me+SH (August 2009) by me+SH

August 09

A SingHealth staff publication

Advancing Clinical Trials Paving the road ahead

Eye on Research

Prof Wong Tien Yin about SERI

Happy Nurses Day!

SingHealth celebrates with a bang

Special Features

Honouring our nurses

04-06

Contents • Foreword by Prof Fong Kok Yong

01-02 me+YOU

• Groundbreaking surgery at National Heart Centre (3) • Honouring our nurses (4-5) Clinician-scientist award winners (6-7) • Working together for better outcomes (8-9) • Quicker X-rays (10) • New Inspirational Patient Award (11) Vibrant Campus: medical student Dixon Grant and Clinician-scientist Dr Gopal Iyer (12-13) • MICO wins big (14)

03-15

me+GROUP

Working together for better outcomes

08-09

• New diploma for healthcare leaders (15) Advancing clinical research in Singapore (16-17)

• • •

An eye on research (18-19) Medical social workers write a book (20-21) Humanitarian aid with impact (22-24) Children face shorter wait for MRI scan (25)

16-26

me+SPOTLIGHT • • • •

Advancing clinical research in Singapore

16-17

At Home With... Dr Camilla Wong (26-28) Speak up to communicate better (29) Expert advice on how to stay healthy (30-31) Book review (32)

SingHealth Editorial Team Tan-Huang Shuo Mei Amelia Champion Katheryn Maung Jeanie Cheah Arthur Wong Mediactive Editorial and Design Team Lyon Low Florence Long Sher Maine Wong Mediactive Pte Ltd 65 Ubi Crescent #06-07 Hola Centre Singapore 408559 T: 6846 4168 | F: 6846 4768 info@mediactive.com.sg www.mediactive.com.sg

me+SingHealth or me+SH represents who we are in SingHealth—as intertwining threads conveying synergy and complementing one another to form a beautiful fabric. me+SH links you to the action in all of SingHealth and around the healthcare industry. Do check out me+SH Online (http://mysinghealth/Singhealth/ MeSH) and me+SH Flash in your emailbox too!

27-32

me+LIVING • The Lighter Side (34) • Challenge the challenges (35)

34-35

me+SMILES • Medical milestones in history (36) • Upcoming events

me+HORIZON

Patients. At the Heart of All We Do.

All rights reserved. Reproduction in whole or part is prohibited without the written permission of SingHealth and the publisher. The views and opinions expressed or implied in the publication are those of the authors or contributors and do not necessarily reflect those of SingHealth and the publisher. Whilst due care has been exercised, both SingHealth and the publisher do not accept responsibility for errors in advertisements or articles, unsolicited manuscripts, photographs or illustrations.

MICA(P) 059/03/2009

me+YOU

Igniting

the Spirit of Inquiry

Prof Fong Kok Yong Group Director, Clinical Research, SingHealth; Chairman, Division of Medicine, SGH

me+YOU

Extraordinary

research M

edical breakthrough is made possible through research. In science as it is in healthcare, the equation for success includes passion, commitment and teamwork. This issue of me+SH pays tribute to some of the keenest inquiring minds in Singapore’s medical circle and the groundbreaking work they are doing.

On The Cover

Prof Wong Tien Yin Director, Singapore Eye Research Institute, Senior Consultant Ophthalmologist, SNEC Prof Wong leads a research programme on retinal diseases, including diabetic retinopathy, age-related macular degeneration, early retinal vascular changes and the use of novel retinal imaging techniques to predict cardiovascular disease. He is the recipient of the inaugural 2008 Singapore Translational Researcher Award (STaR) and the 2009 NUS Outstanding Researcher of the Year award. Find out how Prof Wong keeps a keen eye on research on pg 18 - 19.

Prof Kanaga Sabapathy Principal Investigator, NCCS Prof Sabapathy’s research focuses on understanding the cause and nature of genetic changes in human genes so that efficient molecularbased therapeutic strategies can be developed to eradicate cancerous cells. When normal cells are subjected to various environmental factors, they can react in various ways. By studying these reactions, Prof Sabapathy and his team are then able to gain useful insights into how cell-fate is determined. Understanding a normal cell’s working pathways will allow the identification of suitable molecular targets for therapy and the design of better approaches to treat cancer.

Wang Hongyan, Ph.D. Assistant Professor of neuroscience and behavioural disorders, Duke-NUS A/Prof Wang was instrumental in discovering a tumoursuppressor gene in flies and its mammal counterpart that may provide insights for human brain tumours. A/Prof Wang and her team found that the fruit fly protein PP2A has the ability to suppress brain tumour formation and controls the balance of self-renewal and differentiation of neural stem cells.

first in Asia to repair heart valve the non-invasive way The National Heart Centre Singapore offers a lifeline to ailing heart patients who might not qualify for open-heart surgery. By Sher Maine Wong cardiac anaesthetist Dr See Tho Ving Yuen and echo cardiologist Dr Lee Chung Yin. Said Dr Victor Chao, citing key challenges faced:

“A good outcome for the patient is heavily dependent on close cooperation and teamwork within the small group of operators, each with specific roles. This has encouraged us to work even more closely than we did before, fostering mutual understanding and regard.”

The procedure is a lifeline for patients with severe valvular diseases who might have multiple medical problems or other health issues, and who are deemed unsuitable for open-heart surgery. A small hole is made either in the groin or chest for the catheter to pass through, and recovery time is shorter. “Open heart surgery is still the gold standard,” said interventional cardiologist Dr Paul Chiam. “This is a relatively new procedure in which we must be very precise. But it is an achievement because we are the first in Asia to carry it out, and it is testimony to our medical technology and skill.”

he challenge: Carefully navigate a wire-like catheter through a maze of blood vessels to the intricate chambers of the heart, pass a special gadget along that catheter to the exact spot where a heart valve is blocked, expand the gadget so it acts like a pipe to prop open the valve, then carefully pull out the catheter leaving the gadget in place. At all times, the only images guiding the entire procedure are onscreen – the patient is never cut open – and the heart plays havoc with precision as it is pumping away. The heart is not stopped. Percutaneous (through the skin) aortic valve replacement (PAVR) is a delicate coordination procedure which involves a team of six doctors all playing crucial roles – unlike Did you know…? open-heart surgery where the key responsibility An interventional cardiologist deals specifically with the catheteris with the surgeon. It is for those who suffer based treatment of heart diseases such as coronary angioplasty and from Severe Aortic Stenosis, when the heart valves cardiac catheterisation. become narrower or are obstructed. Approximately 4 per cent of those above 75 A cardiac surgeon specialises in heart operations such as coronary years old in Singapore have this disorder. With artery bypass, valve replacement or repairs, heart transplants, and an ageing population and longer life expectancy, repairs of complex heart problems present from birth (congenital the need for surgery to replace heart valves will heart disease). They are also qualified to operate on organs other continue to escalate. than the heart, such as the lungs, esophagus, and blood vessels. The National Heart Centre Singapore (NHC) was An echo-cardiologist deals specifically with diagnosing the first in Asia to carry out PAVR and six patients cardiovascular diseases via ultrasound techniques such as have gone through it since February. echocardiogram and transesophageal echocardiogram. The medical team which performed the first case included interventional cardiologists A cardiac anaesthetist is a physician who specialises in providing A/Prof Koh Tian Hai and Dr Paul Chiam, cardiac anaesthesia care for patients undergoing either cardiac (heart), surgeons Dr Chua Yeow Leng and Dr Victor Chao, thoracic (lungs) or vascular (blood vessels) surgery.

me+GROUP

National Heart Centre –

me+GROUP

Nurses’ Day 2009: Highlights By Jeanie Cheah

abulous Inspiring Talent (FIT) – this fitting description of our nurses is also this year’s theme for Nurses’ Day at SingHealth. A whole host of events took place leading to Nurses’ Day on 1 August.

Planting the seeds of appreciation Tending the garden is a labour of love very similar to nursing. For the first time ever, our gardens sprouted with flowers and messages of joy and appreciation for SingHealth nurses. This was made possible with sponsorship from our supportive partners, Lee Foundation and SGH Medical Lounge. A Wall of Appreciation has also been put up at SGH, outside Clinic G near block 3, and at CGH, close to the staff canteen. And two SBS Transit buses, services 33 and 174, have specially been decorated with our festive Nurses’ Day greetings.

Nurses’ Day Party Although some risk-mitigation measures have been taken this year due to the H1N1 situation, this year’s celebration of our nurses was no less elaborate. If anything, the logistics involved in staggering the attendance at the party grounds to avoid a massive gathering meant much more work went into the planning. Hampers were sent to nurses in every ward to show our senior management’s appreciation for their untiring efforts in these stressful times. We were privileged to have Manpower Minister Gan Kim Yong join us in paying tribute to our nurses. In addition to visiting our colleagues at Outram Polyclinic, Mr Gan took a bus ride with nurses on our special SingHealth bus. He also led in Stretchercise, a cool set of exercises, specially formulated by the physiotherapy team from SGH Life Centre.

Book Launch In conjunction with Nurses’ Day, our prolific SingHealth nurses launched their sixth publication, Wound Management Guide for Healthcare Professionals. With contributions from allied health professionals and doctors, this book shares the best practices in wound management that every healthcare professional would find useful. Said A/Prof Lim Swee Hia, Group Director of Nursing, SingHealth, “Wounds can affect patients physically, socially and psychologically, and some patients have to live with a wound till the end of their lives.”

The book reflects the remarkable advances in wound management that help improve the quality of life for patients.

Earlier publications by SingHealth nurses: • Cultural Journeys by Nurses for Nurses • Pictorial Communication Aid • Pharmacology for Nurses: A Quick Guide Book • SHS Pocket Guide for SingHealth Nurses • SingHealth Language Cue Book

President’s Award for Nurses Congratulations to winner Ms Lim Siok Hong, Senior Nurse Clinician, KKH! Ms Lim leads the hospital’s Infection Control Unit, activating protocols and implementing crucial measures that safeguard her patients and the community against infections. She is the Programme Director for the MOH Voluntary Opt-out HIV Screening for inpatients and has been chairing the Infection Control Chapter of Singapore Nurses’ Association since 2005. Other awards given out on Nurses’ Day 2009: • SingHealth – Lee Foundation Nursing Awards • SingHealth – Alice Lee Institute of Advanced Nursing Scholarships • Dr Della Lee Nursing Bursary Awards • SingHealth Health Science Top NYP Nursing Awards • SGH CEO Best Clinical Nurse Awards • SingHealth Nursing Debate awards For a full listing of award winners, visit SingHealth Desktop Portal>>http://mysinghealth

the Wounded

me+GROUP

Care for

Once in a while, there may be a patient whose wound is gangrenous and will not heal. Ms Tay believes that the least she could do is Behind every wound, there is a story. And Ms to dress the wound properly Tay Ai Choo, Senior Nurse Clinician at SGH, has and conceal the odour to treated enough wounds in her career to explain boost the self-esteem of the the causes of many of the wounds she sees on patient. a daily basis. me+SH turns the spotlight on a Having seen pictures of the wound specialist this Nurses’ Day. Ms Tay Ai Choo various wounds Ms Tay has encountered, I am convinced that in addition to passion, t the start of this interview, I was rather taken aback wound care takes courage and a very strong stomach. by Ms Tay Ai Choo’s forthright declaration. I left the interview with the feeling that nursing is really “Mine is a job which interest alone is not enough a labour of love, not just any old job. And long after the to sustain. There is no glamour in the job. Passion is what interview, Senior Nurse Clinician Tay’s words continue to drives me. That and my belief in doing my best for my resonate in my mind, “Better than any award is a patient patient.” who remembers me.” In the earlier days of her nursing career, Ms Tay was Kudos to Ms Tay and all nurses. trained in both oncology and stoma care. Over time and with more experience in the area of wound management, her interest in helping patients heal from their wounds developed Nurses and their Specialty into a real passion. Nurses who specialise in particular disciplines are Specialty Hers is an uncommon route in the local nursing Care Nurses. In addition to a basic degree, they need to have scene. The only local nurse accredited as a Certified an advanced diploma in their specialty. They will be developed into the role of Advanced Practice Nurses if they undertake Wound Specialist by the American Academy of Wound the clinical master’s programme and complete the required Management, Ms Tay is one of 2,800 healthcare internship after the training. professionals in the world. In addition to the Wound Care Specialty, other specialty Because wounds are a common sight in any hospital, areas include: all nurses need to know about them. But being a wound • Acute/Chronic Pain • Neuroscience specialist means that Ms Tay knows a whole lot more about Management • Nutrition Support wounds – their origins and the appropriate dressing – than • Breast Cancer Care • Obstetrics the average nurse would. • Children’s Hospital • Oncology Emergency Transport • Ortho-geriatric She sees many patients with complex wounds or wounds Service • Orthopaedic that are not healing. These patients usually suffer from • Cleft and Craniofacial • Osteoporosis and Bone chronic ailments such as diabetes. Ms Tay works closely on • Community Care Metabolism their care and management with fellow nurses, doctors and • Coronary/Cardiovascular • Paediatrics Care • Paediatric Palliative Care allied health colleagues, especially podiatrists. • Critical Care • Paediatric Home Care Ms Tay speaks very animatedly about her work and • Dementia Care • Plastic Reconstructive passion, “Each wound has its own individual character, and • Dermatology and Breast • Diabetes • Psychological Medicine needs to be dressed accordingly. In order to heal, wounds • Ear, Nose & Throat (ENT) • Radiology need a moist environment that encourages cells to grow. • Endocrine Care • Rehabilitation “A wound nurse has to be creative. When I visit patients in • EYE/ Opthalmology • Respiratory Medicine • Emergency Care • Rheumatology and their homes, I teach them and their family how to modify the • Gastroenterology Immunology things around them to suit their needs especially when they • Geriatrics • Spinal Care have to do dressings at home.” • Gynaecological Cancer • Sports Medicine For Ms Tay, wound management is both a science and an • Hepatobiliary • Stomatherapy • Infection Control • Trauma Service art. Science because it involves hard facts and technology, • Lactation Services • Urogynaecology and art because it is highly skilled and there is a strong • Mental Health • Urology element of creativity in the holistic care that she provides with • Neonatology • Vascular Care a deep understanding for their feelings and self image”.

me+GROUP 06

Gastric cancer

researcher

wins award Dr Ling Khoon Lin never thought of being a researcher but his laboratory work is now paying off. By Sher Maine Wong

ut of 10 people reading this article, three or four have a bacterium called Helicobacter pylori in their stomachs. Of this group, 2 per cent will develop stomach cancer. Scientists believe that the bacterium is almost always responsible. The question is: Why is it that the other 98 per cent can live healthily with the bacteria? “Clearly it’s not just the germ which causes cancer,” said Dr Ling Khoon Lin, a consultant at the Singapore General Hospital’s (SGH) Department of Gastroenterology & Hepatology, “but the way our immune systems react to the germ that determines who eventually gets cancer.” Dr Ling has just won a Clinician Scientist Award by the National Medical Research Council for his work in trying to discover why some people develop stomach cancer in reaction to the bacterium, and if there is any way to mitigate this. If Dr Ling’s research comes to fruition, what may happen in five to 10 years’ time is that a tiny bit of tissue taken from the stomach can tell doctors if a patient is at higher risk of developing gastric cancer – before it takes root – and there may be ways to reduce the cancer risk. He spends 30 per cent of his time seeing patients with gastric and intestinal problems at SGH and the rest doing his research. It was not something he planned for, not when he graduated from the National University of Singapore in 1993. Dr Ling states point-blank: “I was not interested in laboratory work.” Like most of his peers, he seemed destined to become a full-time clinician. It was a four-year overseas stint at the Oxford University in the United Kingdom that completely changed his outlook. “The department that I went to had a very strong research focus and I was literally thrown into the lab,” said Dr Ling. “The whole culture is such that I have a question and I try to find out the answer myself, instead of having someone answer for me.” “In Singapore, we don’t really have the time to think a little bit deeper (in terms of research). We are so busy seeing patients.” Now he finds research deeply satisfying.

“The joy is in translating what I have found into something that will change the way we manage our patients.”

me+GROUP

Cultivating

a clinicianscientist culture

edical advancement is only possible when new discoveries are made and applied to our daily lives. To encourage new discoveries, the Clinician Scientist Award was introduced in 2004 to provide protected time for clinician scientists to do internationally competitive research. The award funds full salary support along with a competitive research grant at two levels – Senior Investigator and Investigator. Besides Dr Ling, the other 2009 Clinician Scientist Award winner from SingHealth is Dr Joseph Wee, a Senior Consultant at the Department of Radiation Oncology at the National Cancer Centre Singapore. He is conducting research on a new treatment for Nasopharyngeal Cancer, which ranks sixth in cancer incidences among all male Singaporeans, to improve the cure rate and overall survival. Another 2009 winner is A/Prof Tai E Shyong, formerly with SGH’s Department of Endocrinology. He takes a closer look at the causes and effects of obesity, high blood pressure, diabetes and high cholesterol in Singapore. The award builds on the work he has done at SingHealth as a clinician scientist over the past seven years.

2008 Clinician Scientist Award winners Associate Professor Tan Eng King - Senior Investigator National Neuroscience Institute (NNI) Department of Neurology at Singapore General Hospital (SGH) Duke-NUS Graduate Medical School Research: Identify genetic risk factors for essential tremor and various areas of clinical and laboratory research in related neurodegenerative diseases that are extremely relevant to the ageing Singaporean population.

Associate Professor Aung Tin - Senior Investigator Singapore National Eye Centre and Department of Ophthalmology, Yong Loo Lin School of Medicine, NUS Research: Improve the characterisation of angle closure

glaucoma, to improve the understanding and management of the disorder.

Associate Professor Ong Sin Tiong - Senior Investigator Duke-NUS Graduate Medical School Singapore Research: Improve the response rates to treatment and minimising therapy-related toxicities for leukaemia patients.

Associate Professor Allen Yeoh Eng Juh - Senior Investigator Department of Paediatrics, Yong Loo Lin School of Medicine, NUS University Children’s Medical Institute, National University Hospital Research: Customised treatment for childhood leukaemia, taking into consideration the genetic makeup of the child

me+GROUP

Working

together for

better outcomes 08

From service quality to legal resources to how hospitals respond to the H1N1 situation, working together pays off. me+SH zooms in on how SingHealth institutions unite to achieve more effective and efficient emergency planning and responses, strengthening our defence against threats such as H1N1.

hen the H1N1 virus surfaced, a room on Level 3 of the SGH Bowyer Block was immediately converted into a very special room which Eileen Lew, Head, Preparedness & Response, SingHealth and SGH, calls the “war room”. It is where over 30 top-level strategy and operations heads meet to map out war tactics against the H1N1 virus, and initially only those at SGH Outram Campus were involved. Now, colleagues from Changi General Hospital, the KK Women’s and Children’s Hospital and the SingHealth polyclinics are in the team, collectively known as the SingHealth Cluster Emergency Response Command Centre. “This is so that we can better coordinate a consistent approach and response to the outbreak situation, so policies are standardised,” said Ms Lew. Dr Wong Yue Sie, the Group COO of SingHealth, COO of SGH, and also chief of staff at the Command Centre added: “Cluster alignment also means we can benefit from team synergies, and share resources. For instance, sharing of laboratory PCR testing resources for H1N1 as this is a relatively new test and it took time

to build up testing capacity in all the hospitals.” Dr Wong has the mammoth task of streamlining processes to achieve cluster alignment and strengthen the integration of Operations within the group. Integration is necessary to capitalise on our unified yet diverse strengths and optimise resource utilisation. Said Dr Wong: “The need for integrated emergency management at Outram Campus level was highlighted during SARS. Now we have included the entire SingHealth cluster. Our challenge in the beginning was the many uncertainties as we were making swift decisions and ensuring that actions were well-executed down the chain of command.”

The H1N1 strategy is one instance of a macro co-ordinated response, and the outcome of collaboration is clear: patients can expect consistently vigilant treatment across all of SingHealth’s institutions.

During a group operations retreat in March involving 124 SingHealth staff, participants were reminded that when it comes to emergency preparedness, integration can be in the form of collaborating on joint emergency preparedness activities like infection control training sessions and exploring areas for mutual support like in manpower and equipment. Some of the other ideas for integration discussed during the retreat include: • Standardising service quality feedback forms across clusters so there is a better basis for comparison • Sharing of in-house service excellence training content and resources • Creating a cluster legal register with one source of expertise, to advise institutions on the impact of new legislations • Extend institution-based accredited training programmes to all SingHealth institutions

Responding to

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H1N1

Me+SH finds out how KKH and the SingHealth polyclinincs respond swiftly to the evolving H1N1 situation. 09

KK Women’s and Children’s Hospital

ecause of KKH’s expertise and experience with children and expectant mothers, KKH stepped up to take the lead in handling all paediatric and obstetric H1N1 cases in Singapore. KKH has adopted the following measures to deal with the situation: • Formation of multi-disciplinary task force team comprising medical and nursing personnel, operations and support services. • Upgrading wards 46, 41, and 51 with custom-built facilities for isolation to cope with the anticipated surge in H1N1 patients. In addition, wards 61 and 62 were designated cohort wards to house confirmed cases.

Before

After

• Maintaining swift communications through the KKH intranet. This site serves as a single, updated point of reference for all information, protocols and updates on the hospital’s measures related to H1N1. • Enhancing infrastructural support such as visitor screening and registration system, 24-hour laboratory standby for tests, and centralised reconstitution of Tamiflu syrup. In addition dedicated flu/fever clinics and staff clinics were established.

“The situation was evolving quite rapidly every day. I must commend the dedicated and spirited way in which every level of our staff responded: working tirelessly and making changes overnight to activate the isolation wards, infection control measures, laboratory facilities and meet the logistical demands for screening and visitor registrations.” – A/Prof Kenneth Kwek, Chairman of Medical Board, KKH

SingHealth Polyclinics

olyclinics see a huge load of flu patients every day. As the proportion of H1N1 flu cases is expected to form up to 80 per cent of all flu cases, SingHealth Polyclinics have adapted the following measures: • Setting up a flu clinic with a separate queue for flu patients, so these patients can be quickly attended to in order to lessen the risk of spreading the flu to other patients at the polyclinic. • Providing health checks – blood pressure, oxygen saturation level and pulse rate - for flu patients so those who are more prone to developing flu-related complications can be attended to first. • Harnessing an IT system called the Acute Care Model that allows the health check results to be accessed by the doctor, so he does not have to waste time making further checks.

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Xploring new possibilities Patients can expect shorter wait and greater convenience.

new integrated radiology system will reduce patient record mismatches by 80 per cent and waiting time by 30 per cent when it is rolled out at the Singapore General Hospital (SGH) later this year.

Said Dr Wong Yue Sie, the Clinician Leader for this project, “Providing better, safer integrated care for our patients is always our top consideration. With ready sharing of image studies, our patients can move seamlessly across the care continuum. This brings SingHealth one step closer to supporting the Ministry of Health’s vision of a national Electronic Health Record system for every Singaporean.” Plus points: Better safety with reduced risk of mismatch of patients’ results and images, as well as shorter waiting time due to faster turnaround time for results. A partnership project between SingHealth and Microsoft, the system will be used by all SingHealth institutions within the next two years.

before

AFTER

(Paper-based driven radiology workflow)

(Electronic order driven radiology workflow)

Patient Service Clerk re-enters order into system

Doctor orders x-ray on paper

Radiologist extracts information from two separate systems - an imaging system (PACS) and a report system (RIS)

Radiologist dictates report to tape

Doctor orders x-ray online through CPOE

One integrated system reduces reporting mismatch because image and report are always in sync

X-Ray Taken

Typist transcribes the report into report system

OK!

Radiologist reads and signs off report

Report goes into SingHealth’s Electronic Medical Records. With electronic order driven workflow, it makes reporting faster and more accurate

Voice recognition system transcribes radiologist’s report. With VRS, radiologist can sign off the report immediately and reduce report turn around time

OK!

Radiologist reviews and signs off his report immediately

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Resilient patients

inspire healthcare workers

eard of a patient whose tenacity you want to emulate? Know of a patient with a positive mindset that is infectious? Met a patient whose courage you admire? Now you can recognise that patient who inspires you. Do you know why they are an inspiration? When our patients struggle against the odds to deal with the curve ball that life has dealt them, their positive spirit and doggedness bring out the compassion in us. We are reminded of the reasons why we chose to serve in public healthcare. We reinforce our own commitment to push on for the benefit of all patients. SingHealth Group Service Quality will be rolling out its first clusterwide Inspirational Patient Award in September 2009. Staff from all SingHealth institutions would be able to show appreciation to patients who have touched and inspired them in their course of work. A patientâ&#x20AC;&#x2122;s attitude plays a crucial part in his recovery, and it also rubs off on people around him. This award, in highlighting patients who are role models, also helps to spur other patients and their caregivers on. The award will be given to 10 inspirational patients. Staff who have picked the top three inspirational patients will also be rewarded. This award creates a win-win situation for both patients and nominating staff.

In 2008, SGH started its Inspirational Patient Award. It showcased patients who persevered in their battle against their illnesses. Their stories touched and motivated both our medical and non-medical staff, and also drew the attention of the media. Major news dailies such as The Straits Times and Lianhe Zaobao featured their stories, providing inspiration to the public. This meaningful initiative is now extended to all SingHealth institutions. If you know of patients who inspire you, nominate them for the Inspirational Patient Award, starting 7 September 2009. Let their stories inspire others, too. For enquiries, email karen.tang.p.w@singhealth.com.sg

SingHealth scores in HR SingHealth institutions garnered 18 awards at the Singapore HR Awards, organised by Singaporeâ&#x20AC;&#x2122;s leading HR professional body, the Singapore Human Resources Institute.

Corporate HR Award HR Advocate Award 1. Quality Work-life Leading HR Practices Awards 1. Strategic HR 2. Manpower Resourcing & Planning 3. Quality Work-Life 4. Health & Employee Wellness 5. Workplace Safety & Health 6. Corporate Social Responsibility

Leading HR Practices (Special Mention) Awards 1. Talent Management, Retention & Succession Planning 2. Fair Employment Practices

HR Advocate Award 1. Quality Work-life 2. Health & Employee Wellness Leading HR Practices Awards 1. Quality Work-Life 2. Health & Employee Wellness 3. Workplace Safety & Health

HR Advocate Award 1. Quality Work-life Leading HR Practices Awards 1. Quality Work-Life 2. Workplace Safety & Health Leading HR Practices (Special Mention) Awards 1. Health & Employee Wellness

me+GROUP 12

More than a good fit Dixon Grant, third year Duke-NUS Graduate Medical School medical student, greeted us with a handshake and a nervous smile. He’s been studying for an exam two weeks away but we reckon a 30-minute interview is just what he needs to get away from all the books. By Arthur Wong On coming to Duke-NUS Graduate Medical School One of the things Chelsea (my wife) and I used to discuss was how nice it would be to live in another country. The chance came when I heard of Duke coming to Singapore. I applied and we were so excited when I got accepted. What’s great was that Chelsea also managed to find a job in SingHealth.

encounter. There’s a lot of teaching and learning done.

On his SingHealth mentors I think one of the best lessons I’ve learnt is to not be a doctor for the money. If you wanted to be rich you’re better off in the financial sector. Our teachers taught us all that we’re in it to help our patients. There’s definitely a focus on providing high quality care to the patients.

On Outram Campus I spent most of my second year in SGH. The faculties were happy to have us and you could see they wanted to do their best to train the future doctors of Singapore despite their busy schedules. There is also a very good patient medical record system here. Every patient’s records are already in and you have knowledge of their illnesses, past summaries, what type of treatment, and how many times they’ve been to hospital recently. IT really helps a lot in delivering care.

On being in the wards as a medical student We were assigned rooms in wards and three patients each. A typical day starts with us giving updates to the patients, checking on them and performing physical examinations to see if there is any change to their conditions. Then the students meet with the teachers and are taught how best to deal with the problems we

On the union I travel to work with Chelsea when I can, and sometimes we have our meals on campus. She works in the service side while I’m on the clinical side so we tell each other how things work. Our careers are intertwined and it’s a perfect set-up. Yeah, it’s really nice being on the same campus together.

Himself Dixon Grant is a 27-year-old American from Utah with a Bachelors degree in Cellular and Molecular Biology. He is married to Chelsea Grant, age 25, also from Utah. They are expecting their first baby, a boy, in December.

His aspirations He hopes to help research and pioneer new medical treatments, and would also like to play an active role in helping developing countries improve medical education and healthcare.

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Bench-and-bedside doctor

Dr Gopal Iyer’s work straddles the laboratory bench to the hospital bed. me+SH takes a peek at some ongoing research at NCCS. By Sher Maine Wong

r Gopal Iyer is an oncologist who, like all oncologists, saves the lives of cancer patients. The difference is his work does not just centre on patients who are on the operating table. In his spare time, Dr Iyer, who specialises in cancers which affect the head and neck – anything in the mouth, nose and throat except the brain - conducts research in a laboratory which can potentially save the lives of future cancer patients. Unknown to many, the top two floors of the National Cancer Centre Singapore (NCCS) houses fully functional research labs dedicated to cancer research. Together with a division which handles clinical trials, they form the Humphrey Oei Institute of Cancer Research, the research arm of NCCS.

Here, scientists and doctors work together to advance cancer treatments and detection techniques. Some, like Dr Iyer, take on both roles, giving him a unique perspective when he treats his patients and when he is at the laboratory bench. “Surgery is very exciting,” said Dr Iyer, who is an associate consultant at NCCS. “But getting results in a laboratory is also very exciting in a slow and methodical manner.” He reckons he gets the best of both worlds. Most of the week, he zooms in on actual cases at the Singapore General Hospital: seeing patients, making the ward rounds in the mornings and operating two full days.

Thursdays and some mornings are times when he puts on his white lab coat to turn researcher at the NCCS’s Wee Kim Wee Laboratory of Surgical Oncology, trying to push the frontiers of cancer treatment. As someone who straddles both the academic and hands-on aspects of cancer, Dr Iyer is well-placed to identify relevant research topics based on what he sees in his clinic. For instance, one of his research subjects involves studying cancer stem cells from young adults, in their 40s and below, who have had tongue cancer. “Generally, head and neck cancers are on a downward trend because people are no longer engaging in habits like chewing betel nuts, and fewer are smoking,” he said. “But we are seeing an increasing number of young patients with tongue cancer, and these are people who have no bad habits. They don’t smoke. We don’t know why there is such a trend.” In his research, he and his team have isolated cancer cells which do not respond to therapy, and they are testing different drugs on these cells to see what works. Individualised treatment, in fact, is what Dr Iyer feels is inevitable for cancer patients. And it is where his research work is heading. “We want to find out why people respond differently, depending on their genetic makeup. This is the future of cancer treatment.”

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MICO wins

prestigious IT award

ingHealth’s Mission to Improve Clinical Outcomes (MICO) won the accolade of ‘Best Business Enabler’ at the annual MIS Asia IT Summit and IT Excellence Awards on 24 July 2009. The regional MIS Asia IT Excellence Awards are regarded as the only accolades that specifically recognise organisations for management excellence in using IT to drive business value and to attain business goals. And MICO is indeed helping us attain our goal of helping to build a national Electronic Health Records system for every Singaporean. In the words of Dr Low Cheng Ooi, Chairman of the MICO Project Steering Committee, who is also SingHealth’s Chief Medical Information Officer and Chairman, Medical Board, Changi General Hospital, “It is a clinical transformation, enabling our doctors and healthcare staff to make better clinical decisions, reduce errors in work processes, and importantly, provide consistent care across our institutions.”

T For a full list of the HMDP awards, refer to the SingHealth Desktop Portal >> http://mysinghealth

he Health Manpower Development Plan (HMDP) awards - which gives healthcare professionals the opportunity to be attached to renowned international healthcare centres for further training and development in their chosen area of specialty – is being given to 183 doctors, nurses and allied health professionals from SingHealth this year. This is the largest number of award recipients to date and 13 team-based awards have been given out as SingHealth continues to strengthen its multi-disciplinary teams across specialities and professions.

healthcare leaders A good doctor does not always make a good administrator. To better prepare medical professionals for leadership posts, a new Graduate Diploma will equip clinicians with business management and leadership skills.

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Moulding

ingHealth’s top man was, in his own words, “not prepared” when he stepped into a leadership role 21 years ago. Orthopaedic surgeon Professor Tan Ser Kiat was appointed to head Singapore General Hospital’s Department of Orthopaedic Surgery and he suddenly found himself having to think budget, manpower and strategy on top of saving lives. “I was practically thrown into the deep end of the pool,” said Prof Tan, speaking at the launch event for a new healthcare management and leadership diploma. “What I went through was the traditional method of healthcare leadership appointment. There was no formal training structure for new leaders then, and many of us had little basic management skills. We had to learn it the hard way, along with a lot of heartaches.” Prof Tan wants to nurture a pipeline of leaders that will be better

prepared to take on leadership roles. He is confident there will be great outcomes from the new Graduate Diploma in Healthcare Management and Leadership, a SingHealth and Singapore Management University (SMU) collaboration. The $20,000 course for medical professionals, which requires a time commitment of at least 160 hours, is targeted at doctors in Singapore, the Asia Pacific and beyond. Participants to the course will learn from thought leaders of both industries and will stand to benefit from the course that will cover topics from healthcare management strategy and financial management to people and leadership skills. Lecturers will come from SMU and SingHealth. With SMU providing the business management expertise, SingHealth’s key contribution is in creating course content that is relevant and localised.

A/Prof Annie Koh and GCEO Prof Tan Ser Kiat marking the start of future healthcare leadership training.

For instance, in a module on ethics and governance, students will study issues of decision-making in hospital boards and how this is influenced by the fact that many hospitals in Singapore are funded by the Ministry of Health. Associate Professor Annie Koh, Dean of Executive Education & Professional Education and Associate Dean, Lee Kong Chian School of Business at the SMU, said: “The participants can click with the issues and the cases presented because it’s happening right there in their own backyard.” Said Prof Tan: “As sophistication and complexity of healthcare demands increase exponentially with public expectations and costs rising in tandem, we need to train and groom newer and younger leaders and managers to meet these challenges.” Because Singapore’s healthcare standards are well regarded, SingHealth and SMU hope the graduate diploma will also train healthcare leaders in other countries. As Singapore’s largest healthcare group and an established industry leader, SingHealth will tap on a wealth of expertise to create case studies and course materials.

For more information on the SMU-SHS Graduate Diploma in Healthcare Management and Leadership, please visit www.singhealthacademy.com.sg

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Inquiring Minds

Acquiring Knowledge

Benefiting Patients

As clinical research picks up speed locally, me+SH takes a closer look at how it is gaining momentum in SingHealth in an interview with Prof Fong Kok Yong.

By Jeanie Cheah

he bottom line of clinical research is bringing benefits to patients. It is no rocket science why SingHealth is making every effort to embed research and clinical trials at the core of what clinical staff do. “Research is a natural and logical extension to our excellent clinical service. It is an investment in the future, which our leaders are very supportive of,” said Prof Fong Kok

Yong, Group Director, Clinical Research at SingHealth, and Chairman, Division of Medicine at SGH. The outcome of this investment is improved quality of clinical care and Prof Fong outlines the immediate steps we are taking to advance research across our institutions. 1. Putting in place facilities for clinical research, one of which is the Investigational Medicine Unit (IMU). 2. Fostering more inter-institutional research 3. Continuing to support ongoing efforts 4. Facilitating multi-disciplinary research amongst doctors, nurses and Allied Health professionals. Nurturing the spirit of inquiry, although not one of the steps mentioned, is a must for research to flourish. Budding researchers are encouraged to tap on the mentors and the available facilities and seed funding. The IMU has facilities to conduct early phase (Phase 1 and Phase 2a) human medical research in novel drugs, devices, biologics, and diagnostics, and including research on biomarkers (e.g., bio-imaging) and disease mechanisms. Said Prof Fong, “The biomedical environment in terms of drug development is only a few years old in Singapore, but it is getting more competitive. Our aspirations in academic medicine have given real impetus to boosting research here.”

With resources and a system in place for contingencies and building on the strength of our clinical service, SingHealth is well-positioned to encourage more staff to take on research. According to statistics on certified trials provided by the Health Science Authority, a total of 286 clinical trials were conducted in Singapore in 2009. In the last five years, SingHealth institutions have conducted approximately 550 clinical drug trials across Phases I to IV. These trials, involving more than 30,000 participants, are in collaboration with pharmaceutical companies or investigator-initiated. They cover many specialties including Cardiovascular & Metabolic Diseases, Opthalmology, Oncology, Neurosciences, Infectious Diseases and Immunology. In tandem with the pursuit of research, regular workshops on research ethics and sound clinical practice are organised as a way of infusing the right values for an ethical culture. For instance, the Good Clinical Practice course organised by the Division of Research and Clinical Trials Resource Centre at SGH addresses issues of rights, safety and well-being of clinical trial subjects. Added Prof Fong, “A proper framework is essential to ensure we remain on track. With the right guiding principles and a strong culture of ethics, we will not detract from our mission to serve patients.”

SingHealth Clinical Trials

Flowchart on stages of research

Filtering

Pre-clinical phase

Phase 0

Phase I/II Early Phase Clinical Facilities

SEMC

Animal Facilities (SGH)

Tissue Bank

Phase III/IV

IMU Chronobiology Lab

Duke-NUS

CGH

Clinical Research Units (CRU)

- CGH - KKH - SGH - NCCS - NDC - NHC - NNI - SERI

Subject Safety 101 1. Gather all possible information and study to the greatest extent the possible impact 2. Gather data from pre-clinical trials, and ensure that there have been no adverse events 3. Do a risk-benefit assessment, ensuring that benefits outweigh risks 4. Provide all the information to potential research subjects so they can make informed decisions monitoring subjects closely and continuously 5. Make sure all subjects are indemnified IMU • Started in 2009 • 32 beds (including 2 beds in the Chronobiology lab of Duke-NUS) • 12 in the team

The IMU team

CGH’s Clinical Trials Research Unit (CTRU) • 31 ongoing Phase I to Phase IV clinical trials • 20 beds • 13 in the team

The team at CGH’s CTRU

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Clinical Research at

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eye research

An on

With a $25 million grant in translational clinical research, the Singapore Eye Research Institute is exploring new research frontiers. By Sher Maine Wong

t has been said that the eyes are the windows to the soul. If Singapore’s top eye researchers have their way, the eyes would also be windows to the inner workings of our body. Now an eye scan might tell you if you have a heart condition you had not known about. “Advances in eye imaging technology allow us the very exciting possibility of using the eye to study human disease in a non-invasive way,” said Professor Wong Tien Yin. The newly-appointed director of the Singapore Eye Research Institute (SERI) who took over from Professor Donald Tan this year, points out how, for instance, micro blood vessels that are narrower in the eye might point to kidney damage. Prof Wong, who won the Outstanding Researcher Award from the National University of Singapore this year for his research in this area, made the connection after studying eye images taken from almost 3,300 people. “How would one study early changes in the blood vessels of the heart and

kidney without invasive procedures or tests? The eyes offer this unique opportunity to study early blood vessel changes before the onset of clinical disease,” said Prof Wong, whose research aspiration is to “develop a world-leading research programme in retinal imaging that has broad application in medicine and public health.” Identifying all the ways the eyes can be a signpost to diseases lurking in the body is one of the exciting research areas SERI is moving into. Helping to fund SERI is a new $25 million translational clinical research (TCR) grant from the National Medical Research Council, which oversees the development and advancement of medical research in Singapore. Translational clinical research, which makes research findings understandable and useful to people on the ground, “is about how research we do in the laboratory ends up benefiting patients,” said Prof Wong. The $25 million TCR grant is based on research on corneal diseases and glaucoma that will have

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direct clinical implications for patient care and management. Since its inception, SERI, which is located at the Singapore National Eye Centre (SNEC) in Outram, has contributed to more than 90 per cent of eye research publications in Singapore. Internationally, it has brought Singapore to the forefront of global eye research. From 11 people in 1997, the institute now has over 130 staff housed in five locations, and plans are for everyone to go under one roof. “SERI came about through the vision of Professor Arthur Lim, the Founding Director of SNEC, who could foresee in the early 90s that Singapore needed a dedicated eye research institute, way before biomedical research was in vogue in Singapore and in other countries in Asia. In a sense, we had a 10-15 year headstart over our competition regionally,” said Prof Wong. “Now is a very exciting time to do research in Singapore. ” He added: “We have developed an extensive collaborative network comprising of research not just done at the SNEC and SingHealth, but with healthcare and academic institutions including NUS, NTU, A*Star, and TTSH.” Whilst the institute has traditionally focused its research efforts on myopia and glaucoma, Singapore is faced with an ageing population and chronic diseases such as diabetes is on the rise. Because of these health demographics, SERI will move into research on related eye conditions, like retinal disorders, diabetic retinopathy and macular degeneration. SERI will also study specific genetic factors affecting glaucoma and conduct more research into corneal diseases. Researchers are also studying and imaging the crystalline lens in the eye, to see if it is possible to predict the onset of cataracts before it forms. “The eye is a good marker of what happens in the body when people age,” said Prof Wong. “We can use the eye to study the effects of ageing, and find out, for example, why some people age well, while others develop diseases.”

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Touching

Medical Social Workers (MSWs) operate quietly behind the scenes to ensure a better quality of life for their patients. Tapestry of Care, a collection of stories from MSWs, gives an insight to the work they engage in. me+SH catches up with MSW Crystal Lim, as well as Neo Chia Reei and Patricia Ng from SingHealth Academy who helped make this book a reality.

L ives

“…if patients are alone and are unable to garner help from their personal support network, the MSW will have to be prepared to soldier on as the patient’s lifeline. And this requires courage. We need courage to persevere with these patients, in dealing with the uncertainties of their future, and the problems wrought by their dearth of resources and complexity of medical problems. We also need courage to be the voices of advocacy for patients, be it to their loved ones, the medical team or the community at large.” (Excerpt from “Making Amends”, Tapestry of Care)

ndeed, for some patients, the Medical Social Worker (MSW) is the lifeline they cling to, particularly when everyone else appears to have abandoned them. MSWs offer solace, encouragement and advice, and at times, their mere presence serves to comfort when words fail. They also help to bridge the gap between patients and their family members, caregivers and the community at large. Said Crystal Lim, Senior Principal MSW with SGH, “We are the voice because sometimes patients don’t know how to express themselves. Other times it’s just too painful for them to speak about it.” The role of an MSW has evolved and expanded from looking into the basic welfare of patients to providing holistic care, spanning the physical, psychological, emotional, economic, social, and ethical. The scope of work has widened, and the workload of each MSW has multiplied over the years. But the upside is that the profession has

gained recognition and there has been an increase in the number of scholarships and graduate and post-graduate programmes offered locally. Crystal is still enthusiastic about her clinical work despite being in the helping profession for 18 years. She has handled a myriad of wideranging cases that have allowed her to share in her patients’ joy, sorrow, pain, and hope. This has been a fulfilling career for her and she has no regrets, a sentiment shared by many other veteran MSWs. Given their wide-ranging cases and wealth of experience, it is not surprising that the MSWs had long wanted to compile and use their stories to help patients and trainees. What started as an idea from MSWs at SGH soon took on a life of its own. MSWs from other institutions saw the value of such an anthology and generously shared their time and stories. Before long, the Tapestry of Care was born.

Tapestry of Care is now available at selected pharmacies, NUS Co-Op and Kinokuniya Bookstores.

SingHealth Academy Publishing “There’s so much good content in SingHealth, so why don’t we do something about it?” With these words from Ms Neo Chia Reei, SingHealth Academy set out on their quest to build a catalogue of titles published by SingHealth itself. The first thing to do was create a family of imprints that would reflect the group’s background in medicine as well as indicate the main target readership for a title. Books under the Red Cells Series are of a more clinical nature and cater to healthcare professionals. The Grey Cell Series of books are intended for the general public while titles under the White Cell Series focus on research as well as clinical practice improvements in SingHealth, showcasing the innovative milestones of our healthcare professionals. To date, three titles have been produced: Behind the Stethoscope and Tapestry of Care, both under Grey Cells; and Medical Relief Mission Handbook under Red Cells. More titles will be available later this year.

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Each story gives readers a taste of what MSWs handle on a daily basis. Some are dramatic; some end happily while others leave a bitter-sweet after taste; some leave you in tears while others frustrate; and some amaze you with the courage and strength of patients. But most of all, the book sets you thinking about what you would have done in similar circumstances. To publish every single case would have taken numerous volumes, so a decision was made to include only the most impactful stories with clear learning points. Clinical information, highlighted in coloured bubbles, serve to relate practice pointers with real cases for trainee MSWs. Working on the editorial and production of this title was the publishing team from SingHealth Academy (SHA). Published under the Grey Cells imprint, Tapestry of Care was a labour of love that brought an unexpected level of accomplishment to SHA General Manager Neo Chia Reei and Senior Executive Patricia Ng who heads the publishing unit. “We set out with three objectives — to let patients know that they are not alone, to provide a professional approach to the issues they face, and as a teaching tool for future medical social workers,” revealed Patricia. The team worked intensively — writing and re-writing — with the MSWs over a period of six months to ensure that it was a final product that everyone would be happy with and proud of. SHA’s second book has set the team firmly on their path to achieving their long-term goal. “We have a vision to be the leading publisher for health service publications. Everyone will be able to identify our imprints, and we aim to have a whole bookshelf all to ourselves in the stores,” said Chia Reei. Tapestry of Care is definitely a testament to the possibilities of collaboration — when a group of people with a book idea in mind meet a publishing team with the ambition and foresight to bring it to life. The book reveals what it really is to be an MSW and it makes one wonder how MSWs cope with the psychological stress of working with their patients. Do they ever sink into depression themselves? “We see a lot of recoveries as well. In grief, we can see the love of family that binds and succours them through that painful journey. In illness, we see the patient’s tenacity that gives him or her strength to take the next step. Working with our patients has enriched us. It has taught us that we must never give up on life,” said Crystal. Most of all, this is a book about hope and resilience, celebrating the many wonderful ways MSWs have made a difference in their patients’ lives and how they have been touched in return.

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“The critical, long-term needs of disaster survivors can now be addressed by rebuilding destroyed buildings and restoring hope to displaced individuals and families… not only will SHRP provide healthcare volunteers, there is also potential in many areas of staff training and development.” Prof Tan then encouraged SingHealth staff to lend a hand and be part of the newly formed SHRP. “I am heartened to see the passion of SingHealth staff ready and willing to lend

Key

Emergency or Disaster

Media Focus

Risk Assesment Mitigation/Prevention

n his presentation at the official launch of the SingHealth Humanitarian Relief Programme (SHRP), Dr Mark Leong, Head of SHRP and Head and Senior Consultant, Dept of Emergency Medicine, SGH, revealed a little-known fact about humanitarian relief work. Pulling out a detailed illustration, he alerted the audience about the crucial need for volunteers not only at the acute relief phase (the provision of immediate assistance to disaster-stricken areas), but more so at the post-disaster phase (restoration and reconstruction). “As the number of natural disasters increase over the last few years, there is also an increasing number of displaced families and survivors in need of not just medical attention, but also a means to continue with their lives,” said Dr Leong. With that he introduced SHRP – SingHealth’s next step into humanitarian relief provision. While he admitted that entering the fray to provide acute relief would be the more ‘sexy’ approach, his vision of SHRP moves beyond the glory and media attention. Concentrating on forming a properly organised and well-equipped task force of ready volunteers, SHRP focuses its attention on deploying volunteers to areas assisting in reconstruction for sustained periods of time. GCEO Prof Tan Ser Kiat then brought the audience back to 2004, when SingHealth participated extensively in the humanitarian efforts following the epic Boxing Day Tsunami. Highlighting SingHealth staff’s compassion to serve and passion to excel, Prof Tan reiterated SHRP’s instrumental role in paving the way ahead for SingHealth’s level of involvement in providing humanitarian aid.

Ongoing Development Activities Economic & Social Recovery

Reconstruction (Resettlement/ Relocation)

Restoration of Infrastructural Services

The symbol of hands in the SHRP logo signifies the strong teamwork with our partners in humanitarian relief, and represents the commitment and compassion of the care-givers (staff volunteers) to the carereceivers (disaster victims) as we pull through the pain and hardships of a disaster. Together, we make a difference in lives.

Apart from the Asian Tsunami in 2004, SingHealth volunteers have also changed the lives of victims from several other missions. Pakistan Quake, October 2005

The Disaster Risk Management Cycle

West Java Quake, May 2006

Risk Assessment Mitigation/Prevention Preparedness

Warning/ Evacuation

Cyclone Nargis in Myanmar, May 2008

Saving People Providing Immediate Assistance

Yeman Floods, November 2008

Assessing Damage Ongoing Assistance

Reaching Further with Reach out and touch someone – in the case of the SingHealth Humanitarian Relief Programme, reaching out is only the beginning, as it hopes to bring humanitarian aid beyond acute relief and into the next crucial phase. By Arthur Wong

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SingHealth and Humanitarian Aid

their support at a moment’s notice. In volunteering, staff can be exposed to different environments and people while contributing to a greater good and leaving with a sense of fulfilment,” he said. With SingHealth’s wealth of experience in management and medical expertise, backed up by a ready pool of experienced and well-equipped volunteers, SHRP looks set to extending its reach to the poor and suffering.

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Making It

When I was in the war conflict areas like Sudan and Liberia, you would treat children one day and they could be dead the next time you come around.

Personal

What’s it like to be out in the fray? Veteran volunteers Dr Andrew Wee, SHP - Marine Parade, and Senior Staff Nurse Chua Suan Ngoh, SHP - Bukit Merah, recollect their experiences as volunteers.

me+SH: Any unforgettable moments? Dr Wee: One of our team members fell gravely ill within the first few days of our medical mission. He lapsed into a coma and had to be resuscitated in the hotel room, rushed to hospital, ventilated in intensive care and finally air-evacuated back to Singapore. This incident almost derailed our mission trip and the team’s morale took a nose-dive to its lowest during this crisis. The harrowing memories are still fresh right to this day. This experience underscores the need for physical, psychological and emotional preparation. The risks are out there and it can be different for every mission trip.

SSN Chua: The culture shock. Every time, everything’s different – the people, their attitudes and the pace of life. You have to prepare yourself for challenges at every turn.

me+SH: Why become a volunteer? Dr Wee: Not only can one get to see multiple facets of humanity when going on missions, he actually gets to immerse and become an active participant in that aspect of humanity itself by being exposed to the same risks, hazards, food and culture. Yet ironically, a pervasive sense of inequality still nags at the conscience as every patient we treat would probably pay the world to trade places with us if they are offered the choice. If one has the ability to stare at such conflicting emotions in the face, and digest it with the spectrum of disaster-related issues, then the experience gained could be invaluable, enriching oneself emotionally, educationally and spiritually.

SSN Chua: It’s a feeling that you’ve done something good. It’s about a kind of giving and receiving that’s hard to express and can only be seen from the looks of gratitude from the faces of the people whom you have helped. It’s also a journey for yourself as well, that in the end you know that it’s just something we all need to do. Do you want to play a part in changing the lives of the unfortunate? Join SHRP as an active volunteer now! Send your particulars (name, contact, designation, department and institution) to sandy.lim@singhealth.com.sg

An invaluable companion to healthcare workers on any medical relief mission, this handbook provides essential information on pre- and post-trip expectations, physical and psycho-emotional health issues, overview of effects of disasters, diseases and trauma scenarios and other pertinent topics. Ideal for both first time volunteers and veterans. Medical Relief Mission Handbook (S$9.90)

Produced by SingHealth Polyclinics and published by SingHealth Academy. Please call 6326 6034 for orders.

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The project team From left to right: NM Ho Wah Pong NC Pamela Teo Salem Koh Coleen Beck Dr Choong Chew Thye NM Tan Seok Gek Dr Harvey Teo

Children face shorter wait for MRI scan A team effort to cut down waiting time for paediatric MRI scans is helping to improve access, cut costs and enhance productivity.

efore 2007, non-urgent cases of child patients at KK Women’s and Children’s Hospital (KKH) waited six to seven weeks for Magnetic Resonance Imaging (MRI) scans. Longer waits translate to anxious parents, higher costs and for the physician, compromised standards in delivering quality patient care. Dr Choong Chew Thye, Senior Consultant, Neurology Service & Paediatric Medicine at KKH and her project team of seven sought to reduce waiting time to less than three weeks for elective paediatric MRI cases, without increasing the wait time beyond three weeks for other patients. MRI scans play a crucial role in paediatric healthcare. Conducting MRI scans for young children is a challenge and general anaesthetic is often required to ensure successful scanning. However, limited anaesthetic resources may add to waiting time. Using tools from the Clinical Practice Improvement Programme (CPIP), the project team set out to improve the process by: • Revising the MRI request forms and workflow

• Actively promoting sedation as an alternative to general anaesthesia • Training staff on the safe use and administration of sedation • Empowerment of patients and families to optimise MRI resources: » appointment reminders » dedicated telephone hotlines » oral and written instructions on fasting guidelines • Promptly contacting wait list patients to fill scan cancellations • Creating a child-conducive MRI environment Since implementation of the various measures, waiting time for elective paediatric MRI was successfully reduced to below three weeks without compromising waiting time of other patients. This was in spite of an increasing MRI scan workload. For the patient, CPIP has delivered a shorter wait and cost savings when the option of sedation is chosen over general anaesthesia. For the organisation, enhanced MRI efficiency has helped to increase capacity and revenue. CPIP is organised by SingHealth Clinical Governance & Quality Management. For more information, visit http://mysinghealth/Singhealth/CorporateOffice/QM/ Programmes/cpip.

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At Home With…

Dr Camilla

Wong

Dr Camilla Wong is slowly but surely changing the face of the pharmaceutical profession in Singapore. By Sher Maine Wong

harmacist Dr Camilla Wong stands tall in Singapore’s pharmacy profession, one which she is in the midst of helping to transform. Yet, when you meet the diminutive Deputy Director in the Allied Health Division of Singapore General Hospital, she does not have the air of the “Very Important Person”. She shows you around her simply-furnished condominium home, cheerfully shows off several handmade paper puppets – her indulgence on weekday nights – and obligingly digs up ancient receipts when you admire her wooden furniture so you can check out the shop. Her prefix is Doctor, but she is less “Dr Wong” than just “Camilla”. It is that downto-earth demeanour which puts her in good stead to nurture and nourish the local pharmacy profession, which is in the midst of improving and expanding quality pharmacy services. “Retention and recruitment is a big challenge. There is a shortage of pharmacists locally and worldwide, so we do hire quite a number from overseas,” said Dr Wong, who is trying to put in place measures – including developing a new career pathway and incorporating competency frameworks – and is very much involved in the set-up of the first Pharmacy Specialist register in the world. “We need to put our blood, sweat and tears into this. Without manpower, we cannot do anything.” She herself never even wanted to be a pharmacist. “At the time I finished my A levels, there was a huge write-up in the newspapers on the front page about how Singapore needs pharmacists,” said Dr Wong. “My mother

Camilla and her family

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encouraged me to read pharmacy as she thought it was a decent job.” Today, for Dr Wong, it is more than a decent job. From starting out behind the counter at the outpatient pharmacy in SGH, she ventured into clinical practice and fell in love with the intricacies of optimising drug therapy to in-hospital patients. “I don’t just dispense medication, I review case notes and laboratory results, make rounds with the doctors, and give advice on medication use.” Then came two life-changing trips: One to the University of California in San Francisco in 1996 and the other to the Albany College of Pharmacy and Clarian Health Partners, where she obtained her Doctor of Pharmacy with honours and completed a critical care residency respectively. “I learnt so many things it blew my mind. I saw pharmacists making a big difference in patient care. It opened my eyes to what clinical pharmacists can do, and that got me very excited about raising the level of pharmacy practice in Singapore.” Upon her return in 2002, Dr Wong was quickly put in charge of the Clinical Pharmacy services at SGH. Not too long after, she was promoted to become deputy head of her department. A heavy load was upon her shoulders. But she reckons it is worth carrying. “My role matrix has changed over the years. I helped shape the pharmacy profession by being a clinician, a manager, an educator and a researcher, and now an administrator. As I move into a more administrative position, I am actually losing more of my clinical practice. However, I have always felt that I could either be that ICU pharmacist managing those few patients a day or that administrator leading a team of not just pharmacists but other allied health professionals, managing 1,600 beds.” It is a role she clearly enjoys. She speaks with relish about the milestones that have been reached in the last few years, including how Singapore is being regarded as the leader in clinical pharmacy practice in Asia. She also wants to forge a career pathway for pharmacists who want to advance into clinical practice. Right now, upon further promotion, most of them take up administrative posts. She said: “Many pharmacists are excellent clinicians but not administrators. We are short-changing these pharmacists.”

me+LIVING 28

She said: “I enjoy being a pharmacist, because it’s a profession in which there is a breadth of practice with so much room for expansion!” She is thankful that her family can put up with her heavy work schedule. At one point she would reach home at 10pm. Husband Errol Champion is a work-at-home dad to their five-year-old daughter, Keri-Ann. As an itinerant church minister, Mr Champion manages a football league for church teams. Most days, when not conducting soccer training, he works into the wee hours of the morning doing administrative and planning work, sleeps late, and by way of nocturnal activity plays lots of FIFA soccer games on the Playstation with Dr Wong. Her mother, who stays with her, is also a godsend. “She continues to give me support and cooks for the family every day,” said Dr Wong, who has two sisters. “We are very close. In the morning when I arrive at work, I occasionally have breakfast with my mum when she has appointments at the hospital. It’s our little quiet time together.” What will keep her on the job for years to come, as with any clinician worth his salt, is, in Dr Wong’s words, “the joy of seeing a patient going home better than when he first entered the hospital”. She spends about two hours every morning in the ICU tending to patients. She said: “Sometimes, all it takes is a little empathy, care and concern to make someone feel just a little better. Sometimes, it’s not just the pill that we dispense but how we dispense that pill, that impacts patients’ lives.”

Did you

know ?

• Dr Wong enjoys action movies like “Matrix”. • She plays the piano. • She plays for the MOH ladies basketball team and loves swimming. • Archie comics remain a firm reading favourite, which she started reading when she was a child. • Her husband cooks better than her. • Her prescription for family fun: Going for a football match with her daughter to support her husband who coaches, and screaming themselves hoarse.

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ost people believe that they cannot be honest with others if they want to preserve the relationship. Thus, they refrain from voicing their opinion. In reality, it is never easy discussing sensitive topics such as competence with colleagues, or even your superior, but staying silent could result in more harm. At a recent talk organised by the SingHealth Group Human Resource Department with the support of the SingHealth Academy, inspirational speaker Joseph Grenny shared seven crucial conversations to reiterate the importance of effective communication. Based on the 2005 groundbreaking US study involving more than 1,700 healthcare professionals and administrators, a series of alarming facts emerged. 84 per cent of physicians have seen coworkers take shortcuts that could

ilence S

Kills

â&#x20AC;&#x153;People become defensive because of why they think you are saying it, they never become defensive about what you are saying.â&#x20AC;? When silence kills: No.