AHA Magazine Jan - Mar 2024

aha

ISSUE 1: jan–mar 2024

MCI (P) 020/07/2023

Living Life to the Fullest

GOING THE EXTRA MILE AT JOURNEY’S END

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LEADING BY EXAMPLE AND MAKING POSITIVE CHANGE THROUGH VOLUNTEERING

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DELIVERING HOSPITAL CARE IN THE COMFORT OF HOME

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ontents

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COVER STORY Living Life to the Fullest Though he needs dialysis daily, 54-year-old Mr Subhan Ali continues to live an active and fulfilling life. He shares how peritoneal dialysis gives him the flexibility to run his own business, socialise and travel – and reflects on his journey of becoming an empowered member of the dialysis community

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

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YH IN THE NEWS A roundup of Yishun Health appearances in the media

16 Q&A Health and wellness questions asked and answered!

18 EVERYDAY HEROES Going the Extra Mile at Journey’s End From birthdays and weddings to other last wishes, the Palliative Care team bring light to dark days

21 LIVE WELL Leading by Example and Making Positive Change Through Volunteering Read how Helen and Martyn bond as mother and son over active living and giving back to others

Part 2 of 3

JOURNEYS IN HEALTH 2 |

The second part of our series on the health journeys of patients showcases how coming to terms with a chronic disease - and embracing one’s own active role in making appropriate choices and lifestyle decisions - can uplift and enrich one’s life. Importantly, this issue not only emphasises the role we can play in our own journey in health, but also how we can help others on their own path to wellness.

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

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EDITORIAL TEAM 24 SPOTLIGHT Delivering Hospital Care in the Comfort of Home Patients with acute but stable medical conditions can now receive treatment at home 28 5 THINGS ABOUT… Supporting Someone with Chronic Illness A guide on what to say at these times 30 DAILY DOSE A Daily Dose of Fibre It’ll surprise you how fibre benefits your health 32 MAKAN TIME Prawns with Mango Mayonnaise A fresh and fruity prawn salad for the festive table 34 FIT & FAB Fight Arthritis with Movement and the Right Exercises It may appear counterintuitive, but you can relieve your pain with these exercises Scan here to subscribe to aha online for regular updates and stories from Yishun Health!

aha

ISSUE 1: jan–mar 2024

Living Life to the Fullest

Nur Amalina Hannah Wong Jack Lau 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 Fatimah Moideen Kutty Shirley Heng Teresa Foong

www.ktph.com.sg/ about-us/media/publications 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 E DITO R

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

Sheralyn Tay

MCI (P) 020/07/2023

W GOING THE EXTRA MILE AT JOURNEY’S END

18

LEADING BY EXAMPLE AND MAKING POSITIVE CHANGE THROUGH VOLUNTEERING

21

DELIVERING HOSPITAL CARE IN THE COMFORT OF HOME

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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 R E AT I V E

Lee Lily

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

Justin Loh

aha is the official quarterly 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 express 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) 020/07/2023

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hat’s Up

Taking Healthier SG on the road and into your life!

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he Healthier SG Roadshow made its way to the heart of Yishun on 21 October 2023. Over 2,800 residents turned up for the event, which was held to highlight the initiative and encourage people to enrol.

To support this national push, teams from Yishun Health’s Regional Health Office (RHO) and Nutrition & Dietetics

transformed the space into different zones and pitstops.

These zones covered a wide range of activities, such as educational talks, cooking demonstrations and exercise sessions – all aimed at nudging residents to adopt a healthy well-being and lifestyle.

In addition, there was a joint performance by the singers from the Wellness Kampung @ 765 Nee Soon Central’s Tune UP community singing group and the Yishun Public Library’s singing group. In all, the roadshow got a great response, succeeding in getting more than 800 people enrolled that day!

RHO’s Ms Elaine Toh (Executive Director) and Evon Chua (Assistant Director) and A/Prof Pek sharing a light moment with Minister K Shanmugam, MP for Nee Soon GRC, one of our partners in the Healthier SG journey

(Left to right) Thumbs up to health! AIC CEO Mr Tan Kwang Cheak, Ms Elaine Toh (Executive Director, Regional Health Office, Yishun Health) and A/Prof Pek Wee Yang (CMB, Yishun Health) were joined by the Nee Soon GRC MPs – who were down in full force! – and Healthier SG representatives, Mr Dinesh Vasu Dash (Deputy Chair, Healthier SG Implementation, MOH) and Mr Tan Leong Boon (Director, Healthier SG Task Group, MOH) at the Healthier SG Roadshow

Singers from the Wellness Kampung 765 Tune UP community singing programme came together with Yishun Public Library’s singing group to put up a performance

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It was a busy day for the RHO team, who actively reached out to members of the public to share about Healthier SG to encourage enrolment

Supporting our breasts through screening and awareness

Mdm Ho Fui Fah (centre) shared her experience as a breast cancer survivor during a fireside chat

Interactive booths were set up by our partners - the Breast Cancer Foundation, Health Promotion Board, National Healthcare Group Diagnostics, National Healthcare Group Polyclinics and Singapore Cancer Society

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n 1 October 2023, Yishun Health held our inaugural Breast Cancer Awareness Month Carnival to shed light on the disease and its impact and drive early detection.

Some 200 residents attended the event at Tzu Chi Humanistic Youth Centre, and enjoyed a line-up of activities such as informative talks, interactive booths, mammogram screenings and wellness programmes

Dr Jerry Goo, Head & Senior Consultant, General Surgery, shared how early screening can save lives and breasts

Our GOH Mdm Rahayu toured the many booths as well as the Mammobus where pre-registered residents could get their mammograms done on-site

that included calligraphy sessions and mindfulness therapy. The event was attended by guest-of-honour Mdm Rahayu Mahzam, Senior Parliamentary Secretary for Health.

To start, there was a talk conducted in English and Mandarin by a panel of doctors and healthcare professionals from Yishun Health and supporting institutions. Not only did the

sessions provide insight into breast health, it also highlighted the importance of regular screening and cancer prevention. One speaker was cancer survivor, Mdm Ho Fui Fah, who was diagnosed early and successfully completed her cancer treatments and surgery.

She told her story and urged women to make breast health a priority at every age. | 5

hat’s Up

Making mental health a priority

Through the activities, the event spread the message that whether young or old, improving our mental well-being is a lifelong process!

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recent Ministry of Health survey revealed that while mental health has deteriorated in Singapore, more are willing to seek help. This increased willingness to do so reflects higher awareness of mental health and reduced stigma around the related conditions.

Staff well-being has always been a priority, and our Yishun Health CEO Prof Chua Hong Choon (third from right) showed up to support the Psychological Medicine team!

To commemorate World Mental Health Day, which falls on 10 October each year, KTPH Psychological Medicine department organised a series of activities for members of the public and staff.

The combination of educational panels, interactive activities, resources and treats such as ice cream made

for an engaging event that was both informative and enjoyable.

At the mental wellness workshops, staff also got to try out various relaxation techniques as well as gratitude journalling, a practice that can help practitioners manage negative thoughts and promote positive thinking.

Looking out for our eyes during AMD Week

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ge-related Macular Degeneration causes irreparable vision loss and affects those aged 50 and above.

This condition and other macular diseases are estimated to affect 27% of Singapore’s ageing population, a rate that may be exacerbated by the rising prevalence of diabetes.

To help spread awareness of macular diseases, KTPH Ophthalmology and Visual Sciences department launched their 19th run of the Awareness of Macular Diseases (AMD) Week, themed ‘Healthy Life, Healthy Eyes’. More than 350 senior residents along with their caregivers, Yishun Health staff and healthcare staff from other institutions attended the launch on 7 October 2023.

Various activities and interactive booths were set up to encourage 6 |

The morning kicked off with pre-event activities, such as a Zumba workout at the Yishun Pond Promenade

participants to adopt four simple lifestyle habits - Eat Healthy, Stay Active, Quit Smoking and Get Your Eyes Checked. These will go some way towards reducing the risk of getting macular diseases and improve overall well-being.

Our chefs and dietitians showed participants how to prepare quick and easy recipes that are delicious and good for the eyes

Recognising our staff for safe, quality care on NHG Quality Day Y

ishun Health won 12 awards at the 2023 NHG Quality Day, an annual event held to recognise individuals and teams within the NHG cluster for their excellent service and provision of safe, quality care.

All smiles for Yishun Health as the NHG Quality Day winners pose for a photo with Senior Management and their supporters

Nur Afrah Binte Mohamed, Senior Staff Nurse, Major Operating Theatre, KTPH received the Good Catch Award for being an advocate for patient safety with the courage to speak up

Excellence in Action Award winners (individual and team) • ALLIED HEALTH: Wong Wan Mun, Senior Podiatrist and Liew Mei Wan, Senior Podiatrist Assistant • ADMINISTRATION: Lynn Shi, Senior Manager, YCH Operations and Lim Yujun, Manager, GeriCare • NURSING: Eileen Lim, Nurse Manager, Ward A71 and Yu Lee Hoon, Senior Nurse Clinician, Ward A62 • PALLIATIVE MEDICINE: Dr Khemlani Mansha Hari, Senior Consultant, Geriatric Medicine • TEAM AWARD: Telehealth and Integrated Network (THINK) Centre team

Quality Improvement Award winners • SERVICE REDESIGN & DELIVERY (GOLD): Dr Chen Xinying, Senior Consultant, Anaesthesia, and team, for the ‘Improving ROTEM Timings in Major Trauma Patients’ project • SERVICE REDESIGN & DELIVERY (MERIT): Dr Jerry Goo, Head & Senior Consultant, General Surgery, and team, for the ‘Ambulatory Care in Emergency Surgery (ACES): Reducing Admissions and Length of Stay for Surgical Patients’ project • IMPROVING AND SUSTAINING QUALITY & SAFETY (MERIT): Dr Lau Weida and team, for the ‘Improving the “Time-ToDiagnosis” for Patients with Gross Haematuria’ project Good Catch Award winner • NURSING: Nur Afrah Binte Mohamed, Senior Staff Nurse, Major Operating Theatre

Celebrating our GeriCare class of 2023

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ishun Health’s GeriCare department – which is part of the Population Health & Community Transformation team – held a graduation ceremony on 22 September 2023 for 37 nurses from 10 of our partner nursing homes as they marked the completion of the TeleGeriatrics Nurse Training Course.

The course, which is part of GeriCare’s efforts to upskill nursing home staff in geriatric and palliative care, aimed to build the telemedicine consultation capabilities of these staff so that they can better identify and

Nurses from our partner nursing homes celebrating the graduation of their course

manage symptomatic nursing home residents whose conditions require escalation to hospital specialists.

This helps to support right-siting of care and improve quality of life for the nursing home residents. | 7

hat’s Up

Flowers for our community gardens!

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ach year, the Community in Bloom Awards recognise sustainable, beautiful and diverse community gardens that actively engage people. This year, a number of Yishun Health’s community gardens made it to the top 50 list! One of these is the little plot near Wellness Kampung@260 Nee Soon East, which has become an impressive local attraction for its creative designs and use of recycled items and toys that coincide with festive occasions. Both KTPH and YCH rooftop gardens also made it to the Top 50 list, keeping up their impressive long-running winning streaks!

Much work and camaraderie happen behind the scenes at these beautiful gardens at Wellness Kampung @ 260 Nee Soon East

Organised biennially by NParks, the Community in Bloom Awards aim to inspire communities to take responsibility for the environment and to promote stewardship of green spaces. It also empowers residents to co-create gardens, enabling them to have touchpoints with nature and access to greenery to promote physical and mental well-being.

We like to move it for wellness

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ishun Health marked the closing of our Wellness Festival 2023 on 17 October 2023 with an awards ceremony and mass cardio workout.

Organised by the Yishun Health Well-being Team, this day marked the end of a four-month-long Fitness Challenge which began in June.

This year, we collaborated with the

Our staff even participated in a 10km walking trail to Upper and Lower Peirce Reservoir Park

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Health Promotion Board’s (HPB’s) Healthy 365 app for our Fitness Challenge. Staff could sign up as departments and were encouraged to exercise to clock steps and MVPA (Moderate-to-Vigorous Physical Activity) to hit record highs. Various group workout sessions such as Piloxing, Yoga, KpopX Fitness and

walking trails were also organised.

30 winning departments that clocked the most steps and MVPA were awarded with packets of healthy nuts and snacks! Physical activities aside, mental health activities were also held to help staff feel supported and valued, both professionally and personally.

YH in the News …in The Straits Times

…on KTPH Instagram

hoo Teck Puat Hospital (KTPH) has hired Eldercare Companions (ECC) to look after the socio-emotional needs of patients with dementia, delirium, and depression.

ECCs act as additional ‘eyes and ears’ to augment the role of doctors and nurses. As befrienders, they are able to assess a person’s emotional and physical well-being, pick up on things that matter to them and their preferences such as language of communication, favourite food, hobbies, and what makes them happy or sad. This information is then used by the healthcare team to provide suitable care interventions and plans that best cater to the patient.

ECCs are not required to have a medical background.

To prepare for the role, they undergo five days of training with occupational therapists, speech therapists, and more experienced ECCs.

n conjunction with World Pharmacists Day this year, we invited Senior Pharmacist Leow Si Min to react to several pharmacist memes. Watch as she candidly explains her role as a pharmacist and debunks common misconceptions that people may have in this short and quirky video.

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Scan the QR code to catch her spontaneous reactions

Scan the QR code to read the full story in The Straits Times

...on KTPH Facebook

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therapeutic garden has opened in Yishun Pond Park and is located adjacent to KTPH. The 1,900 sqm garden was designed in collaboration with the National Parks Board and KTPH’s Rehabilitation Services. The garden has features such as a wheelchair-accessible exercise bridge, therapy stairs and a three-generational fitness corner. It also offers therapeutic horticulture and rehabilitative activities for both general visitors and outpatients. According to Senior Physiotherapist Muhammad Jazimin Haron, the garden serves as a natural extension of the hospital space, designed to help patients recover in a soothing community environment while also empowering residents to become active participants of their own well-being.

any people think that the work of these allied health professionals is easy, but it’s not always black and white; there are lots of ‘grey areas’ too.

In this new series, we interviewed a medical expert who works well in the dark and knows all the right buttons to push! Can you guess his job?

Scan the QR code to watch the first episode

Scan the QR code to read the full story in The Straits Times

Follow us on Facebook & Instagram!

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@khooteckpuathospital | 9

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JOURNEYS IN HEALTH PART 2 OF 3

LIVING LIFE to

THE FULLEST Being on dialysis has not stopped 54-year-old Mr Subhan Ali from living his best life and doing the things he loves. From running a part-time home-based food business to ticking countries off his bucket list, the former IT professional’s life is a vibrant one. As an active member of a kidney failure support group and a spokesperson for peritoneal dialysis, he gives back to others by sharing his story and encouraging those living with kidney disease.

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“Peritoneal dialysis gives me more freedom, has less restrictions on my diet and is better tolerated by the body.”

Mr Subhan Ali

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rowing up, Mr Subhan Ali was no stranger to illness. His family had a history of diabetes – and he was dismayed to find himself diagnosed with the disease at the age of 13. “I had always thought it was an old person’s disease,” he recalls. “Everyone at the hospital was older than me, so it was hard to accept. I remember I cried and wanted to go home.”

Being a teenager, he pushed back against the restrictions and regimes. “Everything was controlled, and at that time, all I knew was to cut sugar, and not eat any cake, sweets and soft drinks,” he shares.

Little was known of carbohydrate counting and medications were less advanced during that period, he adds. “It was a confusing and frustrating time.”

In fact, exasperated by all the rules, he went through a period of rebelliousness during his teen and early adult years, which led to a

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stay in hospital due to infection.

“I was in my 20s and I was angry because I was convinced that all the treatments had caused issues with my eyes. Looking back, I realised that I was in some denial that these complications were actually because of my diabetes.” When he went to university in the United Kingdom, he even ignored his medication regime for about a year but says that “fortunately, nothing bad happened”.

It was not until he was back in Singapore that he started to feel sick – and decided to begin taking better care of his health.

THE ROCKY ROAD OF LIVING WITH CHRONIC ILLNESS Things took a turn for the better when he took part in a patient education workshop where he learned about carbohydrate counting, the relationship between his diet, insulin and blood sugar, as well as the role of medications.

JOURNEYS IN HEALTH PART 2 OF 3

Mr Subhan has chosen to go on Automated Peritoneal Dialysis, which allows him to receive treatment in his sleep

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“We all did a week of glucose tests to monitor our insulin levels in conjunction with medication and diet,” he says. “From there, I learned about my individual nutrition and carbohydrate needs.”

The step-by-step guidance from the multidisciplinary team, consisting of diabetes nurses, doctors, psychologists, dietitians and physiotherapists, helped the information sink in better. “We were allowed to eat anything we wanted, but were asked to do our own glucose testing so that we could observe the impact of the food we ate on our blood sugar. That really made an impression.”

This workshop cut through the flood of all the dos and don’ts. Instead of blindly following a fixed set of rules, it increased Mr Subhan’s feeling of control over the disease and helped him connect the dots between his actions, diet, medication, and blood sugar. “It became easier to manage my blood sugar levels,” he says.

However, beyond blood sugar control, Mr Subhan also had high blood pressure – another trait he thinks he inherited – which he found harder to control. It was very limiting and challenging to keep an eye on so many things, from sugar and salt to potassium. Despite his best efforts, he was told in late 2018 that he had end-stage kidney disease.

OWN TIME, OWN TARGET The news this time was not quite as big a blow as when he was a teen. “I was mentally prepared and I knew what I wanted to do,” says

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Mr Subhan, who managed to do his pilgrimage as well as go on a longawaited trip to Japan before his dialysis treatment began. From his experience with his aunt and late mother – both of whom had the

dialysis solution. Apart from this, Mr Subhan shares that the set-up is not difficult and treatment is convenient.

With his confidence in handling his own treatment at home,

same condition – and discussions with his doctor, he opted for peritoneal dialysis (PD) instead of haemodialysis.

The ownership over his own treatment and flexibility are key advantages for Mr Subhan.

“Peritoneal dialysis gives me more freedom, has less restrictions on my diet and is better tolerated by the body,” he shares. Instead of going to a dialysis centre three times a week for the four-hour treatment, he does peritoneal dialysis at home during the night while he sleeps.

He can also travel with peace of mind, simply arranging for the dialysis fluid to be delivered to his hotel so he can continue treatment even as he ticks destinations off his bucket list. Most recently, he went on a nine-day trip to Istanbul, a destination he had been planning on revisiting for some time now.

Mr Subhan acknowledges that just like any medical treatment, there are some challenges and precautions that need to be taken with PD, such as catheter care. A catheter is a soft tube that is surgically placed in the abdomen through which the dialysis solution is introduced.

“To prevent infection, it requires basic hygiene and must be kept clean,” he explains. Another factor is to set aside some storage space for the month’s worth of

Mr Subhan has become a spokesperson for PD and often shares his experiences with others at the National Kidney Foundation.

He is also an active member on a Facebook group called PD Warriors.

“This is an inclusive group that consists of people on haemodialysis and peritoneal dialysis as well as kidney transplantees,” he says. “It is for us to share our knowledge, journey, and experiences.” He has offered encouragement and advice to many in the group to help them make more informed decisions, even opening up his home to show his set-up. “As a group, we learn a lot and support each other.”

His advice to others is to take ownership to learn about their chronic conditions. “Information is now at your fingertips; find out more so you can be empowered to take better care of yourself,” he says. He also urges patients and caregivers to seek out community and social support.

And what a journey in health it’s been! As a teen, he had no friends or support system of people his own age to share his frustrations with or to guide him along. But these days, he is a part of a support system for others. “I feel fulfilled that there is something I can do to give back and share to let others know they are not alone.”

JOURNEYS IN HEALTH PART 2 OF 3

DIFFERENT TYPES OF DIALYSIS Dialysis is a type of renal replacement therapy.

When the kidneys can no longer remove excess water, solutes, and toxins from the blood, dialysis performs these functions. There are two modes of dialysis.

Haemodialysis cleans waste products from the blood using a machine with a special filter. Needles are inserted into a specially constructed vein known as a fistula or into a catheter.

Peritoneal dialysis uses a special fluid that is introduced into the body through a catheter which is surgically placed in the abdomen. This process uses the lining of the abdomen to act as a filter to remove waste products from the body. There are two types of peritoneal dialysis: • Continuous Ambulatory Peritoneal Dialysis (CAPD): this is a daily manual treatment done several times a day at home.

This method uses gravity to introduce the dialysis solution into the abdomen and drains it out after about 30 minutes.

• Automated Peritoneal Dialysis (APD): this uses a machine to deliver and drain the fluids at night during sleep.

It is done daily and takes 8 to 10 hours.

Scan this QR code to watch how peritoneal dialysis fits into Mr Subhan’s active life!

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&A

START THE

ACP CONVERSATION Yishun Health experts answer your frequently asked questions about your health, well-being and personal care needs.

In consultation with the Advance Care Planning Team, Yishun Health

What is Advance Care Planning (ACP) and when do I need to start thinking about it?

Advance Care Planning (ACP) is an on-going and voluntary communication process between you, your loved ones and health providers about your future healthcare and personal care preferences. It includes discussing your personal beliefs and goals for care with your nominated healthcare spokesperson (NHS).

ACP can help you to: • Explore your values, beliefs, and preferences • Understand your options regarding healthcare • Communicate your future healthcare preferences to your family, NHS and medical team ACP is for everyone, regardless of age or state of health. If you are a resident in Yishun, you can arrange 16 |

“I thought I knew my dad’s preferences, but I could not have been more wrong.

Thankfully, the ACP process shed much light about my dad’s care and treatment preferences. It even gave me more insight into his concerns and wishes.

Thank you, Yishun Health and the ACP facilitator, for this.”

Mr Calvin Teo, 41 nominated healthcare spokesperson for his father to do an ACP discussion with Yishun Health anytime.

Your documented care preferences will be used to guide your NHS and healthcare providers in making care and treatment decisions should you lose the mental capacity to make

those decisions for yourself.

The discussion allows you to prioritise your care plans as you can express your desires for comfort care, pain management and end-of-life support, ensuring you receive care that aligns with your goals.

What is the difference between Advance Care Planning (ACP), Advance Medical Directive (AMD) and Lasting Power of Attorney (LPA)?

ACP

AMD

LPA

Healthcare and personal care preferences, such as endof-life plans and place of death

Instructions for the doctor treating you (in the event you become terminally ill) to withhold extraordinary life-sustaining treatment that prolongs the dying process

Empowers nominated donee(s) to make financial and/or personal welfare decisions on your behalf, in the event you no longer have the mental capacity to do so

Medico-legal document akin to medical case notes

Legal document backed by AMD Act

Legal document backed by Mental Capacity Act

Process

Conversations with a trained facilitator, who will then consolidate your plans with your NHS

Form signed in the joint presence of a doctor and a witness who must not stand to gain from your death

Certified by a certificate issuer lawyer or doctor.

An LPA covers two areas: • Personal Welfare • Property and Affairs

People involved

Up to 2 NHS

Appointed witness

Appointed donee(s)

Scope

Legal status

Who can I pick as my Nominated Healthcare Spokesperson (NHS)?

Your NHS speaks for you when you do not have the capacity to decide for yourself or to communicate your wishes. Your NHS should be someone who: • Is 21 years old and above • Understands you well • Is willing to speak up for your goals and values on your behalf • Can be trusted to act in your best interests and tell the healthcare team about the care you wish to receive, should you lose your mental capacity • Is able to handle stressful situations well

What if I make an ACP and later change my mind about my preferences?

ACP is an ongoing conversation, and does not end after the document is signed. Your life goals and values may change as you transit through phases in life and you may continue to make changes to your ACP as long as you have mental capacity. If you wish to make any changes to your ACP, you may contact your ACP facilitator to update it. Your most updated ACP will replace the previous version(s).

Be an ACP facilitator!

“Advance Care Planning is not just a medical document – it is a compassionate and meaningful conversation that empowers individuals to shape their own healthcare journey.

As a doctor in geriatric medicine, I have witnessed the peace of mind it brings to patients and their families.”

Dr Ng Chong Jin Head & Senior Consultant, Geriatric Medicine, KTPH

Make your ACP today!

Keen to have an ACP discussion and have it documented?

To book an appointment: Call KTPH Mainline: 6555 8000 Email: ktph.advancecareplanning @ktph.com.sg

Looking to volunteer as an ACP Advocate on a regular and/or ad-hoc basis? You may email the ACP team at ktph.advancecareplanning@ktph.com.sg.

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veryday Heroes

GOING THE EXTRA MILE AT JOURNEY’S END In their work with patients at the end of life, the palliative care team understands that medicine has its limits. Despite this, they find meaning in embracing the small joys that life – even at the end – has to offer. Working as a team, they bring light to these dark days with exemplary acts of compassion, providing patients and their families comfort, companionship and a measure of closure.

Members of the palliative care team, such as Senior Staff Nurse Daniel Sii (left) and Senior Staff Nurse Hazeena Banu Binte Shaik Alaudeen (right), ensure that patients are comfortable in their last days

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T

he day of 15 August 2023 was sunny and warm like any other, but for Ms Anu and family, it was a special one that she remembers with bittersweet emotion. Gathered with her immediate family and hundreds of guests via Zoom, she exchanged marriage vows with Mr Varman, her partner of four years. Witnessing this momentous event was her father, Mr Suriandran, who was nearing the end of his battle with end-stage renal failure.

“It was important to him to see me get married,” she says. “We were already planning to get married in October 2023, but we knew he did not have much time left.” When the idea of bringing forward the wedding was raised by Daniel Sii, Senior Staff Nurse, Advanced Practice Nurses (APN) & Specialty Nurses, KTPH, Ms Anu and her family were unsure if it could be done. But – supported by their family, friends, doctors and nurses from the palliative care team and volunteers from a social enterprise – they pulled off the event successfully. Two weeks after their marriage solemnisation, Mr Suriandran passed away.

HONOURING WISHES AT THE END OF LIFE Ms Anu shares that it was a relief and blessing to know what her father’s wishes were and to be able to fulfil them. “Daniel shared that my father said he wanted to see me get married, and I’m glad that I could do that for my father,” she says.

She acknowledges that such conversations at the end of life are not always easy – and can sometimes be difficult for loved ones to hear. “I appreciate that in palliative care, the nurses and doctors try ways and means to get people to talk about what they want. It is also helpful to talk to a third party about their last wishes,” she reflects.

The palliative team facilitated Ms Anu's marriage in the ward, fulfilling one of her father's last wishes before he passed

Yau Sew Peng, Nurse Clinician, APN & Specialty Nurses, KTPH, points out that many patients like Mr Suriandran are opening up about their wishes and preferences through conversations like Advance Care Planning (read more about ACP on page 16). Once considered taboo, more people are appreciating the value of setting down their medical preferences and other decisions, especially with regard to decisions about their end of life.

Armed with this information, Sew Peng and her team of nurses strive to facilitate these wishes. One of the ways is through Compassionate Discharge, which allows patients who are facing terminal illnesses or life-limiting medical conditions to live out their remaining days at home, in a more familiar environment.

To facilitate the transition from hospital to home, the care team

“We cannot perform miracles, but we can remind patients and their families about the beautiful and meaningful parts of life.”

YAU SEW PENG Nurse Clinician, APN & SPECIALTY NURSES, KTPH

makes arrangements to provide caregiver training, pain management, medical equipment and home nursing so that family members are able to render care at home. The goal is to improve the quality of life, manage symptoms, and offer emotional support to patients and their family.

WORKING AS A TEAM TO FULFIL LAST WISHES Sew Peng notes that apart from Compassionate Discharge, her team of nurses have also gone the extra mile to give patients a sense of control, autonomy and dignity in their final days and to bring families some joy and closure during some of their darkest days. “We cannot perform miracles, but we can remind patients and their families about the beautiful and meaningful parts of life.”

Daniel shares that the team has organised birthday parties, tea ceremonies and even hosted a small concert. One patient said that he missed playing the erhu (a Chinese musical instrument), so accompanied by a music therapist, he gave a small performance in the ward. Another patient missed her dog, so the nurses got special dispensation to bring in her golden retriever for some | 19

veryday Heroes

The multidisciplinary team consists of doctors, nurses, physio- and occupational therapists, medical social workers, psychologists and pastoral care professionals

comfort and cuddles. For another family, the team organised a cooking session because the mother wished to cook her signature chicken curry for her son one last time.

These efforts go above and beyond typical medical care and take a fair bit of coordination and planning from the palliative care team. But this is what adds meaning to the usual nursing routine, says Daniel.

A large part of nursing can be very task-oriented and administrative, but these examples show that there are many opportunities for nurses to connect with people and find extra inspiration in their work.

For Ms Anu’s wedding solemnisation ceremony, Daniel explains that they had to seek senior management’s approval, coordinate with operational departments like Visitor Management & Screening and Security, liaise with the Registry of Marriages, and partner with a social 20 |

enterprise, Ambulance Wish, for the decorations, flowers, food, music and photography. The task was not without its challenges, Daniel admits, but seeing everyone’s joy – and the happy tears on Mr Suriandran’s face – made all the extra effort worthwhile.

The touching ceremony was held in the Lily Room – a single room in the wards which is usually used as a private space for family conferences, counselling and bereavement. “I was happy that my friends and family could be part of this very special day,” says Ms Anu, “I could not imagine how beautiful it would be and how well everything turned out.”

She looks back on her unconventional wedding day in Khoo Teck Puat Hospital with gratitude. “I am very satisfied that we could fulfil one of my father’s last wishes; I am grateful to the team without whom we could never have made it happen.”

Learn about end-of-life planning

Find more resources for caregivers from the Singapore Hospice Council

ive Well

Leading by Example and

Making Positive Change Through Volunteering

Though they each have their own different professional pursuits, schedules and social circles, mother-and-son duo Helen Liew and Martyn Chek share something in common – a love for giving back to enrich their communities and bring about positive change.

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ive Well

A

s a working mother of three, Helen has always had to juggle the responsibilities of family and career. But she also wished to do more for her community and the people around her. In 2015, she chanced upon an advertisement calling for volunteers for the 28th Southeast Asian (SEA) Games, which was hosted in Singapore. The prospect of taking part in such a momentous event was exciting to her, and she promptly signed up, becoming part of the 17,000-strong Team Nila volunteer contingent.

Helen enjoyed the energy and camaraderie so much that she then went on to volunteer for a host of other events. In fact, in addition to sporting events such as OCBC Cycle (2015) and the Asian Masters Athletics Championship (2016), she has participated as a volunteer almost every year in the Chingay Parade since 2017 and three National Day Parades.

Besides volunteering, Helen brings her enthusiasm to Yishun Health's various fitness activities

Outside of volunteering, Helen participates in almost all the evening fitness initiatives on offer at Yishun Health. There’s yoga on Mondays, bowling on Tuesdays and K-Pop dance on Wednesdays – with the occasional Wednesday morning jog around the Yishun Pond with CEO Prof Chua Hong Choon.

“It is very fun and very meaningful,” says Helen. With her sons all grown up and independent, volunteering and leading an active

lifestyle are some things she does for herself, keeping her body and mind healthy and giving her a sense of purpose.

She adds that her volunteer work fits in well with her job as a Senior Human Resource Assistant with Yishun Health’s Staff Well-Being Team, where she has worked for a decade. “We are in the ‘business’ of well-being,” Helen points out, “And so, I want to show how we can achieve this in our daily lives. I keep myself active to show that when we keep ourselves healthy, we can take care of our patients and other colleagues also.”

“I admire my mum for walking the talk, and setting a good example.

I see her making a quiet but effective impact on others.”

As the valedictorian at the Youth Corps Leaders Commencement Ceremony 2022, Martyn delivered an inspiring speech to his cohort

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Martyn Chek Medical Social Worker KTPH

“I keep myself active to show that when we keep ourselves healthy, we can take care of our patients and other colleagues too.”

Helen Liew Senior Human Resource Assistant Staff Well-Being Team

TAKING HIS CUE FROM MUM Martyn, who works at Khoo Teck Puat Hospital as a Medical Social Worker, shares that his mother’s love for social participation and giving back has, in part, inspired him in many ways. “I grew up seeing my parents embrace their interests and hobbies and form their own social circles and communities,” he says, “I’ve been brought up to connect with people, so even during secondary school and university days, volunteering

has been a very big part of my life.”

He is currently an Assistant Director (North-East District) for the Singapore Red Cross Youth, an Assistant Mentor for the Youth Corps and a Red Cross Community Responder. In this work, he leads a team of youth volunteers to plan community engagements to promote standard and psychological first aid. As a mentor, he also promotes youth volunteerism and guides new volunteers. “Volunteering ties in with my personal and professional identity,” adds Martyn. “In both my work and my volunteering, I provide psychosocial support to people and their families.” Notably, Martyn is also a regular blood donor and has attended various events to encourage others to do the same.

for these activities outside of work and home life is enriching, and is an important aspect of active ageing.

“I admire my mum for walking the talk, and setting a good example,” says Martyn. “I see her making a quiet but effective impact on others.” For example, he notes that his mother’s active lifestyle has inspired their family members to take more walks and be more active. His older brother and sisterin-law have since started joining Helen for walks, and now go on long trails together on Saturdays.

“It goes to show that our actions, no matter how seemingly small and insignificant, can also play a part in making positive change!”

BETTERING THEMSELVES BY GIVING BACK Mother and son reflect that meeting people and having interests outside of work widens their perspectives, broadens their horizons and takes them out of their own troubles and concerns. “It gives us a space to share our experiences and learn more from others,” Martyn shares.

Helen added that finding time

Interested to volunteer at Yishun Health? To learn about the various volunteer opportunities at the hospital, scan this QR Code or visit https://for.sg/ktphvolunteer

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N F l w K

potlight

DELIVERING HOSPITAL CARE IN

THE COMFORT OF HOME

KTPH@Home helps patients with acute but stable medical conditions, who would otherwise have been admitted to the hospital, to continue treatment at home, shortening their stay or avoiding hospitalisation altogether.

W

henever 91-yearold Mr Loh Sin Kok requires emergency attention or a hospitalisation stay for a flare up of his heart condition or other chronic conditions, he undergoes a high state of anxiety and frustration. His daughter, Mdm Loh Khee Chaw, shares similar feelings, making the experience a worrying and stressful one for the entire family.

Recently, when he sought medical attention at KTPH, Mr Loh was able to avoid hospitalisation altogether.

After being discharged directly from

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the Emergency Department (ED), he was able to continue treatment at home, monitored daily by a team of doctors and nurses under an initiative called KTPH@Home, overseen by Population Health and Community Transformation (PHCT).

Dr Boh Toon Li, Consultant, Geriatric Medicine and clinician lead of the programme’s Geriatric Medicine track, explains that this doctor-led multidisciplinary programme was started in May 2019, where patients recruited were predominantly above 80 years old and moderately frail. This care model has multiple benefits. “During

a hospital stay, geriatric patients who are frail are at higher risk of functional decline, acquiring another infection and becoming confused in an unfamiliar environment,” she explains. “Being able to recover at home can help reduce the risk of such complications.”

Mdm Loh shares that being able to continue her father’s hospital treatment at home was very convenient. Usually, she says, she worries about hospital visiting hours, her father’s diet and missing out on doctor’s updates after their ward rounds.

As for Mr Loh, he found that being able to recover at home was

The KTPH@Home team of doctors, nurses, and therapists is well supported by pharmacists, medical social workers, dietitians and operations colleagues

“excellent”. “The care and treatment provided by KTPH@Home is no different from that in the hospital,” he says, adding “Not only do I have ample time to rest and recover, but I can also continue with my daily activities. It doesn’t make me feel like a patient at all.”

THE ADVANTAGE OF RECOVERING AT HOME Recovering at home made Mr Loh feel more at ease, which he thinks contributed to his speedy recovery.

Mdm Loh also appreciated the home visits as well as the daily phone calls.

“During the period of admission,

the doctor came in three times,” she recalls, “The nurses continued to monitor (my father) by calling me and telling me what to look out for and how to record his vital signs.”

She also found it valuable that her father was asked about what he hoped for his own health outcomes.

When Mr Loh said that he wished to walk independently, the team linked the family up with a physiotherapist who made several home visits to do an assessment and teach him exercises.

It was also helpful to take part in her father’s treatment regimen.

“When he is in the ward, we do not get to see what is being done, but at

home, we take his vital signs and monitor the trends, and when we notice any issues, we can report them and receive advice on what we should do with his medication,” she says. “This involves not just me and my father, but one of my children who works from home – who would take all the vital signs every morning.” This she adds, has helped to pull the family closer together in learning to take better care of Mr Loh. “The benefit is really tremendous because you get to learn how to care for your loved ones.” She also notes that her father has become more confident that

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potlight

his issues can be managed at home and do not always require a visit to the ED. Low Sing Ee, Nurse Manager and nurse lead of the programme, highlights these outcomes as some of the critical advantages of KTPH@ Home. Significantly, it also helps patients and care teams better develop care plans. “We can actually see how they function at home and consider all the psychosocial factors that we may not see in the hospital.

This allows us to assess patients more accurately.”

Fiona Yoong, Senior Staff Nurse and nurse lead of the programme, adds that this care approach empowers patients and caregivers to be able to carry on care beyond an acute episode and become more involved. “We hope that this can reduce unnecessary ED visits and translate to better outcomes in the long run.”

FACILITATING CARE AS A TEAM To ensure that patients are adequately supported at home, the team works together to provide resources, services and equipment. Where necessary, the team arranges for patients to be transported back to hospital for scans, deploys team members to conduct allied health reviews at home, and loans home monitoring equipment to ensure patients are safely monitored. The operations team also plays an important role in the coordination of services as well as medication delivery, connecting patients with third-party providers and conducting follow-up referrals, especially if support is required after-hours and weekends.

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Without leaving their home, patients like Mr Chan, 86, can receive acute procedures, such as the intravenous administration of antibiotics

The team also does scheduling, financial counselling and data collection to evaluate the clinical, functional, quality of life, experiential and cost-effectiveness outcomes.

“This is a fairly new model, so this data is useful for us and the Ministry of Health to do needs- and -impact analyses so we can work towards making this a mainstream care model in the future,” says Tan Rui Ling, Executive, Ageing-in-Place Community Care Transitions (AIPCCT), PHCT. On the ground, Fiona shares that a team of on-duty nurses, supported by an on-duty doctor, “are rostered to conduct home visits and man our

helpline so that patients have 24/7 access and “always have care at hand”. According to Sing Ee, home visits are also scheduled on a needs basis. “We may do an initial visit together with a doctor to establish a care plan. Subsequent reviews will either be in the form of a nurse home visit for procedural tasks or a phone call.” Should a patient need further clinical assessment, the doctor will come in together with the nurses.

EXPANDING TO BENEFIT MORE PATIENTS Since it started in 2019, the KTPH@ Home initiative has translated into 4,429 hospital bed days saved,

“Not only do I have ample time to rest and recover, but I can also continue with my daily activities.

It doesn’t make me feel like a patient at all.”

MR LOH SIN KOK, 91 a recent Ktph@home patient according to Ken Tham, Manager, AIP-CCT, PHCT. KTPH@Home has also been expanded to serve General Medicine patients since July 2023, with another 32 patients benefitting since.

Rui Ling shares that thus far, the KTPH@Home initiative caters to a wide range of conditions, including fluid overload, pneumonia, cellulitis, urinary tract infection, poorly controlled hypertension and diabetes. For geriatric patients, common conditions include geriatric syndromes such as postural hypertension, constipation, retention of urine and falls. Within General Medicine, patients with acute illnesses such as dengue, gastroenteritis (stomach flu) and

Among the services provided by the team in the convenience and comfort of patients’ homes is wound dressing and education on wound care

rhabdomyolysis may also be enrolled for the programme, particularly if they require intravenous antibiotics or fluids.

Dr Valliammai d/o Nallakaruppan, Senior Consultant, General Medicine, and medical lead of the programme’s General Medicine section, notes that early supported discharge for General Medicine patients sees a younger age group, who are typically more independent and more mobile.

“We are growing the KTPH@Home General Medicine team to build

processes and capabilities to expand enrolment to more patients and a wider range of conditions,” she says.

Dr Valliammai reflects on this alternative to inpatient care as a “timely” expansion as the direction of healthcare moves into the community. She says, “We are already doing it with primary and preventive care so it’s appropriate that we are evolving acute care too, to right-site care, optimise resource utilisation and ‘save’ hospital beds, as well as improve care for patients.”

MORE ABOUT KTPH@HOME Apart from having a stable acute condition, eligibility for this programme relies on functional and social suitability such as the ability of the patient to care for themselves or the presence of a caregiver to perform home vital signs monitoring with guidance from the care team.

To facilitate care at home and provide support, the team not only does home visits and calls, but may also arrange for the loan of medical equipment.

Patients and caregivers are also advised on how to manage their treatment and medication and when to escalate and seek help.

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Things About...

5

Things About...

SUPPORTING SOMEONE WITH CHRONIC ILLNESS A diagnosis of a chronic illness can be difficult to cope with – and may lead to a complicated spectrum of challenges that range from emotional stress and physical discomfort to financial impact and social burden.

As a friend or family member, it is natural to want to help and offer support.

Try these tips to navigate this challenging situation with sensitivity.

In consultation with A/Prof Tan Kok Yang, Senior Consultant, General Surgery, KTPH

1

LISTEN AND PRACTISE EMPATHY

Very often, we feel the burden of trying to take control of the situation and do the decision-making. It is also natural to want to say something to ‘fix the problem’ or ‘make them feel better’.

However, try to listen first and refrain from providing anecdotes of cases that you have heard about or sharing unsolicited opinions. Instead, provide a listening ear for the individual to express their feelings, concerns, and fears.

Do not deny or question the accuracy of the diagnosis. Avoid platitudes like: ‘Don’t worry’, ‘everything will be alright!’, ‘at least it’s not that bad’ or ‘just be positive’. Express compassion and empathy by trying to feel with the person, instead of feeling bad for the person.

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2

VALIDATE THEIR FEELINGS, EMOTIONS​AND EXPERIENCE

Validate and believe your loved one’s needs, feelings, concerns, and wants. This helps them feel a little less alone and misunderstood.

Use words that acknowledge their experience without downplaying it, like: 'I understand that this is hard for you.

I cannot imagine what it is like, but I am here to support you'. If you do not know what to say, it is alright to say that and also still express your support, such as 'I don’t know what to say, but I appreciate you sharing this with me; I would like to help you in any way you want’.

Honouring their experience may also mean sharing silence with them, giving them personal space to be alone and letting them feel it is alright not to be okay.

3

OFFER PRACTICAL HELP

While many of us offer help, the responsibility often falls to the person in question to ask for it, and this can add to their mental load. They may also feel bad to ask for help. Instead of waiting to be asked, offer help in practical ways.

Think about how you can ease the burdens of everyday living.

This may include providing meals, taking care of chores, buying groceries, or caring for family members.

You can also offer to accompany them or drive them to doctor appointments.

5

EDUCATE YOURSELF

4

SPEND TIME WITH THEM

It may also be helpful to engage with your loved one in other ways: exercise together, organise outings, or treat them to massages or movies.

These activities are not just enjoyable, but also help them engage in everyday life in a way that is not defined by their illness.

Support your loved one by learning about their illness. Keep in mind that the goal of learning more is for your own understanding so that you can better empathise with them and the challenges they are facing. It is not necessarily your responsibility to find a ‘miracle cure’ or pepper them with alternatives as this can add a lot of stress and conflict, which can worsen their condition.

If you are a caregiver or involved in some aspect of their health journey, learn about their treatment regimen and see how best to help them in ways that align with their goals and needs.

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aily Dose

A DAILY DOSE

OF FIBRE

Most of us have been told to eat our wholegrains, fruits and vegetables because they are healthy and good for us. What are they made of and why is it so important?

In consultation with the Skill UP Team, Population Health & Community Transformation, KTPH

D

ietary fibre is the indigestible component of wholegrains, fruits and vegetables that passes through our digestive tract unchanged. It’s not only indigestible, but indispensable, as it plays an essential role in keeping our bodies in good working condition.

A little-known fact is that fibre is sometimes referred to as roughage (pronounced ‘roughage’). And indeed, just as its name suggests, fibre plays an important role as the body’s internal scrubbing brush. Because it does not break down, it acts as a scrub brush as it moves along the digestive tract, picking up bacteria and other buildup. This characteristic gives fibre its ‘special powers’ in helping to keep the body healthy.

Dietary fibre comes in two forms: soluble fibre, which dissolves in water to form a gel-like substance, and insoluble fibre which does not dissolve in water and remains whole in the digestive tract. Each plays significant and complementary roles.

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Feeds healthy gut bacteria

Softens stool

Soluble fibre soaks up water as it passes through the digestive system, which helps soften the texture of stools so that they can be passed more easily.

Some types of soluble fibrerich foods are fermentable in the colon, which feeds gut bacteria, and keeps the gut microbiome healthy and balanced. This not only improves digestion, but also regulates hormones and supports immunity.

SOLUBLE FIBRE

Lowers cholesterol and stabilises blood sugar

Soluble fibre can help to reduce the absorption of cholesterol by the liver and slow down the release of sugar from the digested food.

This can help to lower our cholesterol levels and reduce sharp spikes in our blood sugars, decreasing the risk of heart disease and diabetes.

Increases satiety for weight management

High-fibre food takes longer to chew, slowing down food intake, and adds bulk to meals, which can help you feel full faster and longer. The gel-like consistency of soluble fibre (also called viscous fibre) can slow digestion, which helps to keep you feeling full.

Adds bulk to stool

Because it is indigestible, insoluble fibre adds bulk to by-products of digestion to form stools that are easy to pass. Fibre speeds up the movement and processing of waste to promote regular bowel movements.

INSOLUBLE FIBRE

HOW MUCH FIBRE DO THESE EVERYDAY FOODS CONTAIN?

1 bowl of white rice 0.8g

1 bowl of brown rice 3g

2 slices of white bread 2g

2 slices of wholemeal bread 4.5g

1 cup of cornflakes 2.6g

1 cup of bran cereal 8g

1 small plain roti prata 1.7g

1 small plain chapati 4.1g

1 bowl of white beehoon 1g

1 bowl of brown rice beehoon 3.4g

Registration for English sessions

Registration for Chinese sessions

Lowers the risk of intestinal disease

By preventing constipation and intestinal blockages, insoluble fibre may reduce the risk of developing small folds and haemorrhoids in the colon.

EAT YOUR FIBRE! Current recommendations suggest that adults consume 20 to 35 grams of dietary fibre per day. A high-fibre diet is also associated with a lower risk of many diseases, including obesity and metabolic syndrome. But before you add more fibre to your diet, keep in mind that unless you are already used to it, a sudden increase in fibre intake can cause gas, bloating, or constipation. It is important to increase your fibre intake gradually, making sure that you drink plenty of water to help your body process the additional fibre. You can make small changes to your diet with these smart fibre swaps.

Want to learn more about how the fibre and sugar in your diet can make or break your health?

Scan these QR codes to register for our Skill UP workshops!

Facilitated by health and care professionals, Skill UP is a three-session programme which focuses on practical yet impactful steps towards a healthier lifestyle.

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akan Time

cut & keep

PRAWNS WITH MANGO MAYONNAISE

Ring in the Lunar New Year with this refreshing twist on the old-school prawn cocktail. This fresh and fruity prawn salad is made with tropical mango, tart strawberries and sweet dragonfruit, adding a delicious and healthy combination to your festive table.

Recipe provided by Calvin Sio Cing Kai, Cook, Food Services, in consultation with Nutrition & Dietetics, KTPH

INGREDIENTS Serves 4 • 170g prawns, medium, deshelled • 5g lower sodium chicken stock concentrate • 1 egg white • 40g sweet potato flour • 10g cooking oil • 45g pureed mango • 60g reduced fat mayonnaise • 120g diced fruit (combination of mango, strawberries and dragonfruit)

METHOD 1. In a medium bowl, marinate the prawns with lower sodium chicken stock for around 30 minutes 2. Coat each prawn in egg white and sweet potato flour 3. In a heated pan, add the oil and pan-fry the marinated prawns until golden brown 4. In a medium bowl, gently combine the pureed mango, reduced fat mayonnaise, and diced fruit with the pan-fried prawns 5. Serve and enjoy!

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NUTRITIONAL INFORMATION (PER SERVING) Energy

159kcal

Carbohydrates

15.2g

Protein

10.5g

Fat • Saturated • Polyunsaturated

6.2g

• Monounsaturated

0.7g 2.3g 2.6g

Cholesterol

67mg

Dietary Fibre

2.1g

Sodium

347mg

Potassium

188mg

Phosphate

83.4mg

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it & Fab

FIGHT ARTHRITIS WITH MOVEMENT AND THE RIGHT EXERCISES

While it can appear counterintuitive, exercise is actually one of the best ways to relieve arthritis pain. Learn about the common types of arthritis and what you can do at home to reduce pain, improve your function and lower the risk of arthritis complications.

A

By Rehabilitation Services, KTPH

rthritis is an inflammatory condition that affects our joints. Its symptoms can include pain, tenderness, stiffness, and swelling of the affected area. With progression of the joint disease, joints could gradually become stiffer or deformed, causing increased disability or decreased mobility.

There are many different types of arthritis with different causes. Some of the most commonly seen arthritis are: • Osteoarthritis: a chronic, progressive degenerative joint disease which may lead to stiffness and pain in the affected joints, particularly after prolonged/ strenuous activity or immediate movement after prolonged rest • Rheumatoid arthritis: the degeneration of the joint cartilage due to an autoimmune disease (when the body’s own immune system attacks the cushioning membrane in the joints). It can be accompanied with other associated symptoms such as a persistent fever, fatigue and malaise

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• Gout: a metabolic condition where high levels of uric acid cause the accumulation of uric crystals inside the joints. This leads to redness, swelling, pain, and warmth in the affected joint (typically in the lower limbs)

ALLEVIATE PAIN WITH THE RIGHT EXERCISES Although the painful symptoms of arthritis may deter movement, being active is an important way to reduce arthritic pain and maintain healthy joint function. For the best outcomes, your exercise routine should target four goals: increasing range of motion, strengthening of muscles, enhancing endurance, and improving balance.

You can start with exercises such as gently moving your limbs within their available range of motion, which can be helpful in relieving stiffness, even when your joints are painful or swollen. Strengthening exercises are also safe and beneficial to do to help build muscle strength to support the affected joints. Lastly, do consider adding on low-impact aerobic activities such as cycling, brisk walking and swimming to help improve endurance.

Get your heart and lungs pumping by aiming for at least 150 minutes of moderate intensity or 75 minutes of vigorous intensity cardiovascular execises per week.

Improve flexibility and range of movement by stretching the targeted muscle group daily, for two to four sets of 30- to 60-second repetitions. You should feel a gentle stretch or mild discomfort at the targeted area, but intense pain should be avoided.

Option 1: Standing quadriceps stretch, with or without towel

Option 2: Side lying quads stretch, with or without towel, lying on your left/right side

Weight Bearing Option: Incline brisk walking

Other stretches that would be beneficial for the flexibility of your lower limbs are hamstring and calf stretches

Non-weight Bearing Option: Cycling

Resistance training builds muscular strength. Aim for three sets of 10-15 repetitions, on two to three non-consecutive days a week.

Option 1: Double leg squats

Other cardiovascular exercises you could consider include stair climbing, elliptical training, skipping, dancing, swimming and more!

Option 2: Double leg bridges

Exercises that aim to strengthen the legs are also beneficial, and can be done with resistance bands, dumbbells or household items as weights

If you are having pain while doing the exercises which does not improve after rest or reducing the exercise intensity, please consider seeking medical attention to help manage your condition.

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