AHA magazine Mar - Apr 2021 by Yishun Health

Community Nurse Post

Wellness Kampung is an initiative comprising three wellness and care centres for residents in the orth. 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.

Issue 2: March–April 2021

Wellness Kampung

aha

Issue 2: Mar-Apr 2021

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

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)

Khoo Teck Puat Hospital (KTPH)

Yishun Community Hospital (YCH)

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

KTPH is a ǚǜǘ-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. 90 Yishun Central Singapore 768828

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

2 Yishun Central 2 Singapore 768024

6807 8000

6555 8000

6807 8800

www.admiraltymedicalcentre.com.sg

www.ktph.com.sg

www.yishuncommunityhospital.com.sg

www.fb.com/admiraltymedicalcentre

www.fb.com/khooteckpuathospital

www.fb.com/yishuncommunityhospital

MCI (P) 088/07/2020

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COLLABORATIONS FOR EMPOWERING RELATIONSHIP-BASED CARE Engaging patients with coordinated support beyond clinic hours for better outcomes

SPREADING JOY THROUGH 16 INCLUSIVITY IN SPORTS MLP_#0032/21_Cover_4Cx4C

MAKING A WORLD OF DIFFERENCE 20 THROUGH THE LITTLE THINGS

A LIBRARY WITHOUT 24 BORDERS

ontents

What’s Up Community events, outreach efforts, and more

DAILY DOSE Adapting to the Work-From-Home (WFH) Life Elements of a good home office can make WFH a lot better for your wrists, neck and back

COVER STORY

Collaborations for Empowering Relationshipbased Care Engaging patients with coordinated support beyond clinic hours for better outcomes

16 EVERYDAY HEROES Spreading Joy Through Inclusivity in Sports Dr Teoh Chin Sim co-founded PlayBuddy, a sports programme for children with disabilities 18 Q&A Health and wellness questions asked and answered!

A MODEL FOR UNIFIED CARE 2 |

THERE ARE TWO TYPES OF STRETCHES:

20 SPOTLIGHT Making a World of Difference Through the Little Things The Leaving Well Fund enables meaningful, dignified support in the final passage of life

STATIC STRETCH

DYNAMIC STRETCH

Holding a specific position so that the muscle is held at tension

Moving a limb through its full range of motion repeatedly

HAMSTRING STRETCH

LEG SWINGS

QUADRICEPS STRETCH

BUTT KICKS

CALF STRETCH

CALF RAISES

PECTORAL STRETCH

ARM SWINGS

24 LIVE WELL A Library Without Borders A volunteer grows a mobile library from a tiny cupboard to a cosy community corner 26 5 THINGS ABOUT… Preventing Pressure Injuries Daily care and management helps to prevent painful sores

Part 2 of 3 Yishun Health’s Integrated Medical Clinics (IMC) are more than under-one-roof platforms to manage complex chronic illness. Beyond a more streamlined clinical process and convenient patient experience, it is all about building rapport, trust and relationships for a person-centred approach that truly puts patients at the heart of care.

TIPS FOR SAFE STRETCHING GO SLOW AND WARM UP FIRST Muscles stretch more easily and safely when warm. Swing your arms or march in place before starting to stretch. Start slow, increasing the intensity of your stretches over time. FOCUS ON SENSATION, NOT SHAPE Pay attention to how the muscle you are working on feels when stretching. You might not achieve the ‘shape’ you think is ideal, but as long as you

feel the stretch, that is sufficient. Do not force yourself into a stretch with jerky or sudden movements. FEEL THE STRETCH, NOT THE PAIN Stretching should not hurt. When stretching, be mindful that you should feel tension, not pain. If a stretch hurts, stop immediately! Reset and try again. HOLD AND BREATHE A stretch should be comfortable to hold and breathe through. Hold each stretch for 15 to 30

seconds a set, breathing slowly and regularly throughout. Repeat each set four to five times. You can intensify the stretch slowly with each set as long as you do not feel pain. PRACTISE OFTEN Flexibility is gained over time. You will be surprised by how much more flexible your muscles become with regular stretching. Aim to do a stretching routine two to four times a week.

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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.

EDITORIAL TEAM Hannah Wong Sabrina Ng Sharon Ng Albert Foo

EDITORIAL COMMITTEE 28 MAKAN TIME Tuna sushi roll Get rolling! Make sushi at home for a quick lunch or snack 30 FIT & FAB S-t-r-e-t-c-h — it’s good for you! Regular stretching keeps you flexible and improves mobility to prevent injury

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

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

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

Chua Kim Beng

CONTR I BUTI NG E DITO R

Sheralyn Tay E D I TO R

Dang Hui Ling H E A D, C R E AT I V E

Sean Lee

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

CONTR I BUTO RS

Justin Loh Lee Lily

aha is the official bi-monthly publication of Khoo Teck Puat Hospital (Co. Reg. No. 200717564H) and is produced by ThinkFarm Pte Ltd. All rights to this publication are reserved and no part may be reproduced without the expressed written consent of the publishers. While every effort has been made to ensure that the information in this newsletter is accurate and up to date, the editorial team will not be responsible for errors due to information received. Opinions expressed are that of the writers and do not necessarily represent the views and opinions of the publishers. Printed by Mainland Press Pte Ltd. MCI (P) 088/07/2020

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hat’s Up

Welcoming Our New CEO

Some members of Yishun Health’s Senior Management and Union gathering for a shot after the CEO handover ceremony

n the first Townhall of 2021, held on 15 January, Yishun Health marked several important milestones, including the start of our organisation-wide vaccination for COVID-19. Significantly, it was Mrs Chew Kwee Tiang’s last Townhall as Yishun Health CEO, during which she passed the torch to Prof Chua Hong Choon. The handover was marked by the passing of a symbolic ‘key’ and two framed posters from our days as Alexandra Hospital. Staff also presented gifts to Mrs Chew, and played a touching tribute video. Prof Chua, previously the CEO of the Institute of Mental Health (IMH), was to take over the helm of Yishun Health on 1 February. At the Townhall, he shared his excitement for his new assignment and expressed his admiration for the good work undertaken by the organisation over the last 10 years.

Prof Chua Hong Choon receiving a symbolic key, hassle-free house poster, and Toyota Way book from outgoing Yishun Health CEO, Mrs Chew

From left: Senior Management colleagues handing gifts to Mrs Chew; Mrs Chew conveying her appreciation after a surprise tribute video, which compiled words of thanks from staff, was played for her

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Protecting Ourselves to Protect Our Patients

Yishun Health’s Senior Management leading the way to kick-start the organisation-wide COVID-19 vaccination exercise Left & below: Our hardworking team ensuring — behind the scenes — the smooth vaccination process for everyone, including post-jab monitoring and observation

n 11 January 2021, Yishun Health began its COVID-19 vaccination exercise, with Senior Management taking the lead to get their shots. Former CEO Mrs Chew Kwee Tiang said, “This, like any other vaccination, helps to keep ourselves and our family safe.” Our new CEO, Prof Chua Hong Choon, also joined the vaccination exercise, taking his first shot “in unity” with his new colleagues. He noted that it was a significant step in more ways than one, as the date of his second shot will coincide with his first day on the job at Yishun Health. Also present that day was Medical Board Chairman A/Prof Pek Wee Yang, Chief Operation Officer Ms Yen Tan, and Chief Nurse Ms Shirley Heng. Vaccinations ran from 11 January to February 2021, and all staff who took the shot were monitored for 30 minutes afterwards to ensure their safety.

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hat’s Up

Celebrating the Lunar ‘Niu’ Year the Yishun Health Way!

t was a spring celebration with a difference, but no less special, as Yishun Health staff enthusiastically welcomed the Year of the Ox by participating in a range of safedistanced Lunar New Year activities. Some of the healthy, interesting and engaging programmes organised by LifeWorks! included a photo hunt, cooking demonstrations, an inter-department decoration contest, and fun classes. The photo hunt saw small teams, which had been given clues over a period of two weeks, solving them in order to deduce and reach six locations in Yishun. The active treasure hunt required team members to break sweat as they had to walk, run and cycle to ‘collect’ each site. Good food contributed much to the festive atmosphere of the occasion, including demonstrations on how to make healthier versions of dishes such as kimchi pancake, mapo tofu and abalone rice.

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Every department took part in a friendly decoration competition to see which team could out-moo-noeuvre colleagues in creativity ty

More than 200 staff took part in Zoom classes and workshops, from dance sessions to mosaic making [above]

From far left: Senior Dietitian Ryan Ong demonstrated how to make deliciously healthy versions of mapo tofu and abalone rice, while Billy Ong from HRD showcased a recipe for kimchi pancakes

Right: Staff ran, walked and cycled to find six locations in Yishun, guided by clues in a fun and active photo hunt

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aily Dose

ADAPTING TO THE WORK-FROMHOME LIFE As Singapore moves cautiously towards what looks — optimistically — to be the early stages of a postpandemic world, life is regaining a semblance of normality. However, working from home may be here to stay for a while yet, underscoring the importance of good home office ergonomics to prevent long-term problems and pain.

In consultation with Ng Lih Yen, Head & Senior Principal Physiotherapist, Rehabilitation Services

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hile working from home has its benefits, it comes with some downsides, including lower levels of activity, longer work hours, and poor posture. All these extra hours spent slouched over our computers and electronic devices can take its toll on the body, contributing to aches, pains and soreness — especially in the neck, back, shoulders and wrists.

Set reminders to move every 45 minutes or so. Take time to stretch or take a little walk to get the blood flowing and muscles limber.

A proper home office set-up and good ergonomics is critical in keeping these problems at bay. • Be it carving out a spot at the dining table or in a study, try to set aside a work zone that you can customise to your operational needs. • Your monitor should be an arm’s length away from your head and level with your line of sight when seated upright. If you work on a laptop computer, use a separate monitor; alternatively, use a laptop stand or place your laptop on a stack of books. The

point is to raise your laptop screen to the right height. • Avoid prolonged use of the laptop trackpad and keyboard. While these are great for the short term, they force your wrists into unnatural positions. To prevent Repetitive Strain Injury (RSI), use a stand-alone mouse and keyboard to ensure that the wrist is in a neutral position. • Use a chair that allows you to keep your arms bent at a 90-degree position, and your knees level with your hips. Your feet should be flat on the floor. You may use a box or footstool to help you achieve the correct height and position. • Without the daily commute, walks to meeting rooms, or faceto-face client meetings outside the office, you are unlikely to move much these days. Set reminders to move every 45 minutes or so. Take time to stretch (see page 30) or take a little walk to get the blood flowing and muscles limber.

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Cover Story

COLLABORATIONS FOR EMPOWERING RELATI 10 |

A MODEL FOR UNIFIED CARE PART OF 3

Episodic care can only go so far. What matters is the care and management that happens between appointments. To aid patients, family members and caregivers in keeping up with care plans and medication regimes, Yishun Health’s Integrated Medical Clinics (IMC) care coordinators plug the gaps to offer sustained support that drives self-management and active participation.

s someone with several chronic diseases, the elderly Mr Arjan is no stranger to the medical system. However, while he tries his best to keep on top of things, having multiple appointments at different hospitals and numerous medications often leaves him feeling lost. He is not alone — many patients have similar experiences, especially if they suffer from more than one condition. According to Dr Lim Eng Kuang, Senior Consultant, Renal Medicine, more than 70% of renal patients see as many as eight different doctors and allied healthcare professionals, making multiple trips to the hospital. “Being able to deliver a wide range of care does not mean better care,” he points out. In fact, he adds, patients may end up becoming frustrated or confused, or skip appointments altogether. “This leads to gaps in care and poorer outcomes.”

For Mr Arjan, the solution was to enrol him under one of the two Geriatric IMCs led by Dr Ang Yan Hoon, Senior Consultant, Geriatric Medicine. Dr Ang, together with Senior Care Coordinator Audrey Tan, spent more than two hours to comprehensively review Mr Arjan’s case. It turns out that Mr Arjan had more than 16 active appointments, and as many as four of these were for eye specialists at different institutions! Taking time to understand Mr Arjan’s medical issues, concerns and capabilities for selfmanagement, Dr Ang streamlined his treatment — in consultation with him — and reduced his appointments from 16 to seven. For care needs that could be tackled outside of the hospital, Audrey roped in the Ageing-In-Place Community Care Team (AIP-CCT) to conduct home visits and further reconcile his medication regime of more than 20 drugs and supplements.

ONSHIP-BASED CARE | 11

Cover Story

Today, Mr Arjan is supported with reminders, advice and guidance over text, phone and emails. It has greatly helped him to understand his own medical needs and manage his conditions more independently. This has motivated him to make the lifestyle changes needed to keep him living his best life, even with chronic illnesses.

INTEGRATING THE MEDICAL, SOCIAL, AND MORE This approach builds on what geriatricians such as Dr Ang have long done for their patients. “Working in geriatrics, we know first hand that a lot of care goes beyond medical support; there is often a lot of psychosocial needs to be taken care of as well,” she reveals. “We believe care needs to be better consolidated and coordinated so that patients can best benefit from our care plans and achieve their own goals.”

“We are moving the intensity of care to an earlier and more easily managed stage to avoid the crisis and complication in the later stages, when outcomes are poorer.” DR LIM ENG KUANG SENIOR CONSULTANT, RENAL MEDICINE, KTPH HEAD, RENAL IMC, KTPH

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Elderly patients with chronic illnesses often present with frailty, mobility limitations, and other issues. These can include social, psychological, and even financial considerations. As such, Dr Ang and her team are mindful of potentially complex and multi-faceted factors in their care plans and efforts. The aim of the IMCs is to offer a more seamless delivery and management of chronic illnesses, and build collaborative and empowering relationships between care teams, patients, and caregivers that drive ‘beyond hospital to home’ imperatives and improve outcomes.

TAKING TIME TO BUILD CARE THAT MATTERS This is why one of the most significant goals of the IMCs is to develop relationship-based care. Dr Foong Yi-Lin, Senior Staff Physician, Geriatric Medicine, notes that building better rapport

with patients leads to improved outcomes, as patients and family members understand the need for self-care and management. “A big part of our work is building rapport and trust between us, patients, and their family and caregivers. When we are able to engage them and help them embrace what we can do together, we can work together better,” explains Dr Foong. And this all starts with building relationships, she adds. “Once you earn their trust, then patients see the value of this model of care and become invested in the process. From there, the outcomes will improve.” The foundation of this relationship is built during each IMC appointment, which involves both physician and care coordinator — and sometimes other medical and allied health professionals. At these appointments, the team takes the time to understand the patient’s needs and explain their care management.

A MODEL FOR UNIFIED CARE PART OF 3

The Cardiology IMC team, comprising Senior Consultants A/Prof Ling Lee Fong and Dr Dinna Soon (far left and far right), work closely with care coordinators Saemah Bte Sinwan, Assistant Nurse Clinician, and Samsinah Bte Mohd Yusof, Senior Staff Nurse, to manage their patients

This is a resource-intensive effort, especially on the part of the doctorcare coordinator team, who have to invest more time in each case for co-consults and follow-ups outside of appointment hours. Dr Lim, who leads the Renal IMC, notes that while there is a lot more legwork and follow-up, it makes care more efficient and focused in the long term. “We are moving the intensity of care to an earlier and more easily managed stage to avoid the crisis and complication in the later stages, when outcomes are poorer.”

AN ACCESSIBLE POINT OF CONTACT Importantly, the effort of the IMC extends past the clinic and provides

continuous support that goes beyond intermittent care. As Dr Ang notes, “In most cases, patients are managed only via periodic visits to various clinics. We are unaware of what happens in-between, and thus have no idea how they are coping with their medications at home, activities of daily living, or potential complications. The IMC strives to plug these gaps.” This is where the work of care coordinators such as Audrey come in. Their work lies at the heart of the IMC’s care approach. Care coordinators spend time with patients, check on them between visits, and learn about their spectrum of needs. So, while

doctors undertake the planning of care, care coordinators build upon the engagement, follow-up with patients, and send reminders. “This helps to build trust and understanding,” Dr Foong shares. “It allows us to engage patients and families better so that we can work together towards common goals.” Audrey explains that she helps to support patients outside of appointments. “By keeping in touch with patients beyond their appointments, we learn more about how they are coping, their progress, and their problems. We can also track and record any issues that come up between visits.” This way, help can be initiated before problems have a chance to

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Cover Story

“Care coordinators are an important resource to the IMC. Where needed, they hand-hold patients who need extra help and act as the ‘eyes’ and ‘ears’ for primary physicians outside of clinic hours.” A/PROF SUBRAMANIAM TAVINTHARAN DIRECTOR & SENIOR CONSULTANT, DIABETES CENTRE, ADMC HEAD, DIABETES IMC, KTPH

deteriorate. For example, for patients with heart failure, this may mean calling in when they experience leg swelling. The care coordinator can then immediately advise them how to increase their medications to manage water retention. By keeping an open channel of communication with patients, gaps in care can be plugged, unplanned emergencies are reduced, and patients are less likely to end up with severe complications that require hospitalisation. According to A/Prof Subramaniam Tavintharan, Director and Senior Consultant of the Diabetes Centre at Admiralty Medical Centre, who also heads the Diabetes IMC, the work that care coordinators do is essential to the success of the IMC. “They

are an important resource to the IMC. Where needed, they hand-hold patients who need extra help and act as the ‘eyes’ and ‘ears’ for primary physicians outside of clinic hours. Importantly, they are well versed in different areas of support, and link patients to various such avenues, ranging from the social to medical as well as financial.” For instance, Yao Yan, Care Coordinator for the Diabetes IMC, often links patients to community nursing resources and other home-based healthcare services, such as physiotherapy and more. “We have also persuaded some patients who need extra support to enrol for day care or rehabilitation,” she elaborates.

WHERE TRUST LEADS TO BETTER HEALTH Care coordinators play an important role in educating patients and helping them navigate through care processes

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Cardiology Senior Consultants Dr Dinna Soon and A/Prof Ling Lee Fong, who co-run the Cardiac IMC, have noted that these better support structures have led to improved engagement with patients. “Sometimes, patients are confused and unsure about their care, and this can lead to unwillingness to come for appointments or follow their medication plan,” Dr Soon advises. However, by taking the time to better engage them, compliance improves over time. “We try to build mutual understanding,” she affirms. “Slowly, this leads to greater trust.” A/Prof Ling adds that investing the time to engage patients helps form mutually beneficial relationships. “We spend more time discussing

A MODEL FOR UNIFIED CARE PART OF 3

IMC PRIMARY PHYSICIAN

PATIENT

• Manages the chronic conditions of patients • Takes charge of medical management • Pulls in multidisciplinary specialists and expertise where needed • Reviews patient’s medications and reduces polypharmacy

goals of care, what patients want to work towards, so we can tailor care for them,” he assures. “This helps patients see that we are working together, leading to better outcomes that motivate all of us — the patient and the care team — to continue our partnership towards better health.”

CARE COORDINATOR • Acts as a point of contact outside of appointments • Empowers patients for self-monitoring and advises on care escalation plans • Refers patients to community support services where needed • Reminds patients about appointments, investigations and tests • Navigates patients and their families through the healthcare system and processes

“This helps patients see that we are working together, leading to better outcomes that motivate all of us — the patient and the care team — to continue our partnership towards better health.” A/PROF LING LEE FONG SENIOR CONSULTANT, CARDIOLOGY, KTPH CO-HEAD, CARDIAC IMC, KTPH

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veryday Heroes

SPREADING JOY THROUGH

INCLUSIVITY IN SPORTS Senior Consultant Dr Teoh Chin Sim makes sports a way of life in more ways than one. Besides planning and organising field medicine for sporting events, this sports medicine practitioner is an advocate for inclusivity in sports, and is also the co-founder of PlayBuddy, a free, volunteerbased programme for children with disabilities.

n active lifestyle has always been a big part of Dr Teoh’s life. Not only is it her chosen profession as Clinical Director of Yishun Health’s Sports Medicine Centre, the avid sportswoman has also participated in a range of sports both recreationally and competitively. “Physical activity brings about many benefits,” she points out. “Not only does it keep people healthy, it also builds emotional health, mental

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discipline, and supports social engagement.” It was in 2012, while attending her first Paralympics, that the idea of extending her love for sports and games began. As Team Singapore’s Chief Medical Officer for the London Paralympic Games, she witnessed the prowess and adaptability of more than 4,000 para-athletes. Seeing how they have overcome various impairments to carry out activities of daily living and perform feats of athleticism sparked

something in her. Upon Dr Teoh’s return to Singapore, she began to learn more about the needs and activities of children with disabilities.

A SPACE TO PLAY It took a little time and searching for the right platform, but in mid-2016, she — and a like-minded physiotherapy colleague — co-founded PlayBuddy as a socially inclusive sports playgroup for disabled children catering to varying levels of physical ability. “The aim was for it to be a way for them to get active and play together with their families, caregivers and friends,” she explains. The free programme runs every Saturday morning, and games are held at public spaces and parks. Some 15 families regularly attend PlayBuddy, and half a dozen more drop in whenever possible. During each session, the children learn and play a game, such as tee-ball, tag rugby, or table tennis. Every four to six weeks, a new activity is introduced

Drr T D Teoh eo oh h hanging angiing out with one of her P layyBu udd dy chi ild PlayBuddy children during a recent ssafe-distanced afe e-d distanced dP PlayBuddy session, w hicch inv volvess ssmall groups which involves cconnecting onn nectin ng and playing over the Z oom m video-co on Zoom video-conferencing platform Photos: National Healthcare Group

Things evolved organically from T hing gs ev vo “What happened since has tthere. herre. “W Whatt h been unexpected, but we have grown b een un nexpe ec by word mouth, and we welcome b yw ord d of m o anyone wants to join us,” Dr Teoh a nyon ne who w While sshares. hare es. W hile e she provides leadership and guidance, a nd g uid dance, the programme is supported wholly by a core group of ssup su up u ppo por orted w h dedicated Dr Teoh recruits d edic cate ed volunteers. vo olu them by leveraging her wide circle of tth hem b y leve era ffriends, ri r en nds, patients, patie en athletes, coaches, students, teachers, colleagues and sst ttu ud ud de ents ts, tea ac healthcare professionals. PlayBuddy he h hea ea e alth lttth hcare p ro also funded is a is lso funde ed though the generous donations off a few benefactors. do don d on o nati na atiions o

GROWING G RO OW WIN NG COMMUNITY AND A N ND D IN INC INCLUSIVITY CL so that participants are exposed to a wide range of sports and games. Some modules are even co-designed with professional Singapore athletes — these have included the national women’s rugby team as well as table tennis Olympian Isabelle Li. People have an innate knack for sports, games and play, Dr Teoh points out. “There is healthy competition, interaction and fun.” PlayBuddy’s mission is to be a platform where children with disabilities and their families can simply enjoy time together and bond over play. Dr Teoh enrolled the first child into the programme in April 2016 after approaching a father and his disabled son at East Coast Park. From this initial meeting, she learnt more about the family, their needs, and their expectations for a sports programme. This trust-based relationship led to the family becoming the first participants for PlayBuddy.

Over the last four years, PlayBuddy has become more than a programme solely for children with disabilities. Many of the participants’ siblings, parents and helpers often join in. Other families, seeing the initiative as a meaningful way to nurture compassion and empathy in their own children, also show up. “It is a good way to learn and teach values,” Dr Teoh advises. It has also become a community in itself, and acts as a social and support group for families and caregivers. Parents and helpers from the Philippines and Indonesia have found mutual support in each other, forming chat groups and friendships. And, apart from sports, some Saturdays are spent on outings to Sentosa, the Botanic Gardens, and Kallang SplashN-Surf, as well as special celebrations for festive occasions such as Mother’s Day, National Day, and New Year’s Day. In many ways, PlayBuddy combines Dr Teoh’s own professional pursuits as a clinician who supports patients in participating in their physical activities

and functional abilities safely with her own personal love for sports. She is moved that others find meaning in PlayBuddy, and by how the initiative has grown. “I just planted a seed,” she says modestly. Dr Teoh recalls one PlayBuddy Mother’s Day celebration several years ago. As she had to be out of town, the group sent her a photo of all the children gathered around a cake. That photo brought tears to her eyes — although Dr Teoh is single and does not have children, in many ways, she has formed her own extended ‘family’ with her PlayBuddy children. In 2020, amid the COVID-19 pandemic, PlayBuddy moved to a video-conferencing format, and even began to welcome elderly participants. These days, about five seniors — including Dr Teoh’s aunt and uncle — all aged over 90, join the weekly activities. “Everybody exercises together, and it’s fun to motivate each other with some friendly intergenerational competition,” Dr Teoh says with a laugh. The programme also runs concurrently in smaller groups across the island, in keeping with safe-distancing rules. Dr Teoh hopes to grow the programme “one child at a time” and perhaps one day see 50 to 100 children playing together. For now, her goal for PlayBuddy is simple — let children of all ages do what they are meant to do: play, have fun, and enjoy life as best they can.

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COVID-19 VACCINE: TO TAKE OR NOT?

Yishun Health experts answer your frequently asked questions about health, well-being and medical conditions.

In consultation with Dr Ooi Say Tat, Senior Consultant, General Medicine, and Foo Meow Ling, Senior Nurse Clinician, Infection Control

I am considering taking the COVID-19 vaccine being rolled out. How effective and safe is it? The BioNTech-Pfizer vaccine that is currently approved for use in Singapore is 95% effective at preventing COVID-19. As is the case with all vaccines, this one has undergone Phase III clinical trials and passed safety checks by the vaccine makers as well as the Food and Drug Administration (FDA) in the USA. Singapore’s Health Sciences Authority (HSA) has also assessed the vaccine for safety.

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Who is the vaccine recommended for, and who should avoid it? HSA has approved the vaccine for people aged 16 years and above. To protect those at high risk, priority is given to healthcare workers, frontliners and seniors. All other healthy people in Singapore can receive the vaccine progressively, and it is free for Singaporeans and long-term residents till end-2021. While vaccination is voluntary, anyone who is medically eligible is encouraged to be vaccinated. The vaccine is safe for a majority of

the population, but extra data is being gathered to extend a greater level of precaution towards more vulnerable groups. Those who should wait include: • children below 16; • people with low immune system due to underlying medical conditions or treatments (eg patients who have had transplant surgery within the past three months, or cancer patients undergoing chemotherapy or immunotherapy); • anyone with a history of severe allergy or an allergy to any of the vaccine ingredients; and • women who are expecting. If you are unsure whether you are suitable for the vaccine, please consult your doctor.

What can I expect from the vaccination process? What kinds of side effects should I be aware of? The approved COVID-19 vaccine is given via an injection in the upper arm, just like a flu jab. It will be given in two separate doses; the second one is given 21 days after the first. It is normal for some people to develop symptoms after a vaccination, since the vaccine triggers a natural response in the body as it builds immunity towards a virus. Common side effects include soreness at the injection site,

fever, fatigue and headache. These symptoms typically last only a day or two. Should they persist, please consult your doctor.

After I get vaccinated, does it mean I no longer have to abide by safedistancing rules? Vaccination lowers the risk of getting sick from the virus. The goal of vaccination is to achieve a high rate of protection. However, even if you are vaccinated, you must be mindful that there are still people who have not been vaccinated, or groups who cannot be vaccinated. This means masking and safe-distancing measures are important even after vaccination so as to keep everyone safe.

DON’T FORGET YOUR FLU JAB! Apart from being protected from COVID-19, remember to get your seasonal influenza shot as well. In fact, the Ministry of Health strongly recommends the flu shot for vulnerable groups, such as older people, young children, pregnant women, and those with chronic conditions. Those who are well should also be vaccinated as it prevents the flu from spreading. Inoculation from both COVID-19 and influenza decreases their circulation, lowering the risk of getting sick at both a public health and an individual level. In Singapore, flu cases peak around May to July and December to February.

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potlight

MAKING A WORLD OF DIFFERENCE THROUGH THE LITTLE THINGS For the needy and lonely, their days leading up to the end of life may be a harder road to travel compared to other folks. The Leaving Well Fund allows for meaningful and dignified support in the final passage of life by creating connections and fulfilling last wishes.

L-R: Halim Zul Fahmi, Senior Physiotherapist; Mona Mok, Occupational Therapist; Dr Wang Yu Chen, Medical Officer; Dr Akhileswaran Ramaswamy, Senior Consultant; Lim Lay Cheng, Nurse Manager; Lee Yin Yin, Staff Nurse

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uying a new shirt to look smart for a photo; ordering in a favourite hawker dish to break the monotony of hospital meals; topping up a prepaid phone card for calls to loved ones. These are all mundane, everyday activities that seem inconsequential. But for some people, these little things that many of us take for granted make a world of difference, and add some joy in their journey towards life’s end. It is with this in mind that the team at Yishun Community Hospital’s Inpatient Hospice Patient Care Service (IHPCS) worked with the Alexandra Health Fund to set up and support the Leaving Well Fund. Dr Caroline Lim, Senior Staff Physician, explains that while the majority of patients are able to fulfil their wishes with the help and care of their family members, there is a minority who do not have the social support and means to do so. These financially needy patients are usually recipients of government

“We look at the treatment, symptom relief, and psychosocial well-being of a person, not just a patient.” DR CAROLINE LIM SENIOR STAFF PHYSICIAN YISHUN COMMUNITY HOSPITAL

assistance. “We started the Leaving Well Fund with the idea of wanting to fulfil the wishes of this group of terminally ill patients,” shares Dr Lim. The goal, adds Lim Siao Ee, Senior Medical Social Worker, is to use the fund to hold activities so as to create experiences and memories for patients and their families, and facilitate some closure.

Some IHPCS members preparing a game of mahjong for a patient

“In our palliative care work, we try to address not just physical health, but also psychological well-being, emotional comfort and spirituality,” Siao Ee emphasises.

MEANINGFUL MEMORIES AND CONNECTIONS Since the launch of the fund in late 2019, the team has used it for a range of activities, including memory-making sessions involving patients and their family members. So far, about 10 patients have benefited from the fund. One of these patients wished to cook chicken curry — her signature dish — for her sons one last time. Occupational Therapist Josiah Koh set up a space at the hospital with an induction cooker and bought the ingredients using the fund so that the patient and her sons could prepare the dish together. “It was not so much about the ingredients or food, but the memory and meaningfulness of spending time together,” affirms Siao Ee. Another beneficiary, Siao Ee relates, is a gentleman who lived in a sheltered home. During one of their chats, the man took out his wallet, which had a list of phone numbers. Siao Ee enquired about it and learnt that they were the contact numbers of family members with whom he had lost touch. “I asked if I could try to call them on his behalf, and we managed to reconnect him with his family.” This reconciliation led to conversations about his preferences for last rites, including his attire for that occasion. “He said he wanted to wear what he had always worn: a polo shirt and Bermuda shorts. He had never worn a formal shirt and pants in his life,” Siao Ee recalls. Learning of this, the team bought him a new collared shirt and, during one of his occupational therapy sessions, took a photo with

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potlight

L-R: Dr Caroline Lim, Senior Staff Physician; Chan Sue Mei, Principal Dietitian; Brenda Soh, Speech therapist; Josiah Koh, Occupational Therapist; Zuno Lilet Reyes, Assistant Nurse; Maryanna Akilasha Gomez, Staff Nurse; Lim Siao Ee, Senior Medical Social Worker

him wearing the new threads. This portrait of him was eventually shared with his family and used for his funeral rites. “The new shirt paved the way to a nice photo, which was a way to uphold his dignity even at the time of death, and something for his family to remember him by,” says Siao Ee. The Leaving Well Fund has also been used to help families visit and say goodbye. One patient was worried about not being able to stay in touch with his brother during his hospitalisation. This was because the brother could not afford to top up his prepaid phone card. The team used the fund to top up the brother’s pre-paid SIM card so that other family members could be contacted in time to be by his side before he passed away.

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HOLISTIC, PERSON-BASED CARE “It is the small connections and the little things that mean so much,” states Senior Staff Nurse Gao Bingzhen, pointing out that the fund has been most beneficial in granting patient’s requests, such as buying their favourite food, clothing, and celebrating birthdays. The fund enables the ward team to provide holistic care with a personal touch and build better rapport with patients who are undergoing a difficult time coping with their terminal illness while in hospital. Halim Zul Fahmi, Senior Physiotherapist, recollects his work with a patient who had a high level of anxiety and declined

participating in rehabilitation due to breathlessness. The ward team used the fund to purchase his favourite drink of bubble tea and some snacks. These small gestures helped to ease the patient’s anxiety and establish a relationship with the therapists and nurses. The patient was eventually able to manage his breathlessness, which helped him to get out of bed more frequently for activities. In another instance, one of the ward nurses ordered bak chor mee, the favourite hawker food of a patient who had been refusing to eat or bathe. “After the meal, she became more cooperative and friendly, allowing us to clean her during shower time,” Staff Nurse Lee Yuan adds. Chan Sue Mei, Principal Dietitian,

says that it is often challenging to provide foods that most patients find enjoyable. Many experience symptoms such as pain, dry mouth, taste bud changes, and the loss of ability to feed themselves, which prevents them from eating and drinking enough. The team utilises the Leaving Well Fund to fulfil patient requests for comfort foods that provide some relief and supplement hospital meals. Seeing to more than merely clinical needs is what palliative care is all about. “We look at the treatment, symptom relief, and psychosocial well-being of a person, not just a patient,” Dr Lim explains. This idea of person-based care considers personhood: someone’s history, individual preferences, choices, and goals. Palliative care also seeks to understand a terminally ill

patient’s wishes for their last days. This is an area in which the Leaving Well Fund hopes to do more: this year, it will start an initiative to engage a private nursing service to assist terminally ill patients who wish to spend their last days at home. “We are planning to help make this possible for patients who have expressed a strong wish to pass away at home — but who do not have next-of-kin or carers — to do so,” Dr Lim reveals. The service will be engaged to provide terminal nursing care for patients without kin or caregivers, and who are expected to pass away 48–72 hours after discharge. “We want to support and fulfil wishes for their last journey to be in the familiar surroundings of home, with a trained nurse, till their last breath,” Dr Lim explains. Importantly, this fills a gap in the terminal nursing support,

especially for those with poor social support and no finances to hire private nurses. Such a move will support efforts to improve end-of-life care and fulfil preferences and wishes set out during Advance Care Planning (see box story). “We want to give people who may not have the means to still have a dignified send-off that recognises their preferences and honours their wishes,” insists Siao Ee.

ADVANCE CARE PLANNING: PLANS FOR THE END OF LIFE Advance Care Planning (ACP) is an ongoing conversation between a patient, his/ her family members, and healthcare professionals. It seeks to understand the patient’s preferences for future medical choices. It also articulates the patient’s values and personal wishes so that all decisions — medical and otherwise — that are made for him/her meet these requirements. The ACP is helpful in starting conversations about last wishes. To book an ACP appointment: Call: 6555 8000 (KTPH mainline) Email: ktph.advancecareplanning@ ktph.com.sg

A team member helping to groom a patient who is about to have his portrait taken

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ive Well

A Library

Without Borders Hoping to share the joy of reading with more children, Mr Chia Kam Poi, 66, took it upon himself to take ownership of a small mobile library in his neighbourhood and expand it into a community-owned library and sharing corner.

ucked in a quiet and leafy estate in Yishun Avenue 11 is a place where superheroes, detectives and fantasy creatures dwell. It is where one can dive into fictional worlds, be immersed in the past, or explore futuristic imaginings. All this and more can be found within the pages of books in a small but growing community library that has become the neighbourhood treasure trove. Leading this ground-up effort is Mr Chia, a retiree and former product developer. Learning of the small mobile library initially started by Yishun Health’s Population Health and Community Transformation (PHCT), the long-time Yishun resident volunteered to expand the collection in October 2020. “It was just a small shelf of books, but I thought we could do better.”

FROM THE GROUND UP He called on buddies Mr Wong Poh Khim, 66, and Mr Azhar Mohamed Soh, 58, both of whom readily agreed to join the initiative. “It is a very meaningful thing to do,” says Mr Azhar. Though none of them

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had any experience setting up a library before, it did not matter, as they had willing hearts and hands. “We just did what we could, like ask our friends for donations,” shares Mr Wong. Impressively, the three friends — who met on a woodworking course — reconstructed and upcycled most of the shelves and tables used at the library. Bits of old and discarded furniture have been transformed into a unique assortment of book displays that lend the library a homely charm. It is an achievement they are deservedly proud of. Mr Chia explains that the library works on an honour system. Anyone can pick up a book, take it home, then return it afterwards. “If they wish to keep it, we just encourage them to donate a book in return.” Hearteningly, in just over six months, the library has grown far beyond its original intent. It has amassed a decent collection of children’s books, growing sizeably from a single cupboard to several shelves. Beyond books for

pre-schoolers to teenagers, the collection also comprises self-help books, bestselling novels, textbooks, educational magazines, and more. There are also books in other languages, such as Malay, Mandarin and Tamil. While Mr Chia welcomes books of all sorts, he tries to curate donations to ensure they are suitable for the readership, particularly young children, to whom he wishes to reach. “It’s important to start from young to inculcate a love for reading,” he asserts. “Children today are

Left: Mr Chia Kam Poi took over a small collection of books and expanded it with the help of buddies (above) Mr Wong Poh Khim (in checked shirt) and Mr Azhar Mohamed Soh (on personal mobility device)

Below: A Thank-You note from a grateful library user

exposed to a lot of digital media, but they should start with reading books first — the rest can come later. They have their whole lives to enjoy the Internet.” The community has even donated other items, creating sharing corners where those in need can pick up pre-loved items, such as clothes and toys. Little treats such as cookies, sweets and fruits are sometimes placed there to be shared with the neighbourhood. Mr Chia finds it encouraging that the community has taken ownership of the spot.

“People sometimes walk by and help to arrange the books,” he says. Others have donated rugs and chairs to make the area cosier. “It has gone beyond a library — people have taken ownership of this library. It is our library without borders.”

DO GOOD, FEEL GOOD The library is just one of the activities that Mr Chia spends time on. Together with Mr Wong and Mr Azhar, the ‘three musketeers’ — as they have been dubbed — are avid volunteers and take part in community gardening as well. Mr Chia says this form of giving back is useful to keep his mind active, so that he is always learning and growing. He has also recently joined Repair Kakis at the nearby Wellness Kampung in order to pick up new skills in electrical and electronic maintenance. Mr Azhar, who uses a personal mobility device and goes to dialysis three times a week, finds taking part in community activities a meaningful way to use his time and keep his spirits up despite his health issues. Mr Wong echoes this sentiment. “It’s better than only staying home to stare at the walls. This is interesting and fun. It keeps me happy and healthy.”

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Things About...

5 Things About

Preventing Pressure Injuries Knee

Ear Shoulder

Elbow

Being confined to a bed or chair for long periods can increase the risk of pressure injuries. A regular and conscientious routine to alleviate pressure and maintain good skin care can n go a long way in preventing g distressing and burdensome me pressure injuries. In consultation with Dr Mansha Khemlani, mlani, Senior Consultant, Geriatric Medicine, e, and oup Chair of the Pressure Injury Workgroup

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Knee

Hip

Bone

Ankle

Weight from the body

Muscle

Subcutaneous fat

Dermis Pressure from mattress Epidermis

IDENTIFY AREAS AT RISK AND KEEP A CLOSE WATCH ON THEM

Shoulder

Buttock

While the back, buttock and hips Heel are common sites, pressure injuries can develop on any part of the body. Although medical devices such as oxygen tubing, catheters, neck collars, and casts are essential for the care of certain individuals, the pressure from these devices on skin can cause the skin to break down.

Ball of foot

POSIT POSITIONING POS SIT FOR PROTECTION PROTECTIO

Positioning changes cha are im important mportant to reduce the time that pr pressure ressure is applied on any one sp specific pecific area of the body. If you ar are re lying in bed, it is important position at least to o change your p once even on nce every two hours, h during Avoid lying on your du uring sleep. Av side degrees, where most si de at 90 degr pressure over pr ressure is concentrated con the th he hip bone. For side-sleepers, a 30-degree position is ideal. The head he ead of the bed should also be elevated el evated and an ideally maintained at about to reduce the ab bout 30 degrees d risk developing an injury. When ris sk of dev seated se eated in a chair, wheelchair or any mobility device, you should try to m shift sh hift your yo weight every 15 minutes.

DEVISED FOR COMFORT

BOOST YOUR SKIN’S HEALTH WITH GOOD DAILY SKINCARE

MAINTAIN A HEALTHY DIET AND LIFESTYLE TO AVOID PRESSURE INJURIES

Pressure injuries can develop when your body is in persistent contact with one or more external surfaces, such as the bed, a chair, or even tubes and drains. One way to mitigate this pressure is in applying a layer of protection between the skin and the surfaces it comes in contact with. Some specialised mattresses or cushions can help to redistribute pressure and offer some protection. Other devices, such as sliding sheets, help to reduce shear and friction when a person is repositioned. Pillows can also be used as an aid to support those who have been turned to lie on their side.

A skincare routine that keeps skin hydrated is important in preventing pressure injuries. Damage is more likely to occur if the skin is either too dry or too moist. Select the right skin cleanser and moisturiser to keep the skin supple and prevent dryness. Be gentle with your skin and avoid water that is too hot when bathing. Vigorous rubbing or massage over bony areas should be avoided when drying or applying moisturiser. Check the skin daily for redness or other discolouration. While the skin may still be intact, colour changes to maroon or purple suggest deeper pressure injuries. Other things to note are blisters or broken skin over pressure areas.

Consuming a diet balanced in proteins, fats and carbohydrates, and drinking enough water go a long way in preventing malnutrition and in maintaining an ideal body weight. Both extremes of being underweight or obese can lead to an increased risk of pressure injuries. A balanced diet can ensure healthy skin as well as promote wound healing.

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akan T akan Time im ime me

28 2 8 | 28

cut & keep

Tuna Sushi R ll High in fibre and low in sodium, this colourful homemade sushi roll is the perfect addition to your lunchbox. Recipe provided by Chef Goh Ghim Guan, Food Services, KTPH, in consultation with Nutrition & Dietetics, KTPH

INGREDIENTS SERVES 4 MIXED RICE

Rice Marinade

• ¾ cup white short-grain rice, washed • ½ cup brown rice, washed

• 1½tsp rice vinegar • ¾tsp sugar

• • • • • •

220g tuna in mineral water, drained and flaked 3tbsp Japanese mayonnaise 2tsp low-sodium soy sauce ½ each of red, yellow and green capsicum, deseeded and cut into strips 3tbsp furikake seasoning 4 large nori sheets

Tip: Wet the knife blade edge each time you cut the sushi roll to prevent the seaweed and rice from sticking to the blade.

METHOD 1. Add both types of rice into a rice cooker with 1¾ cup of water to cook 2. In the meantime, blanch the capsicum slices and set aside in 4 portions 3. When the rice is cooked, season with the rice marinade and place in mixing bowl 4. Combine the rice with the tuna, mayonnaise, furikake and soy sauce 5. Divide the rice mixture into 4 portions 6. Place the nori sheet on a bamboo mat, spread one portion of the rice-and-tuna mixture evenly on top, smoothening it with the rice paddle 7. Layer one portion of the capsicums horizontally about 1 inch from the bottom of the seaweed sheet 8. Roll it up tightly 9. Cut each roll into 6 to 7 equal pieces and serve

NUTRITIONAL INFORMATION (PER SERVING) Energy

541kcal

Carbohydrates

57g

Protein

26g

Fat

17g

• Saturated

>2.5g

• Polyunsaturated

>4.3g

• Monounsaturated

>7.9g

Cholesterol

48mg

Dietary Fibre

8.4g

Sodium

>534mg

Potassium

>774mg

Phosphate

>358mg

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it & Fab

S-t-r-e-t-c-h

— it’s good for you! Regular stretching does more than keep you flexible — it can help improve overall mobility, prevent injury, and maintain independence. In consultation with Tan Jia Ling, Senior Physiotherapist, Rehabilitation Services

tretching is more than something to do before or after a hard workout. In fact, daily stretching is useful in overall physical health. Regular stretching overcomes tightness caused by inactivity and poor posture, and helps

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to maintain the length, pliability and strength of muscles. This, in turn, reduces tension and raises the ability of muscles to perform at their full range, which enables us to perform our daily activities safely.

ontents

What’s Up Community events, outreach efforts, and more

DAILY DOSE Adapting to the Work-From-Home (WFH) Life Elements of a good home office can make WFH a lot better for your wrists, neck and back

COVER STORY

Collaborations for Empowering Relationshipbased Care Engaging patients with coordinated support beyond clinic hours for better outcomes

A MODEL FOR UNIFIED CARE 2 |

THERE ARE TWO TYPES OF STRETCHES:

20 SPOTLIGHT Making a World of Difference Through the Little Things The Leaving Well Fund enables meaningful, dignified support in the final passage of life

STATIC STRETCH

DYNAMIC STRETCH

Holding a specific position so that the muscle is held at tension

Moving a limb through its full range of motion repeatedly

HAMSTRING STRETCH

LEG SWINGS

QUADRICEPS STRETCH

BUTT KICKS

CALF STRETCH

CALF RAISES

PECTORAL STRETCH

ARM SWINGS

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Community Nurse Post

Issue 2: March–April 2021

Wellness Kampung

aha

Issue 2: Mar-Apr 2021

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

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)

Khoo Teck Puat Hospital (KTPH)

Yishun Community Hospital (YCH)

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

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

90 Yishun Central Singapore 768828

2 Yishun Central 2 Singapore 768024

6807 8000

6555 8000

6807 8800

www.admiraltymedicalcentre.com.sg

www.ktph.com.sg

www.yishuncommunityhospital.com.sg

www.fb.com/admiraltymedicalcentre

www.fb.com/khooteckpuathospital

www.fb.com/yishuncommunityhospital

MCI (P) 088/07/2020

ҡ ) '$"#/ *! Ҋрш . ! ( ) " ( )/ ( .0- .Ѷ +' . # & /# 2 .$/ !*- /# )/- . # 0' ) '' $) 1 ) /* . $! /# - - 1 ) $ . !*- "-*0+ /$1$/$ .ѵ

COLLABORATIONS FOR EMPOWERING RELATIONSHIP-BASED CARE Engaging patients with coordinated support beyond clinic hours for better outcomes

SPREADING JOY THROUGH 16 INCLUSIVITY IN SPORTS MLP_#0032/21_Cover_4Cx4C

MAKING A WORLD OF DIFFERENCE 20 THROUGH THE LITTLE THINGS

A LIBRARY WITHOUT 24 BORDERS