTS
SEP-OCT ISSUE 47
22 THE SUM OF
ALL PARTS
Working with four ‘giants’
in healthcare has prepared
Dr Eugene Soh’s career
for the challenges ahead.
26
23 LESSONS OF
A FOREFATHER
Mr Roney Tan talks about
the legacy left by his
well-known philanthropist
ancestor, Mr Tan Tock Seng.
24 TECH SUPPORT
How technology can
ease — and even prolong
— life as we get older.
26 THE AIR YOU
BREATHE
From mould to dust,
what makes up the air
indoors could be worse
than what’s outside.
24
28 AGE IS BUT
A NUMBER
You need not and should
not spend your golden
years being sedentary.
28
regulars
EDITOR’S NOTE
NEWSROOM
ASK THE EXPERTS
SPOTLIGHT/NHG NEWS
SPOTLIGHT/NHG DIRECTORY
2
LIFEWISE SEP - OCT 2013
03
04
31
36
48
ON THE COVER:
DR MELANIE SEAH AND
PATMAVATHY CHELLAIYYA
PHOTOGRAPHER HONG CHEE YAN
ART DIRECTION DON LEE
STYLING ZEAN CHAN
GROOMING MANISA TAN
CLOTHES MELANIE: SLEEVELESS
BLOUSE AND PENCIL SKIRT FROM
WAREHOUSE. PATMAVATHY: KNIT
CARDIGAN FROM UNIQLO, SHIFT
DRESS FROM WAREHOUSE, AND
NECKLACE, STYLIST’S OWN
NATIONAL HEALTHCARE GROUP
EDIT O RIAL
Wong Fong Tze, Lim Phay-Ling, Tania Tan, Eleanor Toh,
Hamidah Aidillah, Praveen Nayago, Chong Pei Wen,
Ng Si Jia, Christopher Lam, Audrey Wong
L IFEW IS E ADVIS ORY PANEL
A/Prof Lim Tock Han, A/Prof Thomas Lew, A/Prof
Chua Hong Choon, Dr Chong Phui-Nah, Prof Roy Chan
MEDIACORP PTE LTD
EDIT O RIAL & DES IG N
Senior Editor
Supervising Editor
Editor
Associate Creative Director
Art Director
Senior Writer
Writers
Chief Photographer
Executive Photographer
Senior Photographer
Photographer
Agatha Koh Brazil
Ronald Rajan
Amir Ali
Augustine Tan
Don Lee
Fairoza Mansor
Gene Khor
Alex Ngai
Steve Zhu
Ealbert Ho
Kelvin Chia
Hong Chee Yan
CON T RIBUTORS
Wanda Tan, Nirmala Sivanathan,
Elisabeth Lee, Evelyn Mak, Wilson Pang
BUSINES S DEVELOPMENT
Senior Business
Relationship Manager
Michele Kho
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E ve r y c a r e h a s b e e n t a k e n i n t h e p r o d u c t i o n o f t h i s
m a g a z i n e , b u t N a t i o n a l H e a l t h c a re G ro u p ( N H G ) , t h e
publisher, editor and employees assume no responsibility
for any errors, inaccuracies or omission arising thereof.
Opinions expressed by contributors and advertisers are
not necessarily those of NHG, the publisher or the editor.
The information produced is for reference and educational
p u r p o s e s o n l y. A s e a c h p e r s o n ’s m e d i c a l co n d i t i o n i s
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concerned about your health or that of your child, please
consult your family physician or healthcare professional.
Copyright © is held by the publishers. All rights reserved.
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Printed in Singapore by Times Printers, www.timesprinters.com.
MICA (P) 092/11/2012.
Walking tall
WHEN LIFE PRESENTS A CHALLENGE that knocks
you off your feet — such as the onset of a serious
disease — it is important to not let it bring you
down. And being aware of the disease risks around us
can mean the difference between conquering illness and
losing the battle to it.
In our fast-paced world — in which many of us obtain
information in bite-size portions on mobile phones and
online — we rarely have the time nor attention span to digest
every piece of news on health initiatives out there. But some
awareness campaigns have been more successful than others.
You would have noticed that the healthcare professionals on
this issue’s cover are holding up a pink ribbon, which can only
mean one thing: October — Breast Cancer Awareness Month
— is here.
In this issue’s cover feature, experts spell out exactly what
breast cancer is and demystify common misconceptions
that still persist about it (page 8). For example, you may
have wondered, when it comes to the risk of developing
this potentially deadly disease, does breast size matter? The
simple answer is yes, but there is so much more to managing
this condition that afflicts about 6 per cent of women in
Singapore. For starters, there’s the human element: what
must it be like to be on the front line of the battle against
breast cancer? Lifewise speaks to women whose wealth of
experience in talking to sufferers and survivors brings hope to
patients of the Breast Clinic @ TTSH (page 12).
Another disease which affects mainly women is
osteoporosis, in which a sufferer’s bones are prone to
breaking. Sufferers thus have a propensity to fall and break
major bones, especially in the legs or hip area. But as you will
read on page 15, one way to stave off falls as one gets older
is to stay in shape — find out how on page 28. But if you are
afflicted by pain and injury due to falls or over-exercising,
physiotherapists are here to help (page 18). A critical field of
healthcare, physiotherapy encompasses treatments for sports
injuries, age-related disability and amputee rehabilitation to
even weight management.
Physiotherapists work closely with patients — literally
helping them get back on their feet — and this patientcentred treatment is being inculcated in the next generation
of doctors being taught at the Lee Kong Chian School of
Medicine, which welcomed its pioneer batch of students in
August. The National Healthcare Group is proud to be the
school’s principal training partner (page 42) and students will
gain exposure to the hospital environment at NHG’s flagship
institution, Tan Tock Seng Hospital (TTSH).
TTSH is also at the core of the Novena precinct, and
this status will be maintained when Health City Novena is
completed in 2030. This master plan, outlined on page 40,
will greatly increase the area’s capacity to treat patients
in a modern environment that is conducive to wellness.
So, here’s looking forward to Health City Novena and with it,
more years of active and healthy life.
THE EDITORIAL TEAM
3
(newsroom)
S N I P P E T S F R O M T H E H E A LT H C A R E W O R L D // C A L E N DA R O F E V E N T S
PSYCHOLOGY
Misery Vital To
Mental Health
While being angry or sad can be
unpleasant, these emotions are
important and possibly vital to good
mental health, say psychologists. A
recent study by psychologist Jonathan
Adler of the Franklin Olin College
of Engineering and Hal Hershfield,
Professor of Marketing at New
York University in the United States
examined the link between emotional
experience and psychological welfare
among a group of people undergoing
12 sessions of psychotherapy.
“Acknowledging the complexity
of life may be an especially fruitful
path to psychological well-being,”
Dr Adler told Scientific American.
In fact, suppressing bad thoughts
can actually have a contrary effect —
instead of making you feel better,
avoiding negative emotions can even
diminish your sense of contentment.
Unpleasant feelings can help you make
sense of life’s ups and downs. “One of
the primary reasons we have emotions
in the first place is to help us evaluate
our experiences”, Dr Adler added.
ONCOLOGY
STARVING CELLS
TO TREAT CANCER
S cientists have discovered a way to kill cancer cells by
depriving them of nutrients. Professor Chris Proud from
the University of Southampton in the United Kingdom,
along with Canadian researchers from the British Columbia
Cancer Agency Research Centre, think this could lead to a
new treatment for cancer.
“As cancer cells grow and divide much more rapidly
than normal cells, they have a much higher demand for
nutrients and oxygen,” explained Prof Proud. “We have
discovered that a cellular component, eEF2K, plays a
critical role in allowing cancer cells to survive nutrient
starvation, while normal, healthy cells do not usually
require eEF2K to survive. Thus, blocking the function of
eEF2K should kill cancer cells without harming normal
healthy cells in the process.”
Traditional therapies such as radiotherapy and
chemotherapy often harm normal healthy cells, while
targeted treatments may only work for a particular type of
cancer. This discovery does not damage healthy cells, and
can potentially be applied to treat many different cancers.
Prof Proud hopes to develop drugs that block eEF2K.
4
BLOCKING THE
FUNCTION OF
THE CELLULAR
COMPONENT
eEF2K SHOULD
KILL CANCER
CELLS WITHOUT
HARMING
NORMAL
HEALTHY CELLS
PULMONOLOGY
HAZARDS OF HAZE
calendar
The dust and dirt in the air don’t just sting your eyes —
they can kill you, say scientists. Researchers from
the University of North Carolina in the United States
estimate that about 2.1 million people worldwide die
each year as a result of a surge of fine particulate
matter air pollution, according to a study published in
the journal Environmental Research Letters.
“Outdoor air pollution is among the most important
environmental risk factors for health,” said study
co-author Jason West. “Many of these
deaths occur in East Asia and South
Asia, where populations are high and
air pollution is severe.”
Researchers simulated the
concentrations of ozone and fine
particulate matter air pollution at the
start of the Industrial Revolution in
1850 and compared it with data from
the year 2000. The study showed
that since then, millions died from
an increase in air pollution. It also
estimated 470,000 deaths occur every
year due to increased ozone levels.
SOME 2.1 MILLION
PEOPLE DIE EACH
YEAR AS A RESULT
OF A SURGE IN
AIR POLLUTION
ONCOLOGY
HPV Vaccine
Protects Throats, Too
PHOTOS: CORBIS, SHUTTERSTOCK
A
A CERVICAL
CANCER VACCINE
PROVIDED 93 PER
CENT PROTECTION
AGAINST THE
VIRUSES THAT
CAUSE MOST
THROAT CANCERS
cervical cancer vaccine
also appears to protect
against certain throat
cancers caused by the human
papillomavirus (HPV), according
to a study by the World Health
Organization’s International
Agency for Research on Cancer.
The study found that
Cervarix, a cervical cancer
vaccine, provided 93 per cent
protection against infection
with the two types of HPV that cause the majority of
throat cancers. While researchers have long suspected
that the vaccine would prevent throat cancer, this is the
first study to provide evidence. “We were surprised at how
big the effect was,” Dr Rolando Herrero, the study’s lead
author, told The New York Times newspaper. “It’s a very
powerful vaccine.”
While the study only surveyed young sexually-active
women, men would “probably” get the same level of
protection because the vaccine produces the same amount
of antibodies in both sexes, said Dr Herrero. What remains
unknown is “how long-term the protection is, or if
re-vaccination is necessary”.
SEP/OCT
PINK RIBBON WALK 2013
Join National Healthcare Group
Diagnostics at the Pink Ribbon
Walk 2013. The event shows
solidarity with breast cancer
survivors and raises awareness
of breast cancer. The first
500 women to sign up will enjoy
a $10 discount on a mammogram*
on NHG Diagnostics’ Mammobus
at the event or at National
Healthcare Group Polyclinics,
courtesy of NHG Diagnostics.
* To see who is eligible for a mammogram,
please refer to the BreastScreen Singapore
eligibility criteria at www.hpb.gov.sg.
DATE
28 Sep 2013
TIME
5pm — 7pm
VENUE
Marina Bay Waterfront Promenade
FEE
Adults: $38. Concessions are
available for group participations,
past participants, Breast Cancer
Foundation members, students
and senior citizens. Register at
www.pinkribbonsingapore.com
CARE FOR THE
ELDERLY COURSE
The Primary Care
Academy is offering
a training programme
conducted by experienced
registered nurses to equip you and
your caregiver with the skills for
caring for the elderly.
A Caregiver’s Training Grant
is available. To be eligible for the
grant, the caregiver must:
} Be looking after a person
needing care, who is a
Singapore citizen or Singapore
Permanent Resident.
} Be the main caregiver; he or she
could be a family member or
foreign domestic worker.
DATE
21 Oct 2013
TIME
10am — 5pm
VENUE
Primary Care Academy Learning
Centre, Choa Chu Kang Polyclinic,
Level 3, 2 Teck Whye Lane, S(688846)
FEE
$117.70 (incl GST). Call 6496-6682
or 6496-6683 to register.
5
PHYSIOLOGY
DERMATOLOGY
LINK BETWEEN ECZEMA
AND FOOD ALLERGIES
A
study by scientists from King’s College London
in the United Kingdom has found that children
with the skin condition eczema are more likely
to have food allergies as well. Published in the Journal of
Investigative Dermatology, the study found that the more
severe the eczema, the greater the person’s sensitivity to
food allergens such as peanuts and cow’s milk.
Dr Carsten Flohr, a dermatologist who led the
study, told The Telegraph Media Group that it would
appear that eczema plays a key role in the development
of allergies by damaging the barrier created by the
skin. Eczema causes itchy, cracked skin which exposes
the immune system beneath the skin to particles of
food it would not normally encounter, thus priming
it to see the food particles as a threat. This can cause
inflammation, and in people with severe forms of the
allergy, can also result in swelling and shock.
Dr Flohr said, “We thought that food allergies are
triggered from the inside out, but our work showed that
in some children it could be from the outside in, via the
skin. It opens up the possibility that if we can repair
the skin barrier and prevent eczema effectively then we
might also be able to reduce the risk of food allergies.”
6
Writing Heals,
Literally
ECZEMA CAUSES
CRACKED SKIN,
WHICH LETS IN
UNUSUAL FOOD
PARTICLES. THIS
PRIMES THE
IMMUNE SYSTEM
TO SEE SOME OF
THESE PARTICLES
AS A THREAT
Emotions — and the expression
thereof — really do have an effect
on a person’s physical health. A New
Zealand study reported in Pacific
Standard magazine showed that the
physical wounds of healthy seniors
healed more quickly if the seniors
wrote about their feelings.
Published in the journal
Psychosomatic Medicine, the study
confirmed the results of an earlier
2010 study and extends the findings
to cover older adults, a group that is
prone to suffering wounds and which
tends to have fewer ways of coping.
A University of Auckland
research team looked at 49 healthy
elderly people who were asked to
write either about an upsetting
experience or to merely list their
daily activities, without mentioning
their opinions, feelings or beliefs. The
half that wrote about their traumatic
emotions recovered more quickly
from a skin biopsy done on their
inner arms.
“The biological and psychological
mechanisms behind this effect
remain unclear,” said the researchers,
who noted that the expressive
writers did not exhibit lower
stress levels nor fewer symptoms
of depression.
NEUROLOGY
Memory Lapses
A Concern
R
ecent studies show that physically healthy people prone
to memory lapses are significantly more likely to develop
more severe problems in the future, reports The Telegraph
Media Group. This suggests that people should seek advice early
if they are concerned about memory lapses, said researchers.
One study conducted by two American hospitals found that
elderly people with memory concerns but who were otherwise
healthy had significantly greater levels of the plaque that also
appears in the brains of those suffering from Alzheimer’s.
Another study by the University of Kentucky also showed
that those who self-reported changes in their memory were
almost twice as likely to be diagnosed with dementia or
cognitive impairment over the next 10 years.
Dr Marie Janson of Alzheimer’s Research UK said, “Selfreported memory problems could become an important tool
for clinicians seeking to detect dementia early. A serious worry
about declining memory or thinking skills could be an early
indicator that something else is going on.”
NUTRITION
PHOTOS: SHUTTERSTOCK
A GENE FOR OVEREATING
If you’ve wondered why you can’t seem to stop
overeating, the answer may lie in your genes.
Scientists at the University College of London in
the United Kingdom have found that a gene called
FTO, which has been linked with obesity, can cause
weight gain by reducing the chemical signals that
tell your brain to stop eating. The same gene can
also increase your attraction to calorie-laden,
fatty foods.
In the study, which was published in the Journal
of Clinical Investigation, men with two copies
of the obesity-variant of the FTO gene ranked
themselves 20 to 25 per cent hungrier after a meal
than men without the gene. Concentrations of
ghrelin, a hormone that stimulates appetite, were
also elevated. Carriers of the FTO variant also
rated the most calorie-laden foods as 50 per
cent more attractive than non-carriers.
“People with the gene variant don’t
suppress ghrelin properly after a meal, so they
remain hungry,” Rachel Batterham, one
of the study’s co-authors, told
The Telegraph Media Group.
“You become a slave
to that extra ghrelin.”
PEOPLE WITH THE
GENE VARIANT
DON’T SUPPRESS
GHRELIN
PROPERLY AFTER
A MEAL, SO THEY
REMAIN HUNGRY
calendar
SEP/OCT
WORLD MENTAL HEALTH
DAY 2013
The Institute of Mental Health and
the Singapore Association for
Mental Health are commemorating
World Mental Health Day 2013.
In line with this, a showcase
of the creative talents of
recovering patients — dubbed
“Towards Recovery: A Showcase
of Talents” — will be on show,
including photography, paintings,
pottery, books and crafts. Join
in the carnival and sign up for
the workshop for caregivers by
our keynote speaker on “Crisis
Management in the Community”.
DATE
12 Oct 2013
TIME
12pm — 5.30pm
VENUE
Lasalle College of the Arts,
1 McNally St, S(187940)
FEE
Open to the public (free).
Registration is required for the
caregivers’ workshop. Please email
your name and contact details to
[email protected]
7
(IN THE PINK)
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HERE’S WHAT TH
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BY FAIR
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TTSH;
CLINIC @
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DR JULIA
IN CO
BREAST
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RECTOR //
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// DEPA
AND
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TAN TO
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H
EW
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MS TANG OGRAPHY SERVIC AGNOSTICS
RADI
UP DI
CARE GRO
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NATIONA
SENIOR CO
8
EVEN IF YOU HAVE JUST a passing
interest in the news and popular culture of
today, you would have noticed that many
major illnesses are associated with a logo
or icon, a celebrity, a wearable ornament
and possibly even a range of consumerproduct tie-ins. For example, the awareness
campaign for heart disease has its red dress,
and the one for testicular cancer, its yellow
bracelet. Prostate cancer has been associated
with keeping a moustache. But one cannot
talk about awareness campaign emblems
without bringing up the pink ribbon — the
universal symbol for breast cancer awareness
since 1998.
Throughout the Breast Cancer Awareness
Month of October, women and men all over
the world pin this iconic ribbon to their
IN SINGAPORE, BREAST
CANCER IS THE DEADLIEST
CANCER AMONG WOMEN
PHOTOS: GETTY IMAGES, SHUTTERSTOCK
is for breast
cancer
Over the years, experts have
argued that breast cancer
isn’t a singular disease.
There are multiple types
of breast cancers which
behave differently, have
clothes, or sport other pink-coloured clothes
different causes and respond differently to
and accessories as a display of support and
treatment. There is basal-like breast cancer
solidarity and — most importantly — as a
which is most prevalent in younger women
reminder that everyone, not just women,
and women with the breast cancer genes
are in some way affected by the disease.
BRCA1 and BRCA2; Luminal A and B
In Singapore, breast cancer is the
with tumours that feed on oestrogens
deadliest cancer among women. Each year
(a group of hormones that influence the
between 2005 and 2009, more than 350
female reproductive tract in its development
deaths resulted from it annually, according
and function); and HER2 positive,
to Ministry of Health statistics.
which produces too much of a protein
Six in 100 women will develop breast
called human epidermal growth factor
cancer, says Dr Juliana Chen, Director
receptor 2.
of the Breast Clinic @ TTSH and Senior
In addition, the cancer can begin
Consultant of the Department of General
in different parts of the breast,
Surgery at Tan Tock Seng Hospital (TTSH).
namely the lobules (where milk is
Between 2006 and 2010, 7,781 cases were
produced), milk ducts (which carry
detected and accounted for 29.3 per cent of
the milk to a reservoir that lies
all cancers affecting women in Singapore.
beneath the nipple) or the connective
Although the overall rate
tissue in the breast that is made up
of breast cancer
of muscles, fat
in this country is
and blood vessels.
significantly lower
Breast cancer can
PECTORALIS MUSCLE
than in Western
also be non-invasive
FATTY TISSUE
populations —
(in-situ) or invasive.
the incidence is 12
In-situ breast cancer
LOBULE
in 100 in the United
refers to cancer in
NIPPLE
States, for example
which the cancerous
— Singaporean
tissues remain within
women tend to
their place of origin
contract the disease
and have yet to
CHEST WALL/
at a comparatively
spread to breast tissue
RIBCAGE
younger age, says
around the lobule or
Dr Chen.
duct. Invasive breast
cancers, in comparison, spread outside
the membrane that lines a duct or lobule,
to invade surrounding tissues and can
then travel to other parts of the body. The
disease becomes deadly when the tumour
metastasises — spreading from its primary
site to other parts of the body.
Invasive breast cancers exist in Stages 1
to 4. The mortality rate for an early Stage 1
breast cancer patient — that is, when the
size of the tumour is at 2cm or less — can
be as high as 98 per cent over five years if
left untreated. However, at Stage 4 — when
the cancer has spread to other organs such
as the liver and bones — the mortality rate
is 100 per cent. Identifying the source and
the chemical and genetic makeup of the
breast cancer helps doctors prescribe the
most effective treatment.
is for
reconstructive
urgery
Breast tumours can be
surgically removed via a
mastectomy, a surgical
procedure which involves the
removal of the whole breast.
“Patients who choose to have a mastectomy
performed will also be offered the option of
reconstructive breast surgery,” says Dr Chen.
Reconstruction of the breast can be
performed with autologous tissue flaps
which are made from tissue sourced from
other areas of the patient’s body. The
most common tissue flap, according to
Dr Chen, is the TRAM (transrectus abdominis
myocutaneous) flap, which is essentially fat
and muscle taken from the tummy. “This
has an added benefit of also giving the
patient a tummy-tuck at the same time,”
9
(IN THE PINK)
is for
Assumptions
is for
Examination,
detection
and scans
Encouraging women to
go for mammograms
is the primary message
of the pink-ribbon
awareness movement.
Women aged 40 to 49 are advised to go for
a mammogram screening every year and
women 50 years and older are advised to
GET YOUR CHECKUP
The national breast cancer screening
programme, BreastScreen Singapore,
advises women to schedule
mammograms at least one week
after the last day of their period.
At The Breast Clinic @ TTSH, all
procedures from screening to
treatment are done under one roof.
The clinic is located at Level B1, TTSH,
11 Jalan Tan Tock Seng, Singapore
308433. Tel: 6357-1000. Mammography
screening is also available at all
NHG Polyclinics. Call 6-ASK-NHGD
(6275-6443) for an appointment.
10
go every two years. However, those
with a family history of breast cancer
are advised to consult a doctor who
would determine when they need
to have their first mammogram and
how often, whether it be every six
months or every two years.
A mammogram is performed on one
breast at a time to check for a possible lump
or to define the extent of a self-discovered
lump. During the scan, a female radiographer
positions the breast between two flat
plastic plates and a highly-specialised X-ray
machine compresses it. The procedure is
then repeated for the other breast. Though
uncomfortable, it is important that the
breast tissue is compressed to take a
clear X-ray. Mammograms are sometimes
combined with an ultrasound of the breast
to determine if the lump is mainly solid or
filled with liquid.
There is no health risk associated with
mammography as it does not overexpose
patients to radiation, says Ms Tang Kiew
Hoon, Acting Head of Radiography Services
at National Healthcare Group Diagnostics
(NHG Diagnostics).
Mammograms performed by NHG
Diagnostics under the Health Ministry’s
BreastScreen Singapore programme are
targeted at women who do not have
symptoms like breast lumps and nipple
discharge. Patients are referred for further
assessment if suspicious lesions are found.
When a breast lump is detected, a biopsy
may also be needed. This involves removing
a small sample of tissue from the growth.
The extracted tissue is processed and sent
to a pathologist who assesses whether it
is cancerous. In the event that cancer is
diagnosed, a chest X-ray, an ultrasound
MYTH #1
Women who have
not given birth
are more likely to
develop breast
cancer than those
who have.
There is some truth to this.
The risk of breast cancer can
be heightened by an increase
in oestrogen exposure.
Pregnancy results in increased
production of progesterone
— a hormone that prepares
the body for conception and
regulates the menstrual cycle.
Comparatively, women who
have not given birth have
an uninterrupted exposure
to oestrogen. That said, the
risk is only increased by one
to two times the average
population risk.
scan of the liver and a bone scan
may be ordered to determine if the
cancer has spread.
Some women would rather eliminate
the risk of contracting breast cancer entirely
and opt for a preventive approach. Genetic
testing made headlines in June this year
when actress Angelina Jolie revealed that
she had undergone a preventative double
mastectomy after discovering that she had
genetic mutations that predisposed her to
breast cancer. The BRCA1 gene mutation,
along with other factors, led her doctors
to estimate her risk of breast cancer to be
87 per cent, so the 38 year-old had the
surgery to reduce her odds to five per cent.
“The BRCA gene test using DNA
analysis is not a new technology,”
says Dr Chen. “The two breast cancer
susceptibility genes, BRCA1 and BRCA2,
have been known for more than 10 years.”
In Singapore, the first BRCA gene test
costs about $3,000 but subsequent ones
cost less. However, the test is offered only
to those who are likely to have an inherited
mutation, and is not recommended for
women who have only an average risk.
Besides, BRCA mutations have been known
to affect only a few people and account for
less than 10 per cent of breast cancer cases.
PHOTO: GETTY IMAGES
explains Dr Chen on why this procedure is
preferred by some patients.
Alternatively, artificial breast implants
can be used. But these can harden and need
to be removed and replaced. Instead of the
usual silicone or saline breast implants,
which are bags inserted under the skin to
simulate breasts, patients can also opt for
implant expanders. These are temporary
implants that are inserted to help expand
the skin envelope and allow the definitive
tissue reconstruction — in which permanent
breast implants are inserted — to be
performed at a later date, Dr Chen explains.
Both types of reconstructive surgeries
— with autologous tissue flaps or artificial
breast implants — can be performed either
as an immediate procedure together with
the mastectomy, or as a delayed procedure.
However, Dr Chen encourages patients to
have their reconstructive breast surgery
performed immediately to avoid the hassle
of a second procedure. That said, the
combined surgery, being larger in scope,
carries an increased risk of complications,
which in some cases may lead to a delay in
treatments such as chemotherapy.
MYTH #2
Women who have had
breast augmentation
(implants) or reduction
surgery are more susceptible.
There should not be an
increased risk. However, certain
augmentation procedures such
as free silicone injection and
fillers may make breast imaging
more difficult, which could
interfere with and thus delay
the detection of breast cancer.
However, if the surgery had
involved only implants, it is likely
that the cosmetic surgeon would
have placed the implants under
the chest muscle, which would
then still allow for effective
breast imaging.
MYTH #3
Wearing an underwire bra
increases breast cancer risk.
This claim has been widely
debunked. Neither the type of
bra you wear nor the tightness
of your undergarments or other
clothing has any connection
to breast cancer risk.
MYTH #4
Women with bigger breasts
have higher risk of breast cancer.
There is some truth to this.
A 2006 study by the Harvard
School of Public Health on
90,000 pre-menopausal
subjects found that larger
breast size in slim young
women gave them a higher
risk of breast cancer in later life.
The study also revealed that
women with a body mass index
of 25 or less with a cup size of D
or larger had a significantly higher
risk of breast cancer than those
of similar weight with an A cup
or smaller. Despite the results, the
study’s lead author, A/Prof Karin
Michels, said the findings did
not mean that those with small
breasts could assume they were
safe, and urged all women to
go for breast cancer screening.
MYTH #5
Men do not get breast cancer.
Although uncommon, breast
cancer can happen to men.
In Singapore, about 15 new
male breast cancer cases are
discovered every year. The most
common visual symptom of male
breast cancer is a lump in the
breast. Some patients may also
notice bleeding or ulceration
over the nipple and some may
discover an enlarged lymph
node or lump in their armpit.
Men are advised to seek
medical help the moment
they notice such
abnormalities.
is for Treatment
Surgery to remove cancerous
tissue is usually the first course
of treatment. Patients can opt
for a mastectomy — total removal
of the breast — or a lumpectomy,
often called “breast-conserving
surgery”, in which the tumour and
some surrounding tissue are removed.
The choice lies with the patient who has to
consider one of breast cancer’s nastier traits
— that even the lowest-grade variety can
recur years after treatment.
A lumpectomy can be a day surgery.
It is usually followed — depending on the
doctor’s advice — by five to six weeks of
radiotherapy to decrease the recurrence rate
to a level similar to that of post-mastectomy.
“A lumpectomy is not advised if the cancer
involves multiple tumours, or tumours are
so large that to remove them would cause an
unacceptable cosmetic defect. Lumpectomy
is also not advised if the patient has had
radiotherapy,” says Dr Chen.
A mastectomy involves an overnight
hospital stay and
continuous care for
a week. A bilateral
mastectomy of both
breasts drastically
reduces the chance
of breast cancer
recurrence since almost
all of the breast tissue
is removed. However,
as some breast tissue may remain, there
is a slim chance of cancer cells resurfacing,
so regular checkups are still important.
In addition to surgery, chemotherapy
may be recommended, especially to younger
women, to prevent cancer surfacing
elsewhere. The regime takes three to six
months and may result in nausea, hair loss,
lethargy or tiredness, as well as a loss of
appetite. Chemotherapy is sometimes given
before surgery to shrink large tumours.
Another post-surgery treatment is
hormone therapy. Tamoxifen can be
prescribed to block the body’s natural
oestrogens and fight the cancer’s growth.
The downside to tamoxifen however is an
increased likelihood of developing cancer of
the uterus (endometrial cancer). Other risks
include deep-vein thrombosis, blood clots
in the lungs, stroke and cataracts.
Overall, the recommended treatment
depends on the patient’s stage of cancer,
age, general health and other risk factors.
THE SURVIVAL OF A WOMAN
WHO HAS BREAST CANCER
DEPENDS VERY MUCH ON THE
STAGE OF DETECTION
is for
Symptoms
“The survival of
a person who
has breast cancer
depends very much
on the stage of
detection of the
cancer,” says
Dr Chen. Some experts encourage monthly
breast self-examination but numerous
studies have refuted the reliability of
self-check, claiming it does more harm
than good. A study conducted from
October 1989 through October 1991 in
Shanghai, China of 266,064 women aged
between 30 and 64 years found that the
portion of women from this population
who were given breast self-examination
(BSE) instructions had the same number
of cancers detected as compared to the rest
of the population in the city. Additionally,
there was no reduction in the number of
deaths as a result of their self-examining.
Women who performed BSE were also
found to have had more biopsies for lumps
that turned out to be harmless, causing
unnecessary scarring of their breasts.
The study’s results were reported in the
Journal of the National Cancer Institute,
published by the Oxford University Press.
Instead of BSE, women are
encouraged to be aware of what their
breasts should look and feel like normally.
In Singapore, about 80 per cent of women
with breast cancer had consulted their
doctor because they had self-detected a
symptom. Being “breast-aware” involves
looking out for changes in the nipple
(a pulling inwards, discharge, bleeding
or rashes), puckering of the skin, a
thickening of tissue in the breast or armpit
that feels unusual, a change in the shape
of the breast, a painful sensation in the
breast or if one breast becomes larger
than the other.
11
(IN THE PINK)
HELPING hand,
DR MELANIE SEAH
THROUGH TREATMENT
AND EMOTIONAL
SUPPORT, DR MELANIE
SEAH AND SENIOR NURSE
CLINICIAN PATMAVATHY
CHELLAIYYA OF THE
BREAST CLINIC @ TTSH
HELP PATIENTS
TO BATTLE
BREAST CANCER.
INTERVIEWS BY
FAIROZA MANSOR
AN ABSENCE OF A FAMILY
HISTORY DOESN’T MEAN
YOU DON’T RISK GETTING
BREAST CANCER
12
38, CONSULTANT AND
SURGEON
SINGAPORE’S ABILITY TO TREAT
breast cancer is world-class, says
Dr Melanie Seah. “What we have is
as good as, if not better than many other
countries. Availability of modern treatment
is not an issue here, but even for a firstworld country, there are unfortunately many
who are still coming in late for diagnosis.”
Of this problem, Dr Seah, who
graduated from the Yong Loo Lin School
of Medicine (then known as the Faculty
of Medicine) at the National University
of Singapore in 2000, says the majority of
patients she sees are aged 40 and above. But
there are also a handful of women in their
30s who seek treatment at the clinic, having
already developed late-stage cancer.
“These are the patients I feel really sorry
for because if they had come earlier, the
disease would likely have been very treatable
and they might have gone on to live many
good years,” says Dr Seah. She sees 25 to
35 patients a day while on clinic duty two
to three days a week. As a breast surgeon,
her other working days are spent in surgery.
A consultant at The Breast Clinic @ TTSH
since its inception three years ago, Dr Seah
follows each of her patients’ progress from
diagnosis on. She is one of the more than 10
consultants at the clinic whose specialities
range from medical oncology to breast
surgery and reconstructive procedures.
Breaking the news to a woman after
her biopsy results is never easy. A question
newly-diagnosed patients commonly have
is, “No one in my family has breast cancer;
how come I do?” An absence of a family
history does not mean you are not at risk,
Dr Seah says. In fact, 95 per cent of the
cases she sees are not family-related.
After giving the patient her diagnosis,
Dr Seah lays out a plan of action. Together
with the patient and her family, they
discuss the most suitable treatment track,
which usually begins with surgery to try
and remove the cancer. Subsequently,
Dr Seah will continue seeing the patient
through post-operation treatments, which
PHOTOS: HONG CHEE YAN CLOTHES: DR SEAH: CLUB MONACO MDM PATMAVATHY: BLOUSE, MDM PATMA’S OWN; CROPPED PANTS, BANANA REPUBLIC
listening ear
can include chemotherapy, radiotherapy
or hormonal treatment, as well as at
follow-up consultations. Dr Seah has been
a surgeon in the Department of General
Surgery breast unit of TTSH since 2005,
before becoming a consultant in The
Breast Clinic @ TTSH in 2010.
Despite years of experience dealing
with a range of breast conditions,
breast cancer and the patients battling
it still form the bulk of her lunchtime
conversations with her Breast Clinic
colleagues. Some days Dr Seah is saddened
by the worsening state of some patients
but most of the time, she is inspired by
their courage. “I am as susceptible to
breast cancer as they are,” the mother of
three children, aged one to nine, says. “It’s
easy to think I can handle it and be strong
because, being a doctor I know what steps
to take when diagnosed. But if I get the
disease, will I really be able to soldier on
and do what I need to do as these brave
women have done? I sure hope so.”
MDM PATMAVATHY
CHELLAIYYA
54, SENIOR NURSE
CLINICIAN
HAVING WORKED WITH
patients with breast conditions
for over 13 years out of her
30-plus years in nursing, Senior Nurse
Clinician Patmavathy Chellaiyya has heard
a myriad of reasons why some breast
cancer patients still come to the clinic late
in their cancer stages — despite the many
breast cancer awareness campaigns and
push for early screening in Singapore.
“Some patients delay coming forward
out of fear of losing their breast while
some feel they just cannot afford the cost
of treatment. There are also some who are
simply in denial,” Mdm Patma says. She
once cared for a patient in her 40s whose
tumour was visibly growing but who did
not consult the doctor until she had a fall.
By then, the tumour had broken through
the skin’s surface revealing a fungating
wound on her breast — which the patient
SOME PATIENTS DELAY
COMING FORWARD BECAUSE
THEY ARE SIMPLY IN DENIAL
then attributed to the fall.
“Some patients believe that it is a
certain incident causing the cancer. But the
event only serves to bring the disease to
their attention,” says Mdm Patma, who has
two children in their 20s.
Mdm Patma’s duties in the clinic
commence after the patient has seen
the consulting doctor and received their
diagnosis. In her private room at the
clinic, she then reiterates the information
that has already been articulated by the
consultant. She also provides additional
advice and emotional support to the
patient after their operation.
“Some newly-diagnosed patients are
known to ‘blank out’ when informed of
their diagnosis, which is an understandable
reaction, says Mdm Patma, who has a
Diploma in Counselling and a Certificate
in Oncology Nursing. “But this can also
mean that they have not absorbed what the
doctors have told them about the treatment
they are being advised to take up.”
Together with her colleague, Nurse
Clinican Josephine Anthony, Mdm Patma
also attends to patients’ concerns via
phone after office hours. “It can be quite
demanding with just the two of us, but
we enjoy what we do and we always want
to do our best to help patients cope with
the disease,” says Mdm Patma who works
office hours.
What she finds most challenging
emotionally is seeing a patient succumb
to the disease despite putting up a good
fight. For example, she once cared for a
patient who was diagnosed with stage 3
breast cancer when five months pregnant.
“In order to save the baby’s life, the
patient delayed surgery to remove the
cancer, and instead proceeded only with
chemotherapy,” she recalls. After having
her baby, the patient then underwent
surgery and responded well to treatment.
But after a couple of years of remission,
her cancer came back and she died.
“Working here, knowing these women
and their stories, has made me treasure life
even more,” says Mdm Patma. “I take every
day as a blessing from God. You never
know what may happen tomorrow.”
13
(OSTEOPOROSIS)
BONE
battle
SINGAPORE’S POPULATION IS
RAPIDLY GREYING. HERE’S HOW
TO HELP FIGHT OFF AN AGERELATED DISEASE, OSTEOPOROSIS.
BY EVELYN MAK IN CONSULTATION WITH
ASSOCIATE PROFESSOR LOW YIN PENG
EMERITUS CONSULTANT //
DEPARTMENT OF ORTHOPAEDIC SURGERY //
TAN TOCK SENG HOSPITAL
PHOTO: GETTY IMAGES
WISDOM, CONFIDENCE AND EXPERIENCE
come with growing older, but unfortunately,
so does the possibility of developing osteoporosis.
A disease that typically affects elderly women, it
happens when bones lose calcium and become more brittle.
This happens when the body starts to resorb more bone than
it is creating, or when calcium is leached from the bones by
excessive salt and caffeine in the diet.
More people are getting osteoporosis and its precursor,
osteopenia. According to the Switzerland-based International
Osteoporosis Foundation (IOF), osteoporosis is believed to
affect over 200 million people worldwide. The World Health
Organization says the disease affects 10 per cent of women
aged 60, 20 per cent of women aged 70, 40 per cent of women
aged 80, and 67 per cent of women aged 90. Annually, more
than 8.9 million cases of osteoporosis-related bone fractures
are recorded around the world.
In Singapore, the number of osteoporosis-related hip
fractures in women over 50 is eight times higher than breast
cancer cases, according to press reports. And, as Singapore’s
population is ageing rapidly, the incidence of osteoporosis
here is on the rise.
15
(OSTEOPOROSIS)
The condition’s most noticeable effects
are on the bones and mobility. A person with
osteoporosis could fracture a bone simply
by bumping against something, which can
make going out into crowds or falling down
dangerous. The loss of bone density can also
cause the spinal column to ‘bend’ forward,
and cause internal organs to be compressed,
leading to breathing difficulties and pain in
the abdomen.
The Bare Bones
To understand osteoporosis, we need to
understand our bones, which are living
tissue made of blood vessels and cells. They
develop and strengthen from birth until the
early 20s, which is when our bones are most
dense, reaching what doctors call the peak
bone mass. As we age, the production of the
hormones responsible for generating bone
tissue starts to slow. This means
bone resorption is faster than
regrowth, lowering the “bone
mineral density” — the amount
Here are tips to keep your bone
of minerals found per cubic
mineral density up:
centimetre of the bone — and
causing bones to become porous.
DO WEIGHT-BEARING EXERCISES
“Osteoporosis is when the
AVOID SMOKING
bone mineral density of the
DECREASE ALCOHOL CONSUMPTION
patient falls more than 2.5
INCREASE CALCIUM INTAKE
standard deviations below
the peak bone mass of an
average young, healthy adult,”
controlled and some that cannot. Of the
says Associate Professor Low Yin Peng,
risk factors that cannot be changed, the
Emeritus Consultant at the Department
most important one is gender. Women have
of Orthopaedic Surgery at Tan Tock Seng
bones that are thinner and lighter compared
Hospital. This figure is referred to as
to men, as well as longer life expectancy,
the patient’s T-score. “Another way you
which puts them at higher risk of developing
could describe the condition is to say that
osteoporosis. Pregnancy and breastfeeding
osteoporosis is present when the T-score of
also cause increased calcium loss in women.
the patient is lower than -2.5.”
Hormones also play a part. In
There are deferent types of osteoporosis:
women, the production of oestrogen and
Primary osteoporosis, which is related
to ageing and menopause in women;
progesterone which are responsible for
menstruation, halts in the 50s. Progesterone
Secondary osteoporosis, which
is linked to other conditions such as
is required to build bone mass, so in its
hyperparathyroidism, hyperthyroidism and
absence the bones weaken, leaving women
leukaemia, among others;
in their 60s and above more susceptible to
osteoporosis.
Idiopathic juvenile osteoporosis,
which occurs in children between eight
Diet, exercise and medication also play
and 14 years of age.
a part. “Besides gender and age, a sedentary
When a patient’s T-score falls
lifestyle, smoking, drinking and indulging in
between -1.0 and -2.5, this is referred to
a diet low in calcium can all increase the risk
as osteopenia. And while this could be
of osteoporosis,” says A/Prof Low. “You can
considered a precursor to osteoporosis,
also develop it if you have hyperthyroidism
not every patient with below-average bone
or hyperparathyroidism (conditions in
mineral density goes on to develop it.
which the thyroid and parathyroid glands
malfunction), or have a medical condition
that requires long-term steroid treatment.”
There are a number of risk factors to
And although osteoporosis afflicts
osteoporosis, some of which can be
women more, men are also known to
Fend Off Bone Loss
Risky Business
16
develop it when they get older and their
testosterone level falls. “This is called ‘senile
osteoporosis,” A/Prof Low says. Men and
women are at equal risk for this.
According to A/Prof Low, genetics is
the most important factor. If your parents
or grandparents suffer from osteoporosis,
or have shown symptoms like breaking a
bone after a seemingly minor fall, you are
at a higher risk of developing osteoporosis
as well.
Signs and Symptoms
Very often called the “silent disease”,
osteoporosis is a condition for which there
are often no obvious symptoms for months,
or even years from its onset. In many cases,
the first discovery of the disease happens
when the patient fractures a bone — most
commonly at the wrist, spine or hip. People
at risk of osteoporosis should heed warning
signs like frequent joint pain, or having
difficulty standing and sitting up.
Traditional X-rays may not be able to
effectively detect bone loss, but other scans
are available. “The DEXA, or dual energy
X-ray absortiometry scan, is the standard
method of diagnosing and monitoring
osteoporosis,” A/Prof Low explains.
Once diagnosed, treatment usually
RISK
ASSESSMENT
The National Healthcare
Group (NHG) has a range
of services available to
help prevent falls at home.
} TAN TOCK SENG HOSPITAL
FALLS & BALANCE CLINIC
At this clinic, a team of
healthcare professionals
trained in rehabilitation and
geriatric assessment are
on hand to help.
The team includes a
nurse clinician to start the
assessment and give general
advice on fall prevention, a
geriatrician who specialises in
taking care of senior citizens,
and a physiotherapist and
occupational therapist to help
improve mobility.
} AGEING IN PLACE STUDIO
GENETICS IS THE MOST IMPORTANT FACTOR.
IF YOUR PARENTS OR GRANDPARENTS SUFFER
FROM OSTEOPOROSIS, YOU ARE AT A HIGHER RISK
OF DEVELOPING OSTEOPOROSIS AS WELL
includes a combination of medication
and recommended lifestyle changes.
Osteoporosis can be effectively treated by
drugs like bisphosphonates and selective
oestrogen receptor modulators, among
others. “Together with a change to a healthy
lifestyle and adequate consumption of
calcium and Vitamin D, osteoporosis need
not be a lifelong condition,” says A/Prof Low.
PHOTO: SHUTTERSTOCK
Diet and Exercise
Calcium is key to avoiding osteoporosis. The
recommended daily dietary allowance (RDA)
of calcium for adults up to 50 years of age is
1,000mg, and 1,200mg for those above 50.
Pregnancy and breastfeeding increase the
loss of bone density, so pregnant women
and lactating mothers should also increase
their daily calcium intake to 1,300mg.
Good sources of calcium include dairy and
soy products, and vegetables like Chinese
cabbage, kale and broccoli.
It is also important to include sufficient
Vitamin D because it helps with calcium
absorption. Vitamin D is produced when the
body is exposed to sunlight, and is found in
cod liver oil, fish, eggs and mushrooms.
Exercise is essential in building bone
and maintaining bone and muscle strength,
which is vital to preventing excessive
bone loss. In fact, doctors estimate that
a 10 per cent increase in peak bone mass
in children from exercise can reduce the
chances of fractures caused by osteoporosis
during adulthood, by 50 per cent.
The best exercises to increase bone
density and mass are weight-bearing ones,
as they ‘stress’ your muscles and bones.
These exercises include tai chi, yoga, brisk
walking, and strength training. LW
Pick up practical skills to make
your home elderly-friendly
at the Ageing in Place studio
in Toa Payoh Polyclinic, set
up as part of an initiative by
NHG Polyclinics to assess the
fall risk of seniors.
As Dr Tung Yew Cheong,
who heads the Toa Payoh
Polyclinic, has said, “Many
don’t think it’s important to
see a doctor for a fall… but
once you have a fall, the risk of
a second one is higher if you
don’t address the root cause.”
The studio is modelled
after a one-room HDB flat,
in which many elderly folks
live on their own. A health
promoter is on-hand to give
visitors suggestions on how
to make their homes safer by
installing hand grips along
stairs, non-slip mats in the
bathroom, and even choosing
a bed of a suitable height.
The polyclinic also works
with TTSH’s occupational
therapists to advise patients
on modifications they can
make to their homes to
prevent falls.
17
(PHYSIOTHERAPY)
Let's get
PHYSICAL
A MULTI-FACETED FIELD
WITH NUMEROUS AREAS OF
FOCUS, PHYSIOTHERAPY IS
AN INTEGRAL COMPONENT
OF PATIENT CARE TODAY.
BY WANDA TAN IN CONSULTATION
WITH MS TRICIA YEO PHYSIOTHERAPIST //
TTSH'S CENTRE
FOR ADVANCED
REHABILITATION
THERAPEUTICS HAS
STATE-OF-THE-ART
MACHINES TO HELP
PATIENTS GET BACK
ON THEIR FEET.
18
a nasty injury whether from
playing football, falling down
the stairs or from some other mishap,
chances are you would have encountered the
terms ‘physiotherapy’ or ‘physical therapy’
during your recovery. Both terms refer to the
same thing: a health profession that aims to
enhance the physical function and quality of
life of a person whose ability to move
normally is impaired.
By dispensing advice and performing a
wide range of treatments, physiotherapists
take a whole-body approach to restoring
movement and normal body function in
cases of illness, accident or disability, taking
into account other ailments a patient might
have. And while normally associated
with post-injury treatment, there are
many forms of physiotherapy, from
rehabilitating amputees or the care of
cardiovascular disease patients, to
weight management and pulmonary
rehabilitation for patients with
impaired respiratory function.
At Tan Tock Seng Hospital
(TTSH), the physiotherapy services
offered include cardiopulmonary
physiotherapy, geriatric
physiotherapy, sports physiotherapy
and orthopaedic physiotherapy, to
name a few.
Being allied health professionals (AHPs),
physiotherapists — unlike doctors — are
PHOTO: CORBIS
IF YOU’VE EVER SUFFERED
not normally the patients’ first point of
contact. Nevertheless, AHPs (which include
physiotherapists, medical social workers
and dietitians) play important roles in the
ongoing care of a patient. As Ms Tricia
Yeo, a physiotherapist at TTSH, says, “A
patient who has, for example, just had an
angioplasty would be managed by a team
comprising a cardiologist, physiotherapist,
dietitian, cardiac nurse, stress psychologist
and pharmacist.”
Tailored Treatments
Physiotherapy programmes are structured
to fit the needs and goals of individual
patients. Taken into consideration
are the injury sustained, the extent of
physical impairment and the functional
goals the patient would like to achieve.
“Each individual is assessed on his or her
physical function, symptoms and ailments
before the need, type and duration of
rehabilitation are decided on,” says Ms Yeo.
Physiotherapists at TTSH’s Centre
for Advanced Rehabilitation Therapeutics
(CART) conduct a wide variety of
customised programmes. For example,
vestibular rehabilitation is carried out using
special equipment such as the Neurocom
Balance Master to aid in the assessment
and retraining of sensory and motor control
for balance in patients with dizziness or
vertigo. LOKOMAT, a robotic walking aid,
helps patients who have varying degrees
of neurological impairment regain some
degree of walking ability.
Patients with chronic obstructive
pulmonary disorders have oxygen therapy
incorporated into their exercise regimens.
Those recovering from a shoulder operation
for recurrent dislocations would be
instructed to follow a programme that
prescribes exercises to strengthen the
affected limb and restore its range of
motion. Group therapy incorporating
physical and cognitive exercises is
offered for dementia patients, while
clinical Pilates classes may be prescribed
for patients suffering from a herniated
disc to strengthen their core muscles.
And specialised weight management
programmes involving advice on lifestyle
changes and tailored exercises are devised
for overweight patients who have medical
ailments such as heart diseases or diabetes.
Helping the Elderly
Given Singapore’s growing elderly
population, many areas of physiotherapy
centre around the care of seniors, who are
prone to falls and chronic illnesses such as
diabetes and high blood pressure. “As Tan
Tock Seng Hospital is located near mature
housing estates such as Toa Payoh and Ang
Mo Kio, a large proportion of our patients
are seniors who may require help restoring
their physical function,” says Ms Yeo.
Many people develop balance and
mobility problems as they age, predisposing
them to falls. In order to prevent a further
decline in their physical function, the
physiotherapists at TTSH plan a tailored
exercise programme to help improve the
patient’s flexibility, strength and balance.
TTSH’s physiotherapists assess
elderly patients who seek treatment at the
Emergency Department after
a non-traumatic fall. They
educate these patients and
their caregivers on the use of
walking aids, provide tips for
a safe home environment,
recommend strengthening
and balancing exercises, and
share other advice to reduce
the likelihood of falls.
In the event of a traumatic fall-related
injury such as a fractured hip, older
patients may have to have hip replacement
surgery. “Our physiotherapists will manage
these patients during their hospital stay,”
says Ms Yeo. “Their management will
focus on restoring range of motion to the
hip joint, improving muscle strength and
getting the patient to walk again.”
As the elderly are more prone to
getting a chest infection during periods
of immobility, chest physiotherapy is
also prescribed. This involves therapeutic
respiratory exercises such as taking
slow deep breaths through an incentive
spirometer to help remove mucous from
the lungs, and improve the patient’s
respiratory function.
Physiotherapists can help elderly
patients with degenerative joint disease
manage their pain and prevent further
degeneration. Strengthening and flexibility
exercises may be prescribed, and education
is given on proper posture and movement.
Prevention as Cure
For physiotherapists, the prevention of
injuries is just as important to healthcare
as rehabilitation. “Education on healthy
lifestyle and disease prevention constitutes
a large component of physiotherapy, ”
Ms Yeo stresses. Physiotherapists may,
for instance, educate office workers on
PHYSIOTHERAPISTS TAKE
A WHOLE-BODY APPROACH TO
RESTORING MOVEMENT AND
NORMAL BODY FUNCTION
ergonomics and teach exercises to prevent
neck and back pain. They may also help
golfers improve their swing in order to
prevent injury.
Given its broad scope, physiotherapy is
sometimes confused with a distinct, albeit
complementary, allied health profession:
occupational therapy. Occupational
therapists help patients modify their
lives to adapt to their environment and
overcome their disabilities to lead more
independent lives. In the case of patients
who have suffered a stroke, for example,
occupational therapists train them to use
assistive equipment to bathe and feed
themselves. Concurrently, physiotherapists
would help these patients relearn motor
skills to regain limb function so that they
can stand and walk again. LW
LET’S WALK!
The TTSH Rehabilitation Centre has registered a breakthrough in
physiotherapy treatment with its ‘Let’s Walk’ initiative. Designed to
speed up recovery for patients suffering from stroke, bone fractures and
head injuries, it has helped cut the average length of patients’ hospital
stay from 27 days to 25 days.
"Let’s Walk" is a two-week programme in which patients walk
around customised tracks or ‘runways’ with distance markers. Patients
are required to walk for 15 minutes every day, and the distance is
incrementally lengthened until they are able to walk 600m to 1km in
15 minutes by the 14th day. Nurses monitor a patient's progress daily.
They will also observe a patient's gait and balance, and provide
walking aids and gait belts — devices worn for support — if necessary.
Since a prototype was set up in 2009, the programme has grown.
There are now three ‘runways’ at the TTSH Rehabilitation Centre wards.
19
(WELLNESS)
The value of
PEOPLE WHO MAY HAVE LOST
THEIR WILL TO LIVE CAN
BE HELPED WITH TREATMENT
AND COUNSELLING.
BY ALEX NGAI
IN CONSULTATION WITH DR ALEX SU
CHIEF OF GENERAL PSYCHIATRY //
INSTITUTE OF MENTAL HEALTH
WHENEVER
ANYBODY TALKS
ABOUT COMMITTING
SUICIDE IT IS OFTEN
A CRY FOR HELP
20
20
“OH MY GOD, I’M GOING
TO KILL MYSELF.” For many
people, this is merely an
expression blurted out in times of deep
embarrassment and usually uttered in a
joking manner. For some however, such a
statement is no laughing matter — because
the person saying it might have every
intention of acting out the words.
In 2012, there were 467 suicides
recorded in Singapore — a 20-year high,
and an alarming 30 per cent jump from
the year before. In figures released by the
Singapore Registry of Births and Deaths,
people aged between 50 and 59 made
up the largest proportion of those who
committed suicide, with a worrying rise
in cases in the 60-and-above age group.
This demographic includes parents and
grandparents who often leave behind an
extended grieving family.
“Most people who are suicidal suffer
from a major mental illness, and the
most common is Major Depressive
Disorder,” says Dr Alex Su, Chief of General
Psychiatry at the Institute of Mental
Health (IMH). Also known as clinical
depression, this disorder is different from
other types of depression — including
chronic, manic and atypical depression.
Major depressive disorder has a prolonged
effect that can last for weeks or even
months, and it is disabling, unlike the
temporary depressive episodes that people
face on occasion.
Major depression is often triggered by
big life changes, and this is something that
people face after they turn 50. As they grow
older, they might find themselves without a
focus in life after retirement, or feel lonely
as children get married and move out.
But it isn’t just the elderly who take
their own lives. Dr Su says, “The young are
also fairly susceptible to suicidal thoughts.
Suicide in the young is usually due to
LIFE
stress from unhappiness at home like
family relations breaking down or constant
academic or social pressure from parents;
stress at school due to academic pressure or
bullying or even relationships and Internet
bullying.” Indeed, in 2011, there was a 43
per cent rise in the number of youth suicide
attempts in Singapore, and suicide is
among the top three causes of death among
people aged 15 to 35. Other reasons young
people try to kill themselves include the
breakdown of romantic relationships and
feelings of inadequacy.
Take Threats Seriously
In many cases, people are of the opinion
that someone who is talking about suicide
is merely being melodramatic. The truth is,
whenever anybody talks about committing
suicide it is often a cry for help — some
80 per cent of completed suicides had prior
warning signs.
“We must never assume that it’s just
a case of a more dramatic or pessimistic
person ‘acting out’ or ‘seeking attention’.
PHOTO: ISTOCKPHOTO
PHOTOS:
CORBIS
FACTORS TO FEAR
Pay attention if a loved one suffers
one or more of the following:
} Depression or other mental
disorders: People suffering
from mental illnesses including
depression are more likely to
commit suicide than others.
} Substance abuse like alcoholism
or drug abuse: Chronic drug or
alcohol dependence is a known
risk factor for suicide victims.
} A family history of suicide or
exposure to suicide behaviour
in peers: A prior example might
create justification in the minds
of those who are suicidal.
} Domestic or sexual abuse:
Victims of domestic and sexual
abuse often have low selfesteem and suffer from victim’s
guilt, thinking that they “do not
deserve to live”.
Once the family or friends notice
something unusual about a person, or they
notice worrying behaviour, it is best to seek
professional support and help,” says Dr Su.
There is no harm in paying attention to
someone’s threats of suicide, since talking
to a suicidal person does not necessarily
increase the likelihood of that person going
through with it.
“As long as you are being sincere and
empathetic, many people who suffer from
suicidal thoughts will be glad to have
someone to talk to,” says Dr Su. In fact, you
should not take a person’s threats of suicide
lightly. Many people with suicidal thoughts
feel insignificant, and not having someone
take their feelings seriously can actually
exacerbate these feelings.
Other factors that can aggravate
suicidal thoughts include daunting life
changes such as the failure of a longterm relationship or loss of income,
especially among those who are by nature
perfectionists or pessimists. Perfectionists
tend to be harsher on themselves and get
stressed easily, so their reaction might
be very extreme when they experience a
negative life event. Pessimists tend to see
things in a very negative light and are easily
discouraged and unhappy, which could
result in depression.
Heed The Warnings
Those concerned that someone close to
them may be at risk should take note of
any sudden changes in behaviour, or if he
or she does something out of that person’s
character. “People who are suicidal usually
perform some sort of ‘last rites’,” explains
Dr Su. “These can include writing wills,
closing out bank accounts, penning suicide
letters and saying goodbyes.” Also pay
special attention to the things that the
person says. Regularly uttering phrases like
“I am sick of life” or “I wonder if anybody
will miss me if I disappear” are signs that
he or she may be entertaining suicidal
thoughts. Expressing the desire to try
something different “before I die” can also
be significant.
If you detect such warning signs in a
GET HELP
Not everybody is qualified to counsel
someone who is under stress or
feeling suicidal. Professional help
should always be sought. Here are
some counselling hotlines to call.
SAMARITANS
OF SINGAPORE
Call 1800 221 4444
SOS is dedicated to the emotional
support of suicidal people.
TINKLE FRIEND
Call 1800 274 4788
This helpline is for children,
especially those with family
problems.
SAGE HELPLINE
FOR SENIORS
Call 1800 555 5555
This is for anyone who is
50 years and above or those
concerned about them.
AWARE
Call 1800 774 5935
This is the hotline for the
Association of Women for
Action and Research.
COMMUNITY HEALTH
ASSESSMENT TEAM
Visit youthinmind.sg/bust-themyth/suicide/
CHAT is a youth-oriented
programme to educate young
people about mental wellness.
friend or a family member, make sure to
share your suspicions with others who are
close to that person. Simply talking to him
or her is often very helpful in demonstrating
to the depressed person that people are still
concerned about their well-being. It is very
important for everybody to be positive.
“Most people with suicidal thoughts and
plans still have within them the desire to
live — the aim is to engage them early and
move them from thinking of dying towards
ambivalence and finally, to the will to live,”
says Dr Su.
In his view, one of the most important
things people who harbour suicidal thoughts
should know is that help is always available.
“IMH has seen people who have decided to
end it all take a positive turn after proper
treatment and timely help,” he stresses. LW
21
IN PERSON
The Sum
of All Parts
TTSH CHIEF OPERATING OFFICER DR EUGENE SOH, 39,
WORKED WITH FOUR ‘GIANTS’ WHO PREPARED
HIM FOR HIS BIGGEST PROJECT TO DATE.
INTERVIEW GENE KHOR
“SINCE JOINING the National Healthcare Group
22
22
WE WANT HEALTH CITY NOVENA
TO EMBRACE OUR COMMUNITY, AND
HAVE OUR COMMUNITY EMBRACE US
AS THEIR HEALTHCARE PARTNER.
PHOTO: EALBERT HO
(NHG) in late 2003, I’ve had the privilege of
working with four ‘giants’ of Singapore healthcare who
have taught me invaluable lessons. My first boss was
Agency for Integrated Care CEO Dr Jason Cheah, who
was Chief Projects Officer of NHG then. His advice
regarding project management was just one word —
‘people’. And not just how the patients would be taken
care of, but the healthcare staff, as well.
I gained management insights in 2004 as secretary to
the NHG Chairmen of Medical Boards Committee led by
then-NHG Assistant CEO (Clinical), Prof Chee Yam Cheng
(currently Group CEO, NHG). Before moving onto a new
initiative or programme, he would ask what we could
learn from it. It was important to him that we learned
while doing, and that learning not be an afterthought.
Another healthcare giant I owe a lot to is our former
NHG and TTSH CEO, Dr Lim Suet Wun. He asked me,
‘Do you want to be COO of operations or COO of the
hospital?’ Though I was unsure what he meant then, his
question made me contribute better at the systems level.
Dr Lim once said, ‘Never ask for a promotion. Instead, ask
how you can contribute and a promotion will come’. This
became a guiding principle for me.
My last lesson came from my current boss, NHG
Deputy Group CEO (Regional Health) and TTSH CEO
Prof Philip Choo. He had the foresight to learn geriatrics
medicine in Britain years before Singapore’s ageing
population became a concern. He’s quite a visionary and
made me realise the importance of looking further ahead.
These four giants have given me invaluable
lessons on ‘People’, ‘Learning’, ‘Leadership through
Contribution’ and ‘Vision’, which has shaped my
involvement in the conceptualisation of the Health
City Novena Master Plan. Still in its early stages, the
project will grow to connect the different medical service
providers in the Novena area. The result will be a Health
City which integrates seamlessly with the surrounding
community. We want healthcare that serves not just
patients but also the community to encourage healthy
living for all. We want Health City Novena to embrace
our community, and have our community embrace us
as their healthcare partner. This will define the legacy of
care that is NHG and TTSH.”
IN PERSON
Lessons of
a Forefather
MR RONEY TAN, 67, TALKS TO LIFEWISE
ABOUT THE LEGACY LEFT BY HIS
GREAT-GREAT-GRANDFATHER, MR TAN TOCK SENG.
INTERVIEW NIRMALA SIVANATHAN
PHOTO: WILSON PANG
“TAN TOCK SENG’S grave was never lost.
There is a story going around that the grave
was ‘rediscovered’ by a tour guide about 25 years ago,
but the truth is my family and I always knew where it
was. Growing up, my dad used to bring me to the
gravesite at Outram Hill once or twice a year.
But you can’t adequately maintain a grave just
once a year, during the Qing Ming Festival or Tomb
Sweeping Day. Singapore’s climate is such that in just
a few weeks, the grass and weeds grow back. The grave
was simply not well-maintained, which is why I called
a meeting of the family some years back and said,
‘Let’s maintain it regularly, not just at Qing Ming.’
So now, there is a fund to maintain the gravesite.
Worldwide, there are about 2,500 members in
our extended family tree. One thing that brings us
together is a core value from Tan Tock Seng himself:
if you can afford to give, give. We learned to have a
good heart for the poor and the needy, and that you
should give while you are still alive, because you can’t
bring your money with you when you pass on.
That is what makes Tan Tock Seng special; he
gave during his lifetime. The situation in Singapore
at the time was frightening; people were dying in
the streets. He petitioned the Governor-General of
Singapore to build a hospital for locals and personally
contributed 7,000 Spanish dollars — the common
currency at the time — towards its construction. This
is how Tan Tock Seng Hospital came to be.
The hospital recently celebrated its 169th
Founder’s Day. One Founder’s Day two years ago, the
family donated two ornate tiles from Tan Tock Seng’s
original home in Malacca to the hospital. The tiles
were brought to Singapore by cyclists who retraced
Tan Tock Seng’s 350km journey 200 years ago.
Events like this educate Singaporeans about their
history. I’ve noticed that the younger generation is
getting increasingly interested in their heritage, and
this is a good thing. You must know your roots before
you can think about the future. Otherwise, there will
be nothing to anchor young people to their country.
Mr Roney Tan is a company director and is
President of the Singapore Scout Guild.
GIVE WHILE YOU ARE STILL
ALIVE, BECAUSE YOU CAN’T
BRING YOUR MONEY WITH
YOU WHEN YOU PASS ON
23
23
(SILVERGLOW)
Tech
SUPPORT
WITH ADVANCES IN TECHNOLOGY,
SENIORS CAN LIVE LONGER AND HEALTHIER.
BY NIRMALA SIVANATHAN IN CONSULTATION WITH
DR LAURA TAY // ASSOCIATE CONSULTANT // DEPARTMENT OF
GERIATRIC MEDICINE // TAN TOCK SENG HOSPITAL
DR KAREN CHUA // SENIOR CONSULTANT // DEPARTMENT OF
REHABILITATION MEDICINE // TAN TOCK SENG HOSPITAL
MR CHRISTOPHER KUAH // PRINCIPAL OCCUPATIONAL THERAPIST //
CART // TAN TOCK SENG HOSPITAL AND
MR LIM WEI SHEONG // SENIOR PHYSIOTHERAPIST //
CART // TAN TOCK SENG HOSPITAL
AS HUGE TECHNOLOGICAL
Video Games To
The Rescue
Age-related memory loss and impaired
judgment are a terrifying spectre for seniors.
But thankfully, technology can help. A 2013
University of California study found that
playing video games can contribute towards
improving mental agility, and more so than
traditional crossword puzzles.
The study, published in medical journal
PLOS One, found that people aged 50 and
older who played just 10 hours of a game
that tested their mental skills were able to
slow their mental decline so much so that,
in speed and attention tests, their brains
were said to be up to seven years younger.
A second test group that played the game
for an additional four hours even managed
to improve their cognitive ability.
Another study has shown that “active”
24
video games, such as those played on the
Nintendo Wii and Xbox consoles, have the
benefit of providing an invigorating physical
workout as well. Games
like these are controlled
by physically moving
the body in front of the
games console — so if
the game requires you to
swing a bat to hit a virtual
baseball, you swing the
controller, and if it needs
you to jump, you jump.
The 2012 study conducted by
researchers from Michigan State University
found that such video games are able
to provide light- to moderate-intensity
workouts for seniors. In a moderateintensity workout the body consumes
calories at a rate that is three to six times
that of the resting rate.
The researchers said that the exercise
one can get from a video game is not as
good as “real-life exercise”, but concluded
that they are suitable for use in structured
exercise programmes at physical
rehabilitation and senior citizen centres.
These studies are not conclusive of the
effectiveness of computer-based training
programmes. But, says Dr Laura Tay,
PHYSICAL OR MENTAL EXERCISES
PROMOTE BRAIN HEALTH IN
THE FACE OF ADVANCING AGE AND
REDUCE THE RISK OF DEMENTIA
Associate Consultant with the Department
of Geriatric Medicine at Tan Tock Seng
Hospital (TTSH), “any physical exercise or
mentally-stimulating activity will promote
brain health in the face of advancing age
and reduce the risk of dementia”.
What’s Vital To
The Mind
The prevalence of dementia in Singapore is
rising. According to the Alzheimer’s Disease
Association of Singapore, it is projected
that the number of people aged 65 and
above with dementia will more-than-double
PHOTO: GETTY IMAGES, CORBIS
strides have been made, so too
have life expectancies jumped.
For example, in Singapore — a developed
country with clean drinking water and a high
standard of living — the average person is
projected to live to about 82 years of age.
But as a population greys, there is a
growing need for technological advances to
help ease the pain of ageing. From simple
video games to costly robot-aided walking
machines, here are some of the ways tech
can add years of healthy life.
Games Robots Play
The benefits of animal-assisted therapy
have long been documented. Studies
have found that dementia patients who
have access to therapy animals enjoy
improvements in their social, emotional
and cognitive functioning. But hospitals
and extended care facilities might not
be suitable for live animals to visit.
The solution? PARO the Robot Seal.
Developed by a Japanese industrial
automation firm, PARO is built to
resemble a baby harp seal in order to evoke
memories of pets and babies. It has sensors
that detect touch, light, sound, heat and
the posture of the person holding it. This
gives it the ability to recognise voices, track
motion and “remember” behaviour that
elicits positive responses from patients.
Nursing home managers have found
that PARO is especially comforting to
patients suffering from cognitive
loss. PARO has also been found
to reduce stress as well as
stimulate interaction
between patients and
their caregivers.
PARO the robot
seal weighs about
2.7kg and is warm
to the touch.
to 53,000 by 2020.
This has prompted
the Ministry of Health and
healthcare institutions to explore
new ways to slow down the march of this
degenerative brain disease. At TTSH’s
Geriatric Medicine Clinic, a programme
which uses the iPad to help dementia
patients has been implemented.
Called MINDVital, this programme
incorporates cognitive stimulation, physical
exercise and tailored leisure activities in a
bid to stem dementia. “The introduction
of iPad games is but one component of the
individualised leisure activities conducted by
MINDVital,” says Dr Tay.
Launched in April 2012, the results of
the eight-week programme — conducted
in either English or Mandarin — have been
good. Initial results show that 80 per cent
of patients manage to achieve their preset goals in the areas of cognition, mood,
behaviour, engagement and socialisation
by the end of the programme. “We saw
that patients with mild dementia are able
to engage in and derive enjoyment from
tailored iPad group activities,” says Dr Tay.
The Good
Get Going
Technology has also been
harnessed to get disabled
people walking again.
At TTSH’s Centre for
Advanced Rehabilitation
Therapeutics (CART), robotic
and standard therapies are combined
in programmes that aid patients suffering
from stroke, spine or brain injuries and
other neurological conditions.
One such programme is a roboticsaided gait and balance rehabilitation
programme called RoboWALK, using the
LokomatPro. This system, which trains
posture and gait, supports patients in a
harness and shell and puts them through
intensive gait cycles of up to 1,000
repetitions an hour. Conventional therapy
registers about 100 repetitions an hour.
A 2010 study published in the Singapore
Medical Journal found that the use of
robot-assisted locomotor training systems
such as LokomatPro resulted in “significant
improvement” to a patient’s walking ability.
It also reduced the physical demands of
training on patients and therapists alike.
CART’s ReARM programme, focusing
on upper-limb rehabilitation, incorporates a
device called the Armeo Spring. This device
is an exo-skeleton based mechanical system
which helps patients with mild to moderate
weakness or reduced coordination, such as
stroke patients, regain movement.
Both robot-aided training programmes
artfully combine with standard therapy to
enhance intensity, repetitions, engaging
feedback and motivation for patients. They
have shown significant gains in motor
impairment reduction and achievement of
patients’ goals.
Kickstart My Heart
Millions of heart patients around the world
walk around with artificial pacemakers
in their chests — devices that keep the
heartbeat above a certain level. While
lifesaving, pacemakers can be problematic
because most of the device, including its
battery and electronic control systems, sits
just under the skin and is connected to the
heart using thin, flexible leads.
These leads can be difficult to implant
and can sometimes be dislodged by vigorous
activity. If the leads fail, removing them
may require major surgery. They also bring
about the risk of infection. This is why the
medical community has responded so well
to the invention of leadless — or wireless
— pacemakers, with several biomedical
companies in a race to perfect the device.
One such device, invented by the United
States-based company Nanostim, is not
only wireless, but miniaturised as well. The
size of an AAA battery, the entire pacemaker
is implanted inside the heart and is powered
by a built-in battery that can last between
eight and 17 years. Initial trials in humans
have yielded positive results. LW
The LokomatPro trains
posture and gait. Patients
are supported in a harness
while being put through
intensive gait cycles of
up to 1,000 repetitions
an hour.
25
(LIFESPACES)
The
that you
breathe
IN JUNE THIS YEAR, when the
Pollutant Standards Index
(PSI) shot up to record levels
in Singapore because of the haze, residents
were advised by the National Environment
Agency to stay indoors. The quality of the
air outside — which hit an unprecedented
401 on the PSI — was deemed “very
hazardous”. But although we can breathe
easy for now, it doesn’t mean there is room
for complacency, especially when it comes
to the quality of the air indoors.
According to studies by the United
States Environment Protection Agency
(EPA), the air indoors can be, on average,
two to five times more polluted than
outdoor air — sometimes 100 times worse.
With so many spaces being airconditioned these days, could it be that we
are exposing themselves to more pollution
indoors than if we were to venture out?
EPA studies have also shown that more
than 400 harmful chemicals can be found
in the air indoors.
Here are a few common culprits found
in homes that can affect your health.
26
THE HAZE MAY HAVE CLEARED,
BUT THE QUALITY OF AIR IN YOUR
HOME IS SOMETHING TO BE MINDFUL OF.
BY ALEX NGAI
IN CONSULTATION WITH DR DAVID TAN HSIEN YUNG
FAMILY PHYSICIAN ASSOCIATE CONSULTANT //
JURONG POLYCLINIC // NATIONAL HEALTHCARE GROUP POLYCLINICS
Mould
A type of fungus, mould grows in damp
areas of the house such as the bathroom
and laundry areas. Singapore’s warm
and humid climate helps to create ideal
conditions for mould to develop in homes.
The spores that mould produce as part of
reproduction can trigger or worsen nose
and lung allergies, resulting in symptoms
ranging from a cough to an asthma attack.
“Patients with a history of asthma are
advised to keep their living areas free of
mould, as this could worsen control of
their illness, leading to recurrent attacks or
wheezing. Some patients with a sensitive
nose due to allergic rhinitis may also be
affected,” says Dr David Tan Hsien Yung,
Family Physician Associate Consultant
at Jurong Polyclinic.
So if you have been hanging your damp
laundry indoors without providing for
adequate ventilation, don’t. An elevated
moisture level creates ideal breeding
conditions for mould spores and dust mites,
according to a report published late last year
in The Daily Telegraph newspaper.
Mould can grow on most surfaces and
the best solution is to scrub it off using
detergent and water, and subsequently
keeping the area dry. Pay extra attention to
areas where water leaks might occur, like
under sinks and near pipes, and fix leaks
immediately.
Second-hand Smoke Burning Pollutants
Cigarettes release between 10,000 and
40,000 microgrammes of the pollutant
PM2.5 per stick, and this can be especially
harmful to children. The Health Promotion
Board says children who are subjected to
second-hand smoke have a higher risk of
suffering ear and chest infections, and they
might also develop diseases like bronchitis,
pneumonia and asthma. Prolonged exposure
to second-hand smoke increases the risk of
developing heart and lung problems, making
smoking indoors a big health hazard.
Volatile Organic
Compounds
Many common household cleaners, as well
as glues and paint products contain volatile
organic compounds (VOCs), which consist
of chemicals such as acetone (found in nail
polish remover, for example), formaldehyde
(found in particle board and other budget
furniture items), xylene and toluene (found
in paint, nail varnish and glues). VOCs are
contained in items that “off-gas”, releasing
chemicals into the air at room temperature.
Exposure to VOCs can result in allergic
reactions or respiratory problems like throat
irritation, headaches, nausea, or — in
sustained doses — even damage to internal
organs and the central nervous system.
The best way to avoid inhaling VOCs is
to ventilate rooms that have recently been
cleaned with cleaning products, or which
have new items of furniture in them as many
wood adhesives and varnishes contain large
amounts of VOCs. And instead of using toxic
household cleaning products, opt for lowand non-VOC alternatives.
CLEARING THE AIR
PHOTO: GETTY IMAGES
GROW
PLANTS
Plants remove
pollutants, according to
a study done by the US
National Aeronautics and
Space Administration.
Areca Palms, Bamboo
Palms and 'money plants'
can filter ammonia,
formaldehyde, xylene
and toluene, which
are found in cleaning
products. The study
recommended keeping
one such plant per
nine sq m of living area.
We may not realise it, but we are exposed
to pollution when we cook. Gas stoves can
produce a lot of carbon monoxide (CO)
and nitrogen dioxide (NO2) which, in a
poorly-ventilated kitchen, can be harmful
to health. According to the Mayo Clinic in
the United States, exposure to too much CO
can be deadly because it can diminish the
body’s ability to absorb oxygen. Elevated
levels of CO and NO2 in the air can cause
headaches, dizziness, nausea, vomiting,
memory loss and flu-like symptoms.
Always use exhaust fans or hoods, keep
the kitchen well-ventilated and refrain from
MOSQUITO COILS EMIT
THE EQUIVALENT OF UP TO
137 CIGARETTES’ WORTH OF
POLLUTANTS, INCLUDING PM2.5
cooking on a charcoal fire when indoors.
Another significant source of indoor
pollution is the burning of mosquito coils
which — in a country where dengue is an
ongoing problem — presents a quandry. A
Malaysian study carried out 10 years ago
reported that each mosquito coil emits
the equivalent of up to 137 cigarettes’
worth of pollutants, including PM2.5
and formaldehyde. So how to get rid of
mosquitoes without presenting a health
hazard from burning coils? The use of
natural repellent oils like citronella has been
shown to repel mosquitoes. LW
To breathe clean air at home, here are some measures you can take:
VACUUM
INSTEAD
OF SWEEP
Sweeping stirs up dust,
while vacuuming with a
machine that has a highefficiency particulate air
(HEPA) filter traps dust,
removing it from the
air. When dusting high
surfaces, use a microfibre
cloth that collects dust
better than regular cloths,
to prevent dust from
flying about.
CLEAN AIR
FILTERS
The filters in
appliances such as air
conditioners, vacuum
cleaners and cooker
hoods remove dust from
the air, so clean or replace
them regularly. Besides
accumulating dust and
mould, poorly-maintained
filters can be breeding
grounds for bacteria. This
also applies to the aircon
in your car, so replace the
cabin air filter regularly.
AIR SOFT
FURNISHINGS
Mould can
grow anywhere, including
inside mattresses and
cushions. Take advantage
of Singapore’s hot
weather by regularly
airing and sunning your
mattresses, curtains
and cushions to dry out
trapped moisture, as well
as stem the growth of
mould and bacteria.
27
(WORKOUT)
FITNESS PLAN SERIES
Age is but a
NUMBER
THE EFFECTS OF EXERCISE ON THOSE
IN THEIR 60s AND BEYOND MIGHT
NOT BE APPARENT, BUT THERE ARE A
HOST OF BENEFITS FOR GETTING ACTIVE.
BY GENE KHOR
IN CONSULTATION WITH MR KWOK BOON CHONG // SENIOR PHYSIOTHERAPIST //
why senior citizens in their
60s and beyond might be
apprehensive about getting into a fitness
routine. The fear of falling or aggravating a
chronic ailment are valid reasons indeed.
However, being sedentary and avoiding
exercise altogether can be even more
detrimental, both mentally and physically.
Inactive people young and old are nearly
twice as likely to develop heart disease than
those who are active. Sedentary older folks
can develop sarcopenia (a condition that
affects many once they are past their 50s)
more rapidly than their active counterparts.
The most common symptom associated
with sarcopenia is the loss of muscle mass at
the rate of around 1 to 2 per cent annually.
The bodies of sarcopenia sufferers become
weaker and slower over time.
While exercise presents some risk of
injury, the pros of working out in one’s
golden years far outweigh the cons. Not
only does regular physical activity reduce the
chances of developing chronic conditions
like arthritis, heart disease, diabetes or high
blood pressure, it can even help reverse
them. In addition, exercise strengthens the
lower body, which improves balance and
mobility, which in turn reduces the risk
of falls that in elderly people often lead to
major fractures.
PHOTOS: CORBIS, ISTOCKPHOTO
CLINICAL SERVICES // NATIONAL HEALTHCARE GROUP POLYCLINICS
THERE ARE VARIOUS REASONS
28
Getting Started
Easing into a fitness routine need not
be difficult, and it doesn’t need a highimpact activity to get the limbs moving.
For example, a moderate-intensity aerobic
exercise like brisk-walking improves
cardiovascular health and can be done
almost anywhere. Getting the heart
pumping in this way improves blood
circulation and burns calories — and aids
in maintaining an ideal body weight which
lowers the risk of age-related conditions
such as heart disease and stroke.
For those concerned about pushing
themselves too hard, gauging the degree
of intensity is simple. “To evaluate your
level of perceived exertion, see if you
can communicate in three- to fourword sentences during the workout,”
suggests Mr Kwok Boon Chong, Senior
Physiotherapist from Clinical Services in
the National Healthcare Group Polyclinics.
“If you experience chest discomfort, reduce
your intensity to a point where you can
communicate in full sentences of around
eight to 10 words during the workout.”
It is also important to incorporate
muscle-strengthening exercises, particularly
for the lower limbs, in order to maintain
mobility and manage joint problems like
EXERCISE PRESENTS
SOME RISK OF INJURY, BUT
THE PROS OF WORKING OUT
IN ONE’S GOLDEN YEARS
FAR OUTWEIGH THE CONS.
NOT YOUR USUAL WORKOUT
There are a growing number of more
interesting options available to seniors these days.
ZUMBA GOLD
AQUAROBICS
PÉTANQUE
Zumba Gold is a Latininspired dance fitness
programme specially
tailored for the
‘active ager’ or those
who want to start
an exercise routine.
Participants coordinate
their movements to
catchy Latin beats but
with less intensity than
the standard Zumba
moves. Benefits
include improved
balance, coordination
and stamina. Sign
up for lessons at a
Community Club,
which can be located
at www.pa.gov.sg/
This low-impact
exercise takes
participants through
aerobic exercises in
the shallow end of a
swimming pool — so
swimming knowledge
isn’t necessary. With
water supporting
the body’s weight,
the risk of muscle
and joint injury are
reduced, while the
water’s resistance
helps build up muscle
endurance and burn
calories. Check out
In this French sport,
players score by
throwing balls as
close to the target
as possible. It’s not
an aerobic sport, but
requires stamina as
play can last several
hours. It trains handeye coordination and
keeps the mind active
with strategy and
teamwork. Pétanque
is also suitable
for seniors with
mobility difficulties
as little movement is
required. Visit www.
locate-our-centres
for classes.
www.viriya.org.sg/
mycentre/_html/
ourprogrammes.html
osteoarthritis in the knees. “If you are an
older person, a basic but useful exercise
would be to try to stand from a seated
position without supporting yourself with
your arms. Try and do this 10 times for
three sets,” says Mr Kwok. “This exercise
can also help ascertain your level of
physical ability.”
A combination of aerobic and lower
limb strengthening exercise would be
‘walking’ in waist- to chest-deep water in
the swimming pool. This is useful for those
with severe joint pain. Water has 12 times
the resistance of air, so walking through it
in the same way you would on land builds
and strengthens muscle. Furthermore,
water has the property of buoyancy that
can reduce joint pressure. The deeper the
water, the more strenuous the workout. A
good idea would be to wear a flotation belt
to keep the body upright.
Moving Along
Seniors with limited mobility or who require
a wheelchair can still exercise. For example,
they could use an upper-limb ergometer,
sportsboules.org.sg
for more information
on classes.
an exercise machine that works like an
exercise cycle but is specifically for the arms.
Depending on the intensity and duration
of each set, the user can build upper-body
strength and cardiovascular fitness.
But arguably, the biggest hindrance to
exercise among seniors — especially those
who haven’t worked out in ages — is a lack
of motivation, with reasons like “I’m too
old” or “I need my rest” being commonplace.
“In such situations, signing up for group
exercises like social dances might benefit
such individuals,” says Mr Kwok. “The
opportunity to interact with others would be
a stronger motivating factor.”
Regardless of the activity, however,
it is important to remember that anyone
planning on embarking on any fitness
regime should consult a doctor to ensure
that it is safe to do so. Similar advice is
recommended for those who want to change
their diet in a bid to lose weight.
In the presence of medical conditions
like heart disease or diabetes, a dietitian’s
advice should be sought before modifying
one’s diet.
29
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(Q&A)
ASK
THE
EXPERTS
YO U R M E D I C A L Q U E S T I O N S A N S W E R E D
Q1) Eyes Wide Open
I have had trouble sleeping lately. I read online that
sleeping aids like Xanax and Ambien have different
effects on sleep — one produces a deeper sleep
than the other, for example. I would like to try both
these medications to solve my sleep problems, so
what requirements would I need to fulfill in order to
be prescribed medication? I am a 36 year-old man
working in the advertising industry. I often work
long hours and don’t have time to exercise. Would a
lifestyle change be better than taking sleeping pills?
Medications such as Xanax and
Ambien are sedatives. While they
can be effective sleeping aids in the
short term, prolonged use an result
in tolerance (when reaction to the
drug is reduced, requiring more of it
to achieve the desired effect), abuse
and significant morbidity (a higher
risk of contracting disease).
The short-term use of such
medications is best done in
conjunction with lifestyle changes
that promote sleep and good health.
Before contemplating the use of
medications that are associated
with side effects, it would be better
to practise good sleep hygiene.
Examples of good sleep hygiene
include regular bedtimes, a routine
to wind down, as well as minimising
activities such as work and exercise
just before bedtime.
A review of your lifestyle
includes looking at a good balance
of work, exercise and play — and
decreasing the use of stimulants
such as coffee and smoking — will
all help with sleep.
DR MOK YEE MING
HEAD // MOOD DISORDER UNIT //
CONSULTANT/DEPUTY CHIEF //
DEPARTMENT OF GENERAL PSYCHIATRY
// INSTITUTE OF MENTAL HEALTH
31
Q3) Ear Ye, Ear Ye
I am a 25 year-old man working as a
foreman at a construction site. In the
course of my work, I am constantly
exposed to loud noises. Lately,
I’ve been hearing ringing in my ears,
which comes and goes without warning.
What could it be, and what should I do?
Q2) Nailing It
How safe and hygenic are those paraffin
wax treatments offered by nail salons?
If someone with a skin condition has
dipped his or her hands into the hot wax
before me, will I be put at risk? Also,
can nail fungal infections be passed on
by manicure and pedicure tools?
A person’s nails can be infected by a fungus from
three common sources:
}Another human being who has a fungal skin,
nail or hair infection
}From household pets or farm animals
}From plants, rotting wood and soil
Human-to-human spread often occurs in wet
places like wash basins, swimming pools, gyms and
spas, as well as at nail treatment centres. Most chemical
sterilising agents can kill bacteria but not fungi, and
therefore are not effective in preventing their spread.
A more certain method of sterilising instruments is
by using an autoclave — a pressurised, steam-heated
device to sterilise equipment and supplies — which is
often not available in nail bars.
Water is the main medium of fungal transmission.
On the other hand, paraffin wax does not allow
fungus to live, but the repeated use of manicure or
pedicure instruments may allow fungal spores to be
mechanically passed on.
The way to prevent the spread of infection in a nail
treatment centre is to make sure that the instruments
used as well as the environment are free of the fungi
that can cause disease. Ideally, an instrument should
be for single-use only, and disposable. Otherwise,
proper sterilisation using an autoclave after each
treatment should be done.
DR SEOW CHEW SWEE
SENIOR CONSULTANT DERMATOLOGIST //
NATIONAL SKIN CENTRE
32
Certain jobs — such as shipbuilding, certain
occupations in manufacturing industries and
construction — expose workers to very loud noises.
Constant and prolonged exposure to loud noises can
result in permanent, irreversible hearing loss.
As occupational ‘Noise Induced Deafness’ (NID)
tends to progress gradually, sometimes the associated
tinnitus or ringing in your ears may be the first warning
that you are developing NID. Many NID patients are
actually relatively young but there is a tendency for them
to delay seeking help. Unfortunately, we frequently see
40 year-old patients with the hearing of an 80 year-old.
Despite robust laws in Singapore regulating
workplace noise exposure, NID remains the most
common occupational disease in Singapore. Prevention
is still the best cure. Appropriate use of ear protectors
can reduce the damaging effects of loud noises.
Your employer should also be monitoring all at-risk
employees. If you fail the hearing screening test, you will
be referred to a Ministry of Manpower clinic for more
objective hearing tests. You may be eligible for financial
compensation should your hearing deteriorate beyond a
certain level. Hearing loss, regardless of the cause — can
reduce your quality of life, although this can be at least
partially overcome by the use of hearing aids.
DR HO EU CHIN
CONSULTANT // JOINT OCCUPATIONAL DEAFNESS CLINIC //
EAR, NOSE & THROAT DEPARTMENT //
Q5) Vox Pox
I am a 50 year-old man. Recently,
I contracted shingles, which I understand
comes from the same virus that causes
chickenpox. My two daughters have
never had chickenpox before and have
not received the vaccine for it, so for
their safety I have been giving them a
wide berth and avoid being in the same
room as them. But I am still worried. Is
shingles as infectious as chickenpox?
Shingles is not as infectious as chickenpox. However,
fresh blisters and erosions can be a source of
transmission, and pregnant women and family
members who had not had previous infection
should avoid direct contact. You should consider
taking your daughters for a chickenpox vaccination.
DR PAN JIUN YIT
Q4) Urge Overkill
CONSULTANT DERMATOLOGIST // NATIONAL SKIN CENTRE
ASK THE
SEXPERTS
I am a 74 year-old man and increasingly,
I have trouble holding in my urine.
Is incontinence a direct result of old
age, or is it caused by other factors?
You have described a condition that is known as urge
incontinence. You are correct on both counts — urinary
incontinence can develop as a man ages and it can also
be caused by other factors.
As a man gets older, his prostate gland — which is
responsible for producing much of the fluid that makes
up semen — tends to get bigger as well. An enlarged
prostate can cause various urinary problems, including
urge incontinence. Older men may also develop an
overactive bladder that causes them to have frequent
strong urges to pass urine, which can cause urinary
incontinence. If the pelvic floor muscle is weakened,
they may find it difficult to control these strong urges
and may leak urine before reaching the toilet.
Other conditions that can result in urge
incontinence include prior pelvic radiation therapy,
bladder infection, stones in the bladder, bladder
cancer, prostate cancer and some neurological diseases.
Smoking and certain beverages such as alcoholic drinks,
coffee and tea are known to aggravate the problem.
Urge incontinence is a very distressing problem
but it can be easily treated. It is therefore advisable for
you to seek relevant medical advice, both to get this
condition treated and to evaluate for other serious
underlying causes.
DR SIMON CHONG
CONSULTANT // DEPARTMENT OF UROLOGY //
GETTING CHECKED OUT
I am a 34 year-old woman who is in a
monogamous relationship with my boyfriend of
three years. I received the Gardasil vaccine last
year, which prevents the human papillomavirus
(HPV). Does this mean that I don’t need to go
for annual Pap smears anymore?
Gardasil helps protect against four types of HPV (6, 11 —
associated with genital warts; 16, 18 — associated with cervical
cancer). The full course is three injections over a six-month
period. Even if you have completed the vaccination course,
at present, you should still have routine Pap smears. These
should be done every three years.
DR ELLEN CHAN
ASSOCIATE CONSULTANT DERMATOLOGIST // NATIONAL SKIN CENTRE
33
(EAT WELL)
Food for
THOUGHT
KEEP YOUR MIND HEALTHY AND
ACTIVE BY EATING RIGHT.
BY WANDA TAN
IN CONSULTATION WITH MS CHARMAINE TOH
DIETITIAN // COLLABORATIVE CARE //
NATIONAL HEALTHCARE GROUP POLYCLINICS
THERE’S MUCH TRUTH to the
adage “You are what you eat”.
To have a healthy body, you
must eat healthy food. And given the
brain–body connection, it follows that
eating healthily will also help to develop
and maintain a healthy brain.
While it has long been suspected
that food has a direct impact on brain
function, research on this topic is still
recent. Only in the last five to 10 years
have scientists examined how certain
foods affect cognitive processes in
the elderly so as to prevent or delay
dementia. These foods have been dubbed
“superfoods” for their high concentration
of nutrients that confer all-round health
benefits to mind and body alike.
But while these foods are good for
your health, it is important to keep in
mind that they are not ‘miracle foods’,
and be realistic about their efficacy.
Clearing Up Myths
There are no foods that promote the
growth of brain matter. “Studies show
that the volume of grey matter —
the part of the brain associated with
cognition and sensory perception — is
highest during early adolescence. It
then decreases after middle age,” says
Ms Charmaine Toh, Dietitian for Clinical
Services at National Healthcare Group
Polyclinics. There are however foods that
boost cognitive function.
In other words, ‘brain food’ isn’t
about pushing your brain beyond its
limits or making you smarter. Rather, it
is about maximising your brainpower and
operating at your full potential for longer.
Also, just eating one type of superfood
34
34
will not make you any brainier. What
matters is that you eat in moderation.
Choosing foods from all four food groups
in the Healthy Diet Pyramid — rice and
alternatives, fruits, vegetables, and meat
and alternatives — will keep your mind
and body healthy at the same time.
“It is important to stick to a balanced
diet high in fibre and low in saturated
fat, refined sugars and salt,” says Ms Toh.
Moreover, pay attention not only to what
you eat, but when and how much. Instead
of three big meals a day, have frequent
small meals with healthy snacks — such
as fruits — in between to ensure a
steadier supply of energy to the brain.
Breakfast is especially critical for
improving memory. Research has shown
that school-going children who eat
breakfast tend to do better academically
and have fewer behavioural problems
than those who skip breakfast.
HOW DOES FOOD GET TO YOUR BRAIN?
Watch Your
Glycaemic Index
The glycaemic index (GI) is a ranking of
carbohydrate-containing foods based on
how quickly they are absorbed and raise
blood glucose levels.
One way to improve mental alertness
is by placing an emphasis on low-GI foods
in your diet. An example of low-GI foods
are wholegrains such as wholemeal bread,
brown rice and oatmeal, which release
glucose slowly into the bloodstream,
helping to maintain a steady blood sugar
level. This provides sustainable energy to
the brain and boosts your concentration.
Avoid processed foods and simple
carbohydrates such as white bread, candy,
table sugar and baked or packaged foods.
These have a high GI as they contain
refined sugars that are used up rapidly in
the bloodstream. This causes a significant
decrease in blood sugar level in a short
period of time. The fluctuating blood
sugar level interferes with the ability to
learn and greatly increases the risk of
cognitive impairment in older adults.
The digestive system breaks down food into smaller molecules that
are absorbed into the bloodstream and transported throughout the
body, including to the brain, to provide energy. Food goes through the
digestive tract until it reaches the intestines, which absorb nutrients.
Food gives you energy, but the digestive process
requires energy, too. Whenever you overeat or eat
a large meal loaded with carbohydrates, your
digestive system has to go into overdrive to
break down all the food. Blood and energy
are diverted away from the brain to the
intestines for digestion. This causes you to
feel full and sleepy — a condition known as
post-prandial omnolence, or ‘food coma’.
mackerel and sardines are very rich
sources of the omega-3 fatty acids EPA and
DHA, and thus should be included in your
diet at least twice a week. Non-fish sources
of omega-3 like walnuts, pumpkin seeds
and flaxseed oil can also be considered.
In addition, studies suggest that the
consumption of monounsaturated fatty
acids — found in olive oil, avocados and
nuts — decreases the risk of depression.
On the other hand, saturated fats
should only ever be consumed in small
amounts. Eating excess red meat and
full-cream dairy products, deep-fried and
processed foods increase the likelihood of
developing memory
problems, which may
advance to conditions
like dementia and
Alzheimer’s disease.
THE BRAIN OPERATES BEST WITH
ABOUT 25G OF GLUCOSE IN THE
BLOODSTREAM — ROUGHLY THE
AMOUNT FOUND IN A BANANA
Studies have found that the brain
operates best with about 25g of glucose
in the bloodstream — roughly the
amount found in a banana.
PHOTOS: GETTY IMAGES, SHUTTERSTOCK
Focus On Good Fats
Polyunsaturated fatty acids are essential
for normal brain function because they
strengthen the synapses in the brain.
A synapse is a structure in the central
nervous system that connects neurons
or ‘nerve cells’ and allows them to pass
signals to other cells. Much learning and
memory occurs at the synapses.
Specifically, omega-3 fatty acids help
rebuild brain cells and have been proven
to lower the risk of Alzheimer’s disease.
They are also associated with a lower risk
of dementia as well as improved focus and
enhanced memory in young adults.
Oily fish such as salmon, tuna,
Eat Your
Fruits And
Vegetables
Foods rich in
antioxidants should be part of your diet.
Flavonoids are a group of antioxidant
compounds found primarily in fruits and
vegetables. By fighting off free radicals —
atoms or molecules responsible for cell
or tissue damage that appear in the body
when it converts glucose to energy —
antioxidants regulate the oxidative stress
that destroys brain cells.
Leafy green vegetables like spinach
are high in vitamin E, an antioxidant
that protects brain cells from free radical
damage. Brightly-coloured fruits and
vegetables like mangoes, tomatoes and
carrots contain naturally-occurring
phytochemicals packed with antioxidants.
Blueberries, strawberries and other darklypigmented fruits and vegetables contain
the flavonoids anthocyanin and quercetin,
which boost overall energy levels and help
to slow cognitive decline. LW
GREY AND WHITE
WHAT DOES YOUR
BRAIN LOOK LIKE?
If you look at a bisected human
brain, two different types of
brain tissue can be distinguished:
grey matter and white matter.
Grey matter is the darker
outer part of the brain that
contains neuronal cell bodies.
Its size peaks during a person’s
adolescence and 20s. It is
involved in muscle control,
sensory perception such as
seeing and hearing, memory,
emotions and speech.
The inner, lighter part of the
brain is called white matter. It
consists of myelinated axons, or
fatty nerve fibres, that transmit
signals between brain regions.
Simply put, white matter is the
tissue that connects different
areas of grey matter. Unlike grey
matter, white matter injuries —
known as axonal shearing — may
be reversible.
35
C O R P O R AT E N E W S + C A L E N DA R O F E V E N T S + F O R U M S
AND THE WINNERS ARE…
THOUGH THIS YEAR’S NHG AWARD RECIPIENTS COME FROM DIFFERENT FIELDS,
THEY ALL SHARE THE SAME GOAL — TO MAKE A DIFFERENCE IN
SINGAPORE’S HEALTHCARE INDUSTRY AND THE LIVES OF PATIENTS.
S
ince 2001, the National Healthcare Group
(NHG) has been recognising their brightest and
most dedicated healthcare workers for their
contributions at the annual NHG Awards. Besides
a certificate and trophy, award winners receive a cash prize
for their extraordinary efforts.
This year, 11 healthcare professionals — including a
non-clinician and a psychiatrist — were awarded accolades
as a testament to their work in healthcare. Though their
specialties lie in different fields, the recipients share a
common passion — to serve patients and provide quality
healthcare in the hospital as well as in the community.
From an infectious disease expert to a geriatrician
passionate about improving the lives of the
elderly, this year’s winners have all made
remarkable achievements.
Of the winners, NHG Group CEO Professor
Chee Yam Cheng said, “You are our inspirational
role models. You have gone the extra mile to make
significant contributions to NHG’s healthcare
delivery, and our patients — and Singapore —
have benefited from your tireless efforts.”
One such role model is Mr Ow Chung Kin,
a Senior Manager from Tan Tock Seng
Hospital’s (TTSH) Diagnostic Radiology
department. At 64 years of age, he is
the oldest award recipient. Considered
to be Singapore’s “Father of Newage Radiography”, Mr Ow operated
Singapore’s first Computed Tomography
brain scanner at TTSH in 1977. Since then,
he has been instrumental in helping to
set up radiology departments and quality
management training programmes and
systems development for TTSH and other
NHG institutions. For his contributions,
Mr Ow was awarded the NHG Outstanding
Citizenship Award.
Clinching the NHG Distinguished
Achievement Award was renowned expert
in communicable infections, Associate
Professor Leo Yee Sin, who heads the
36
Department of Infectious Diseases at TTSH. Over the
last decade, A/Prof Leo led her team through several
challenges. Most noteworthy were her invaluable
contributions during the SARS outbreak in 2003 and her
passionate drive to support and reintegrate HIV patients
back into society.
A/Prof Leo was also the recipient of the Translational
Clinical Research grant in 2008 to head a study on
dengue. She also trains medical doctors and other
healthcare professionals, and is often invited to give talks
and share her expert views internationally.
Another recipient of the NHG Distinguished
Achievement Award was A/Prof Chiam Peak Chiang.
In her 28 years of service at the Institute of Mental
A/Prof Leo Yee Sin (left) was
given the NHG Distinguished
Achievement Award, and Dr Tan
Thai Lian (above) received the
Outstanding Citizen Award.
C O N G RAT U LAT I O N S !
THE FULL LIST OF AWARD WINNERS
THE LEE FOUNDATION – NHG-NUHS
LIFETIME ACHIEVEMENT AWARD
Prof Yap Hui Kim
Head and Senior Consultant, Division of Paediatric
Nephrology, Dialysis and Renal Transplantation
NATIONAL UNIVERSITY HOSPITAL
NHG DISTINGUISHED ACHIEVEMENT AWARD
A/Prof Chiam Peak Chiang
Vice Chairman Medical Board (Education), and
Senior Consultant Psychiatrist
A/Prof Leo Yee Sin
A/Prof Chiam Peak
Chiang was given the
NHG Distinguished
Achievement Award.
Health (IMH), A/Prof Chiam has mentored many
psychiatrists and trainees. As the Vice Chairman
Medical Board (Education) of IMH, she’s in charge of
mental health education for medical students, doctors
undergoing postgraduate psychiatry specialist training,
general practitioners (GPs), allied health professionals
(AHPs) and nurses. She also oversees the continuing
medical education of doctors and psychiatrists in IMH.
In addition to setting up the NHG-AHPL Psychiatry
Residency Programme, A/Prof Chiam has developed
the Graduate Diploma in Mental Health in IMH. The
latter programme trains GPs and polyclinic doctors and
equips them with the knowledge and skills to manage
patients with mild mental illness in their clinics. She has
also developed the Diploma in Psychiatry which allows
temporarily-registered medical practitioners to apply
THEY HAVE GONE THE EXTRA MILE TO
MAKE SIGNIFICANT CONTRIBUTIONS TO
NHG’S HEALTHCARE DELIVERY, AND OUR
PATIENTS — AND SINGAPORE — HAVE
BENEFITED FROM YOUR TIRELESS EFFORTS
NHG GROUP CEO PROF CHEE YAM CHENG
Director, Institute of Infectious Disease & Epidemiology,
Clinical Director, Communicable Disease Centre, and
Senior Consultant, Dept of Infectious Disease
Dr Ang Sze Peng Brenda
Senior Consultant, Dept of Infectious Disease, and
Deputy Clinical Director, Communicable Disease Centre
NHG DISTINGUISHED CITIZENSHIP (DC) AWARD
Dr Tan Chue Tin
Psychiatrist, Tan Chue Tin Clinic Pte Ltd
(IN PRIVATE PRACTICE)
NHG OUTSTANDING CITIZENSHIP (OC) AWARD
Dr Tan Thai Lian
Head and Senior Consultant, Dept of Geriatric Medicine
A/Prof Kwek Tong Kiat
Head and Senior Consultant, Dept of Anaesthesiology,
Intensive Care and Pain Management
Ms Leong Yoke Yin
Deputy Director, Nursing
Mr Ow Chung Kin
Senior Manager, Diagnostic Radiology
for conditional registration to practise in hospitals upon
obtaining this qualification.
Clinching an Outstanding Citizenship Award was
Dr Tan Thai Lian, the head of TTSH’s Geriatric Medicine
department, the largest in Singapore. Dr Tan has
played an important part in developing the Division of
Integrative and Community Care. It is the first of its
kind in Singapore, and looks into the comprehensive
care of frail seniors in hospital settings and community
healthcare facilities.
Dr Alex Su
Chief and Senior Consultant, Dept of General Psychiatry 1 & 2
Ms Loo Swee Cheng
General Manager
37
SHINING THE
SPOTLIGHT
ON NURSES
THE NURSES’ MERIT AWARD 2013 AND
THE NHG NURSES’ DAY ARE REMINDERS
OF JUST HOW VALUABLE THEY ARE
TO THE HEALTHCARE PROFESSION.
T
he importance of nurses cannot be overstated.
They perform a wide range of duties big and
small in order to provide excellent patient
care, assist doctors and ensure the smooth
running of hospitals and clinics. As a show of support
and appreciation for nurses, two events were organised
recently. The Ministry of Health (MOH) held the Nurses’
Merit Award 2013, while the National Healthcare Group
(NHG) celebrated its annual NHG Nurses’ Day.
GIVING NURSES THEIR DUE RESPECT
On 3 July, MOH held the Nurses’ Merit Award 2013
ceremony to honour nurses from public and private
hospitals for their outstanding performance and
unwavering dedication. The event was held at
the Holiday Inn Singapore Orchard City Centre,
and graced by Minister of State for Health and
Manpower, Dr Amy Khor.
Awards were handed out to nurses who
had consistently demonstrated exemplary
performance over the last three years, participated
in professional advancement courses to develop
their career, and contributed towards projecting a
professional image of nursing. Their contributions
included providing compassionate and quality care
to patients, promoting good workplace practices
38
and mentoring junior nurses, among others.
This year’s award recipients comprised 77 nurses
working at both institutional and national level, with
each winner receiving a medal and a monetary gift
of S$200. At the ceremony, MOH Chief Nursing Officer
Dr Pauline Tan said of the winners, “Their numerous
contributions are greatly valued and appreciated.
I hope that recognising them will inspire all nurses to
uphold the importance of nursing.”
Of the 77 nurses who won an award, 17 of them
were from NHG institutions; namely, the Institute
of Mental Health (IMH), National Healthcare Group
Polyclinics (NHGP), the National Skin Centre (NSC)
and Tan Tock Seng Hospital (TTSH).
NHG’S AWARD-WINNING NURSES:
NAME
Ms Frieda Tan Peck Lan
Mdm Paramesvari Jayaraman
Mdm Tan Hoi Hwang
Ms Wong Chui Ping
Mdm Yeoh Ai Lean
Ms Er Lian Hwa
Ms Wendy Ong Kim Leng
Ms Esther Tang Seok Han
Ms Chan Siew Goon
Ms Chen Li
Ms Chen Yang Yuang
Ms Fu Qixin
Ms Joyce Goo Lay Kian
Ms Loh Sok Hiang
Ms Naw Nyo Nyo Win
Ms Sabariah Bte Abdul Radzi
Ms Adeline Tang Lai San
GRADE
INSTITUTION
Senior Staff Nurse
IMH
Nurse Clinician II
IMH
Nurse Manager
IMH
Nurse Clinician I &
IMH
Advanced Practice Nurse
Senior Nurse Manager
IMH
Senior Nurse Clinician
NHGP
Acting Nurse Manager
NHGP
Senior Staff Nurse II
NSC
Nurse Manager
TTSH
Nurse Manager
TTSH
Principal Assistant Nurse TTSH
Senior Staff Nurse
TTSH
Nurse Educator
TTSH
Nurse Clinician
TTSH
Senior Staff Nurse
TTSH
Principal Assistant Nurse TTSH
Nurse Manager
TTSH
MOH celebrated nurses with the Nurses
Merit Awards (left). Celebrating with the
nurses are Prof Philip Choo, Deputy Group CEO
(Regional Health) and CEO TTSH; and
Mr Yong Keng Kwang, Director (Nursing) TTSH.
At the NHG Nurses’
Day celebration held
at TTSH, management
staff — including NHG
Group CEO Prof Chee Yam
Cheng — donned aprons
to serve the nurses lunch
(above and top right).
Nurses were also treated
to games and song-anddance numbers.
GOING ABOVE AND BEYOND
THE CALL OF DUTY
Meanwhile, NHG nurses enjoyed a well-deserved break
on 1 August as they were waited upon and pampered
during the NHG Nurses’ Day celebration held at TTSH’s
Multi-Purpose Hall. Nurses, management staff and
Regional Health System (RHS) partners came together
to celebrate the occasion as nurses were thanked for
their unstinting devotion in caring for patients and
assisting doctors in their duties.
NHG Group CEO Professor Chee Yam Cheng was the
Guest-of-Honour at the occasion, and he joined other
Senior Management members in donning aprons and
serving lunch to the nurses. Nurses were also treated to
games and song-and-dance numbers performed by NHG
staff in their honour.
An increasing number of NHG nurses are exceeding
job expectations by pursuing postgraduate studies and
embarking on research projects to improve patient
care. For example, last year, a group of nurses at TTSH
developed the Decision Algorithm — a set of guidelines
and checklists to ensure that feeding tubes are properly
placed in patients’ stomachs, eliminating the need
for chest X-rays to check feeding tube placements.
This innovation has benefited patients by reducing
their exposure to radiation, as well as lowering costs.
TTSH also has a dedicated Nursing Research
Unit that ensures hospital and nursing practices
are kept up to date. Led by Ms Isabel Ng Hui Leng,
a Nurse Researcher with a Masters Degree in
Epidemiology, the unit’s objective is to incorporate
evidence-based medicine into fields like geriatric
healthcare to improve patients’ experiences.
AN INCREASING NUMBER OF NHG NURSES
ARE EXCEEDING JOB EXPECTATIONS
BY PURSUING POSTGRADUATE STUDIES AND
EMBARKING ON RESEARCH PROJECTS
Another successful nursing research project is
a collaboration between nurses at IMH and their
counterparts at Australia’s Joanna Briggs Institute
to enhance mental healthcare.
Along with these is an initiative by NHGP’s
advanced practice nurses to counsel patients with
chronic diseases on lifestyle changes and medication
management in order to lower cholesterol and
blood pressure. NSC nurses have also introduced
a method to alleviate pain for syphilis patients
during treatment.
39
A HOME FOR HEALTH
SINGAPORE’S HEALTHCARE INDUSTRY LOOKS TO THE FUTURE WITH
THE HEALTH CITY NOVENA INTEGRATED MEDICAL HUB.
N
When completed
in 2030, the area
dedicated to
healthcare will have
grown by 150 per cent.
40
ovena has been a medical precinct for over
a century, since Tan Tock Seng Hospital
(TTSH) moved to this location in 1909. This
has been followed in recent years by the
addition of HCA Hospice Care, Dover Park Hospice,
Ren Ci Hospital, the National Skin Centre (NSC) and
the National Neuroscience Institute, which are all still
located there. The latest addition to the area is the Lee
Kong Chian School of Medicine (LKCMedicine), which
opened on 5 August 2013.
Given the proximity of these institutions to one
another, they have often worked together to provide
care to the public. For example, Ren Ci Hospital wards
are available to TTSH’s patients who are deemed stable
and who need less clinical
care, an arrangement that
frees up beds at TTSH
and allows the acute-care
hospital to care for more
critical patients.
During discussions in
2010 on upgrading TTSH,
the idea to physically expand
and link these different
medical service providers
was conceived. Thus, the
Health City Novena master
plan was born.
Planned for completion in 2030, Health City
Novena will not just be about building a bigger
hospital or having more state-of-the-art facilities, as
this would not be sufficient for a population that is
both increasing and ageing.
In fact, the central region of Singapore has more
elderly people than other regions, and Health City
Novena has been planned as a response to this. It
aims to be a place for excellent healthcare, research
and education, as well as being a community icon
where residents can come together and bond. And
come 2030, it is estimated that the amount of floor
area in Novena dedicated to healthcare would have
Altered
s
ate
Stman
y faces
NOV/DEC 2012
ISSUE 42
BE SAFE,
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NOT SOSTIs
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ON A
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A NEW
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Xiong
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and Menaka
The Jan/Feb 2013 issue of Lifewise has won an Award for
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Diabetes Kris
letting thisway
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winning issues
of Lifewise earned an Honourable Mention in the Best Healthcare/
of Lifewise
Medical Publication category. Lifewise is distributed to GPs
nationwide, and is also available online at www.nhg.com.sg
FEASTING
SMAR T
• AQUA AERO
EASY
BICS MADE
• HEALTHY HOUS
E RULE S
Lifewise JanFeb2013
30
Action for
AIDS president
Roy Chan on
fighting HIV/
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Shape Of
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Heart
EXER CISE RIGHT
•
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An active life is
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with heart dise
Three patients ase.
share how
PUMP ING
•
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cover V4.indd 1
elements to create a sense of arrival and identity to the
area. Lush open spaces, parks, plazas, ecological and
exercise trails will make it more conducive to healing
and wellness.
THE FOUR CS
There are four key design components that make up the
And for easy access, a sheltered boulevard with
Health City Novena master plan — Care, Continuous
shops lining it will cut through Health City Novena
Learning and Innovation, Community and Connectivity.
to Novena MRT Station. A green space called Central
Care will be characterised by the eight new care
Park will be used as a venue for events and activities.
buildings that will be added to the precinct to raise the
Grassroots organisations and residents will be invited
level of specialist care, intermediate care and long-term
to share their thoughts and expectations during the
care in Singapore. These are the new infectious disease
development of the community arenas.
centre; LKCMedicine’s Clinical Sciences Building; NSC’s
Bringing all these facilities and amenities together
expansion wing; TTSH’s expanded ambulatory centre
is the element of Connectivity. About 30,000 people
a day are estimated to visit
and medical educationTTSH when it is completed.
cum-training block; a new
THE MASTER PLAN CONSIDERS
So in order to ensure that
integrated intermediate
the flow of human and
care hub where Dover Park
HOW EACH BUILDING WILL BE SITED
vehicular traffic is smooth
Hospice and an additional
AND LINKED, SO AS TO ENSURE THAT
and safe, all buildings will
second community
be linked at three levels —
hospital will be located; as
COMPLEMENTARY FUNCTIONS CAN BE
above ground, street level
well as the future Health
ALIGNED TO MAXIMISE CONVENIENCE
and basement.
Sciences School and a new
In designing the routes
National Centre.
through Health City Novena, the needs of patients,
The master plan also considers how each of these
staff, students, residents and the general public will be
buildings will be sited and linked to the current and
taken into consideration.
future care buildings, to ensure that complementary
For example, healthcare buildings will be
functions can be aligned to optimise care, comfort and
connected via skybridges to provide inpatients
convenience for patients.
privacy and direct movement. And people coming for
Besides LKCMedicine, Singapore’s third medical
outpatient consultations will find their clinics located
school, there are also plans for two more buildings
nearer to Novena MRT Station for easier access.
for learning: TTSH’s medical education and training
All routes are also planned to be sheltered.
building, and a proposed health sciences school. They
Residents living in the area don’t have to worry about
will create the environment for Continuous Learning
and Innovation in Health City Novena. These will
taking the long way round the new buildings to reach
enable healthcare professionals to constantly upgrade
the MRT station, as an underground walkway from
their skills across a broad range of fields of medicine.
Akyab Road will make the commute a breeze. And to
At the same time, clinical training will be integrated to
keep the surrounding roads as pedestrian-friendly
develop care teams. There will also be a strong focus on
as possible, visitors travelling by car to Health City
the constant review and innovation of care models to
Novena will be encouraged to enter the interconnected
address the increasingly complex needs of patients.
basement car parks immediately upon arrival. About
To integrate with the Community, Health City
4,000 lots are expected to be available.
Novena will create an environment that will draw the
The master plan is set to create an integrated
public in with distinctive architecture and urban design
healthcare development where Healthy Life is Central.
increased by 150 per cent, with some 600,000 sq m of
space used for learning, teaching and healing.
Besides being a hub
for healthcare, the
area aims to be a
community space
conducive to healing.
41
SCHOOL’S IN SESSION!
LKCMEDICINE’S INAUGURAL BATCH OF STUDENTS EMBARK ON THEIR PATH
TO BECOMING PATIENT-CENTRED DOCTORS.
A
fter scoring above the global average in
their BioMedical Admissions Test, on top of
excelling in their A-levels, and subsequently
succeeding in a series of eight interviews,
54 students finally began their semester on 5 August
2013 at Singapore’s newest medical school, the Lee
Kong Chian School of Medicine (LKCMedicine). This
pioneer batch of students was picked from more than
800 applicants after demonstrating they possess the
problem-solving and communication skills required to
be outstanding patient-centred doctors.
The freshmen were
initiated into medicine
at a customary White
Coat Ceremony on
15 August.
42
Jointly set up by the Nanyang Technological
University (NTU) and Imperial College London,
LKCMedicine’s five-year curriculum will teach students
the scientific basis of medicine, as well as how to
cultivate a good doctor-patient relationship. This will be
done by exposing them early on to clinical experience
provided by the National Healthcare Group (NHG), the
school’s principal clinical training partner.
As LKCMedicine Assistant Dean, Associate Professor
Tham Kum Ying, has said, “Medicine is not just about
making star diagnoses. Students need to understand the
value of integrated care and the wide spectrum of clinical
practice.” A/Prof Tham is a senior consultant in the
Emergency Medicine Department at TTSH.
Students will work with patients in a range of
healthcare settings at Tan Tock Seng Hospital, as well as
other partner institutions and polyclinics from as early
as the second month of their first year of study.
As LKCMedicine’s curriculum has a technologically-
advanced focus, the students’ matriculation packages
each include a personal iPad with access to more than
200 e-lectures by professors, clinicians and scientists
as part of the teaching materials developed by
LKCMedicine and NHG.
The iPads will enable students to study the
materials on-the-go as they move between the
school’s two campuses — one within NTU where
their laboratory practicals will be conducted and
another at Novena, which has a 180-seat auditorium,
a 60-seat seminar room, a student lounge as well as
a medical library.
Other cutting-edge learning tools
include the use of plastinated bodies —
human bodies that have been preserved
by replacing the fat and water in body
tissues with plastic — in anatomy
Each LKCMedicine student
is given their own iPad
which enable them to
study on-the-go as
they move between the
school’s two campuses.
THE PIONEER BATCH OF 54
STUDENTS WAS PICKED FOR HAVING
THE PROBLEM-SOLVING AND
COMMUNICATION SKILLS REQUIRED
TO BE OUTSTANDING DOCTORS
classes, a first for Singapore. Assistant Professor
Dinesh Kumar Srinivasan, the Lead for Anatomy
Teaching at LKCMedicine, said the plastinated
human specimens are excellent tools for teaching as
they are durable, safe and non-toxic.
Students will learn anatomy in their first and
second years to build a strong foundation before the
students are given clinical exposure in hospitals in
the third and fourth years.
In addition to using plastinated bodies,
LKCMedicine’s technology-driven lessons will also
incorporate the use of an Anatomage Table which
displays life-sized images of the anatomy using
computed tomography (CT) and magnetic resonance
imaging (MRI) scans.
A model of the school's
Clinical Sciences
Building, to be
completed in 2015, that
will adjoin the existing
Novena campus.
Lab practicals will be
held at NTU.
The school’s headquarters
is housed in an historical
building at Mandalay
Road in Novena.
The school is the first in Southeast Asia to do
virtual dissection on the latest interactive Anatomage
Table. The table’s intuitive touch operation allows
students, for instance, to use a virtual knife to view
the body’s internal structures and at the same time to
fully rotate the body, all with the swipe of a finger.
The students will also learn from histology slides
to understand the microscopic anatomy of human
cells and tissue. From these slides, they will be able to
see at a microscopic level what diseased cells look like,
to aid in their understanding of cells and how these
are affected by various illnesses.
The combination of the plastinated human
specimens, Anatomage Table and histology slides will
allow these students to learn about the entire human
body from the outside in, down to the cellular level,
said Asst/Prof Srinivasan.
LKCMedicine Senior Vice-Dean Professor Jenny
Higham, who has been involved in the school from
the start of its development, said, “The new teaching
materials have been rigorously tested and have
received excellent feedback. We are confident that the
new course will deliver the highest quality of training,
giving [LKCMedicine] students the knowledge, skills
and experience to be top doctors to serve Singapore.”
43
EE
R
A
C
R
G
PRO
R
IO
ESS
N
PATIENT SERVICE
EXECUTIVE
SUPERVISOR
ASSISTANT
SUPERVISOR
SENIOR PSA
PSA
MORE OPPORTUNITIES FOR PSAs
TTSH REVAMPS THE JOB SCOPE OF PATIENT SERVICE
ASSOCIATES TO IMPROVE JOB AND PATIENT SATISFACTION.
T
an Tock Seng Hospital (TTSH) celebrated its
inaugural Patient Service Associate (PSA)
Day on 26 June 2013. Besides honouring
the vital contributions of PSAs in patient
care at the hospital and at other clinics under the
National Healthcare Group (NHG), TTSH also took the
opportunity to announce a redesigned job scope
that will provide PSAs with more opportunities for
professional development, improve productivity
and enhance the patient experience.
As front-line healthcare professionals, PSAs
— numbering 850 in total across NHG — play an
important role in ensuring the smooth running of
clinic operations and maintaining patient relations.
They handle administrative tasks such as assisting
doctors with case notes, making appointments,
registering and billing patients, and handling
general enquiries.
Outstanding service providers are also appointed
as Patient Ambassadors (PAMs) at their respective
outpatient units. PAMs are trained in attending to
the needs, feelings and relationships of patients. On
a typical day, part of the PAM's job scope ranges from
offering drinks and blankets, monitoring waiting
times and updating the patients. Lead PAMs also
coach service teams to improve service standards.
In response to an internal survey conducted
among PSAs, TTSH has revamped their job scope
to enable them to become highly skilled, versatile
professionals. According to the survey, 81 per cent
expressed a desire to learn and perform further patient
services such as financial counselling, patient education
and organising medication. A majority of PSAs also
indicated that they would like to hold leadership
responsibilities and manage a team of associates.
44
Above: Tan Tock Seng
Hospital Chief Executive
Officer Professor Philip
Choo at the Patient
Service Associate Day
celebration ceremony.
The new framework — which was
designed with input from PSAs —
now includes more patient-centric
services in their job duties. There are
now training and learning modules to
teach them the necessary skills and
competencies. Mr Joe Hau, TTSH’s
Director of Operations (Non-Subsidised Services
and Surgery) as well as Advisor for the Job Design
and Career Development workgroup under the PSA
framework, said, “We would like a team of highlyengaged PSAs who will make a positive difference to
our patients’ experience.”
The job redesign also offers PSAs an avenue for
career progression up to executive level. Promotion
to Assistant Supervisor and Supervisor positions will
empower them to manage a team, while the Patient
Service Executive role will give them more leadership
opportunities by giving them the chance to manage
projects to improve work processes. The new initiative
will benefit PSAs by boosting their job satisfaction and
employability. It will also improve patient satisfaction
and relieve the heavy burden often faced by TTSH’s
nurses and pharmacists.
GROWING THROUGH
GOAL-SETTING
WEEKLY GROUP THERAPY HELPS PSYCHIATRIC PATIENTS GET BACK ON THEIR FEET.
F
The PESL team
conducting a
PESL group goalsetting session at
IMH. From left to
right: Dr Joseph
Leong with Senior
Occupational
Therapists
Ms Clare Ang Kai
Yee (seated) and
Ms Vivian Tan Si
Ying. Both Ms Ang
and Ms Tan are from
the Community
Mental Health Team.
or patients with mental health issues,
out in an Asian population, which is culturally more
re-entering society is often a major obstacle.
reserved and conservative. But over the past three
More help is on the way, however, with the
years, approximately 40 patients have joined the PESL
success of the Personal Effectiveness for
group, and there have been signs of success. Among
Successful Living (PESL) pilot programme at the
these patients, a total of 52 personal goals were
Institute of Mental Health (IMH).
identified with 435 specific behavioural assignments
PESL is an ‘empowerment’ programme designed
given, and 74 per cent of these were achieved.
to impart self-esteem, confidence and a sense of
Dr Leong and his team run weekly goal-setting
wellbeing. The programme — originally designed by
sessions with groups of five to eight patients at a
Psychiatric Rehabilitation Consultants at the University
time. Common examples of patients’ goals are getting
of California Los Angeles — is being spearheaded
and keeping jobs, and improving their relationships
in Singapore by Adjunct Assistant Professor Joseph
with their family and friends. Achievement of a goal
Leong, a consultant in the Department of Community
is rewarded with enthusiastic encouragement and
Psychiatry and Deputy Director of the Community
positive reinforcement, which is crucial in building a
Mental Health Team at IMH.
patient’s confidence and ability to relate to others.
The programme is run by psychiatrists and
Some of the patients have successfully been
occupational therapists (allied health professionals who
employed, and a few have gone on to further their
help patients develop or recover their daily
education. One such patient, who wanted only to be
living and work skills). It is designed to help psychiatric
known as Mr Tan, 44, had been in and out of hospitals
patients who have reduced communication and problemmore than 20 times over the years due to a difficulty in
solving skills achieve
controlling his moods.
their personal goals.
But after four PESL
WITHOUT DR LEONG, I WOULD NOT
When Dr Leong first
sessions with Dr Leong,
implemented PESL in
Mr Tan was confident enough
BE A HUMAN BEING. AFTER SEEING
2010, there were doubts
to apply for a job. He became
HIM, MY HOSPITAL ADMISSIONS
whether the groupa Patient Service Associate
WERE ALSO DRASTICALLY REDUCED
based therapy could
for two years, and is currently
PESL PARTICIPANT MR TAN
be successfully carried
employed as a sales assistant.
Said Mr Tan, “Every
doctor is caring, but Dr Leong is special. He
helped me to get back to society. He kept calling
me to check on my recovery. He cut down my
medications so that I would not feel so tired.
Thanks to him, I got a healthcare certificate and
was promoted to healthcare assistant.”
There are now five PESL groups in Singapore
that meet regularly, including one launched
together with community partners at Hougang
Care Centre. Dr Leong has plans to spread PESL
to Simei Care Centre, Bukit Gombak Group
Home, Sunlove Home and Club Heal, with more
involvement by community partners.
He has also launched a monthly PsychoSocial Rehabilitation Clinic where patients,
accompanied by a caregiver, get individual
coaching sessions from him and an
occupational therapist.
For his work in helping to rehabilitate
patients with mental health issues, Dr Leong
received the PS21 Distinguished Star Service
Award in May this year.
45
BRINGING THE HOSPITALTO YOU
WITH A NEW CARE SERVICE, TAN TOCK SENG HOSPITAL SEEKS TO
DELIVER HEALTHCARE STRAIGHT INTO PATIENTS’ HOMES.
T
Far right: A/Prof
Muhammad Faishal
Ibrahim at the launch
of the Virtual Hospital
programme.
an Tock Seng Hospital (TTSH) has officially
launched the Virtual Hospital (VH)
programme, a free service that brings care
directly to patients’ homes. The programme,
launched on June 19, provides medical and social
support to patients who are fit to resume their daily
lives but still require close monitoring of their chronic
conditions. Up till now, these patients — who are
usually elderly and do not have strong social support
at home — often sought treatment at TTSH’s
Emergency Department, sometimes unnecessarily.
Since the programme was first rolled out in a pilot
phase in August 2012, more than 80 patients have
joined, and preliminary results have been encouraging.
Some 30 per cent of them did not require re-admission
to hospital, and 60 per cent managed to keep
themselves well enough to not need urgent
treatment at the Emergency Department.
The VH programme takes in patients
who have been in and out of TTSH five or
medical social worker and case manager all rolled into
one — plans the patient’s care programme with the
patient’s primary physician. The VH Health Manager
also works with community partners such as Ang Mo
Kio Family Centre Service, Central Singapore CDC
and Home Nursing Foundation to conduct home
visits, monitor the patient over the phone and carry
out medical reconciliation, to ensure that the patient
follows medication prescriptions.
At the launch of the VH programme,
Parliamentary Secretary for Health, A/Prof
Muhammad Faishal Ibrahim, said, “The collaborative
approach of the VH involves Tan Tock Seng
Hospital’s proactive engagement of its community
partners. It is a good example of the joint effort
spanning healthcare and
community resources in caring
for needy patients.”
When VH patients are stable
enough, they are transferred to
the care of relevant community
partners near their homes for
follow-up treatment. Some
partners provide home medical
care and nursing services,
medication reconciliation and
therapy services, while others
WITH HELP FROM MY BEFRIENDER
AND MY HEALTH MANAGER, I TAKE
MY MEDICATIONS REGULARLY AND
TRAVELLING IS NOT A PROBLEM
75 YEAR-OLD MR GERARD PALANIAPPA, WHOSE QUALITY OF LIFE
HAS IMPROVED SINCE ENROLLING IN THE VH PROGRAMME
Above: Virtual
Hospital patient
Mr Gerard Palaniappa
(left) at his
home with his
VH Health Manager,
Mr Jesmond Oh.
46
more times in a year and have at least two chronic
conditions that require monitoring. TTSH treats
700 to 800 elderly patients annually who have been
admitted to hospital at least five times in a year.
“The Virtual Hospital identifies those who might
require hospital treatment in the future, and then
provides the attention they need,” said Associate
Professor John Abisheganaden, Programme Advisor
of the Virtual Hospital Programme and Senior
Consultant of the Department of Respiratory and
Critical Care Medicine at TTSH.
Enrolled patients are assigned a VH Health
Manager who is familiar with his or her patient’s
conditions. The VH Health Manager — who is a nurse,
provide social services like befriending the patients
to ensure their continued wellness.
One senior who has benefited from the VH
programme is 75 year-old prostate cancer survivor
Mr Gerard Palaniappa who also has multiple chronic
conditions. He takes 10 different types of medicine
every day. Since enrolling, Mr Palaniappa has only
had to visit the TTSH Emergency Department twice.
“Simple household chores and going to the bathroom
used to be very difficult,” he said. “But with help
from the community partners near my home, my
befriender and my Health Manager, I feel much
better. I take my medications regularly and travelling
by bus to church is no longer a problem.”
STANDING
OUT
TAN TOCK SENG HOSPITAL’S DR NELSON CHUA
WAS THE ONLY DOCTOR THIS YEAR TO RECEIVE
THE SAF NSMAN OF THE YEAR AWARD.
PREPARED IN
TIMES OF DISASTER
DELEGATES FROM THAILAND VISITED IMH TO LEARN MORE
ABOUT MENTAL HEALTH CRISIS ASSESSMENT AND
MANAGEMENT DURING NATURAL DISASTERS.
P
Delegates from
Thailand were here
to give advice gained
from surviving the
massive floods in
Bangkok in 2011.
arts of Southeast Asia are prone to
calamities such as flooding, earthquakes
and typhoons, due to their geographical
location. In recent years, Thailand has been
affected by floods that devastated many parts of the
country and greatly impacted the lives of its people.
In order to build capacity in the areas of mental
wellbeing and resilience to support disasterpreparedness and the recovery of communities that
have been affected by such crises, 40 healthcare
professionals from Thailand participated in an
intensive “Training-of-Trainers” (TOT) session,
conducted both in Bangkok and Singapore between
June and July 2013.
This TOT session is part of a three-year Disaster
Mental Health Programme for Communities in Asia
that Singapore’s Institute of Mental Health (IMH)
embarked on with Thailand’s Galya Rajanagarindra
Institute (GRI) in August 2012 to better support
healthcare professionals and community-based
workers in their preparedness against crises.
The successful completion of the TOT course
marked the first milestone for both IMH and GRI,
with the emergence of the programme’s first group of
master trainers who will, in turn, train communitybased helpers that work directly with individuals
affected by crises in their country.
IMH and GRI embarked on the threeyear programme in 2012 to prepare healthcare
professionals and their community to be able to
face natural disasters. This preparation for crises is
helpful in the recovery of affected communities.
IMH is also collaborating with healthcare
institutions in China and Indonesia on similar
programmes. The total cost of the programme
for these three countries is $2.38 million, largely
supported by a grant of $1.96 million from the
Temasek Foundation.
T
he Singapore Armed Forces (SAF)
commemorated its 45th SAF Day at a
parade officiated by President Tony Tan
Keng Yam at the SAFTI Military Institute
on 1 July 2013. At the parade, more than 3,000
SAF regulars, NSmen and full-time National
Servicemen reaffirmed their commitment to the
defence of Singapore.
At a reception afterwards, Minister for Defence
Dr Ng Eng Hen presented the SAF NSman of the
Year awards to 13 NSmen. “I am proud to see our
soldiers, sailors and airmen — both regulars and
National Servicemen — perform their duties with
commitment, professionalism and fighting spirit to
keep Singapore safe and secure,” he said.
One of this year’s recipients was LTC (NS) (DR)
Nelson Chua, Executive Director of Operating
Theatre and Senior Consultant, Department of
Anaesthesiology, Intensive Care and Pain Medicine,
at Tan Tock Seng Hospital (TTSH). Dr Chua also
holds the distinction of being the only doctor this
year to receive this prestigious award.
Dr Chua, who has been a reservist since 1997,
is the Chief Anaesthetist of his unit, the Naval
Ship Hospital 1 (NSH 1). Besides being involved in
military exercises and humanitarian missions, he
has been on four overseas SAF-related missions.
He was involved in the Yogyakarta earthquake
relief mission in 2006 as well as a United States-led
Pacific Partnership mission in Vietnam.
Dr Chua was “surprised and honoured” to
receive the award. “I have to thank my family,
department and hospital for their support. It is
meaningful to me as I get to serve my country and
help people in need of medical care,”
LTC (NS) (DR) Nelson
he said. He hopes to volunteer his
Chua (centre) receiving
service for as long as he can. This
his NSMan of the Year
Award from Defence
is something he can do, thanks to
Minister Dr Ng Eng Hen
the good work-life balance which
(right). On the left is
Dr Chua’s wife.
TTSH offers.
47
DIRECTORY
WE’VE MADE IT EASY FOR YOU TO CONTACT OR LOCATE US.
health centres, equipped with
support facilities such X-ray
services, mammography, ultra
sonograms and pharmacies
which carry a wide range of
drugs and non-medical items.
ANG MO KIO POLYCLINIC
Blk 723 Ang Mo Kio Ave 8
#01-4136 Fax: 6458-5664
NATIONAL
HEALTHCARE GROUP
CORPORATE OFFICE
6 Commonwealth Lane
Level 6, GMTI Building
Singapore 149547
Tel: 6496-6000 /
Fax: 6496-6870
www.nhg.com.sg
The National Healthcare
Group (NHG) was created in
2000 as part of a national
restructuring of Singapore’s
public healthcare delivery
system into two operative
clusters.
As a leader in public
healthcare in Singapore, NHG
is recognised at home and
abroad for the quality of its
outstanding medical expertise
and state-of-the-art facilities.
Care is provided through
an integrated network of
primary healthcare polyclinics,
acute care hospitals, national
specialty centres, innovative
and business divisions.
Together, they bring a legacy
of 340 years of medical
expertise to our patient-centric
care philosophy.
TAN TOCK SENG
HOSPITAL
11 Jalan Tan Tock Seng
Tel: 6256-6011 /
Fax: 6252-7282
www.ttsh.com.sg
The second largest acute
care general hospital in
Singapore with specialty
centres in Endoscopy,
Foot Care & Limb Design,
Rehabilitation Medicine and
Communicable Diseases.
It covers 27 clinical specialties,
including cardiology, geriatric
medicine, infectious diseases,
rheumatology, allergy and
immunology, diagnostic
radiology, emergency
medicine, gastroenterology,
otorhinolaryngology,
orthopaedic surgery
and general surgery.
48
INSTITUTE OF
MENTAL HEALTH
Buangkok Green Medical Park
10 Buangkok View
Singapore 539747
Tel: 6389-2000 / Fax: 6385-1050
www.imh.com.sg
Specialist mental health
services are provided to meet
the special needs of children
and adolescents, adults and
the elderly. There are subspecialty clinics such as the
Neuro-Behavioural Clinic,
Psychogeriatric Clinic, Mood
Disorder Unit and an Addiction
Medicine Department. The
treatment at IMH integrates
evidence-based therapies,
supported by the departments
of Clinical Psychology, Nursing,
Occupational Therapy and
Medical Social Work, to provide
holistic care for patients.
IMH also provides a 24-hour
Psychiatric Emergency Service.
1 Mandalay Road
Tel: 6253-4455 / Fax: 6253-3225
www.nsc.gov.sg
The centre has a team of
trained dermatologists to treat
patients with various skin
problems. To serve patients
better, there are sub-specialty
clinics for the different skin
disorders and laser surgeries.
NATIONAL HEALTHCARE
GROUP POLYCLINICS
Contact centre: 6355-3000
www.nhgp.com.sg
National Healthcare Group
Polyclinics (NHGP) forms the
primary healthcare arm of
the National Healthcare
Group (NHG).
Its clinics provide a
comprehensive range of
health services for the family,
including treatment for acute
medical conditions; chronic
diseases, dental care and
selected specialist services.
Its clinics are one-stop family
BUKIT BATOK POLYCLINIC
general X-ray, mammogram,
ultrasound, bone mineral
densitometry, and medical
courier.
It also provides teleradiology service, laboratory
and radiology management,
and professional consultancy
services in setting up of
imaging centres and clinical
laboratories.
50 Bukit Batok West Ave 3
Fax: 6566-2208
CHOA CHU KANG POLYCLINIC
2 Teck Whye Crescent
Fax: 6765-0851
CLEMENTI POLYCLINIC
Blk 451 Clementi Ave 3 #02-307
Fax: 6775-7594
HOUGANG POLYCLINIC
89 Hougang Ave 4
Fax: 6386-3783
JURONG POLYCLINIC
190 Jurong East Ave 1
Fax: 6562-0244
TOA PAYOH POLYCLINIC
NHG PHARMACY
Tel: 6478-2478
www.pharmacy.nhg.com.sg
NHG Pharmacy runs retail
pharmacies in NHG Polyclinics,
which include over-thecounter medicines, health
supplements, and surgical
and medical equipment at
affordable prices.
2003 Toa Payoh Lor 8
Fax: 6259-4731
WOODLANDS POLYCLINIC
10 Woodlands St 31
Fax: 6367-4964
YISHUN POLYCLINIC
30A Yishun Central 1
Fax: 6852-1637
NHG COLLEGE
Tel: 6478-2446 / Fax: 6259-6423
www.nhg.com.sg/college
The unit develops healthcare
professionals to their maximum
potential so that they will
provide quality, cost-effective
and safe evidence-based care
to patients.
NHG DIAGNOSTICS
Call centre: 6275-6443
(6-ASK-NHGD) / Fax: 6496-6625
www.diagnostics.nhg.com.sg
National Healthcare Group
Diagnostics (NHG Diagnostics)
is a business division of NHG.
It is the leading provider
in primary healthcare for onestop imaging and laboratory
services that is accessible,
cost effective, seamless, timely
and accurate.
NHG Diagnostics supports
polyclinics, community
hospitals, nursing homes,
general practitioners and
the community at large via
its extensive network in
Singapore, Indonesia and
Vietnam.
Its services are available
in static and mobile centres.
The mobile services include
PRIMARY CARE ACADEMY
Tel: 6496-6681 / Fax: 6496-6669
www.pca.sg
The Primary Care Academy
(PCA), a member of NHG,
was set up to meet the
professional training needs
of primary healthcare
professionals in Singapore and
the region.
PCA aims to be a platform
for sharing of expertise and
capacity building among
community healthcare leaders
and practitioners in and around
ASEAN.
JOHNS HOPKINS
SINGAPORE INTERNATIONAL
MEDICAL CENTRE
11 Jalan Tan Tock Seng
Tel: 6880-2222 / Fax: 6880-2233
www.imc.jhmi.edu
Johns Hopkins Singapore
International Medical Centre
(JHSIMC) is a licensed
30-bed medical oncology
facility located in Singapore, a
joint venture between the NHG
and Johns Hopkins Medicine
International (JHMI).
It is the only fully-branded
Johns Hopkins facility
outside of the United States,
providing inpatient and
outpatient medical oncology
care, medical intensive care,
laboratory services, hospital
and retail pharmacy, general
internal medicine and health
screenings.
BO
LA
RATOR
Y
O
DIOL GY
RA
PR
SERVICE LOCATIONS AT
O
NHG POLYCLINICS :
S
FE
SIONAL
S
VICES
ER
PRIVATE CENTRES/
HOSPITALS :
MOBILE SE
MOBILE SERVICES
IC
RV
ES
D I C AL C
ME
O
UR
IER
Mammogram services available at:
To book your mammogram
appointment, contact
6-ASK-NHGD (6-275-6443)
All National Healthcare Group Polyclinics
Ang Mo Kio
Bukit Batok
Choa Chu Kang
Clementi
Hougang
Jurong
Toa Payoh
Woodlands
Yishun
Mammobus