AHA magazine Jan-Feb 2020: Where healing takes root by Yishun Health

aha

Issue 1: January-February 2020

WherE Healing

Takes Root

MCI (P) 065/04/2019

How our green, thoughtfully designed and sustainable environment supports health and healing

MISSION: INFECTION CONTROL

BEING SOMEBODY FOR SOMEONE

LIFE IS BEAUTIFUL

ontents

COVER STORY

Where Healing Takes Root How our green, thoughtfully designed and sustainable environment supports health and healing

DESIGNED FOR HEALTH 2 |

HEALTH HIGHLIGHTS Healthcare news and updates

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

12 SPOTLIGHT Mission: Infection Control The complex, multi-faceted job of contagion control 16 EVERYDAY HEROES Being Somebody for Someone Being a Healthcare Assistant is more than offering basic care – it is about carrying out humble deeds with dignity

26 24 5 THINGS ABOUT… Our Pillars of Health Yishun Health’s Five Pillars of Health is our philosophy on health for all 26 LIVE WELL Life is Beautiful Mrs Rosalind Tan and Mr Tan Wee Lee on what keeps their bodies, minds and marriage going

Part 2 of 3 Health is more than the absence of disease or infirmity; it is about being well in totality. It is this understanding that lies at the heart of being a health-promoting hospital and a hospital in a garden. By integrating biophilic principles into our environment, Yishun Health not only connects people to nature, but also incorporates wellness into its very walls.

PUBLISHER 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.

28 28 FIT & FAB Squats: A Big Deal! The advantages of squats – and how to do them right 30 DAILY DOSE Cholesterol: The Good, Bad and Ugly The low-down on cholesterol and its many functions and faults 31 MIND & HEALTH Connect with Nature Connect the dots to reveal the beauty of nature

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 Bastari Irwan Chia Kwee Lee Fatimah Moideen Kutty Shirley Heng Teresa Foong

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

PUBLISHING AGENT THINKFARM PTE LTD www.thinkfarm.sg M A N AG I N G D I R E C T O R

Christopher Tay

aha

Issue 1: January-February 2020

WherE Healing

Takes Root

How our green, thoughtfully designed and sustainable environment supports health and healing

H E A D, E D I TO R I A L

Chua Kim Beng

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

Sheralyn Tay E D I TO R

Dang Hui Ling H E A D, C R E AT I V E MCI (P) 065/04/2019

Sean Lee

MISSION: INFECTION CONTROL

BEING SOMEBODY FOR SOMEONE

LIFE IS BEAUTIFUL

hy aha? The name aha holds much significance for us at Yishun Health. In part, it is a nod to our history; 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.

H E A D, 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 Kelly Loh Sunuja Naidu Vernon Wong

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) 065/04/2019

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ealth Highlights

MAKE THE MOST OF All Singaporeans, regardless of income, are eligible for the Community Health Assist Scheme (CHAS) and can use their benefits to offset the cost of managing chronic illness. Application is easy â&#x20AC;&#x201C; just go online.

o you know your CHAS benefits and how you can make the most of the subsidies to best manage your health and chronic conditions? CHAS is a scheme to make chronic care more affordable and enable people to manage chronic disease more easily and conveniently at their participating neighbourhood general practitioners and dental clinics. There are five tiers for CHAS: Blue, Green, Orange, Merdeka and Pioneer Generation.

CHAS

The green CHAS card was rolled out in November 2019 and is for all Singaporeans regardless of income â&#x20AC;&#x201C; it can be used for simple and complex chronic conditions. To apply or renew your CHAS card, simply go to https://chas.moh.gov.sg. 4 |

CHAS Criteria

CHAS Green

CHAS Orange

CHAS Blue

Merdeka Generation

Pioneer Generation

Household monthly income per person (for households with income)

Above $2,000

$1,201– $2,000

$1,200 and below

All Merdeka Generation receive CHAS benefits, regardless of income or AV of home

All Pioneers receive CHAS benefits, regardless of income or AV of home

Annual Value (AV) of home (for households with no income)

Above $21,000

$13,001– $21,000

$13,000 and below

Common Illnesses1

Not applicable

Up to $10 subsidy per visit

Up to $18.50 subsidy per visit

Up to $23.50 subsidy per visit

Up to $28.50 subsidy per visit

Selected Chronic Conditions

Up to $28 subsidy per visit, capped at $112 per year

Up to $50 subsidy per visit, capped at $200 per year

Up to $80 subsidy per visit, capped at $320 per year

Up to $85 subsidy per visit, capped at $340 per year

Up to $90 subsidy per visit, capped at $360 per year

Up to $40 subsidy per visit, capped at $160 per year

Up to $80 subsidy per visit, capped at $320 per year

Up to $125 subsidy per visit, capped at $500 per year

Up to $130 subsidy per visit, capped at $520 per year

Up to $135 subsidy per visit, capped at $540 per year

Selected Dental Services

Not applicable

$50–$170.50 subsidy per procedure (denture, crown, root canal treatment only)

$11–$256.50 subsidy per procedure (dependent on procedure)

$16–$261.50 subsidy per procedure (dependent on procedure)

$21–$266.50 subsidy per procedure (dependent on procedure)

Recommended Health Screening under Screen for Life3

A fixed fee of $5 with Screen for Life Invitation letter

Simple2

Complex2

A fixed fee of $2 with Screen for Life Invitation letter

Free with Screen for Life Invitation letter

Capped at 24 visits for common illnesses per patient, per calendar year, across all CHAS clinics, from 2020 onwards.

“Simple” refers to visits for a single chronic condition. “Complex” refers to visits for multiple chronic conditions, or a single chronic condition with complication(s).

With Screen for Life Invitation letter, for recommended screening test(s) and first post-screening consultation, if required. This refers to screening for diabetes, high blood pressure, high blood cholesterol, colorectal cancer and cervical cancer.

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hat’s Up

A Prize for Our Purple Parade Contingent Y

ishun Health was named one of the top 10 best contingents during the Purple Parade’s appreciation event held on 21 November 2019. The Yishun Health contingent was one of 242 organisations that participated in this year’s parade, which supports inclusion and celebrates the abilities of the special needs community in Singapore. This win was made possible through the support, creativity and energy of Yishun Health’s staff, friends and family, volunteers from YCH’s Fun Fit Club and patient sitter programme, as well as our Corporate Social Responsibility partners, Villa Francis Home for the Aged, Singapore Christian Home, and Sree Narayana Mission Home. Besides underscoring the strong ties between Yishun Health and its community partners, the win also reflects the solidarity exemplified by everyone towards this worthy cause.

Above: Chief Human Resource Officer Ms Magdalene Chai receiving a token of appreciation from Central Singapore Community Development Council’s Mayor, Ms Denise Phua Left: Yishun Health’s contingent at the Purple Parade

Marking TriGen’s Fifth Year T

Right: Representatives from the TriGen team posing for a photo

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h e Population Health and Community Transformation (PHCT)’s Tri-Generational HomeCare @ North West (TriGen) team commemorated its fifth anniversary on 16 November 2019. The TriGen programme sees student volunteers from secondary schools and universities work in tandem with community nurses, doctors and allied health providers to increase the frequency of homecare visits. More than 1,000 students have been involved in the programme. To mark this milestone, some 90 people — including PHCT’s partners, student volunteers and alumni, North West Community Development Council, and representatives from Tan Tock Seng Hospital and Singapore General Hospital — gathered for an afternoon of carnival games and camaraderie. This milestone is a culmination of PHCT’s good and sustainable work in caring for our senior residents. It goes beyond the medical factors and looks after the seniors’ social life, behaviour and environmental settings.

A Winning Harvest K

TPH and YCH brought home several awards at this year’s Community Garden Edibles Competition. The annual event, organised by National Parks, was part of the Community Garden Festival graced by Deputy Prime Minister and Minister for Finance, Mr Heng Swee Keat. In his opening speech, he noted that community garden movements like this give people a platform to contribute to our nation, building a more beautiful and vibrant city. KTPH won in the Heaviest Pumpkin category with its 5.9kg champion, while YCH’s hefty contender, a 5.4kg pumpkin, won third place. Both institutions also brought home multiple consolation prizes, awarded to edibles such as the wintermelon, papaya, luffa, and long beans. These awards recognise the effort, skill and dedication of our gardening volunteers who tend our rooftop gardens. Besides nurturing plants, volunteers also run weekly horticulture therapy sessions for patients in KTPH and YCH.

Deputy Prime Minister Mr Heng Swee Keat holding the prizewinning pumpkin with our ‘Chief Gardener’ Ms Rosalind Tan

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hat’s Up

Lifting Towards Health! K

TPH Sports Medicine held a full-day Public Forum titled ‘Functional Strength: Improving Function through Strength’ on 2 November 2019, which was attended by more than 200 people. Six speakers, including a number of strength training coaches and athletes, shared insights about their sport and highlighted the importance of strength and conditioning for daily functional health. They also touched on safety and proper techniques. Representatives of Olympic Weightlifting, Powerlifting, and Strongman also displayed their prowess in their respective sports and held demonstrations on basic movements.

Strength training coaches and athletes displaying their prowess and holding demonstrations on basic movements

A View of Radiography Through the Years Y

Left: Interested participants at the Diagnostic Radiology department’s annual exhibition

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ishun Health’s Diagnostic Radiology department marked World Radiography Day with their annual exhibition. The exhibits showcased the history and evolution of radiography as well as the many modalities such as X-rays, nuclear medicine, computed tomography and ultrasound. There was also a showcase of interesting case studies. The team prepared an online quiz and held a talk on radiation safety as well.

Diabetes Management: Family Matters

n 9 November 2019, the Kampung Admiralty Community Plaza was enlivened with a number of activities to mark World Diabetes Day. Over 400 people turned up for the Diabetes Health Fair and Active Ageing Day organised by Yishun Health and Active Ageing SG. Titled ‘The Family & Diabetes’, the event was graced by Mr Amrin Amin, Senior Parliamentary Secretary, Ministry of Home Affairs & Ministry of Health, and MP for Sembawang GRC (Woodlands). Booths, posters, screening, educational talks and demonstrations served to emphasise the importance of concerted actions to confront diabetes. One of the key messages was to reinforce Yishun Health’s five pillars of diabetes management: Diet, Exercise, Support, Monitoring and Medication (DESMM). More specifically, the programme aimed to emphasise the importance of inter-generational family support in combating diabetes.

Attendees learnt about the different aspects of combating diabetes at Yishun Health’s Diabetes Health Fair and Active Ageing Day

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hat’s Up

Connecting Through Speech and Action O

A speech therapist working with a nursing home resident

ur speech therapists celebrated Speech Therapy Day with a meaningful outreach event in the community on 2 November 2019. Titled ‘Communication, Our Key to Connection’, the day brought together 43 speech therapists across NHG for a day of volunteering activities for residents of Sree Narayana Mission Home and Lee Ah Mooi Nursing Home. The therapists organised games and facilitated the creation of memory books, which is a helpful way to preserve prized memories and past experiences for persons with dementia. They also took the opportunity to hold an educational talk for nursing home staff on speech therapy and strategies to facilitate communication. After the outreach event, the speech therapists convened for a get-together lunch, with games and a lucky draw.

Raising Stroke Awareness A

stroke carnival was held on 12 November 2019 to commemorate Stroke Awareness Day, internationally observed on 29 October. Organised by the Acute Stroke Unit Workgroup, the event was aimed at educating the public and staff on how to identify the risk factors for stroke. Doctors gave talks on stroke prevention and there were health screening booths to encourage people to get their check-ups done. Over 200 people visited the interactive educational booths, attended the healthy cooking demonstration helmed by KTPH’s Food Services and Nutrition & Dietetics departments, and took part in a mass Zumba workout.

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The public got to learn more about stroke prevention at the stroke carnival organised by the Acute Stroke Unit Workgroup

Staying Engaged for Safety and Security Y

ishun Health’s Safety and Security Week 2019 was held from 31 October to 6 November 2019. This year’s theme was: ‘Stay Engaged, Stay Safe’. To reinforce the safety and preparedness message, safety talks and exercises were held to educate staff and strengthen their safety awareness. Ms Yen Tan, Chief Operating Officer, closed the week at the KTPH Auditorium on 6 November. She highlighted the various risks, such as fire, infrastructure, data, and workplace harassment. As such, it is essential that all staff continue to be vigilant on the ground, and persist in bringing about justice to minimise danger for both staff and patients. She also extended her appreciation to the Singapore Police Force and Singapore Civil Defence Force for working closely with Yishun Health to keep it safe and secure.

The Singapore Police Force and Singapore Civil Defence Force educated staff on keeping their workplace safe and secure

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potlight

Mission: Infection Control At Yishun Health, a hardworking team collects data, monitors trends and develops strategies to keep infections at bay and ensure the safety of patients, staff, visitors and the community.

Stopping the spread of infections in the hospital starts with good hand hygiene â&#x20AC;&#x201C; the Infection Control team is led by Nurse Clinician Foo Meow Ling and Dr Chris Willis (middle)

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nfection control is more than hand hygiene. In fact, it covers a vast spectrum of hospital activities across the wards, operating theatres, ambulatory centres, outpatient clinics, diagnostic facilities and Emergency Department. Dr Chris Willis, Senior Consultant, General Medicine, explains, “The field of infection control is very broad. It covers everything to do with preventing, managing and responding to the spread of infectious disease.” This ranges from screening and reporting infectious disease to staff vaccinations and contact tracing. It also includes establishing infection control protocols and training. Dr Willis heads the eightperson team tasked with the surveillance of in-hospital infection rates. Particular attention is placed on resistant organisms and transmittable diseases. Running the day-to-day work on the ground is Nurse Clinician Ms Foo Meow Ling. She and five other infection control nurses keep a vigilant eye on the spread of pathogens across KTPH, YCH and AdMC. “It’s a full-time role,” Meow Ling says. The focus on infection control has sharpened in the last few years. The work is critical to keep patients and visitors safe, especially in light of the rise of ‘superbugs’ — bacteria that are resistant to antibiotics. According to a 2018 national study, patients warded in a hospital — whether public or private — all run a high risk of catching infections even as they are being treated for other conditions. The study reveals that 11.9% of people, or about one in nine, pick up a bug while in

All Yishun Health staff are aware of infection control protocols regardless of their job scopes in the hospital

hospital. To address this challenge, the team works closely with all the patient-facing departments in the hospital to ensure compliance with infection control protocols.

Screening is the frontline of defence. Every patient who gets warded is tested for major superbug culprits, including MRSA [see box story].

MOST WANTED MRSA: Methicillin-resistant Staphylococcus aureus MRSA infection is caused by a type of staphylococcus aureus (commonly called staph) bacteria. This bacterium typically exists harmlessly on skin, and one-third of all people have staph bacteria in their nose. However, if the bacteria enters the body, it can cause an infection. In most cases, this is mild, usually manifesting as a sore or abscess. But some strains are resistant to commonly used antibiotics and can cause serious infections that are hard to treat. Screening for MRSA involves swabbing the nostrils, armpits and groin. A positive test means that the bacteria is present and that the person is a carrier, but does not necessarily mean an infection is present.

CRE: Carbapenem-resistant Enterobacteriaceae

CRE is a family of bacteria that includes Klebsiella pneumoniae and Escherichia coli (E. coli). These bacteria can cause infections, including pneumonia, bloodstream infections, urinary tract infections, wound infections, and meningitis. CRE are a major concern because they are resistant to carbapenem antibiotics, which are considered the last line of defence to treat multidrug-resistant bacterial infections. To screen for CRE, a stool sample or rectal swab is taken.

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potlight

“We track these multidrugresistant organisms and put up the necessary transmission-based precautions where needed,” Meow Ling explains. This may mean ‘tagging’ a patient so that extra care is taken to lower the risk of spread. For example, if the patient needs to go to a clinic, operating theatre or for diagnostic imaging, he or she is scheduled as the last case. This allows for a thorough disinfection at the end of the procedure. Patients with highly transmissible diseases may also be roomed separately to isolate them from the general population. Where required, healthcare staff use additional protective gear, such as masks and gowns.

These protocols require training, which forms another facet of the work. Familiarisation with proper procedures are essential to keep everyone in a state of preparedness. “Training and education are the basis for good infection control,” reflects Meow Ling. While these protocols can seem cumbersome, they are ultimately about keeping everyone, especially patients, safe, she emphasises. Another major aspect of the work is the management of data, which is critical in the tracking of disease. “We collect statistics, monitor trends and conduct audits.” This helps the team to make informed decisions and formulate infection control strategies.

“This is a significant study because the data is steeped in real-life, on-theground hospital operations. Typically, this bath is only used in the ICU, but the study proved its efficacy for general wards as well.” DR CHRIS WILLIS, SENIOR CONSULTANT, GENERAL MEDICINE

All staff go through a mandatory mask fitting and personal protective equipment training organised by the Infection Control team

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BATTLING MRSA This tracking of data through consistent audits has played an important role in tackling the rise of MRSA. In 2015, Dr Willis and his team published a significant study on the effect of a disinfectant, chlorhexidine, on the spread of MRSA for inpatients. “Yishun Health began screening for MRSA 10 years ago, since its Alexandra Hospital days,” Dr Willis says. Special precautions were taken for those identified to be carrying MRSA. Apart from contact precautions, patients were bathed daily with chlorhexidine. Analysing data collected over three years, the study revealed that chlorhexidine bath has a powerful

protective effect. Dr Willis points out that these preventive measures reduced the risk of developing MRSA infection for carriers by eight-fold. “This is a significant study because the data is steeped in real-life, on-the-ground hospital operations,” Dr Willis stresses. “Typically, this bath is only used in the ICU, but the study proved its efficacy for general wards as well.” The study — the largest of its kind — was published in the International

Journal of Infection Control. Since then, the infection control team has stepped up and broadened the criteria for chlorhexidine baths to include more high-risk populations, such as patients from nursing homes,

those on dialysis, and patients who have been warded for more than seven days. These efforts, notes Dr Willis, play a role in keeping more than MRSA infections at bay. “MRSA is used as an index organism to evaluate and assess the overall effectiveness of infection control across the organisation. Once the multi-pronged processes are in place and running properly, they control other infections as well.”

INFECTION CONTROL AND YOU Infection control is everyone’s responsibility. It is not just about hospital-based precautions; visitors play a role, too. If you are visiting a loved one in the ward, be mindful of these precautions.

Sanitise hands before and after visiting to avoid bringing in and carrying out germs. Look out for Germ Stopper stands conveniently placed around the hospital.

Limit contact with patients and do not sit on their beds or handle their equipment.

Clean your hands after sneezing, coughing, touching your eyes, nose, or mouth, after using the restroom, and before and after eating or drinking. Cover your cough or sneeze with your sleeve.

Stay at home if you are sick or have had any symptoms — such as nausea, vomiting, diarrhoea, fever, an uncontrolled cough or a rash — within the last three days.

Give gifts with caution as food or flowers may not be advisable for some patients.

Protect immunocompromised people, including children, the elderly and expectant mothers. These groups have a higher risk of catching a bug. Where possible, avoid visiting patients until they are well.

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veryday Heroes

BEING SOMEBODY

FOR SOMEONE

Being a Healthcare Assistant may not be glamorous, but to Cheong Lin Wai, known as Aunty Cheong to her colleagues, assisting nurses to show compassion and provide basic care to patients are acts of humility â&#x20AC;&#x201D; the carrying out of humble tasks with dignity. 16 |

leaning up after patients, helping them with toileting needs, serving meals and assisting nurses with caregiving tasks make up most of Aunty Cheong’s workday. While her tasks may seem mundane, she plays an important role in the comfort and recovery of patients at KTPH. Before she started this job four years ago, Aunty Cheong never thought she would work in healthcare. After a stint in an architecture firm, she became a homemaker for 17 years, during which her entire world revolved around her children and their meals, schooling and extra-curricular activities. It was only when her children were older that she started to take part in community and volunteer activities, often with her second sister, whom she was especially close to. In 2016, her sister passed away suddenly from a rare heart condition; a few months later, her older sister died of a stroke. It was during this period of great loss that Aunty Cheong’s husband suggested she take up some courses to keep herself occupied. Having some goals, he hoped, would help her overcome her grief and move forward. As her children were already in their late teens by this time, Aunty Cheong felt it was a good idea to discover a new purpose. After a two-day ‘employability camp’ at e2i, she was encouraged to train to be a Healthcare Assistant. “The course was interesting and it was sponsored too,” she recalls. “I thought it would be good to learn a skill, so I went for it.” Despite possessing an open mind and a willingness to learn, Aunty Cheong admits she harboured reservations.

“I was 53 at the time, and wondered if my colleagues would accept me,” she reveals. “Would I be able to fit into a new workplace, with a new work culture and much younger colleagues?” But once she started work at KTPH, all her apprehension faded away. “My nurse supervisors and colleagues have been very kind. They always encourage me and the nurses to learn from each other,” she says. Aunty Cheong is also thankful to her family for their support.

“We do it to make people comfortable, help them get better.” A HUMBLING JOB Aunty Cheong admits that her work is “humbling”. Tending to the toileting needs of patients and changing diapers are things that many people may shrink from; to her, it is just part of the job. What she does, she says, ultimately benefits people. “We do it to make people comfortable, to help them get better.” Working in a new field is just like dealing with changes — you just have to take the plunge and adapt. “Don’t compare your current and previous job,” she advises. “Each job has its own satisfaction. We have to be ‘nobodies’. It is a humble job but we still maintain our dignity.” Aunty Cheong is far from a ‘nobody’. In fact, she is ‘somebody’ to someone every day, especially the patients: she is the one who puts

patients at ease, helping them with personal care and comfort during their stay; she is the welcoming face at lunchtime, serving a hot, freshly cooked meal; she also offers a listening ear, and can frequently be seen sitting with caregivers or patients to listen to their concerns, worries and life stories. During these interactions, she takes the opportunity to dispense advice and gently remind patients about self-care and the management of their conditions. “Before I worked here, I think I was quite sheltered — I never knew or saw so much. I did not actually know that so many people were struggling and sick,” she shares. “Now, I have adjusted my views on life.” After meeting and caring for so many people from many walks of life, Aunty Cheong has gained a much broader perspective on life, and a deeper appreciation of it too. Listening to people, helping them, watching them get better and going home is something that gives her deep satisfaction. “It makes my job worth doing.”

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Cover Story

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DESIGNED FOR HEALTH PART 2 OF 3

WHERE HEALING TAKES ROOT Yishun Health supports health and healing by delivering more than quality, value-based healthcare services. A green, thoughtfully designed and sustainable environment enhances recuperation and drives well-being not just for patients, but also staff, visitors and the community at large.

he idea of having a restful and healing natural environment was an integral part of the vision and design of the campus, and carries over the legacy of transformation from the old Alexandra Hospital. Today, KTPH and YCH have integrated more than 9,300m2 — that is roughly the size of 19 basketball courts — of greenery into the development. But there is more to the deliberate greening of the hospital than aesthetics. The hospital was designed to leverage nature and its elements to complement health-promoting efforts. In Biophilic Design in Action, Dr Nirmal Kishnani, Associate Professor, School of Design and Environment, and Programme Director, Master of Science, Integrated Sustainable Design, National University of Singapore, notes that this “deep integration of plants and architecture” is the very definition of biophilic design. Biophilic design is based on the premise that people have an affinity for nature and natural processes. This connection, in

turn, supports well-being, recovery, happiness and productivity. According to Ms Teresa Foong, Head and Senior Principal Clinical Psychologist, Psychological Service, biophilic design can reduce stress, enhance creativity and clarity of thought, improve well-being and expedite healing. “Psychological responses to nature impact restoration and stress management,” she explains. “Creating a ‘Hospital in a Garden’ was not just about planting a lot of plants. It took deliberate care and strategic choices. It was not greening for greening’s sake,” shares Mr Donald Wai, Director, Hospital Planning & Infrastructure. The goal, he says, is to maximise the potential of the hospital’s landscape. Welcoming gardens and spaces were not only intended to attract nearby residents to the hospital and create opportunities to encourage healthier lifestyles; they also provide respite for patients and family members to gather their thoughts and even have important discussions.

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Cover Story

For instance, Dr Mansha Khemlani, Senior Consultant, Geriatric Medicine, says that she and her nurses often bring patients to the fish pond at the basement to chat about their worries and concerns as well as their values and preferences. This helps greatly in initiating end-of-life conversations and advance care plans. “Being away from the disruption and busyness of the wards and being in a quiet place allows for introspection,” Dr Mansha notes. In connecting with nature, people get in touch with their own spirituality. It reminds us that we are part of nature and its cycle of life and death. “We find this particularly useful in dealing with palliative care patients.” According to Dr Ng Chong Jin, Consultant, Geriatric Medicine, biophilic experiences involve the senses — sight, hearing, smell, taste and touch — and can be a positive distraction from physical or emotional discomfort. He notes that when the

“Being away from the disruption and busyness of the wards and being in a quiet place allows for introspection... It reminds us that we are part of nature and its cycle of life and death.” DR MANSHA KHEMLANI SENIOR CONSULTANT, GERIATRIC MEDICINE, KTPH

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In the ICU, patients have a view of the outside, a feature aimed at supporting their recovery in critical care

Care for the Acute Mentally Infirmed Elders (CAMIE) Ward was located in Ward B55, the medical team often escorted patients to the connecting open-air garden between Towers A and B for physiotherapy, gardening and communal dining. “Currently at geriatric Ward D87, we have incorporated horticultural therapy in the care of patients with dementia, stimulating their sense of sight, smell and touch. This interaction with nature moderates challenging behaviour and reduces the need or dosage of psychotropic drugs.” The natural elements in the hospital also serve to strengthen organisational health and productivity, Donald adds, especially in the hectic and high-stakes setting of healthcare. “Many of our staff appreciate the fact that there are

many outdoor areas for them to have discussions, short meetings, and even to take their lunch or dinner if they are working late. They feel that the calm and green environment actually helps to reduce their stress levels.” Dr Mansha herself finds the greenscape near the pond a restful sanctuary. She and her colleagues frequently take walks and jog there. “It gives us the space and time to disconnect and reconnect with what matters.”

LETTING THE LIGHT IN One way that the hospital has used nature to its advantage is the use of light. Daylighting has been an effective passive design strategy that is widely used across the hospital. A growing body of research validates the benefits of integrating

DESIGNED FOR HEALTH PART 2 OF 3

“Including biophilic design into our hospital environment brings about additional healing power to our patients.” MS TERESA FOONG HEAD AND SENIOR PRINCIPAL CLINICAL PSYCHOLOGIST, PSYCHOLOGICAL SERVICE KTPH

nature into the built environment, including access to daylight and natural ventilation. A famous study1 published in 1984 in the journal Science by environmental psychologist Roger Ulrich showed that patients with bedside windows and a view of leafy trees healed a day faster, needed significantly less pain medication, and had fewer postsurgical complications than patients who had a view of a brick wall. Sufficient natural light also helps regulate sleep cycles and the circadian rhythms; it also facilitates critical biochemical reactions within the body to positively impact patient

outcomes. For people with dementia, natural lighting reduces agitation and confusion. Daylight is also linked to increased workplace satisfaction as well as improved performance in visual tasks. To this end, large windows and open corridors make up a large part of the buildings’ design: daylight supplements electrical lighting across some 70% of the floor area in wards and 60% of the hospital’s gross floor area enjoy natural light. Even in the Intensive Care Unit (ICU), patients have a view of the outside — a feature aimed at supporting their recovery, even in critical care. The greenery within and around the hospital is similarly being deployed to boost overall well-being and support recovery. In 2018, a study 2 published in Environmental Research found that simply being close to nature and spending time outside has significant and wide-ranging health benefits. Exposure to green spaces reduced the

1 View Through a Window May Influence Recovery from Surgery 2 The health benefits of the great outdoors: A systematic review and meta-analysis of greenspace exposure and health outcomes

risk of diabetes, cardiovascular disease and high blood pressure. Studying data from more than 20 countries, the research team found that being close to nature was correlated to lower levels of cortisol, a stress hormone. Teresa also points to empirical studies that report experiences of natural environments providing greater emotional restoration, with lower instances of tension, anxiety, anger, fatigue, confusion and total mood disturbance than urban environments, which have fewer natural elements. “Hence,” she concludes, “including biophilic design into our hospital environment brings about additional healing power to our patients.”

SUSTAINABILITY MATTERS Beyond beautification, improved patient outcomes and an enhanced visitor experience, the greening of KTPH is also part of Yishun Health’s efforts to be sustainable. For example, greening has been an alternative way to offer shade. Instead of constructed shelters, tall trees have been planted to provide shaded outdoor walking areas. Rooftop gardens and planter boxes outside ward windows have also been added to allow patients to have a calming view during their recovery. These intentional greening efforts were a way to meet our goal of naturally ventilating the space. Mr Jerry Ong, Senior Vice President, CPG Consultants, shares, “As the basic function of the hospital meant that most of the spaces had to be mechanically ventilated or air-conditioned, we decided to free up all the public spaces to be naturally ventilated.” The greening of the central courtyard has not only opened up the hospital to more breezes, it has

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For healthcare workers, the environment provides a calming presence as they walk to and fro between wards as it helps them to disconnect to connect better with their patients

NATURE WILL NURTURE

In November 2017, KTPH won the first-ever Stephen R. Kellert Biophilic Design Award organised by the International Living Future Institute (ILFI). Amanda Sturgeon, CEO of ILFI, said the hospital “surpasses traditional hospitals and opens the door towards a new kind of building type for the healthcare industry, which considers how the built and natural environment can become part of the healing process.”

also reduced urban heating, bringing more comfortable temperatures to our patients, staff and visitors. In a paper 3 published in 2015, Dr Kishnani found that “in post-occupancy measurements, the microclimate of this courtyard was some 2°C cooler than spaces just outside the hospital.” Planners were selective about the types of trees and plants to use: they should be hardy, shed leaves lightly, and not require too much irrigation. These trees and plants thus would need fewer resources for maintenance, yet still keep the hospital grounds clean and green. There is also a focus on local and Southeast Asian species, including a number of endangered species.

Fast-growing and tall plants were also chosen so that a shadier and rainforest-like look could be achieved in a shorter period of time. Yishun Health also works closely with the Public Utilities Board (PUB). In exchange for channelling rainwater collected on hospital premises into the pond, the PUB provides water back to KTPH at a much lower rate compared to using potable water. About 6,000m3 of treated water is channelled from the pond for irrigation needs annually.

USING RESOURCES WISELY The adoption of eco-friendly technologies is another facet of

3 Enhancing Blue-Green and Social Performance in High Density Urban Environment

22 |

DESIGNED FOR HEALTH PART 2 OF 3

NATURAL SUCCESS

The growth in biodiversity in and around the Yishun Health campus speaks to the effectiveness of all the greening efforts. During the first biodiversity survey done at the start of the project, there were only three species of butterflies found. Today, the Yishun Health visitor population includes the following:

• 99 species of butterflies (including the Clipper, once thought to be extinct!)

• 31 species of dragonflies • 88 species of birds

greening efforts, which extends beyond plants to an overall approach to sustainability. “As an organisation, we strive to be judicious with natural resources,” said Mr Chin Yew Leong, Deputy Director, Operations. The key challenge, he notes, is balancing the hospital’s operational needs to function at peak levels while also minimising resource use without affecting day-to-day operations. “We must prioritise healthcare quality, patient safety and comfort; yet, at the same time, we have to be mindful of our carbon footprint,” he stresses. Passive design elements have been an important strategy in this respect. As mentioned, the architecture and design elements of Yishun Health maximise natural ventilation and lighting. This saves 8.6MkWh, enough for the air conditioning needs of 6,718 households for an entire year. Added to this, the Facilities Management team also take an environmentally conscious approach in their work. LED lighting,

• 100 species of fish

• The occasional monitor lizard, pangolin and otter

sensors and an optimised chiller system are some of the back-end ways that reduce the environmental impact of our electrical needs. • LED lights were installed in the car park in 2016; the system operates on timed schedules based on operational needs • Motion-activated lights installed in toilets, pantries and infrequently used corridors save 10% in energy use • Step sensors reduce the speed of escalators when they are not in use, cutting energy consumption by up to 30% • Energy-efficient lifts with sleep mode and variable speed motor drives use 10% less energy • The waste and linen chute system is calibrated to work in alignment with cleaning schedules • Ventilator fans are run according to operational needs These various efforts save enough electricity to power more than 1,400 households for a month.

“Biophilic experiences with nature often involve enhancing one or more of the five senses — sight, hearing, smell, taste and touch — which can be a positive distraction from discomfort.” DR NG CHONG JIN CONSULTANT, GERIATRIC MEDICINE KTPH

TYING IT ALL BACK TO HEALTHCARE These energy savings, sensory delights and picturesque views are all well and good, but they complement an even bigger, farreaching and long-term goal: the responsibility that Yishun Health has as a steward in every aspect of good health. There is a much larger mandate that underpins the belief in sustainable healthcare operations. “It would be counterproductive to treat the population if the by-product of our operations is environmental damage, which would, in turn, harm human health. With this conviction, we have sought to minimise the environmental impact of our daily operations wherever possible, while still prioritising patient care and safety,” emphasises Yishun Health CEO Mrs Chew Kwee Tiang.

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Things About...

5 Things About...

Our Pillars Of Health

Yishun Healthâ&#x20AC;&#x2122;s 5 Pillars of Health summarise our philosophy on how to promote health for not just patients, but staff and community as a whole. In consultation with Lisa Choo, Principal Clinical Psychologist and Chair of the LifeWorks! Committee

24 |

ealthcare is more than curative medical treatment. As an organisation, we believe not only in delivering care in response to sickness, but also in being a health-promoting hospital that takes active steps to inculcate health promotion, preventive intervention as well as positive and sustained lifestyle change. This is achieved through focusing on our 5 Pillars of Health: Eat Wisely, Exercise Regularly, Be Happy, Stop Smoking and Practise Personal Hygiene.

AR S U GR E E F

Yishun Health encourages an active lifestyle through leading by example and creating an environment that is supportive of healthful activities. Regular group exercise classes for staff as well as the public are held prominently at the promenade facing Yishun Pond and other locations around the hospital. Eye-catching and engaging messages are often displayed near many convenientlylocated stairs to nudge people to keep moving.

EAT WISELY

There is a clear connection between healthy eating and good health. At Yishun Health, we’ve built a positive food environment, using strategic marketing practices such as food placement, pricing and signage to influence the way hospital staff and visitors eat. For instance, healthier alternatives, such as brown rice and lower-in-sugar drinks, cost less than white rice and sugary drinks. To make these options attractive, four messages are displayed prominently to nudge people towards making healthier meal choices: EAT REAL FOOD, NOT TOO MUCH.

EAT MOSTLY PLANTS.

TAKE LESS SALT.

EXERCISE REGULARLY

BE HAPPY

Deliberate choices such as a waterfront view, greenery, sounds of nature and cooling breezes were integral elements in the design brief when the hospital was built. These elements are not just for aesthetics, but serve to connect people with nature, ease anxiety, boost spirits, inspire mindfulness and inculcate positive thoughts. Combined with this, Yishun Health runs many community and volunteer programmes, such as gardening. Patient befrienders also improve social wellness and create healthy bonds of friendship that can go towards boosting health, while peer support networks foster a positive mindset and enjoyment of life.

STOP SMOKING

As a ‘No Smoking’ campus, Yishun Health actively drives the message of being smoke-free through signages and health messages, and complements this with active steps, such as smoking-cessation programmes. Brightly coloured signs are prominently displayed throughout the hospital grounds to send an uncompromising message that smoking is harmful to health. There is also a robust staff-driven push to encourage smokers to quit. Within the organisation, based on those who had attended the Health Screening, 88.1% have never smoked before, 8.3% have stopped smoking completely, and 1.6% are smokers who smoke one cigarette or equivalent per day on average.

PRACTISE PERSONAL HYGIENE

Good hospital hygiene is critical for preventing healthcare-associated infections in hospitals. To boost levels of ownership in personal as well as environmental hygiene and cleanliness, there is a ‘self-cleaning’ culture, which encourages all staff and visitors to clear their own food trays and discard litter responsibly. Germ-stopper stations dispensing face masks and hand sanitisers are also strategically placed along common walkways and ward entrances.

TAKE LESS SUGAR.

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ive Well

Life is beautiful

Mrs Rosalind Tan, 79, and Mr Tan Wee Lee, 85, have been married for 54 years, sharing their lives, hobbies and love for beauty. These are what keep their bodies, minds and marriage going.

and in hand, Wee Lee and Rosalind, who is fondly known as Ros, take a stroll through the Screw Pine garden at the basement of KTPH, chatting familiarly with each other. The spot, almost like a second home to them, is one that they’ve seen

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flourish over the years. As Yishun Health’s ‘Chief Gardener’, Ros has spent more than 19 years tending to the plants, shrubs, farms and gardens of Alexandra Hospital (AH) and, subsequently, KTPH. Their love for gardening goes beyond the hospital grounds. At their

home, both Wee Lee and Ros have also grown a beautiful garden of their own. From a bare backyard to one that is lush and flourishing, the area now contains more than 500 species of plants, and even includes a shady 50-year-old Elephant Ear Fig Tree, a giant bonsai largely nurtured by Wee Lee over the years. “He is the gardener at home, I am the gardener in the hospital,” quips Ros. Over the years, the couple have read up on horticulture, learning about plant species, biodiversity, space planning and landscaping. Their shared interest in all things green made for a perfect partnership both at work and home. Wee Lee, a retired Senior Principal Architect, has been an active volunteer at both AH and KTPH, and has contributed his talents in photography and design over the years. His background came in handy when it came to the greening of the AH grounds. “There was a lot

of land with old buildings scattered throughout. We planted trees, shrubs, themed gardens and even plantations to camouflage sparse grounds and beautify old buildings,” he describes.

A LIFE SHARED “We” is a term Wee Lee and Ros use a lot — underscoring just how much they share in their long marriage. They met when they were both fresh graduates and taking part in a local play. Ros was an aspiring actress while Wee Lee was working on the props. Ever the gentleman, Wee Lee would accompany her home after rehearsals and performances, and eventually persuaded her to stop acting as it got a little tiring for him. “My friends joked that I gave up a career on the stage to get married!” Ros recalls. Although she gave up the limelight, Wee Lee and Ros built a life together that has been full of other highlights. Like the plants that they carefully tend, nurture and grow, the energetic grandparents of three have placed much effort to cultivate a rich social and recreational life.

On weekdays, Ros, a retired Chief Occupational Therapist, works as a Senior Executive in Operations, managing the landscaping needs of KTPH. Wee Lee often drops by once a week to walk through the gardens with his wife and take in his favourite plant, a tall Screw Pine tree with lots of supporting roots. “I am surprised that it has established itself so well,” Wee Lee says while glancing at it. “I like trees and gardens like this; they look natural, not so manicured, and a little wild.” Apart from tending to greenery, their calendar is packed with other hobbies and interests. From tai chi and travelling to art and museums to mahjong, they do it all together. “We like to gallivant on the weekends,” reveals Ros with a laugh. “We leave the car at home and take public transport in order to rack up steps on our pedometers.” Wee Lee, an avid amateur artist, also finds time to paint, sculpt and make pottery. He also reads a lot — his bookshelves are filled to the brim with books in both English and Mandarin that cover all manner of subjects.

Ros and Wee Lee 53 years ago, shortly after they were married (right); and doing tai chi today (below)

“It is also important to cultivate an inquisitive mind. Be open to new things, ideas, places and people. Keep your mind and hands active.” “He has too many interests and has no time to sleep,” Ros jokingly complains of her husband. On a more serious note, Wee Lee notes that hobbies are an important aspect of a satisfying life, especially in the retirement years. “I always advise others to develop a hobby early in life,” he states. “It is also important to cultivate an inquisitive mind. Be open to new things, ideas, places and people. Keep your mind and hands active.” Ros agrees that it is not only good for a marriage, but for overall health. “It need not be ‘exercise’ but as long as you are moving — going out, doing things, using your hands and body — you are helping to maintain your joints, muscles, mind and functional ability,” she adds, the occupational therapist in her coming to the fore. “Most importantly, do it together. Even now, we are simply contented and really enjoy each other’s company, and this has kept us going all these years.”

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it & Fab

Squats: a big deal!

When properly done, squats are an easy and effective exercise for the young and old, regardless of fitness level. In consultation with Andy Chen, Physiotherapist, Rehabilitation Services

quats are one of the simplest yet most effective exercises you can do at home. They increase lowerlimb strength for a variety of people, ranging from sedentary couch potatoes to high-level athletes. According to Andy Chen, Physiotherapist, Rehabilitation Services, the benefits of squats are numerous. They: • Assist in daily activities; for example, they make climbing stairs easier • Enhance performance in sports, including basketball and football • Maintain healthy hip, knee and ankle joint movements • Build muscle size and strength around the hips and knees • Reduce the risk of cardiovascular disease and falls • Increase walking speed in the elderly

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SQUAT EFFECTIVELY Technique is very important to squat safely and effectively. To help you, here are some key points to note:

Stand

Make sure the

with feet

knees neither move

hip-width

forward past the

apart

toes nor buckle inwards towards each other

Ensure feet

Keep your

stay flat on

chest upright

the ground

and back straight

Contrary to popular misconception, squats, when done properly, do not increase the risk of injury to the knee or the structures around the knee. In fact, it can actually be helpful in preventing knee problems!

SQUAT VARIATIONS Squats engage big muscle groups and can be more intense than you expect. If you are new to squats, reduce the difficulty by using support. Using the technique below, stand up and sit down with a chair. An alternative is to slide up and down with your back against a wall, bending and straightening your knees.

Sit-to-stand

Sit on a

Keep your back

Sit down

firm chair

straight, lean

slowly by

with your

forward and slowly

bending your

feet apart

stand up

hips and knees

Wall Slide

Place your feet

Bend your

Make sure that

Return to

shoulder-width

knees and slide

your knees do

the standing

apart to keep your

your back down

not go beyond

position

back to the wall

the wall

the toes

As you get better, you can increase the intensity by performing single-leg squats, squatting to a lower depth, or even holding on to weights while squatting.

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aily Dose

Cholesterol: the good, bad and ugly Cholesterol is a natural substance that is present in the food we eat. It is also produced by the body and is essential for certain key functions. However, too much of certain types of cholesterol can cause problems. In consultation with Carol Chan, Senior Pharmacist, Pharmacy

holesterol is a wax-like fat present in the bloodstream and an essential component of cells. It is also vital in many bodily functions, such as synthesising hormones and vitamins, as well as forming healthy nerves. There are two types of cholesterol: • High-density lipoproteins (HDL): the ‘good’ cholesterol that helps to remove excess cholesterol from the body. • Low-density lipoproteins (LDL): the ‘bad’ cholesterol, which can build up and form fatty deposits called plaque, and stick to the walls of blood vessels, especially the arteries that supply blood to the heart. As the plaque gets thicker, it may cause the arteries to harden and narrow. This can reduce blood flow to the heart and result in symptoms such as chest pain and heart disease. When we have ‘high cholesterol’, it typically means that the levels of LDL are higher than normal. • Triglycerides (TG): another type of fat found in your blood. Both high levels of TG and LDL can contribute to increased risk of heart disease, vascular disease and stroke.

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TACKLING HIGH CHOLESTEROL Healthy eating and regular exercise can lower cholesterol levels. Smoking cessation is also important in reducing cardiovascular risks. However, when diet and lifestyle changes are unable to adequately reduce cholesterol, medications can help. Statins are medications commonly prescribed to reduce our body’s production of cholesterol and the build-up of plaque in blood vessels. Studies have shown that, in certain people, statins may reduce the risk of heart attack and stroke by about 20–25% .

As with all medications, some people may experience side effects. Mild side effects associated with statins include stomach discomfort and headache. In rare cases, statins can affect the muscles or liver. Patients are recommended to seek medical attention immediately if there is severe unexplained muscle pain, dark urine, or yellowing of the skin or eyes. However, regular check-ups and monitoring with a doctor can help manage these risks. In most cases, the benefits of lowering cholesterol outweigh the risks. Any concerns regarding medications should be discussed with a pharmacist or doctor.

HDL Cholesterol (Good)

LDL Cholesterol (Bad)

Normal Artery

Narrowed Artery

ind & Health

CONNECT WITH NATURE

Drawing from from the interconnection between nature and health, Yishun Health has taken advantage of biophilic design to improve your well-being. Take some time to connect the dots yourself to reveal the beauty of nature.

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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

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 795-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