As one of the first points of contact, Yishun Health’s Patient Service Associates are also ambassadors of our service and care culture
28 5 THINGS ABOUT…
Automated External Defibrillators (AEDs)
Knowing about AEDs and how to use them could save a life!
30 DAILY DOSE
Hernias Hurting Your Quality of Life?
Learn about hernias and how you can minimise your risk of having one
32 MAKAN TIME
Double Boiled Herbal Chicken
A nutritious dish that’s low in fat and sodium
34 FIT & FAB
Hooked on the Climb
Learn more about this whole-body activity that challenges your mind as well
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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.
PUBLISHER
Yishun Health is a network of medical institutions and health facilities of the National Healthcare Group in the north of Singapore. It comprises Khoo Teck Puat Hospital, Yishun Community Hospital, and community extension, Admiralty Medical Centre.
EDITORIAL TEAM
Nur Amalina
Hannah Wong
Jack Lau
Sharon Ng
Albert Foo
EDITORIAL COMMITTEE
The editorial committee — made up of clinical, nursing, allied health, and administrative heads of department — advises aha’s direction.
A/Prof Tan Kok Yang
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
MANAGING DIRECTOR
Christopher Tay
EDITOR
Adam Yap Keh Chew
CONTRIBUTING EDITOR
Sheralyn Tay
HEAD, CREATIVE
Lee Lily
HEAD, CLIENT RELATIONSHIP
Jessie Kek
CONTRIBUTORS
Justin Loh, Yong Ruey Teng
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) 054/06/2024
‘No Excuse for Abuse’ – standing up for healthcare workers
Y ishun Health joined the other public healthcare institutions in the Ministry of Health’s national public education campaign to prevent the abuse and harassment of healthcare workers (HCWs).
Titled “No Excuse for Abuse”, the campaign is part of the Tripartite Workgroup for the Prevention of Abuse and Harassment’s efforts to protect HCWs. It aims to encourage the public to treat HCWs with respect, bring attention to the seriousness and zero tolerance of abuse and harassment towards HCWs, and educate that offenders will face consequences for their actions.
As part of the initiative, Yishun Health put up posters around the campus. These posters are used as visual aids when speaking to
patients and/or family members during an incident.
Yishun Health’s senior management expressed their commitment and support for this
Taking no chances with patient safety
Every July, Yishun Health reenergises our commitment to safety with Patient Safety Month (PSM). This year’s event theme was “Don’t Leave It to Chance”, with a focus on preventing safety incidents through accurate identification, thorough verification and conscientious confirmation.
endeavour, and the Staff Protection Empowerment Collective has implemented a Recognise-RespondReport approach to help staff in the event of such incidents.
Our staff deepened their safety knowledge through various sharing sessions and e-bulletins on various topics such as safety tips in patient identification, medication safety, diet ordering and falls prevention.
During the closing of the PSM,
CEO Prof Chua Hong Choon reminded that every member of the team plays an equally crucial role in patient safety, and urged the practice of clear, open, honest and empathetic communication with our patients and their family members.
Emergency and critical care nursing
Yishun Health’s Acute & Emergency Care nursing team held its third Emergency Nursing Masterclass on 2 August 2024.
Started in 2021, this learning initiative originated from an Emergency Medicine Masterclass event that eventually spun off into one specially focused on emergency and critical care nursing.
This year’s event - the first
physically sited one - featured a restructured programme with a distinguished line-up of eight speakers, including Advanced Practice Nurses and doctors from various healthcare institutions.
In a unique addition to the roster, there was a principal psychologist from the Singapore Civil Defence Force emphasising mental wellness and tips to avoid burnout among the
The
included interactive Q&A segments covering diverse topics
healthcare workers.
The masterclass also placed a strong emphasis on mental wellness and burnout prevention among healthcare workers. Recognising the demanding nature of emergency care, the event provided valuable insights and strategies to help attendees cope with the challenges of their profession and support their well-being.
The masterclass was well attended, seeing about 150 participants from both public and private healthcare institutions
masterclass
Celebrating our cultural diversity
On 29 May, Yishun Health celebrated the rich and colourful diversity of our organisation with our very first Cultural Diversity Day!
As part of the programme, staff from different countries transformed the KTPH Learning Centre into little ‘cultural centres’ to
share highlights of their culture. Staff enjoyed a plethora of activities that afternoon – from nostalgic games in the Malaysia room and rangoli art in the India room, to puzzle games in the China room and tinikling dance lessons in the Philippines room. They also painted floral and geometric tiles
ubiquitous with the peranakans in the Singapore room, while in the Myanmar room, they could learn about and try thanaka, a paste made from bark and used as a sunscreen and face cream, as well as the traditional yein dance.
Attendees enjoyed learning the traditional dance of tinikling from the Philippines (left) and appreciating the various dances from Myanmar
(right)
Staff, including senior management, came dressed to showcase the various cultures making up our staff body
…in The Straits Times
Siti Farhana Bte Jumari is a Senior Staff Nurse at Khoo Teck Puat Hospital’s emergency department. She is constantly on the go from the moment her shift starts until it ends. Off duty, she transits seamlessly into her second ‘shift’, caring for her mother, who has dementia, and her autistic seven-year-old son. Despite these challenges, she draws on her inner strength to continue her passion for nursing.
Find out how nurses like Farhana stay dedicated to caring for others in this Straits Times feature.
In February 2024, Mr Lee Chiow Jin was rushed to Khoo Teck Puat Hospital’s (KTPH) emergency department. It was later discovered that the 48-year-old bus driver had an extremely rare case of not just one, but three hernias. A hernia is a condition where part of an organ, such as the intestines, protrudes through a cavity wall. In this Straits Times feature, Dr Marc Ong, a consultant from KTPH’s Department of General Surgery, shares how he employed a new surgical technique to repair all three hernias in an eight-hour surgery. Mr Lee was discharged four days after his operation and has made a full recovery since.
Scan the QR code for the full article and see page 8 to learn more about hernia surgery.
…on KTPH Instagram
In conjunction with Nurses’ Day, Ms Rahayu Mahzam, Minister of State at the Ministry of Health, Prof Joe Sim, NHG Group Chief Executive Officer and Yishun Health’s senior management stepped into the shoes of our dedicated nurses for a day. Watch how they tackled demands, embraced empathy, and gained a newfound appreciation for the work that our nurses do daily.
Scan the QR code to watch how they did.
…on KTPH Facebook
People commonly mix up plastic surgery with cosmetic surgery, though they are distinguished by several differences. In the latest episode of “Yes to Health”, we asked Dr Jolie Hwee, a consultant from the Department of Plastic, Reconstructive and Aesthetic Surgery, some questions about plastic surgery, the possible downsides, and the ‘hype’ surrounding buccal fat removal.
Scan the QR code to ‘reshape’ your understanding of plastic surgery!
Photo: Chong
Photo: Kua Chee Siong
FROM NURSE TO PATIENT, from SURGEON TO TEACHER both SIDES OF CARE:
The road to better care delivery is not just about pursuing enhanced systems and processes. Often, it is driven by surmounting personal challenges, inspiring mentorship and the very human instinct to pay it forward. For two healthcare professionals, their separate experiences with hernia surgery intersect in ways that have led them to more positively impact the lives of others.
In her day-to-day work in a renal ward at a public hospital, Staff Nurse Elaine Saw knows all too well the many challenges faced by her patients. Apart from lifestyle and diet restrictions, emotional stress and physical discomfort, they must also exercise caution to prevent infection and risk of hernias. This is because the
constant pressure of the dialysis fluid in the abdomen can weaken the abdominal wall, allowing part of an organ or tissue to push through.
Little did she know that one day, she would experience a hernia herself.
One day in early 2023, Elaine was on the toilet when she felt something “pop” near her navel.
Dr Marc Ong (centre) leads the Hernia Surgery Service, a dedicated team of four surgeons, including Dr Teo Rui Ming (left), Associate Consultant, General Surgery, and Ong Yu Jing (right), Nurse Clinician, APN and Specialty Nurses
“I knew I was in good hands; Dr Ong was very reassuring and walked me through the process of the surgery.”
Elaine SAW
She could feel a soft mass extruding from underneath the skin near her belly button. “There was no pain, but it was a little uncomfortable and I realised immediately that I had developed a hernia,” she recalls. She knew that while it was not a life-threatening condition, it would be better to undergo surgery to rectify the problem.
Based on advice from her friends in healthcare, she sought out Dr Marc Ong, Consultant, General Surgery, KTPH, as she had heard of his surgical expertise in hernia repair, particularly in a new technique of a minimally-invasive hernia repair surgery known as the enhancedview totally extraperitoneal (eTEP) approach. Dr Ong – who leads a dedicated Hernia Surgery Service at KTPH – is one of the few doctors in Singapore formally trained in this technique.
ELAINE’S ROAD TO RECOVERY
Dr Ong explains that Elaine had developed an incisional hernia, likely because of a previous fibroid removal surgery in 2022. Incisional hernias are those that develop at the site of a previous operation (read more about the different types of hernias on page 30).
During the assessment, Dr Ong also discovered that she had an existing condition known as rectus diastasis. This is the separation of the abdominal muscles at the midline, often due to pregnancy, heavy lifting or genetics. In Elaine’s case, it was possible that she had
developed it due to repetitive strain from heavy lifting during her work. This injury and her previous surgery had probably weakened her abdominal muscles, resulting in a hernia.
Elaine shares she was keen on the eTEP procedure, even though it remains quite new in Singapore.
“I knew I was in good hands; Dr Ong was very reassuring and walked me through the process of the surgery,” she says. Her concern was going under general anaesthesia because she had a bad experience before, suffering nausea and tachycardia (elevated heart rate).
She remembers that Dr Ong and
his anaesthesiologist colleagues listened and paid special attention to her worries and goals, including her wish to be independent and get back to her life and work as soon as possible after the surgery.
“I was quite open and optimistic, but there is definitely a little bit of fear whenever you go through surgery,” she says.
All her anxieties were allayed when she woke up from her procedure. Elaine – who decided to also do a calf muscle release surgery for her plantar fasciitis at the same time – recalls that she was able to sit up in bed soon after surgery.
“There was very little pain in my abdomen – which only had four small incisions. In fact, I think I was hindered more by the operation on my foot,” she says with a laugh.
This, says Dr Ong, is the main benefit of keyhole surgery.
“People recover much faster compared to open surgery.
The length of stay in the hospital is shorter, and there are fewer overall complications, wound issues and recurrence rates.”
As a testament to this, Elaine was back at work in no time at all, just as she had hoped for. Today, she is more cautious at work when dealing with heavy loads and is more mindful of her core strength and ergonomics. She also still sees Dr Ong occasionally for follow-ups.
Having gone through this experience, she is also more attuned to the risks her patients face. “I see a fair number of umbilical hernias in my renal patients and I know how to advise them on their surgical options,” she says. “I am glad that I can use my story to help them.”
FROM APPRENTICE TO MENTOR: DR ONG’S TRAINING JOURNEY
As for Dr Ong, he is ensuring that the skillsets that he has acquired are being passed along to help more people as well.
KTPH is only one of two public hospitals with a dedicated hernia
surgery service, and Dr Ong hopes that more surgeons in Singapore and around the world can benefit from learning eTEP to improve the outcomes of hernia surgery.
His own road to learning this advanced technique came about by chance, when he met Dr Kiyotaka Imamura in 2019 while on a camel
AN IMPROVED SURGICAL TECHNIQUE FOR HERNIA REPAIR
The goal of hernia surgery is to move the herniated tissue back into place and repair the weakened tissue in the abdomen. This is usually done through an open or keyhole surgery. It requires stitching healthy surrounding tissue together to create a strong barrier wall and using a surgical mesh that acts as an extra support to prevent a hernia from recurring.
Intraperitoneal Onlay Mesh (IPOM) is a technique used to traditionally repair a hernia. A mesh is placed within the abdominal cavity from the inside of the hernia opening. Special tacks with titanium spirals or absorbable screws are used to hold the mesh in place. IPOM can be performed through either open or keyhole surgery.
Enhanced-view Totally Extraperitoneal (eTEP) retromuscular repair was pioneered in 2018.
eTEP allows the mesh to be placed between the layers of the abdominal muscles, with the muscles ‘sandwiching’ the mesh in place. This requires careful dissection of the abdominal wall muscle layers to create a new space for the mesh to be placed.
eTEP is a more complex surgery as the surgeon has to work between the layers of muscle rather than inside the relatively larger space of the abdominal cavity. This keyhole technique requires a deep understanding of the anatomy of the layers of the abdominal musculature and a high degree of surgical proficiency.
eTEP is reported to result in better outcomes, such as:
• Lowered risk of complications, such as mesh adhesions at the treated area
• Lowered cost, as the mesh for eTEP is about one-third the price of the specially-coated mesh used for IPOM
• Avoidance of expensive surgical tacks/screws to keep the mesh in place
MESH
Skin
Fat
Muscle Fascia Loops of small intestine Peritoneum Omentum
tour in the middle of a desert during a holiday. Dr Imamura is a hernia surgeon from Tokyo with an expertise in the eTEP technique and over 100 successful cases under his belt. “What are the chances of this happening?” Dr Ong says with a chuckle, turning wistful as he adds, “He took me under his wing to train
me. I feel very grateful to him as my mentor. He saw potential in me and has taught me everything I know about eTEP.”
Dr Ong shares that over multiple training sessions over video calls during the pandemic, Dr Imamura shared his expertise and reviewed Dr Ong’s surgical techniques.
“People recover much faster compared to open surgery. The length of stay in the hospital is shorter, and there are fewer overall complications, wound issues and recurrence rates.”
Dr marc ONG SERVICE LEAD, HERNIA SURGERY SERVICE, general surgery, KTPH
Over the next few years, which included an extended learning stint in Japan, Dr Ong diligently built up his surgical competencies in eTEP to offer it in Singapore. Since 2020, he has performed close to 20 eTEP operations and has trained many more in this technique.
He is also leading a collaborative nationwide project to compile data on the Singapore eTEP experience. “We hope to publish Singapore data that covers multiple centres, so we can build robust evidence supporting this technique,” Dr Ong shares.
Apart from teaching the technique to other surgeons in Singapore, he works with Dr Imamura to grow this competency around the world. “It is amazing that we are now being invited to share our eTEP expertise and are journeying in advancing this together!” he says.
A chance encounter with Dr Kiyotaka Imamura (left), led Dr Ong on the path towards mastering the eTEP technique
Under Pressure to Control HYPERTENSION?
Maintaining a regular blood pressure is tantamount to good health, as it is the life force that moves your blood through your arteries from the heart to the rest of the body.
What do the numbers in a blood pressure reading mean?
Blood pressure readings combine two measurements, systolic and diastolic pressures. A blood pressure reading is usually indicated numerically, with the systolic pressure over the diastolic pressure (i.e. 120/80 mmHg).
In consultation with Dr Justin Tang, Senior Consultant, Cardiology, KTPH
Why does blood pressure matter? Isn’t it normal for blood pressure to be higher as we get older?
Blood pressure indeed tends to increase with age because the blood vessels become less elastic. The impact of lifestyle factors accumulates over time, impacting blood vessel health. However, high blood pressure is not considered a normal or inevitable part of ageing.
Systolic: The highest pressure in the arteries when the heart contracts and pumps blood to the rest of the body.
Normal 110 - 130
Borderline 130 - 139
High
More than 140
Diastolic: The pressure against the arteries as the heart relaxes.
Normal 70 - 85
Borderline 85 - 89
High 90 or more
Blood pressure is an important indicator of cardiovascular health, and it matters because persistently high blood pressure can lead to serious health issues such as heart disease, stroke, kidney disease, and other complications. Early-stage high blood pressure does not show any obvious symptoms, so regular check-ups are important to ensure the condition can be managed.
Studies have shown that having a blood pressure of less than 120/80mmHg reduces cardiovascular events by 25% and one’s overall risk of death by 27%. It also lowers the risk of stroke by 37%.
My elderly parents have been advised to monitor their blood pressure at home. What are some tips to make sure that they do this correctly?
Monitoring blood pressure at home is a useful way to provide a clear overview of changes in blood pressure over time. The best time to accurately measure blood pressure is in the mornings, about 10 to 15 minutes after waking up. Try to take a reading at the same time every day. Blood pressure can be affected by physical and emotional states as well. Before taking a reading:
• Avoid caffeine and smoking
• Avoid having a heavy meal
• Use the bathroom
• Sit still and rest for 5 minutes During blood pressure taking:
• Sit with the arm and back supported and both feet flat on the floor
• With the arm supported, put the cuff on the bare skin of your arm
• Do not talk or move
• Breathe regularly After blood pressure taking:
• Wait one minute and take a second reading
• Log the average reading
If I regularly take my blood pressure medications, does that mean I do not need to make any lifestyle changes?
Blood pressure medications are an important tool in managing hypertension, but they work best when combined with healthy lifestyle changes. These changes amplify the effectiveness of medications and reduce the need for higher doses, improving overall cardiovascular health and general well-being. Here are some recommended lifestyle modifications that can make a positive impact on your blood pressure:
loss Maintain normal body weight of BMI 18.5-24.9kg/m2
mmHg per 10 kg of weight lost
CPR SKILLS TO THE RESCUE!
While he works daily to keep patients safe and healthy, Staff Nurse Muhammad Ridhuan Bin Rohaimi never expected that one day, his nursing and CPR skills would also empower him to save his neighbour’s life.
It was a day just like any other.
At about 10pm, Ridhuan had just finished his shower after a long day at work as a Staff Nurse at KTPH’s General Surgery ward. He was just settling down to eat a late dinner. He recalls thinking about nothing more than winding down for the night because he had a morning shift the next day. This quiet ritual was interrupted by a loud notification from his phone.
His myResponder App alerted that someone was having a cardiac arrest nearby. The emergency was occurring just two blocks away. Springing into action, Ridhuan dashed out of the house. “I was in such a rush that I didn’t even inform my wife or lock the door!” he says.
Arriving at the ground floor lift landing of the block, he immediately began to access the Automated External Defibrillator (AED). Upon reaching the unit, Ridhuan
saw that another neighbour who lived next door had already started cardiopulmonary resuscitation (CPR) on the elderly lady, who looked to be in her 70s.
“I was in such a rush that I didn’t even inform my wife or lock the door! I was moving automatically, going through all the motions and it was all muscle memory from our Code Blue training.”
Muhammad Ridhuan Bin Rohaimi Staff Nurse, Surgical Short Stay Ward, KTPH
Ridhuan responded to an alert for a cardiac emergency that took place near his home, helping to save a life using an AED
“I told him that I am a nurse and could help,” Ridhuan remembers. “He asked me to take over the chest compressions and he would set up the AED.” With the AED in place, Ridhuan continued performing chest compressions for about 10 more minutes before the Singapore Civil Defence Force (SCDF) paramedics arrived to take the patient to KTPH. The quick response and early intervention of both CPR and AED had saved the woman’s life.
“MY TRAINING JUST TOOK OVER”
During the whole experience, Ridhuan says all his nursing training naturally took over. “I was moving automatically, going through the motions,” he shares. “It was all muscle memory from our Code Blue training,” he says, referring to the frequent refresher training that ward staff go through for medical emergencies such as cardiac or respiratory arrests.
However, Ridhuan says it was not something he had ever expected. In fact, he has never encountered a similar situation at work in all his years as a nurse. “Actually, this is something we hope will never happen — we just want to do our job well, have an ‘uneventful’ day and go home!” he says with a laugh.
Ridhuan stresses that this experience underscores the importance of regular training. “We go through frequent simulations and refresher courses; they really help keep our first responder instincts and emergency response skills sharp.” He adds that in such critical moments, knowing what to do allowed him to think quickly and act fast to the emergency.
He shares that he bumped into his neighbour at the void deck the day after the incident and was relieved to learn that the latter’s mother was recovering well. For his heroism that day, Ridhuan was awarded the SCDF Community First Responder Award in May 2024.
CHASING THE DREAM
For Ridhuan, being recognised for his act of courage validates his long pursuit of nursing as a career. “It took a long time for me to become a nurse,” he shares.
While his heart had been set on nursing for a long time, he did not qualify for nursing school on his first attempt. He ended up pursuing other routes, earning a Higher National Institute of Technical Education
Certificate in Information Technology (IT) instead and then working in the IT industry for about one and a half years. It was only in 2018 that he reapplied for nursing school again and finally got in.
“I always wanted to be a nurse because my mother was one, and I always wanted to follow in her footsteps,” he says. Hearing her share stories at the end of a workday inspired and motivated him. “I would hear her talk about patients who would come to the ward so sick and get discharged healthy. I wanted to do that. It sounded like such a meaningful thing to do each day.”
Today, six years into the job, Ridhuan is glad that he has achieved his dream. He gets to experience that same sense of satisfaction as
Ridhuan receiving the SCDF Community First Responder Award in May 2024 for his lifesaving efforts
his mother and be part of the same stories that she used to tell.
“From seeing patients come in with all the tubes and being unable to walk, to being healthy and strong when they leave my care — it is very fulfilling. I get a lot of happiness from seeing someone recover from their illness.”
His passion for healthcare is also what led him to join the Sembawang Community Emergency Response Team, a community of volunteers in his estate specially trained to respond to an emergency. “Since I am a nurse, I thought it would be good to contribute my skills in other areas,” he shares. “I would encourage
WHAT IS THE MYRESPONDER APP?
The myResponder mobile app alerts registered community first responders to suspected cardiac arrest incidents within 400 metres of their location before the arrival of SCDF’s Emergency Medical Services. The app also identifies where nearby Automated External Defibrillators (AEDs) are located. See page 28 to learn more about AEDs!
“I see patients come in with all the tubes and being unable to walk, to being healthy and strong when they leave my care. It is very fulfilling. I get a lot of happiness from seeing someone recover from their illness.”
people to take part in their own community emergency preparedness events where you can learn CPR and basic skills for free,” he says, adding that everyone should be always emergency response ready. “You’ll never know when they can come in useful because emergencies can happen at any time, anywhere!”
A LIFETIME OF SERVICE & CARE
Nurse Manager Mary Chan reflects on a fulfilling nursing career spanning 52 years, sharing how compassion, meaningful purpose and love for others keep her going.
Even as a child, Mary had dreams of being a nurse. An avid reader, she loved stories about nuns who were dedicated to serving others and bringing comfort to the sick. These tales of service and kindness resonated with her as she had always felt a strong pull towards helping others. “When I see someone in need, something inside me wants to do something,” she says. It was perhaps only natural that Mary followed this calling to become a nurse. More than a profession, nursing became her life’s work.
EVOLVING WITH THE PROFESSION THROUGH THE YEARS
For the last 52 years, she has dedicated herself to the profession, moving across different specialties and honing her skills. Mary looks back on how far she has come –and how much the job has changed –with a wistful smile. When she was a young nurse, she shares, nursing was very different.
Then, the training was very strict, and the profession was highly hierarchical and junior nurses had little say in their work. “We were just expected to follow instructions and ‘just do’,” she explains. The working hours were long and demanding, and it was considered normal to do seven night shifts consecutively. Junior nurses were also required to live in the hospital hostel, where meals were provided, and life was structured with almost military discipline. Despite the challenges, the experience fostered resilience among the nurses.
In those days, the nursing profession was also much more manual. Mary, who worked in paediatrics early in her career,
remembers
washing and drying cloth diapers and mixing baby formula from large tubs of generic powdered milk. Aside from bedside patient care, nurses had to physically cut bandages, sanitise equipment and even sharpen needles. When she worked in the wards caring for diabetic patients, she performed today’s laboratory tests manually, mixing urine and reagents in old chicken essence bottles and heating them over a Bunsen burner to check sugar levels.
HEALING WOUNDS, LIVING WELL
Over the years, Mary has worked in many different clinical areas, but she found her calling in wound
“We see them go from the crisis of initial surgery to thriving in their lives. It’s rewarding to help people regain their confidence and lead a close-to-normal life again.”
mary chan NURSE MANAGER, WARD A82, KTPH
Nurse Manager Mary received the Long Service Award for 50 years of service from Prof Chua Hong Choon, CEO, Yishun Health in 2022
care. This specialty has seen significant advancements during her career, and Mary takes pride in her contributions to this field.
Witnessing just how frustrating and defeating it can be to live with poor healing wounds, she takes pride in helping patients make progress.
The happiness of patients when they recover and express gratitude for her care is a reward in itself.
“Their thanks is good enough,” she says modestly.
More particularly, Mary is dedicated to empowering and educating patients with stomas.
A stoma is a surgically made opening in the abdomen that allows body
Mary has seen the profession of nursing transform dramatically since her days at the School of Nursing in the ‘70s
Nurse Manager Mary leading a roll call session, where she shares her experience and knowledge to guide her junior nurses
waste to exit into a collection pouch called an ostomy bag. She understands the anxiety that patients experience from taking care of their stomas and preventing their ostomy bags from leaking, especially in public.
Her mission: to teach them how to live well with a stoma. She passionately advocates for her patients, gives them support and encourages them to embrace their new circumstances and get back to what they love. “My work is to help them manage with confidence and see that it is possible to have their lives back,” she says. “With the right apparatus and equipment, they can pursue many of the same activities they used to – even swimming and sports.”
This commitment to supporting patients extends beyond her caring for them in the hospital setting. Mary is also part of the Singapore Nurses Association’s Wound Ostomy Continence Nurses Chapter, a group that creates awareness of the specialisation and aims to raise the standards of evidence-based care of patients with wounds, stoma and continence. She also takes part in patient education talks and other events. “We see them go from the crisis of initial surgery to thriving in their lives,” she says. “It’s rewarding to help people regain their confidence and lead a close-to-normal life again.”
LIVING HER BEST LIFE WITH FAMILY AND FRIENDS
When she is not working, the energetic grandmother of five spends time with her beloved pet dog and carves out family bonding
“We should not just float around aimlessly till the end of our days, but ensure that as we go through life, we do what we can to make the lives of people around us better and happier.”
moments. She credits quality time together with her family as a key source of joy. The close-knit family eats together at least once a week and celebrates milestones and festive occasions together. They also go on at least one big family vacation a year. “My birthday wish every year is to have a family sleepover at my house!” she says with a hearty laugh. She also finds solace in her faith, volunteering for duties at church.
Although her life has been marked by challenges, including the passing of her husband in 2020 and going through three spinal operations, Mary remains positive and believes
in living well by being prepared, both in life and in death. She has already prepared her will and advance care directives, emphasising the importance of making things easier for her loved ones.
Mary’s rich and busy life, filled with meaningful work, family, and spiritual pursuits, reflects her personal motto of making the most out of life. “We only have one life to live,” she says. “We should not just float around aimlessly till the end of our days, but ensure that as we go through life, we do what we can to make the lives of people around us better and happier.”
PASSIONATE SERVICE AWAITS WITH OUR PATIENT SERVICE ASSOCIATES
Whether at the wards or the specialist outpatient clinics, Patient Service Associates are often the first point of contact for patients and their next-of-kin. With warm professionalism, they handle a range of paperwork and administrative duties to keep healthcare operations running smoothly.
Across many areas of Yishun Health, the team from the Patient Service Centre facilitates a wide variety of administrative functions, from registration and appointment scheduling to billing and other patient transactions. Besides enabling a smooth patient journey through backend administration, when it comes to customer service, Patient Service Associates (PSAs) like Muhammad Danial Khoo Bin Muhammad Hafiz Khoo, Vijayalekshmi and Nur Atikah Binte Mohamed Yusoff are front and centre of it all.
Their job, while not directly involved with clinical care, is an essential part of the daily running of the hospital. “We are busy all day,” shares Vijayalekshmi, a senior PSA. “The hospital has many processes and procedures that we have to be familiar with.” Depending on the
type of ward she is based at for the day, her scope of work could range from overseeing 12 to as many as 34 patients. “Every day is different and interesting, so time passes quickly!”
Vijayalekshmi, who has been a PSA since 2012 at KTPH, had no healthcare experience before joining but came about the work by chance. “I always like to help other people,” she says. When she was looking for full-time work, she wanted one that would enable her to do just that. With this in mind, she took up a four-month Healthcare Support (Administrative Support) course at the Health Management International Institute and subsequently joined KTPH. “This work is stable and I can do what I like – help and meet new people every day.”
“When I first joined, there were a lot of challenges. All the systems and processes were new to me,
but my bosses were very encouraging and supportive,” she says. These days, as a veteran in the role, she mentors junior PSAs and guides them in the various processes and paperwork. It is one of her favourite aspects of the work. “I enjoy showing them the ropes and helping them become more familiar with the work.” As a team leader, Danial also enjoys this part of the work as he can help nurture more PSAs into the culture of service that Yishun Health is known for.
Highlighting their importance to the patient experience, Loh Khee Chaw, Assistant Director, Patient Service Centre, says: “Being among the first points of contact, our PSAs set the tone for a seamless patient journey with their unwavering dedication to meeting the needs of our patients and their loved ones. We are really proud of their commitment to excellence.”
Danial attends to enquiries from a patient
BEING PART OF A TEAM
For Nur Atikah, the work is similarly enjoyable because of the sense of teamwork and camaraderie. She also enjoys the opportunity to directly serve patients and next-of-kin, after being involved in backend operations at her previous jobs.
Her experience handling administrative functions and paperwork has been useful in her role as a PSA, while her quick thinking and personable nature suit the front-facing work. “I’m happy in this job. It is close to my home, the hours are stable and regular and
I don’t have to bring work home. This means I can send and fetch my kids to and from school and spend more time with them.”
“I think it is important to try to understand how patients and family members feel when they are sick and this helps you to be more patient and empathetic.”
Muhammad Danial Khoo PATIENT SERVICE ASSOCIATE EXECUTIVE, KTPH
The work itself is quite routine, with the occasional challenging moments. “It’s just like any other job — we go with the flow. Sometimes we have to think outside the box and come up with solutions, or face some difficult interactions,” Atikah explains. “In these situations, I will have to take the initiative to think quickly about how to solve it.”
Some of these solutions were actually implemented in 2019. Atikah
had proposed printing a checklist on the front of the envelope used to contain discharge papers. This allows nurses to tick rather than write routine notes manually, saving them time and enhancing legibility. She also suggested adding a QR code on the envelope so that patients and their next-of-kin can easily access and fill out the feedback form in the comfort of home.
Working at Yishun Community Hospital, she also enjoys seeing the patients – largely seniors – go about their day and participate in various activities. “It is cute to see the older folks participate enthusiastically in the ward’s programmes. They may not always know what exactly is going on, but they just have fun. They also like to chit chat with me and tell me long stories. It’s very amusing.”
She has also faced her share of conflicts. Once, a patient scratched her, and on another occasion, a family member shouted at her about an unrelated matter. “It was upsetting at the moment, but I don’t
THE MANY FACETS OF PSA WORK
• Registration
• Admission
• Financial counselling
• Collection of payment
• Discharge
• Billing
• Feedback management
take these things personally. Being at the frontline, I am the first face they see, so if they are frustrated, they tend to take it out on me. But I am grateful to be close with my team and the nurses; we have each other’s back and I am protected by the nurses and my boss.”
Danial knows all too well about heightened emotions during a crisis. Based at the Emergency Department, there are times when it
“When I first joined, there were a lot of challenges. All the systems and processes were new to me, but my bosses were very encouraging and supportive.”
Vijayalekshmi
senior Patient Service Associate, KTPH
Vijayalekshmi explaining the admission process to a patient’s next-of-kin
Atikah, Patient Service Associate Executive, enjoys interacting with patients and has spearheaded innovative solutions to facilitate discharges
gets quite busy and feelings run high. Calm and collected – and drawing from years of experience in other customer service roles – Danial often brings a measure of coolheadedness to the situation.
“There is no point ‘fighting’ back when someone is upset and screaming. I try to come in with some calm and kindness. I focus on the things I can do instead of the things I cannot control,” he says. “I think it is important to try to understand how patients and family members feel when they are sick and this helps you to be more patient and empathetic.”
“We are here to help,” says Vijayalekshmi simply. “Whatever I can do to make things easier and more convenient for patients, I will try my best.” As Atikah notes, “If I can answer a question or find a solution, I feel good about it. It is fulfilling to be useful.”
“Being among the first points of contact, our PSAs set the tone for a seamless patient journey with their unwavering dedication to meeting the needs of our patients and their loved ones.”
loh khee chaw Assistant director, Patient Service centre, KTPH
Interested in working at Yishun Health? Scan this QR code to view our career opportunities!
5 Things About... AED s
In a cardiac emergency, an Automated External Defibrillator (AED) could be a lifesaver. Learn how AEDs work and their importance in emergencies.
1AED STANDS FOR…
Automated External Defibrillator. An AED is a lightweight, portable medical device that delivers an electrical shock through the chest to the heart, known as defibrillation. This device is used to treat life-threatening and irregular heart rhythms during a sudden cardiac arrest. Through built-in voice prompts, lights and on-screen text, it guides first responders on the steps to take. When attached to a sudden cardiac arrest casualty, the AED first analyses the rhythm of the heart and advises whether a shock is necessary. It will then automatically deliver an electrical shock to the person's heart to re-establish a normal rhythm.
In consultation with Chew Pei Kiang, Senior Nurse Educator, Life Support Training Centre and Nursing Education, KTPH
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AED AND CPR GO HAND IN HAND!
In Singapore, more than 3,000 people suffer from sudden cardiac arrest every year. About 70% to 80% of occurrences happen at home or in public places. For every minute that nothing is done, the person’s chance of survival drops by 10%. In a cardiac emergency, the first thing to do is call 995. While waiting for an ambulance, it is important to start resuscitation because early cardiopulmonary resuscitation (CPR) and AED defibrillation can increase the chance of survival to as high as 60%. As such, AEDs make it possible for more people to respond to medical emergencies where defibrillation is required. However, it is vital to note that an AED does not replace CPR. Do not delay CPR while waiting for someone to get an AED. After the AED delivers its shock, it is likely that CPR will still need to be performed.
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AEDS CAN BE FOUND IN MANY PLACES!
There are over 10,000 publicly accessible AEDs in Singapore. You can find them in residential, commercial and industrial buildings, train stations, bus interchanges and community facilities. There is one AED at the lift lobby of every two HDB blocks island-wide and over 200 taxis and private hire vehicles are also
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YOU DO NOT NEED SPECIAL TRAINING TO USE AN AED
AEDs come with a built-in voice prompt that provides clear step-by-step instructions for anyone, even nonmedical personnel. While you do not need AED training to use one, it would certainly give you confidence in the heat of the moment! If you encounter someone experiencing a sudden cardiac arrest, call 995 and stay on the line with the emergency operator who will guide you through the application of an AED and CPR procedure.
REMEMBER ‘DRS ABC’ IN A CARDIAC EMERGENCY
Check for Danger: Ensure that the surroundings are safe before approaching the person.
Check for a Response: Tap the person’s shoulders firmly, and ask, “Hello hello, are you ok?”
Shout for Help : Ask someone to call 995 for an ambulance or use the myResponder app to dial 995. This will send your geolocation directly to the Singapore Civil Defence Force (SCDF) for faster dispatch. Put your phone on speaker mode and follow the SCDF dispatcher’s instructions. Ask for an AED: Obtain an AED and use it on the person.
Check for Breathing: Look for the rise and fall of the person’s chest.
Early CPR: If the person is not breathing, or breathing abnormally, start CPR immediately.
Learn to use an AED and perform CPR with confidence to save a life!
Scan this QR code or go to https://www.myheart.org.sg/techniques/course/ to learn more. installed with AEDs. You may also use the myResponder mobile app to find the nearest available AED.
HERNIAS HURTING YOUR QUALITY OF LIFE?
A hernia happens when a literal weak spot occurs in the muscles or tissues, allowing a part of the organ to push through. This condition does not always cause symptoms, but most will eventually require surgery.
AIn consultation with Dr Marc Ong, Consultant, General Surgery and Service Lead, Hernia Surgery Service, KTPH
hernia occurs when an organ or tissue pushes through a weakened area in the muscle or tissue wall. It may result in a soft bulge in the abdominal or groin region that appears on and off during different activities or in certain positions. A hernia may or may not cause symptoms, such as discomfort or pain, and depending on the severity and location, most hernias will require surgical repair eventually.
There are several types of hernias, with the three most common being:
Inguinal Hernias
• An inguinal hernia is the most common type of hernia.
• Approximately 6% of men develop this condition and these hernias account for three-quarters of all abdominal wall hernias.
• Usually, they happen when a segment of the intestine protrudes through a weakened spot in the abdominal muscles, typically in the groin area. Surgical intervention for inguinal hernias is very common.
• While a lot rarer in women, it is still the most common type of groin hernia in women.
Incisional Hernias
• Incisional hernias develop at the site of a previous surgical incision. It may happen because the abdominal wall fails to close properly post-surgery.
• The incidence rate of incisional hernias following laparotomy, a type of open abdominal surgery, can be as high as 15 to 20%. However, it is becoming less common as more people are undergoing laparoscopic surgery, which involves smaller incisions.
• Laparoscopic surgery is less invasive and leaves shorter scars, thus reducing the likelihood of hernia development compared to traditional open surgery.
HERNIA AWARENESS AND ADVANCEMENTS
Awareness, early diagnosis, and appropriate surgical intervention are important in spotting and managing hernias effectively to minimise their impact. If you suspect you have a hernia, it is crucial to seek medical advice promptly to explore the best treatment options and avoid potential complications.
New surgical techniques are also improving the treatment of hernias. Read more about a new hernia surgery technique, “enhanced-view totally extraperitoneal (eTEP) retromuscular repair” in our cover story on page 8.
Umbilical Hernias
• Umbilical hernias are less common than inguinal hernias. They make up 6 to 10% of all adult abdominal wall hernias and are typically prevalent in women aged 31 to 40 and men aged 61 to 70.
• They are known as umbilical hernias because it happens when the intestine pushes through the abdominal wall near the belly button (or umbilicus).
• About 65% of adult patients with an umbilical hernia will eventually require surgical repair and a small proportion of about 3 to 5% of these repairs will be emergency surgeries. This is because the hernia can become strangulated or obstructed, which may lead to severe pain, tissue damage, or a life-threatening condition.
PREVENTING A HERNIA
There are a few things that can help prevent hernias. Maintaining a healthy body weight can avoid the constant pressure on the abdominal wall that excess body fat can create. In the same vein, strengthening the pelvic and abdominal muscles with exercises such as planks can help them stay strong and elastic, offering protection against inguinal hernias. Lastly, when lifting heavy objects, use proper lifting techniques or get help to avoid excessive straining, which could lead to a hernia.
cut & keep
DOUBLE BOILED HERBAL CHICKEN
This nutritious, wholesome and flavourful dish makes for a hearty dish that’s not just low in fat, but low in sodium too!
INGREDIENTS
Serves 2
• 2 large chicken drumsticks
• 30g dried red dates
• 10g dried wolfberries
• 1/2 tablespoon of low-sodium salt
• 300ml water
• Chinese herbs:
• 40g yu zhu ( 玉竹 /polygonatum odoratum) slices
• 10g dang shen ( 党参 /codonopsis pilosula) pieces
• 10g nan bei xing ( 南北杏 /sweet and bitter apricot kernels)
• 4g chuan xiong ( 川芎 /rhizoma chuanxiong) pieces
METHOD
1. Clean the chicken thoroughly
2. Bring water to a boil in a steamer or double boiler and put aside
3. Arrange the chicken in a large, heatproof soup bowl and top it with the Chinese herbs
4. Fill the bowl with 300ml of water and salt. Stir to dissolve
5. Cover the bowl tightly with a lid or cling wrap and place it carefully into the steamer or double boiler
6. Steam the chicken at 1000C for 1 hour
7. Carefully remove the chicken from the steamer or double boiler
8. Serve hot and enjoy!
NUTRITIONAL INFORMATION (PER SERVING)
•
• Polyunsaturated
•
Cholesterol
Dietary Fibre
Sodium
Phosphate
Recipe provided by Walter Lok Kwok Wai, Cook, Food Services
HOOKED ON THE CLIMB
Climbers have historically strived to push the boundaries of the human body to conquer ‘giants’ across the globe, from Mount Kilimanjaro to Mount Everest. Bouldering is one form of indoor climbing that is gaining popularity as an accessible, adrenaline-pumping workout that is a great alternative to the gym.
In consultation with Sabrina Valentine Wee Su Min, Senior Physiotherapist, Rehabilitation Service, KTPH
Bouldering initially began as a way for pioneering rock climbers to train for long and steep routes outdoors. Today, it has become a popular activity, and a sport in its own right. Since its inclusion in the 2020 Olympics, it has become globally recognised and accessible to people of all ages.
WHAT IS BOULDERING?
Bouldering is a form of rock climbing that focuses on short, challenging routes on large boulders or low-height rock formations. Unlike traditional rock climbing, bouldering does not require ropes or harnesses, allowing unencumbered movement.
Routes differ by movement difficulty, wall height and incline. Thus, the varied grades cater to
everyone, providing a fun challenge for children and adults, beginners and experts.
BOULDERING BENEFITS
Bouldering serves as a wholebody workout. The arms work hard against gravity to keep the body off the ground, while leg strength and flexibility are also unexpectedly crucial in pushing the body up the wall and maintaining balance. Additionally, bouldering is a mental workout as each movement needs to be assessed and planned, where getting to the top is a problem-solving puzzle in itself.
CLIMBING SAFELY
Climbing is a demanding sport, and preparation is vital. Injuries in both novice climbers and seasoned
boulderers are not uncommon. Most of us are not used to climbing, therefore the muscles we need to boulder need to have
SHOULDER EXERCISES
Level 1: Scapula Pull-ups
• Start in a dead hang position
• Squeeze the shoulder blades back and together and lift the chest slightly upwards, keeping the arms fully extended
• Hold the top position for 3 seconds before lowering back to a dead hang
• Aim for 3 sets of 6 repetitions with a rest in between, increasing the repetitions as it gets easier
• Once you can perform more than 10 repetitions, move on to Level 2
strength and endurance. If you boulder regularly, remember to pace yourself just as with any workout regime. Plan to have days of lower intensity climbing and listen to your body on days you are tired or sore. You should never be forcing yourself to climb through pain.
Level 2: Pull-ups
• Start in a dead hang position
• Squeeze the shoulder blades together and imagine pulling the bar downwards as you bend your elbows
• Hold the position for 1-2 seconds, before lowering back with control to a dead hang
• Aim for 3 sets of 6 repetitions with a rest in between, increasing the repetitions as it gets easier
On some days, it is helpful to cross-train and build up the muscles that you use for climbing. This includes building good shoulder and back strength. However, do not forget about strengthening your leg muscles as well! You can try the exercises on this page to target these two muscle groups.
LEG EXERCISES
Level 1: Reverse Lunges
• Stand with both feet together and torso straight with shoulders above the hips
• Take a step backwards, bending both knees at a 90-degree angle with the weight evenly distributed in both legs
• Lean onto your front leg and return to the starting position
• Repeat 10 times before swapping legs
Level 2: Weighted
Reverse Lunges
• Hold a manageable weight in both hands by your sides
• Follow the movements of Level 1 in a controlled manner, paying attention to form
• Reduce the weight if you are unable to maintain good form
