AHA magazine Jan-Feb 2019: A journey of many steps

aha

Issue 1: January-february 2019

a journey of mANY STEPS MCI (P) 101/04/2018

The road to wellness at Yishun Health is paved with constant improvements in all areas of a health system

What’s cooking?

AHA Jan-Feb 19 cover.indd 1

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“it’s good to know someone cares”

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a wealth of experience

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ontents

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COVER STORY A journey of many steps Part two of the Kaizen series explores the many ways — big and small — in which clinical care is improved at Yishun Health.

THE KAIZEN SERIES

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HEALTH HIGHLIGHTS Healthcare news and updates

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WHAT’S UP Community events, outreach efforts, and more

12 SPOTLIGHT

What’s cooking?

Step inside Yishun Health’s kitchen for a glimpse of how safe, healthy, nutritious and tasty meals are prepared 16 EVERYDAY HEROES

“It’s good to know someone cares”

Sally Low shares how community support has made a difference to alleviate her caregiving struggles

24 5 THINGS ABOUT…

Radiation and X-rays

A better understanding of this important diagnostic tool 26 LIVE WELL

A wealth of experience

Four veteran anaesthesiologists share what keeps them going in the pursuit of their vocation 28 MAKAN TIME Steamed seabass, Teochew style

Learn to prepare this classic fish dish

The Kaizen mindset — a culture of constant improvement and continuous small refinements — has shaped the way we enhance our care processes, develop healthcare programmes, and even locate our services in the community. In this second instalment of The Kaizen Series, we explore what’s been done across our institutions at the clinical, process and community levels.

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PUBLISHER

16 30 DAILY DOSE

Snack smart!

Choosing quality over quantity means you can still indulge a little this festive season 31 MIND & HEALTH

Healthy habits planner Set out your intentions for the day, week, month or year — and achieve your health goals!

Yishun Health is a network of medical institutions and health facilities in the north of Singapore, under the National Healthcare Group. It comprises Admiralty Medical Centre, Khoo Teck Puat Hospital and Yishun Community Hospital. It also includes community extensions such as Wellness Kampung.

EDITORIAL TEAM Hannah Wong Sabrina Ng Sharon Ng Albert Foo

EDITORIAL COMMITTEE

The editorial committee — made up of clinical, nursing, allied health, population health & community transformation, and administrative heads of department — advises aha’s direction.

A/Prof Tan Kok Yang Angeline Tang Bastari Irwan Chia Kwee Lee Fatimah Moideen Kutty Shirley Heng

ktph.com.sg/aha aha@ktph.com.sg

PUBLISHING AGENT THINKFARM PTE LTD www.thinkfarm.sg

aha

Issue 1: January-february 2019

M A N AG I N G D I R E C T O R

Christopher Tay

E D I TO R I A L D I R E C TO R

Chua Kim Beng

C O N T R I B U T I N G E D I TO R

Sheralyn Tay

a journey of mANY STEPS MCI (P) 101/04/2018

The road to wellness at Yishun Health is paved with constant improvements in all areas of a health system

What’s cooking?

12

“it’s good to know someone cares”

16

a wealth of experience

26

W

hy aha?

The name aha holds much significance for us at Yishun Health.

In part, it is a nod to our beginnings at Alexandra Hospital; it also stands for ‘Advocates for Health in Action’. Through these pages, we hope to empower you to take charge of your own health and discover those ‘aha!’ moments that lead to a healthier, happier you.

E D I TO R

Dang Hui Ling A R T D I R E C TO R

Regina Wong DESIGNER

Melissa Poon S E N I O R M A N AG E R , C L I E N T R E L AT I O N S H I P

Jessie Kek

C O N T R I B U TO R S

Justin Loh, Lee Lily aha is the official bi-monthly publication of Khoo Teck Puat Hospital (Co. Reg. No. 200717564H) and is produced by ThinkFarm Pte Ltd. All rights to this publication are reserved and no part may be reproduced without the expressed written consent of the publishers. While every effort has been made to ensure that the information in this newsletter is accurate and up to date, the editorial team will not be responsible for errors due to information received. Opinions expressed are that of the writers and do not necessarily represent the views and opinions of the publishers. Printed by Mainland Press Pte Ltd. MCI (P) 101/04/2018

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ealth Highlights

Better Caregiver Support Being a caregiver can be taxing, especially when the population is ageing and families are small.

This is why the Ministry of Health recently reviewed the system that offers support and relief to people providing this critical role.

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he Ministry of Health (MOH) conducted a series of focus group discussions in December 2018. The aim was to identify opportunities to strengthen care navigation in the community, improve caregiver support services, and find ways to empower caregivers.

As Singapore’s population ages, caregivers play an increasingly important role. However, as family

size is usually small, there is added burden on caregivers.

While steps have been taken over the past few years towards building up the range and quality of eldercare services, MOH also aims to focus on providing more direct and holistic assistance to caregivers and build a strong caregiver support system. This is critical to ensure that the elderly can age well in place.

The discussions included consultations with caregivers, service providers, and various stakeholders, all of whom were encouraged to come together to co-create solutions.

An enhanced caregiver support system will also be implemented, complementing existing programmes and assistance for caregivers, including tax relief for caring for parents or handicapped family members, as well as grants to train caregivers.

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MEDISHIELD LIFE EXTENDED TO COVER MORE NEEDS In November 2018, national health insurance scheme MediShield Life was extended to cover three more groups of patients:

1 Patients admitted directly from emergency departments of public hospitals to community hospitals Eligible patients can claim up to $350 per day from MediShield Life, under the prevailing inpatient limit for community hospitals.

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3 Children born with the rare congenital conditions of trisomy 18 and alobar holoprosencephaly and who need surgery Eligible patients may make a claim from MediShield Life for surgical interventions, up to the prevailing surgical claim limits of $200 to $2,000, depending on the complexity of the procedure.

The broadening of coverage is part of MOH’s continuing review of MediShield Life to ensure that it provides protection for Singaporeans against large hospital bills and selected costly outpatient treatments, in keeping with developments in medical care.

Those who need long-term intravenous nutrition for intestinal conditions Eligible patients who need parenteral nutrition for 90 days or more may claim up to $1,700 a month from MediShield Life and withdraw up to $200 a month from Medisave for items necessary to administer parenteral nutrition.

Have a question about MediShield Life?

Log on to the MediShield Life website at www.medishieldlife.sg

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hat’s Up

Kampung Admiralty wins Building of the Year Award!

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ampung Admiralty, which encompasses Admiralty Medical Centre, was crowned Building of the Year at the World Architecture Festival in Amsterdam in December 2018. The 11-storey complex was picked from 535 other projects spread across 57 countries.

As the first integrated kampung in the world, the development was recognised for its innovative infrastructural design and ‘software’, both coming together to enhance social integration and elder-friendly community, while giving easy access to amenities. The mixed development hosts public housing, a mix of healthcare, eldercare and childcare facilities, as well as retail and dining outlets.

Yishun Health’s Admiralty Medical Centre occupies levels 3 and 4 of Kampung Admiralty, giving the community access to a suite of specialist outpatient services.

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For All Your Urology Needs

Dr Molly Eng, Head & Senior Consultant, Urology (third from right), Mrs Chew Kwee Tiang, CEO, KTPH & Yishun Health (middle), with the rest of the Urology department at the opening ceremony (below)

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ishun Health officially opened the new KTPH Urology Clinic on 29 November 2018. The comprehensive clinic is a milestone for the service, which has come a long way from providing key

urological procedures in the days of Alexandra Hospital.

Located at Tower C, C44, the Urology Clinic will provide onestop hassle-free service across a wide range of conditions and

subspecialties. These include a Haematuria Clinic, Ureteric/Colic Clinic, Fast Tract Clinic, as well as services to address bone health, andrology, women’s urology, oncology, endourology and stones.

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hat’s Up

Raising Pressure Injury Awareness T

o raise the level of skill and awareness of pressure injury, the Pressure Injury Workgroup organised an in-depth event for staff and community partners. STOP Pressure Injury was a full-day event held on 29 November 2018.

Aimed at bolstering the proficiency of healthcare workers, particularly in the community care sector, the event included four plenary sessions and three skills workshops.

There was also a keynote speech

by Mr Emilio Galea, International Medical Director of URGO Medical, who addressed the prevention and management of pressure injuries.

Other experts also expanded on the

Our community partners participated in the lectures and workshops to share the knowledge and skills with their organisations

topic and shared useful ideas on good pressure wound care.

Workshop participants had the chance to try pressure injury devices,

learn wound-dressing methods, and use a pressure-mapping system to ensure proper seating position to lower the risk of pressure wounds.

Diabetes Management: It Takes a Village U

nderscoring the importance of support, Yishun Health commemorated World Diabetes Day with the theme ‘The Family & Diabetes’. Held on 3 November 2018 at the Kampung Admiralty Plaza, the event involved five interactive multisensory booths. Each covered the multidisciplinary nature of

diabetes management and reminded participants of the far-reaching consequences of the chronic disease for both patients and their loved ones.

At the booths, participants were asked to guess their blood glucose ‘number’, and shown the consequences of high blood sugar via illustrations, and the impact of

diabetes-related eye complications.

Foot and footwear were also assessed. There was even a cooking demonstration, which emphasised that food need not be heavily seasoned to be delicious.

Guest calligraphist Mr Jimmy Koh also presented a scroll of a Chinese couplet, which translates to: “A healthy body makes you feel strong, so do not wait and worry about your health in old age.”

Unveiling of Mr Jimmy Koh’s (third from right) calligraphy couplet by Guestof-Honour Mr Amrin Amin and KTPH & Yishun Health CEO Mrs Chew Kwee Tiang (fifth and sixth from left)

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‘X’ Marks the Spot I

Participants took the time to read informational posters in order to find answers to a challenging quiz

Learn more about X-rays and radiation in 5 Things About on page 24

n celebration of World Radiography Day, which falls on 8 November, Yishun Health radiographers set up informational posters to celebrate the 123rd anniversary of the discovery of X-rays. The exhibition showcased the evolution of medical technologies.

There were also posters highlighting the different medical imaging methods and interesting trivia aimed at dispelling myths and fears of radiation exposure from scans.

Combat Sports Comes to KTPH

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n 3 November 2018, Yishun Health’s Sports Medicine Centre, together with WAKO Kickboxing Singapore, held their first Combat Sports Public Forum at KTPH. More than 150 people signed up for the event, which included enlightening talks from a sports doctor, dietitian and physiotherapist on common sport injuries, the impact

of diet for optimal performance, and tips for physical training and rehabilitation.

Apart from this, demonstrations added an action-filled edge to the day.

Athletes showed off a range of pugilistic styles, from kickboxing and Brazilian jiujitsu to silat and savate (French boxing), thrilling the audience with their dexterity and high-powered moves.

Our first Combat Sports Public Forum brought together medical and martial arts experts in an afternoon of educational talks and action-packed demonstrations

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hat’s Up

Mental Wellness for the Family

Turn to page 12 to read more about the Food Services department

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Staff from KTPH Food Services giving a live cooking demonstration

n collaboration with various community partners, the Family Mental Wellness Carnival was held on 20 October 2018 to cultivate a caring and inclusive community, and promote mental wellness. Community partners organised a range of fun activities designed to highlight the signs and symptoms usually manifested by persons with mental illness, and the effects of ageing on cognitive skills.

These included informative exhibits on the five languages of love, and how to connect with and show appreciation for each other. Families bonded over crafting, skin painting, and balloon sculptures. Chefs from KTPH Food Services also conducted a live cooking demonstration to encourage healthy eating, providing recipe cards so that participants can recreate the dishes at home.

A Nurse Leader in the Making S

abrina Tan, Staff Nurse, Acute & Emergency (A&E), KTPH, was conferred the Ngee Ann Kongsi Gold Award on her graduation on 19 October 2018. She was recognised by the Singapore Institute of Technology (SIT) not only for her excellent academic achievements, but also her active involvement in community projects.

She topped SIT’s inaugural batch of 52 nursing degree students. The Bachelor of Science in Nursing is a joint degree awarded by SIT and the University of Glasgow. As part of SIT’s Community Service Club, she led projects to benefit underprivileged children in Laos and Myanmar.

Sabrina’s first taste of nursing occurred in secondary school when she joined the St John’s Ambulance Brigade uniformed group.

“You’re there for the patients most of the time, especially when they’re sick. They can be angry and frustrated sometimes, but there is a sense of satisfaction to see them recover and go home, ” she recalls.

Today, Sabrina continues to show care for people in the wards as she equips herself with the skills required in the rigorous nature of A&E.

Sabrina Tan’s passion for nursing started when she joined the St John Ambulance Brigade in secondary school

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Pledging Support for an Inclusive Society

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ishun Health was part of the 10,000 people who turned up for the Purple Parade on 27 October 2018. Staff were there to pledge their support for the movement, which seeks equal access to education, employment, transport and social networks for people with special needs.

Within the Yishun Health campus itself, there are efforts to build an inclusive workforce through a partnership with SG Enable, an agency dedicated to enabling persons with disabilities. Every year, we provide a batch of students from SG Enable with on-the-job training, equipping them with useful skills for the future.

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potlight Ghazali (left) and Chef Simon, Executive Sous Chef, lead the KTPH Food Services team behind the scenes

What’s Cooking? C A complex choreography of planning goes into each nutritionally balanced and carefully plated meal served across Yishun Health, from inpatient dishes to staff meals.

Here’s a look at what it takes.

ooking 2,700 meals a day is quite a feat. But consider that not all these meals are the same and, in fact, can involve anywhere between 80 and 90 permutations, and the complexity becomes even more apparent.

According to Ghazali bin Mohamad, Head and Manager, Food Services, KTPH, putting together these many variation of meals entails comprehensive planning behind the scenes. Not only does the department provide meal services for patients, it is also

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THE KAIZEN SERIES

a supporting department for the whole organisation and caters for internal and special events as well as provides meals for staff. “Our area of coverage is wide because we cover outpatient clinics, Emergency Department patients, and even support frontline staff so that they can focus on their jobs in caring for patients,” he shares.

Then there are also fresh fruits, coffee and tea provided for patients who come for early morning appointments, and special treats during festive periods. “We do it all,” Ghazali stresses. He emphasises that the department’s key role is to “provide healthy meals and support therapeutic eating plans, and also ensure that the food we provide is safe and good enough for our own families”. This means a high level of care is exercised to ensure that all foods — raw, dried, fresh or cooked — are kept at safe temperatures, handled with care, and tested for quality.

“It all begins at the planning, purchasing and preparation stages,” explains Ghazali, “and takes up almost three-quarters of the work.”

PART 2 OF 3

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Quality control begins at the door Purchasers do stringent checks, acting as ‘bouncers’ to ensure that food items meet minimum quality and temperature standards.

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Safe storage and organisation After passing inspection, food items are stored in respective areas and organised under the first-in-first-out and first-expiry-first-out principles to reduce food waste.

AVOIDING THE DANGER ZONE • The temperature danger zone is between 5oC and 60oC — harmful bacteria grow in food easily at these temperatures • Minimise the time that food spends at these temperatures in order to keep food safe • Refrigerated food needs to be kept at 5oC or below • Hot food needs to be kept at 60oC or above Food should be kept out of the danger zone, i.e. between 5oC and 60oC. The goal of the kitchen’s hot and cold chain is thus to keep food temperatures below or above this zone.

100oC Hot food zone

60oC Temperature danger zone

Cold food zone Frozen food zone

Bacteria grow quickly

5oC 0oC -18oC

Bacteria do not grow

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potlight

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Preparation To raise productivity and speed of cooking, various raw ingredients are cleaned and prepared in advance. Some items are given a quick blanch to par-cook before being blast-chilled to preserve their freshness and flavour. Soups, gravies and base sauces are also made ahead of time.

MEALS IN NUMBERS

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cuisines: Chinese, Malay, Indian and Western

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meals: breakfast, lunch, afternoon tea, dinner and supper

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rice options: white rice, brown rice, mixed white/brown rice, soft rice, plain porridge and pureed porridge

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250kg

vegetables for 1,800 main meals daily

100kg meat for 1,100 main meals daily

100kg rice for 1,450 main meals daily

therapeutic diets

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allergyavoidance diets

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modified texture diets: regular, soft, minced, pureed

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Fire it up!

Closer to meal times, the burners in the kitchen are fired up and chefs pull out the prepared ingredients to cook up a variety of stir-fries, curries and soups.

Each day, about 11 meal options are made available.

Some of the cooked food may have its texture modified — pureed or mashed — in accordance to the speech therapist’s texture guidelines. This ensures that people with swallowing difficulties can eat safely without choking. To do this, foods may be modified with special thickeners.

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THE KAIZEN SERIES PART 2 OF 3

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Testing, plating and temperature checks Each meal prepared is developed in collaboration with Yishun Health’s dietitians and is checked to be low in fat, salt and sugar, but high in nutrition, variety, taste and texture. Once a dish is cooked, it is loaded into warmers for plating. Taste and temperature tests are done before plating to ensure that the food meets all safety (and taste) requirements.

HEALTHY, SAFE, TASTY AND SUSTAINABLE Apart from the many considerations to ensure that meals are balanced, delicious and safe to eat, the department goes the extra mile to be environmentally conscious through many small process improvements. For example, food waste is reduced at the production level. Vegetable and meat scraps are used to make richly flavoured stocks, and fruit trimmings are used for desserts such as pies.

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Load it up!

The plated food is plated according to the patient’s diet order. It is then loaded into the pre-heated food cart. The food cart will then be programmed and transported to the wards via Automated Guided Vehicles.

Even the water used to wash fruits and vegetables is not immediately disposed of; rather, it is recycled and used for the first round of floor washing.

This underscores the Food Services department’s holistic approach to food, health and wellness, assures Ghazali. “The Food Services team strives to provide the best food and care for our patients because we believe eating well also plays a pivotal role in their healing process.” | 15

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veryday Heroes

“It’s good to know someone cares”

Life has been hard for Ms Sally Low, 47, who has been a caregiver to both her parents and is now in need of some care herself. Recently diagnosed with cancer, Sally nevertheless finds joy in the simple pleasures of life and urges people in need to open themselves up to self-care and social support.

As a caregiver, Sally receives free hand massages at the sensory bay. This offers her relief from the numbness in her hands due to chemotherapy

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ally was only in her 20s when her father, then in his 70s, was diagnosed with a brain tumour. As the only child of elderly parents, Sally had to shoulder a lot of the responsibilities as breadwinner and co-caregiver. She even had to hold down two jobs to support the household financially. After some time, Sally realised that the strain of

caregiving at home was too much for her mum and herself, and made the difficult decision to move her father to a nursing home.

When he passed away in 2003, Sally thought that her caregiving duties were over. But a few years ago, her mother had a fall and, during her stay in hospital, was diagnosed with dementia. Sally decided to leave her job to care

for her mother, whose condition was quite severe and resulted in a number of behavioural adjustments.

Back in the role of caregiver — this time on her own — Sally was often overwhelmed. She became depressed, stressed and isolated, constantly worrying about her mother, work and finances. She experienced one of her lowest points when her mother fell and was

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warded at Khoo Teck Puat Hospital.

Recognising the immense pressures that Sally was facing, her mother’s doctor, A/Prof Philip Yap, Senior Consultant, Geriatric Medicine, connected her with Montfort Care, a network of social and community programmes committed to improving the lives of individuals, families and the community facing transitional challenges. It was also during this time that Sally decided to find a new job as a Student Care Officer to support both her mother and herself.

SOMEONE TO LEAN ON IN DARK TIMES It was then that Sally met Jayne Leong, Lead Social Worker at Montfort Care. “Somehow we connected,” says Sally, who found herself opening up about her problems and concerns. Through these chats, Sally made another difficult decision to opt for nursing home care at All Saints Home in Yishun, where her mother would have more supervision and professional care. “I felt very guilty about it but talking with Jayne helped me to see things from a different perspective.”

Having someone to talk to and a support system became even more crucial when Sally was diagnosed with Stage 4 rectal cancer in early 2018. Sally had surgery in April, followed by eight rounds of chemotherapy. Despite this, Sally faces the next phase of her treatment with quiet courage. “I am no longer as worried as I used to be because I know I have someone I can talk to and there is help,” she affirms.

Jayne has helped her to apply for subsidies, reducing the financial

GOODLIFE@YISHUN 838 Yishun Street 81 Singapore 760838 Tel: 6484 8040

burden of treatment.

Aside from this, Sally has benefited from receiving aromatherapy and massage sessions that helped improve her quality of sleep (see sidebar). This has helped her overcome insomnia and manage her stress levels, so she can focus on getting better.

By opening up about her experiences and illness, Sally hopes to encourage others to do the same — and know that there is help out there.

Services such as Montfort Care, and social workers such as Jayne, have had a huge impact on her life. “I wish we had this help when my dad was sick. It would have made such a big difference to us,” Sally shares.

Though she still has her own battles to fight, Sally wishes to make a difference to others, and pay forward the good she has received. In fact, she is looking forward to volunteering at GoodLife@Yishun, and is training to be a listening ear and friend to others.

She hopes the environment of care

Over time, Sally found herself opening up to Jayne about her problems and concerns

will be conducive to helping others “open up to a circle of social support” and know that there is hope and care out there. “I want to dedicate my life to help whoever comes my way,” she says. “I used to be very negative, but I have seen the light at the end of the tunnel. It’s good to know someone cares, so I want to people to know that there is help out there. I have struggled before, but now with support, I know I do not struggle alone.”

HEALING HANDS, CARING HEARTS

GoodLife@Yishun, a one-stop wellness hub and resource centre, was launched on 25 November 2018. Run by Montfort Care and supported by the Nee Soon South community, the space features a drop-in café for residents and a sensory bay that offers free hand massage therapy and mindful tea drinking sessions for caregivers.

Apart from conducting wellness activities for seniors, the centre also runs case management, counselling, caregivers’ support groups, dementia and mental health screenings, and active ageing and befriending programmes.

For Sally, these hand massages offer some relief as her chemotherapy causes numbness in her hands. The sessions are relaxing and help her feel better. Sally encourages caregivers to stop by to engage in some self-care and, perhaps, open up to others about what they are going through. This is the first step to seeking help, she says. “I would like to raise awareness of such spaces and services, and my hope is for others to come out of their shell to share their problems and seek help. If you do, will find that you are not alone and there are many resources and help available.”

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Cover Story

A JOURNEY OF MANY STEPS From ground-up approaches that engage the community to changing behaviours, this article explores the novel ways that Yishun Health improves the delivery of healthcare.

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he pursuit of delivering better healthcare can take many forms. It could be making access to care more convenient for patients, collaborating with partners to improve efficiency, or educating the public to raise awareness. In some cases, it may involve transforming processes completely.

Yishun Health embraces all these moves as part of an ethos of constant improvement across

its various touchpoints and institutions. This stems from a mindset that first acknowledges challenges.

A CARING-VILLAGE APPROACH TOWARDS DEMENTIA Recognising that our population is ageing rapidly, Yishun Health has made improvements to build a more aged- and dementia-friendly community in northern Singapore.

Over the last three years, some 20,000 people — students, retailers, business-owners, and members of religious organisations — have been trained to spot people with dementia, how to interact with them, and help or refer them to suitable agencies.

This awareness is aimed at better addressing dementia, de-medicalising it, and offering greater empathy and support to those with dementia as well as their caregivers. Instead of treating them as patients, the

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THE KAIZEN SERIES PART 2 OF 3

Members of the CARITAS team having a discussion led by A/Prof Yap (fourth from right)

dementia-friendly initiative aims to help people with dementia to live at home rather than in hospitals or nursing homes.

Today, there are more than 13 dementia go-to points in Yishun. These ‘safe return’ spots are places where members of the public can bring lost and wandering people with dementia.

Yishun Health has also partnered organisations such as Montfort Care to provide longer-term support for patients and caregivers [read more

about the newest GoodLife! eldercare centre in Yishun on page 17].

Another partnership to improve the care for frail older persons with dementia as well as support ageing in place is CARITAS iCommunity@ North. Started in 2012, the goals of this integrated care model is spelt out in its name. “CARITAS stands for Comprehensive, Accessible, Responsive, Individualised, Transdisciplinary, Accountable and Seamless care,” says A/Prof Philip

Yap, Senior Consultant, Geriatric Medicine. When patients are discharged from the hospital and head home, or to a nursing home or a day care centre, the CARITAS team continues to be part of the care.

“This extends dementia care into the community,” explains A/Prof Yap. The transdisciplinary team of Yishun Health doctors, nurses, physiotherapists, occupational therapists, speech therapists, psychologists, pharmacists, and | 19

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Cover Story

PATIENT-CENTRED DEMENTIA CARE

Within the hospital setting, Yishun Health has made improvements to the way dementia is cared for. Since 2003, it has run the only specialised inpatient dementia care unit in a tertiary acute care setting in Singapore.

The 16-bed CAMIE (Care for the Acute Mentally Infirm Elderly) ward in KTPH adopts person-centred care that prioritises the needs of each patient. A sister ward in YCH, CARMIE (Comprehensive Assessment & Rehabilitation of the Mentally Infirm Elder), cares for patients with dementia who have less acute medical conditions or who need physical rehabilitation.

As of December 2018, CAMIE and CARMIE have recorded 2,078 and 220 restraint-free days respectively.

According to A/Prof Yap, elderly patients with dementia in hospitals have been found to have better health outcomes if they are not tied down with physical restraints, and if their autonomy is respected.

He leads a study that proves that the restraint-free system is both cost-effective and scalable. Instead of using restraints, nurses find other ways to gain the cooperation of patients. One way is to build rapport and gain their trust. Another is to use technology such as pressuresensor mats so staff are alerted when the patient attempts to get out of bed. Compared to conventional care, restraint-free care sees a: • 32% improvement in well-being • 15% improvement in mobility and function • 45% reduction in challenging behaviour • No increase in the rate of falls

medical social workers — all dementia specialists — meet weekly with community partners to discuss care plans, provide updates, and share recommendations to offer timely and proactive care. This means no patient falls through the cracks even after they have left the hospital. Patients and their families are also holistically supported with individualised, person-centred care.

There is even a patient care manager whom caregivers can readily contact if they need help. This heightens the responsiveness to ad hoc as well as long-term needs.

Today, CARITAS serves more than 800 patients with dementia and differing levels of frailty and comorbidities in the North.

Dementia awareness is nurtured through an intervention programme called New You. This started in 2007, back in the days of Alexandra Hospital, and has been based

Dr Ng Chong Jin, Consultant, Geriatric Medicine, works with A/Prof Philip Yap in the Dementia team to care for their patients

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THE KAIZEN SERIES PART 2 OF 3

All dementia specialists meet weekly with community partners to discuss care plans, provide updates, and share recommendations to offer timely and proactive care. This means no patient falls through the cracks, even after they have left the hospital.

A/PROF PHILIP YAP SENIOR CONSULTANT, GERIATRIC MEDICINE, KTPH in KTPH’s Geriatric Clinic. The programme has been implemented in the Wellness Kampungs since 2017, and more than 50 sessions have been held. It combines exercise, cognitive training and stimulation, and social interaction for patients with early dementia. This programme for early dementia patients combines exercise, cognitive training and stimulation, and social interaction.

This programme is complemented with other groundup initiatives from the community, such as Age Well Everyday, where residents are trained to conduct programmes on health education, exercise and mindfulness. According to Evon Chua, Manager, Population Health & Community Transformation,

this culture of community-led care is making its mark. A group of residents has even begun to use brochures on dementia as part of their hanyu pinyin teaching material!

“They are also doing Sudoku puzzles as a group so that they can support one of their friends who was recently diagnosed with early dementia,” shares Evon.

EMPOWERING DIABETES SELF-CARE Yishun Health has adapted its care platforms to make care more integrated as well as improve patient compliance.

One of these is in the ongoing improvements to diabetes management. The disease is not only about managing blood sugar through medication, but also through longterm lifestyle and dietary changes.

And because the disease can lead to many other complications, such as heart disease, foot problems, poor wound healing, and eye conditions, many specialists need to be involved.

This can result in confusion, frustration and inconvenience for patients.

According to A/Prof Subramaniam Tavintharan, Director and Senior Consultant, Diabetes Centre, Admiralty Medical Centre (AdMC), Yishun Health has been building and refining its diabetes care model since its days as Alexandra Hospital. “The Diabetes Centre has been around for some time, but care has evolved to better treat patients beyond their medical well-being,” he shares.

“First, we tackled the many facets of care by developing multidisciplinary services around the patient.” The approach shifted the idea of ‘illness care’ to ‘holistic healthcare’, viewing each patient as a whole rather than a combination of body parts or medical conditions.

Together as a team, doctors,

diabetes nurses, podiatrists and dietitians work not only on their specific areas, but across specialties to ensure well-coordinated patient care. “We realised our own gaps and the need to train ourselves in the specialised knowledge and skill sets of our colleagues to move towards transdisciplinary care [see diagram on page 23],” he explains.

While state-of-the-art research plays an important role in treating disease, it is just as essential to go back to the basics, emphasises A/Prof Tavintharan, who researches in the area of diabetes and other metabolic diseases. “We have good drugs, surgical advancements, and high-tech equipment, but as medical professionals, we must not neglect bread-and-butter issues,” he notes.

“Lifestyle choices and daily habits make a big — if not more important — difference in sustaining good health and managing disease.”

So, while he researches extensively in the field, A/Prof Tavintharan is just as involved in ‘simpler’ innovations on the ground, particularly in novel ways to move care away from the hospital and into the community, and manage diabetes in the earlier stages of the disease pathway. “We are enhancing our collaborations with general practitioners (GPs), polyclinics, and our own community nurses to influence diabetes care and improve outcomes,” he reveals.

For instance, patients coming to the Diabetes Centre are greeted by a large installation highlighting the Five Pillars of Diabetes Care: • Diet • Exercise • Support • Monitoring • Medication

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Cover Story

The DESMM message is reinforced throughout the clinic in the form of visible cues, such as posters and self-monitoring booths.

“In every corner, the patient is made aware of the steps they can take in their own self-care,” A/Prof Tavintharan highlights.

CO-CREATING A CULTURE OF COMMUNITY CARE A/Prof Yip Chee Chew, Medical Director, AdMC, and Head and Senior Consultant, Ophthalmology and Visual Sciences Department, echoes the point about selfmanagement as a way to improve patient outcomes in the long term, and notes that a sense of

autonomy and agency improves care compliance. “It is well known that patients who are more involved in decision-making regarding their healthcare are more motivated.

This translates to better outcomes.”

To drive patients to participate in their own care, his department developed a mobile app for patients to do their own eye tests at home.

Regular eye checks at the hospital can be inconvenient for patients, and could lead to missed appointments that result in eye problems going unnoticed.

To improve the rate of eye screening, the Macular Amsler Testing Application (MATA) mobile app was developed.

This allows patients to easily screen themselves at home to accurately monitor their eye conditions. It also

Lifestyle choices and daily habits make a big — if not more important — difference in sustaining good health and managing disease.

A/PROF SUBRAMANIAM TAVINTHARAN DIRECTOR & SENIOR CONSULTANT, DIABETES CENTRE, ADMC

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THE KAIZEN SERIES PART 2 OF 3

how they interact, their needs, and how the community can play a role.

In some ways, AdMC, located within Kampung Admiralty, moves management of diabetes and eye conditions away from hospital-based treatment and shifts the perception of care, he notes. “The environment is friendly and more community-based.”

The specialist centre offers the range of services in a more convenient location that integrates both the medical and social aspects of health.

Apart from changing the place where care is delivered, AdMC also shapes its spaces to encourage patients to be more active

At the AdMC Diabetes Centre, patients are treated by the transdisciplinary team led by A/Prof Tavintharan (third from right)

enables them to spot any changes so that they can seek help early.

But beyond the individual, healthcare engagement and education should also be widened.

A/Prof Yip believes that involving the community will play an important role in the management of not just eye disease and diabetes but also other lifestyle-related diseases, which he terms ‘medical social conditions’. “Medical treatment cannot be as effective if the social or familial setting does not permit a change in lifestyle,” he explains.

After all, he adds, “what one person does is a habit, what many people do is a culture”. To truly manage health holistically, healthcare innovations must consider where people live,

participants in their own care, creating a more conducive place that supports the idea of self-care.

Reflecting on these moves, which enormously widens the idea of medical care from curing illness to caring for the whole patient, his family and even his community, A/Prof Tavintharan points to his own care motto, which is premised on a foundation of “caring and learning”.

He stresses, “While these innovations, improvements and realignment of care take more time and effort to put into place, it is worth it if we really want to achieve integrated, hassle-free and patient-centred care.”

The transdisciplinary approach sees the team coming together from the beginning to jointly communicate, exchange ideas, and work together to develop a holistic care plan. A multidisciplinary team involves individual experts who come together with individually developed ideas to formulate a solution. At Yishun Health, the medical teams explore ways to move upstream to address the diseases in the early stages, so that complications can be prevented, delayed or reduced in severity.

TRANSDISCIPLINARY CARE

PATIENT

MULTIDISCIPLINARY CARE

PATIENT

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Things About...

5 Things About RADIATION AND X-RAYS

You may undergo an X-ray as part of a regular health screening or receive radiation therapy as a form of medical treatment, but what exactly are these ‘rays’ and how safe are they?

In consultation with Muhammad Azhar bin Samsudin and Jasmine Lee, Senior Radiographers, Diagnostic Radiology, KTPH

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1

RADIATION IS ALL AROUND US

We often think of radiation as a man-made phenomenon, but low-dose radiation is natural.

We are surrounded by naturally occurring radioactive elements in the environment, and cosmic rays are constantly penetrating the atmosphere from space. We have radioactive elements (Potassium 40, Carbon 14, Radium 226) in our blood and bones, while man-made devices, such as wrist watches and ionisation smoke detectors, emit small amounts of radiation. However, according to studies done by the United Nations Scientific Committee, the risk associated with low-dose radiation from natural and man-made sources is extremely small.

2

RADIATION HAS ITS PROS AND CONS

The use of radiation and nuclear imaging techniques in medicine is one of the most important ways we diagnose and treat disease and injury. Small amounts of radiation are used to obtain X-ray images and larger amounts are used to treat cancers and tumours. Certainly, prolonged exposure can be harmful and, in rare cases, lethal. This is why the risks and benefits are all weighed carefully by medical professionals and explained to patients who are undergoing medical procedures involving radiation.

3

SAFETY COMES FIRST UNDER THE ALARA PRINCIPLE

ALARA stands for As Low As Reasonably Achievable, and is how patients and professionals working with radiation are protected.

It consists of three principles: time, distance and shielding. The idea is to minimise the amount of time one is exposed to radiation, keep a distance of at least 2m from the radiation source, and use shielding to reduce unnecessary exposure of body parts that are not being examined or treated.

TAKING CLEAR X-RAYS

X-rays can be taken in a hospital’s radiology department, a clinic specialising in diagnostic procedures, or even while you’re seated in a dentist’s chair!

Usually, you stand in front of a plate containing X-ray film or detectors. Sometimes, you may

be asked to lie or sit on a plate, while a camera on an arm is moved over your body.

As with any kind of photography, you need to remain still while the X-rays are emitted so that clear images can be obtained.

4

X-RAYS ARE NOT ONLY USED FOR MEDICAL PURPOSES

While X-rays are used for diagnostic or treatment purposes, they are also very useful for security, and are extensively deployed in air and sea ports as part of screening procedures. The usefulness of seeing through the surface also means X-rays are used to analyse fossils and even artworks. In fact, historians have used X-rays to examine underpaintings in ancient artefacts and famous works of art.

5

THE ‘X’ IN X-RAY MEANS ‘UNKNOWN’

X-rays were discovered by Wilhelm Röntgen, a German physicist and mechanical engineer, in 1895 during an experiment with electrical conduction through low-pressure gases. He named them ‘X-strahlen’.

‘Strahlen’ means ‘beams’ or ‘ray’ in German, while the ‘X’ was pulled from algebra’s use of the letter as an unknown quantity in an equation.

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ive Well

A Wealth of Experience With a combined experience spanning more than 150 years, these four veteran anaesthesiologists aged 70 and above are still passionately pursuing their vocation, which helps them keep active in mind, body and spirit.

T

here is more to anaesthesiology than putting people to sleep.

For Dr Low Tut Choon, Dr Lim Kim Seong, Dr Subhashini d/o Anandan and Prof Chandra Mohan Kumar, it is about making challenging medical conditions easier to bear, surgeries safer and more effective, and giving patients a better quality of life. After all, says Dr Subhashini, better known as Dr Subha, “Any illness is tolerable if there is no pain.

And there is a lot of satisfaction in helping to alleviate pain and reassure patients when they are afraid.”

THE VARIETY WITHIN While they have each spent more than 40 years in anaesthesiology, they readily admit that it was not their first choice as a medical specialty, and never thought that it would become a lifelong career.

Most of them joined for practical reasons — they were posted to the department during their houseman rotation. But the year-long training grew on them, so they stayed. Says Dr Lim, “It is a specialty that requires lots of focus, precision, and keeping up with technology. You also get

to see patients from across the age spectrum and medical conditions.”

Another attractive aspect of the job, adds Dr Low, is that the work can span the surgical, intensive care, emergency, and pain management fields, which gives doctors many avenues to choose from. “There are various modes of anaesthesia, from general to regional, as well as mild sedation. The work also involves airway and pain management,” Dr Lim explains.

This variety keeps the job interesting and offers many paths for professional development.

Prof Chandra, in particular, has embraced this wholeheartedly: he even has a Masters in Computing, in addition to his medical qualifications. “I love this work!” he enthuses. “Doing anaesthesiology — whether in the operating theatre, writing papers, or as an educator — keeps me mentally active.”

Just as active is Dr Subha. “I will keep on working for as long as I am able; it is something I really enjoy,” she says with a laugh. “Working in the operating room keeps me active, and I am known to move very fast — but only in short bursts.”

(L–R, standing): Dr Subhashini d/o Anandan, Dr Lim Kim Seong, Prof Chandra Mohan Kumar (Seated): Dr Low Tut Choon

BETTER WITH AGE With their breadth of experience, these four physicians are also respected educators and mentors.

“It feels good to be able to still be an active and appreciated member of the medical profession,” says Dr Lim. They have continued to learn, grow and adapt with the profession, attending weekly lectures and poring over journals. One of the biggest changes has been the incredible advancements in technology.

Dr Low recalls that much of the management of patients was done manually in the early days. “We had to take blood pressure with our hands while ventilating the patient with our knees,” he shares. “Electrocardiograms were recorded not using electrodes but with needles inserted under

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the skin.” Digital technologies, less invasive methods, and automation have changed the practice of medicine tremendously. “Anaesthesia drugs and technology are now safer, more precise, and the outcomes are better,” assures Prof Chandra.

It has not always been easy to keep up with technology, especially when it comes to computers, admits Dr Subha. “But we just need to keep learning and not be afraid to ask for help.” It is all part of the collaborative aspect of medicine, she surmises.

“I enjoy working with my team very much. We need and support each other.” For this reason, she is keen to work in the operating theatre, where there is a strong sense of teamwork and camaraderie, especially under pressure.

This mindset of learning, and embracing change and challenges is a common characteristic among the other members of this quartet.

Dr Lim believes this is essential as patient profiles change; illnesses are getting more complex and doctors have to account for complications such as chronic illness, obesity and an ageing population. Dr Lim, who has an interest in bariatric surgery, works with his peers to ensure that overweight patients optimise their health status before surgery.

Prof Chandra is an advocate for making eye surgeries safer for elderly patients with dementia through regional rather than general anaesthesia. This, he advises, limits the risks of respiratory, liver and kidney issues, and cognitive decline.

He frequently conducts lectures on the role of anaesthesiology in eye surgery for the elderly.

While Dr Low has spent several years heading the Anaesthesia department, one of his areas of interest these days is chronic pain management. Beyond just treating the pain, he believes in supporting patients. “Some patients suffer for a long time with chronic pain but may not be taken seriously by their family and friends,” he reveals.

He finds that listening to his patients supports them more holistically. “It is therapeutic somehow to simply be there for them,” he shares. “All medicine is fulfilling; being able to be there to ensure that patients are safe and taken care of is what matters.” | 27

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akan Time

Steamed Seabass, Teochew Style

cut & keep

Fresh fish, best served steamed, is a deliciously simple addition to the dinner table. It’s high in protein and omega-3, and low in fat.

Recipe contributed by Chef Terry Wan Sau Ann, Food Services, KTPH, and in consultation with Nutrition and Dietetics, KTPH

INGREDIENTS Serves 4 • • • • •

500g seabass, whole 20g tomato, thinly sliced 15g red chilli, thinly sliced 10g salted vegetable, thinly sliced 20g dried Chinese mushroom, soaked and thinly sliced • 10g ginger, thinly sliced • 30g silken tofu, cut into strips • 10g salted plum, seed removed

METHOD 1. Wash and clean the seabass with water, pat dry, then place on a steaming plate 2. In a bowl, combine all other ingredients and spoon on top of the fish 3. Pour ¼ bowl of water over the fish 4. Bring the water in your steamer to a rolling boil 5. Steam the fish for 8 minutes 6. Remove from steamer 7. Add salt and pepper to taste; serve hot

NUTRITIONAL INFORMATION (1 SERVING) Energy

128kcal

Carbohydrates

2g

Protein

25g

Fat

2g

• Saturated

1g

• Polyunsaturated

0.5g

• Monounsaturated

0.4g

Cholesterol

68mg

Fibre

1g

Sodium

229mg

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aily Dose

Snack smart!

Ring in the new year with a healthier approach to traditional snacks and dishes of festive occasions. Enjoy in moderation, and exercise a little extra to burn off the excess.

In consultation with Chow Pek Yee, Principal Dietitian, Nutrition and Dietetics, KTPH

E

ating healthily does not mean depriving yourself of all things delicious. It simply means making informed choices and eating in moderation. It also means choosing quality over quantity, and mindfully enjoying each mouthful.

One simple way to reduce your intake of extra calories is to say “no”

to sodas, packet drinks (even the ‘less sweet’ varieties), and fruit juices, all of which contain lots of sugar. Go for water, Chinese tea, or sugar-free green tea instead. You can then allocate your sugar quota (the Health Promotion Board recommends no more than 8–11 teaspoons a day; that’s 40–55g) on cookies and snacks

that have lower sugar content.

Fat should form no more than 25–30% of your daily caloric intake; this translates to 14–16 teaspoons of fat (55–65g). To achieve this, try forgoing items that are deep fried, and be mindful of any hidden fat and gravy served with dishes.

SUGAR Soda (330ml): 7tsp sugar, 133kcal ‘Less Sweet’ Chrysanthemum tea (330ml): 4tsp sugar, 70kcal

Chinese tea, Green tea, Water 0tsp sugar, 0kcal

Pineapple tart (1 piece) 3tsp sugar, 93kcal

Love letter (1 piece) 1tsp sugar, 17kcal

Deep-fried nian gao (35g) 2tsp fat, 160kcal

Steamed nian gao (20g) 1tsp fat, 46kcal

Traditional yu sheng (387g) 8.5tsp fat, 561kcal

Traditional yu sheng with half the amount of oil dressing and deep fried items (450g) 5tsp fat, 354kcal

Deep-fried chicken breast (with skin) 4tsp fat, 364kcal

Deep-fried chicken breast (without skin) 1tsp fat, 224kcal

FAT

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ind & Health

Healthy Habits Planner Set out your intentions for the day, week, month or year — and achieve your health goals!

EAT HEALTHILY:

EXERCISE REGULARLY:

Cups of water I would like to drink daily

A weekly exercise routine I would like to try out

MONDAY

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TUESDAY

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Fruits and vegetables that I would like to include in my meals

WEDNESDAY THURSDAY FRIDAY

How many times a week I would like to include brown rice into my meals

SATURDAY SUNDAY

BE HAPPY:

3 things I am grateful for in 2018 and 3 things I look forward to in 2019

1 2 3

PRACTISE PERSONAL HYGIENE: Good hygiene practices I would like to maintain

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HEALTHY HABITS: 2 bad habits I would like to overcome

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Community Nurse Post

Wellness Kampung

Wellness Kampung is an initiative comprising three wellness and care centres for residents in the north. They provide a suite of health and social programmes, creating a support network for residents to inspire each other to adopt healthier lifestyles in a close-knit 'kampung' setting.

Opening hours: Mondays to Fridays, 8.30am to 5.30pm (closed on Saturdays, Sundays and all Public Holidays)

115 Chong Pang

260 Nee Soon East

765 Nee Soon

Blk 115 Yishun Ring Road #01-495, Singapore 760115

Blk 260 Yishun Street 22 #01-87, Singapore 760260

Blk 765 Yishun Street 72 #01-366, Singapore 760765

6257 4702

6257 4802

6257 4842

C

M

Y

CM

MY

CY

CMY

K

Admiralty Medical Centre (AdMC) AdMC is a one-stop medical centre for specialist outpatient consultation, day surgery, rehabilitation and diagnostic services, as well as community health outreach activities.

Khoo Teck Puat Hospital (KTPH)

KTPH is a 659-bed general and acute care hospital serving more than 800,000 people living in the north of Singapore.

It combines medical expertise with high standards of personalised care in a healing environment, to provide care good enough for our own loved ones.

Yishun Community Hospital (YCH)

YCH provides intermediate care for recuperating patients who do not require the intensive services of an acute care hospital. Situated beside KTPH, the two hospitals provide an integrated care experience for patients.

676 Woodlands Drive 71, #03-01 Kampung Admiralty, Singapore 730676

90 Yishun Central Singapore 768828

2 Yishun Central 2 Singapore 768024

6807 8000

6555 8000

6807 8800

www.admiraltymedicalcentre.com.sg

www.ktph.com.sg

www.yishuncommunityhospital.com.sg

www.fb.com/admiraltymedicalcentre

www.fb.com/khooteckpuathospital

www.fb.com/yishuncommunityhospital