aha
Issue 5: september-october 2018
MCI (P) 101/04/2018
Activating the ‘community’ in Community Care
Building an empowered, self-managed community equipped with the knowledge, skills and resources to prevent disease and promote health
Souper-hero, at your service
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Losing it for health
22
Oral Health & Ageing
24
ontents
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COVER STORY Activating the ‘Community’ in Community Care Building an empowered community equipped with knowledge, skills and resources to prevent disease and promote health
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HEALTH HIGHLIGHTS Healthcare news and updates
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WHAT’S UP Community events, outreach efforts, and more
14 EVERYDAY HEROES Souper-hero, at your service Volunteer Sharon Yong on giving back and staying active 22 SPOTLIGHT Losing it for health The Integrated Care for Obesity and Diabetes (ICOD) programme provides longterm, holistic support 24 5 THINGS ABOUT… Oral Health & Ageing Good oral hygiene is for everyone, whatever your age
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INTEGRATED CARE SERIES PART 3 OF 3
This three-part series focuses on Yishun Health’s care integration model, which is the delivery of holistic, right-sited care across the healthcare spectrum.
PUBLISHER 26 LIVE WELL It’s in the little things Simple pleasures keep Aunty Betty happy and healthy
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28 MAKAN TIME Cheesy mushrooms on toast Crispy on the outside, oozy on the inside — and high in calcium 30 DAILY DOSE Help for hurting heels Ease the pain of plantar fasciitis 31 MIND & HEALTH Crossword time! Try this workout of words
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
PUBLISHING AGENT THINKFARM PTE LTD www.thinkfarm.sg M A N AG I N G D I R E C T O R
Christopher Tay
E D I TO R I A L D I R E C TO R
Chua Kim Beng
C O N T R I B U T I N G E D I TO R
Sheralyn Tay
aha
E D I TO R
Dang Hui Ling
Issue 5: september-october 2018
A R T D I R E C TO R
Regina Wong DESIGNER
Melissa Poon S E N I O R M A N AG E R , C L I E N T R E L AT I O N S H I P
Jessie Kek
MCI (P) 101/04/2018
Activating the ‘community’ in Community Care
Building an empowered, self-managed community equipped with the knowledge, skills and resources to prevent disease and promote health
Souper-hero, at your service
14
Losing it for health
22
Oral Health & Ageing
W
C O N T R I B U TO R S
Ahmad Iskandar, Jenn Chew Justin Loh, Lee Lily
24
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.
ktph.com.sg/aha aha@ktph.com.sg
aha is the official bi-monthly publication of Khoo Teck Puat Hospital (Co. Reg. No. 200717564H) and is produced by ThinkFarm Pte Ltd. All rights to this publication are reserved and no part may be reproduced without the expressed written consent of the publishers. While every effort has been made to ensure that the information in this newsletter is accurate and up to date, the editorial team will not be responsible for errors due to information received. Opinions expressed are that of the writers and do not necessarily represent the views and opinions of the publishers. Printed by Mainland Press Pte Ltd. MCI (P) 101/04/2018
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ealth Highlights
More Help for the
Severely Disabled
The Ministry of Health has announced steps to improve financial support for the severely disabled. This includes easing restrictions on the withdrawal of cash from Medisave, and a new fund to help those who require financial assistance.
In 2020, Singaporeans aged 30 and above with severe disabilities will have more options to improve their ability to pay for long-term care.
ABILITY TO WITHDRAW FROM MEDISAVE With the change in policy, people who are severely disabled will be allowed to dip into their or their spouse’s Medisave account for cash from the age of 30, provided
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they have at least $5,000 in their accounts. About half the population will potentially be able to benefit from this change within their lifetime. This is the first time that members can withdraw cash from Medisave since it was set up in 1984 — it will not result in higher Medisave contributions. The amount that can be withdrawn will depend on how much they have in their accounts (see table).
Amount in medisave account
Cash withdrawal limit
< $5,000
Not allowed to withdraw
$5,000 to $20,000
$50 to $200 a month
> $20,000
$200 a month
A NEW FUND FOR LOW-INCOME EARNERS A separate fund is also being set up to help the severely disabled: ElderFund is a new safety net for low-income Singaporeans. Those who qualify can receive up to $250 a month to pay for long-term care needs, such as home or day care services and necessities such as adult diapers. This policy will benefit those who are unable to join CareShield Life because of their disabilities, have low Medisave savings, and/or inadequate personal savings to meet their longterm care needs.
Definition of â&#x20AC;&#x2DC;severe disabilityâ&#x20AC;&#x2122; A person is said to be severely disabled if he or she needs help with at least three of six basic daily activities:
6
Moving from a bed to a chair or vice versa
1
Feeding themselves
5
Moving from room to room
2
Getting dressed
3
Using the toilet
4
Bathing
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hatâ&#x20AC;&#x2122;s Up
A Champion for Clinical Quality and Patient Safety F
or her dedication, professionalism and invaluable contribution to healthcare, A/Prof Wong Moh Sim, Deputy Group Chief Quality Officer, National Healthcare Group (NHG), and Deputy CMB (Clinical Quality & Manpower Development), KTPH and Yishun Health, was conferred the National Outstanding Clinical Quality Champion Award at the 2018 National Medical Excellence Awards. The award recognises her exemplary contributions to developing and advancing the field of patient safety, and her inspiring
dedication in designing interventions for sustained clinical quality. A/Prof Wong has served as the Head of Department of Laboratory Medicine for the past 16 years. During this time, she has strived to improve operational efficiencies. Today, her team sets a strong standard and has turnaround time of under 45 minutes for 95% of all laboratory results from the Emergency Department. A/Prof Wong has contributed greatly in other ways. She was the first Patient Safety Officer at Alexandra Hospital (AH), and led AH
to its maiden JCI accreditation in 2005. Today, as Chair of the Patient Safety Collaboration Workgroup, she continues to empower staff to be advocates for patient safety. Beyond her work within Yishun Health, A/Prof Wong sits on various external committees, such as the Singapore Healthcare Improvement Network (SHINe), the NHG Critical Laboratory Results Collaborative, the Association of Clinical Biochemists, and the Technical Advisory Committee for Chemical Metrology at the Health Sciences Authority.
A/Prof Wong Moh Sim receiving the award from Minister for Health Mr Gan Kim Yong at the 2018 National Medical Excellence Awards, held on 16 August 2018
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(Lâ&#x20AC;&#x201C;R) A/Prof Philip Yap (Senior Consultant, Geriatric Medicine, KTPH), A/Prof Yip Chee Chew (Head and Senior Consultant, Ophthalmology and Visual Sciences, KTPH), Mrs Chew Kwee Tiang (CEO, KTPH and Yishun Health), Dr Wong Sweet Fun (Deputy Chairman, Medical Board (Population Health), KTPH and Yishun Health), and Mr Kendrick Tan (Acting Manager, AdMC) at the awards ceremony
Yishun Health Recognised for Dementia and Eye Screening Efforts T
wo of Yishun Healthâ&#x20AC;&#x2122;s patientcentric initiatives were recognised at the Public Sector Transformation Awards, held on 4 July 2018. Mr Chan Chun Sing, Minister for Trade & Industry and Minister-in-charge of the Public Service, was the Guest of Honour. The Public Sector Transformation Award is given to individuals and teams from the Public Service who showcase excellence in service delivery, innovation and best practices. Associate Professor Philip Yap, Senior Consultant, Geriatric
Medicine, KTPH, received the Distinguished ExCEL Innovation Champion award for his pioneering work in the area of dementia. A/Prof Yap established both the Care for Medically Infirm Elders (CAMIE) and Comprehensive Assessment & Rehabilitation of the Mentally Infirm Elder (CARMIE) initiatives. CAMIE is a restraintfree acute medical ward in KTPH for patients with dementia, and CARMIE is its sister ward in Yishun Community Hospital. His work has raised the understanding of
and elevated the level of care for dementia patients in Singapore. The team from Community and Home Eye Screening Service (CHESS) picked up the ExCEL Innovative Project award. CHESS revolutionised community eye care by empowering nurses and optometrists to be physician extenders. This scalable model has reduced specialist referrals to hospitals, increased healthcare accessibility for the elderly and home-bound, and lowered the cost of screening and managing eye conditions. | 7
hat’s Up
Nursing’s Highest Honour F
Right: Ms Shirley Heng at the Istana, receiving her award from President Halimah Yacob, Minister for Health Mr Gan Kim Yong, and Chief Nursing Officer Ms Tan Soh Chin
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or her excellent leadership and committment to the improvement of nursing care and patient well-being, as well as her stewardship of safety processes, Ms Shirley Heng, Deputy Chief Nurse, KTPH and Yishun Health, received the President’s Award for Nurses on 1 August 2018. This highest accolade in the nursing profession acknowledges nurses who have exemplified great competency, leadership, and an innovative spirit. Ms Shirley has contributed to nursing development at institution, cluster and national levels. For instance, she played a key role taking KTPH (then called Alexandra Health) into the digital age. Apart from migrating nursing work into an electronic environment, she also implemented Inpatient Electronic Medical Records to raise safety, productivity and information sharing. Ms Shirley has also led nursing teams to develop and actualise integrated clinical services, such as a Transit Ward and Acute Medical Unit. During her secondment to MOH as Assistant Chief Nursing Officer, she also participated in the National Nursing Taskforce and Future Nursing Career Review Committee. On the ground, Ms Shirley is a well-respected mentor who leads by example, running leadership training courses to groom the next generation of nursing leaders and inspire passion for the profession.
Meet Our 2018 Nurses’ Merit Award Winners! S
even Yishun Health nurses were presented with the Nurses’ Merit Award by Minister for Health Mr Gan Kim Yong on 18 July 2018. This award recognises nurses who have displayed work excellence, a commitment to professional development, and who have made significant contributions to elevate the nursing profession.
Above: Nurses’ Merit Award Winners (L-R): Lee Yen Ein (Senior Staff Nurse, D68), Cherie Koh (Nurse Manager, B86), Pamela Foong (Senior Staff Nurse, ICU2, Surgical), Xu Shuhui (Assistant Nurse Clinician, A61), Ng Huoy Ling (Nurse Manager, Population Health and Community Transformation), Lai Foon Wan (Nurse Manager, Day Surgery Centre), and Ng Siok Qi (Nurse Manager, B95) Right: Recipients of the Nurses’ Merit Award giving the thumbs up together with Yishun Health Nursing Directors and their supporters
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6-13 Whats up.indd 9
20/9/18 10:13 AM
hat’s Up
A Nurses’ Day to Remember!
F
rom celebrity visits and gifts to surprise treats and a special talent show, this year’s Nurses’ Day festivities celebrated the spirit of nursing. Celebrations began on 27 July 2018, when Mediacorp stars from the television drama, You Can Be An Angel, visited KTPH. This starsighting event was followed by a meaningful fundraising walk to Yishun Dam. Nurses and staff who participated pledged donations and raised more than $20,000 for the Singapore National Stroke Association. Nurses’ Day, which falls on 1 August, then kicked off with an elegant celebration in the KTPH auditorium. But even before this, Yishun Health’s Nursing Directors had already personally made the rounds on the eve, distributing gifts to nurses across clinics and wards.
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The day itself featured performances by Yishun Health’s clinical Heads of Departments as well as the A&E Groovers, winners of the 2017 Secret Talent Competition. This celebration also recognised nurses who have done well and received recognition for their contributions to nursing (read pages 8–9 for our recent winners). Most significantly, the day marked the launch of the Mavis Khoo Nursing Leaders Scholarship. The Guest of Honour for the event was Ms Mavis Khoo, Patron of KTPH. She sponsored the scholarship, which will groom high-performing nurses with the potential to be future leaders. This scholarship offers nurses unique learning and development opportunities in areas such as leadership, change management, policy studies, behavioural sciences, and economics.
(L–R) A/Prof Pek Wee Yang (Chairman, Medical Board, KTPH and Yishun Health), Ms Low Beng Hoi (Chief Nurse, KTPH and Yishun Health), Mrs Chew Kwee Tiang (CEO, KTPH and Yishun Health), Ms Mavis Khoo (GOH & Patron of KTPH), Dr Pauline Tan (CEO, YCH), Mdm Chua Gek Choo (Director of Nursing, YCH), and Ms Shirley Heng (Deputy Chief Nurse, KTPH and Yishun Health)
Imparting Skills and Improving Elderly Care for the Region Y
ishun Health’s Geriatric Education & Research Institute (GERI) hosted the International Dialogue on the Provision of Long-Term Care for the Elderly between Singapore and Thailand from 30–31 July. This event was an important platform to learn from international partners and encourage deliberate and engaging conversations between key stakeholders on improving the provision of palliative and end-of-life care in the LongTerm Care (LTC) sector. The highlight of the event was the signing ceremony of a collaborative agreement between Singapore and Thailand. This agreement involves a training programme for long-term care nurses in Thailand. This is part
Signing the agreement were (L–R) Prof Pang Weng Sun (Executive Director, GERI), Mrs Chew Kwee Tiang (CEO, KTPH & Yishun Health), Dr Pannet Pangputhipong (MD & Deputy General Director, Ministry of Public Health, Thailand) and A/Prof Siriphan Sasat (Head, STAR on Long-Term Care for Older Persons)
of GERI’s mission to translate knowledge and research evidence into practice and policy to improve the health of the ageing population. This international bilateral
collaboration and exchange is aimed at tackling ageing issues collectively so that older people in the region can lead a better quality of life.
A Collaboration for Better Dental Care K The MOU was signed by Mrs Chew Kwee Tiang (CEO, KTPH and Yishun Health) and Clinical A/Prof Poon Choy Yoke (Director, NDCS)
hoo Teck Puat Hospital (KTPH) and the National Dental Centre of Singapore (NDCS) signed a Memorandum of Understanding (MOU) on 22 June 2018. The partnership, which commenced on 1 July 2018, establishes a commitment to ensure timely care for dental patients and sees the streamlining of dental services and resources across both institutions. Specifically, it will improve patient access to periodontal, denture, crown and bridge, and root canal treatments. This collaboration between both institutions will provide better quality of care and outcomes for patients.
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hat’s Up
We are Singapore; We are Yishun Health I
Above: The Long Service Medal recipients with GOH A/Prof Muhammad Faishal Ibrahim
n an apt celebration of togetherness that aligned with this year’s 2018 National Day theme, staff across the Yishun Health campus gathered for the yearly National Day Observance Ceremony. Long-service staff and winners of the National Day Awards from Yishun Health were also acknowledged at the ceremony. A/Prof Muhammad Faishal Ibrahim, Senior Parliamentary Secretary, Ministry of Education & Ministry of Social and Family Development, and Adviser to Nee Soon Central GROs, joined the celebrations as the Guest of Honour. He conveyed his thanks to Yishun Health for serving the community in the north and encouraging people to live healthy and better lives.
Top: Children from the Little Skoolhouse charming the audience with their performance of National Day songs
A Rousing Raya Celebration Y
ishun Health celebrated the Hari Raya festivities in a multicultural Rah Rah Raya! Hari Raya Aidilfitri celebration on 9 July 2018. The event welcomed co-workers from across the organisation, including friends from the Healthcare Services Employees’ Union (HSEU) and the Muhammadiyah Association. Mr Amrin Amin, Senior Parliamentary Secretary for Ministry of Health, who graced the occasion as the Guest of Honour, praised the event for its diversity and kampung spirit.
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Mr Amrin Amin (in light blue outfit) celebrating Hari Raya with Yishun Health staff
Thank You, Volunteers! A
get-together tea session was held on 9 July 2018 to thank Yishun Health volunteers for bringing joy, companionship and acts of service to patients. Mrs Chew Kwee Tiang, CEO, KTPH and Yishun Health, and Dr Pauline Tan, CEO, YCH, expressed their gratitude to more than 100 volunteers who attended the event. The two CEOs thanked them and made mention of how the volunteersâ&#x20AC;&#x2122; contributions have played an important role in the creation and sustaining of a caring and healing environment. Yishun Health volunteers contribute in a wide range of activities, such as gardening, stroke support, befriending, advanced care planning, music therapy, hairdressing and more.
Yishun Health volunteers posing for a group photograph after the tea session
Volunteer with us!
Sunshine Buddies
for you to help our patients & their families
Inpatient Mobile Library
Dementia/ Rehab Care
Ageing-In-Place Community Care Team Home Visits
Advance Care Planning (ACP) Booth
Gardening Club
For more information, please contact us at 66023925 or volunteers@ktph.com.sg
Population Health Screening
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veryday Heroes
Souperhero at your service
Every Wednesday, Mdm Sharon Yong, 68, presides over a massive pot, ladling bowls of hearty soup for elderly residents. She is one of the longest-serving Share a Pot® volunteers at Yishun Health’s Wellness Kampung at Block 765.
F
or the last two-and-ahalf years, Sharon has been an active participant at Wellness Kampung. Apart from taking part in the range of programmes, from exercise classes and K-pop dancing to Thai language classes, Sharon also gives back as a volunteer. “I wanted to do volunteer work because I could be exposed to new things,” she shares. “I get to experience a new environment, meet new people, and do new activities. I can learn more.” As the Wellness Kampung’s unofficial ‘Souper Chef’, she prepares one soup a week from a menu of 10 rotating recipes. These recipes, designed by Yishun Health’s Nutrition and Dietetics 14 |
department, are high in calcium and protein. On each Share a Pot day, Sharon arrives at the Wellness Kampung at about 8.45am to begin the laborious task of washing, cleaning, peeling, soaking and chopping a wide range of ingredients — vegetables, legumes, herbs and
meat. Although there is a fair amount of preparation, Sharon does not find the work too difficult as she used to work in the fast food sector. “In my previous job, I had to be an ‘octopus’ doing everything,” she jokes. Using her skills to help others makes Sharon feel special,
INTERESTED IN JOINING SHARE A POT?
Visit www.shareapot.sg
especially when she sees the satisfaction on people’s faces as they eagerly tuck into a steaming bowl of soup. “They will ask me how to cook and what I put into the soup. When they ask me, I feel very contented,” she says, adding that she also freely shares recipes and techniques. One tip she happily imparts is the use of the kitchen staple, vinegar. “If you add a little vinegar to the soup, it will bring out the essence of the chicken bones, making it more nutritious!” Apart from her soup duties, Sharon also volunteers at KTPH’s clinics once a week as a Sunshine Buddy. She answers general questions, helps patients selfregister, and helps people find their way around the hospital. “I am a very active person. I enjoy having something to do,” she states. Most of all, in giving back and looking out for her neighbours, she receives joy in return. “I enjoy the spirit of friendship. I have a community here to support and which also supports me.”
RECIPE TIP!
When it comes to cooking soup, a longer boiling time helps to extract more goodness from the ingredients. There is also another way: vinegar. Vinegar helps to leach minerals from the bones, ramping up the calcium levels. Before starting the boiling process, add vinegar to the soup pot and let the vinegar and ingredients marinate for at least 30 minutes before cooking the soup. Use about two teaspoons of vinegar for every litre of stock. You can use any type of vinegar or acid, such as white vinegar, apple cider vinegar, or even lemon or lime juice. This small amount of vinegar will not noticeably flavour the soup but will enhance its nutrition greatly.
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Cover Story
Activating the â&#x20AC;&#x2DC;communityâ&#x20AC;&#x2122;
in Community Care
Yishun Health believes in engaging people before they fall ill, empowering them to be pro-active about their own well-being, and encouraging them to consider treatment away from acute care settings. 16 |
INTEGRATED CARE SERIES PART 3 OF 3
The community health approach broadens the mission of healthcare from curing illnesses to empowering people to manage their conditions in the best way possible. DR WONG SWEET FUN, DEPUTY CMB (POPULATION HEALTH), KTPH AND YISHUN HEALTH
A
s a geriatrician, Dr Wong Sweet Fun specialises in the care of older people and diseases that affect them. Around the early 2000s, she noticed a worrying trend. Not only was she seeing many older people in poor health and with advanced chronic diseases, she observed that their adult children were also suffering from issues such as diabetes and high cholesterol — albeit in much earlier stages. This sparked her interest in preventive care and an almost twodecade long passion of working in the community health arena. “I wanted to
go upstream to ‘catch’ people before they fall ill,” she explains. At the time, it was an unconventional route for a hospitalbased clinician because preventive care and healthcare for the community outside the hospital were not seen as ‘medical’ care. However, Dr Wong was undeterred. Community health is also part of the healthcare spectrum — even more so in light of the preventable lifestyle diseases and escalating healthcare costs, she says. “The community health approach broadens the mission of healthcare from just a medical goal of curing illness — which is not always possible — to empowering people and using existing resources to help people manage their conditions in the best way possible,” she emphasises.
Dr Wong started some of the first interactive health promotion programmes in Singapore, the Health for Older Persons (HOP) and Home for Independent Persons (HIP) programmes in 2001. Over the years, such community health programmes have not only evolved, but are now a prominent feature across healthcare institutions and nonhealthcare agencies. Today, Dr Wong wears many hats at KTPH and Yishun Health — Chief Transformation Officer, Deputy Chairman of the Medical Board (Population Health), and Clinical Director, Population Health and Community Transformation (PHCT) — and she continues to spearhead many health and wellness initiatives in the community.
BEYOND HEALTH SCREENING
Yishun Health’s community health screening do more than test blood pressure, cholesterol and blood sugar levels. It is an important platform to educate and empower residents to take responsibility for their health and manage their conditions well to prevent and delay complications. Screening the community helps Yishun Health understand the health profile and needs of the population under its care. This ground knowledge goes towards developing better and more relevant initiatives to anticipate and meet community needs.
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Cover Story MAXIMISING RESOURCES IN THE COMMUNITY In contrast to hospital-based care, Dr Wong highlighted that improving community health is not about deferring to the expertise of doctors, nurses or other healthcare professionals. Rather, it is about complementing this and empowering patients, their families, caregivers and even neighbours to play a role in care. “We are activating the help that is already available,” she points out. “People have their own support system, and the community has its own resources.” The role of healthcare institutions is thus to facilitate, empower, educate and bridge the gaps between all the various stakeholders. At Yishun Health, various efforts have arisen to do just that. These shift the language of care from telling to showing, interacting rather than instructing, and educating patients and residents to support themselves. While this takes time and effort to develop, this shift in the care model is taking root, says Dr Ang Yan Hoon, Senior Consultant, Geriatric Medicine, KTPH. She leads Yishun Health’s hospital-to-home initiative known as the Ageing-in-Place Community Care Team (AIP-CCT). Under this programme, a transdisciplinary team of doctors, nurses, therapists and medical social workers conducts home visits for patients who have recently been discharged from hospital. “The goal is to settle them back down at home, and make sure that their medical, nursing and functional issues are taken care of,” she explains. This is done by equipping family members and caregivers with the knowledge and skill to deal with the various aspects of care. “This education and awareness is a slow process, but we are seeing
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At the Wellness Kampungs, simple games such as Rummy-O help senior residents stay socially and mentally active on their own
more patients taking charge of their own health.” It is a team effort, she insists. “It is not just about getting help from the medical teams, but self-management and having family members become more involved in care.”
COMMUNITY NURSING: A ‘SMART’-ER WAY Adding to the community health model is a new breed of nurses. While the traditional approach to medical diagnosis trains doctors and nurses to ask ‘what’s the matter’ with patients, it is just as important to ask ‘what matters’ to a person. It is this mindset that guides the work of community nurses such as Bevin Tang, a Staff Nurse who is part of Yishun Health’s Self-Managed Autonomous Regional Team (SMART). SMART gives community nurses
more autonomy to manage their work. Bevin can design customised care plans and make joint decisions with clients on their own care. “When I understand a person’s priorities, I may then review care plans and medications accordingly so as to help my clients adhere to medication regimes better,” she says. This could even lead to reducing medications and/or medical appointments with the doctor in charge. The goal of SMART is part of an overall community nursing effort to de-medicalise healthcare, says Ng Huoy Ling, Nurse Manager, SMART. “We also look at social, functional, emotional and psychological wellness,” she shares. “This is because more medicine or more trips to the hospital are not always the answer.” This approach puts ownership back into the hands of people, adds
Laura Tham, Nurse Clinician, AIPCCT, who works alongside Huoy Ling. “With community nursing, we are going back to basics and teaching people how to take care of themselves.” This may mean getting them to take blood pressure or blood sugar readings and helping them to make sense of the results. If there is an abnormality, they may be asked to think about the cause — could it be that they missed a dose of medication or have been eating more than they should have? These interactions help patients become more aware of their own conditions and, more importantly, how to resolve the issue or where to seek help.
EXTENDING EYE CARE Since February 2017, Yishun Health has run a community-based initiative to improve access to eye screening and medical care. Called Community & Home Eye Screening Services (CHESS), the initiative is a collaboration between KTPH’s Department of Ophthalmology & Visual Sciences (OVS) and the PHCT. It targets residents aged 50 years and older as well as persons with diabetes of any age who have not had follow-up appointments with an eye doctor for more than a year. According to A/Prof Yip Chee Chew, Medical Director, Admiralty Medical Centre, and Head and Senior Consultant, OVS, KTPH, CHESS
makes access to eye screenings more convenient without the need for specialist resources. Under the programme, community nurses and healthcare assistants do First-level Community Eye Screening (FiLCES). If any problems are picked up, the person will proceed to have a Second-level Eye Consultation (SeLEC) by optometrists at the Wellness Kampungs. These consultations are done under the tele-supervision of a KTPH ophthalmologist. “The model revolutionises community eye care by empowering nurses and optometrists as physician extenders,” says A/Prof Yip. “This allows us to leverage the skills of nurses and optometrists, who are able to spot problems and refer patients to the right type of care.” Depending on their condition, they may be referred to an optician, GP, polyclinic or specialist. This scalable model means that care can be more appropriate, and has reduced referrals to specialists. More importantly, adds A/Prof Yip, it has increased healthcare accessibility for the seniors and home-bound,
Rather than asking patients ‘what’s the matter’, it is just as important to ask ‘what matters’ to them as a person. DR WONG SWEET FUN, DEPUTY CMB (POPULATION HEALTH), KTPH AND YISHUN HEALTH
HOW CHESS WORKS GP FIRST-LEVEL COMMUNITY EYE SCREENING
SECONDLEVEL EYE CONSULTATION
POLYCLINIC
Yang Lijun (Optometrist, OVS, KTPH) giving one of the residents an eye screening at the Wellness Kampung
SPECIALIST OPTICIAN | 19
Cover Story
Four of our Wellness Kampung regulars smiling after a hearty bowl of soup!
and lowered the cost of screening and managing eye conditions. These innovative efforts were recognised at the 2018 Public Sector Transformation Awards (turn to page 7).
PULLING TOGETHER FOR HEALTH Other Yishun Health efforts focus on simply bringing people out of their homes and into their neighbourhoods. “The community needs to become a ‘pull’ factor that draws residents out of isolation into wellness,” says Dr Wong Sweet Fun. The Wellness Kampungs, for
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example, have become hives of activity for many in the community. They congregate for group exercises, art classes and games — and even volunteer for programmes such as Share a Pot® and Repair Kaki. Share a Pot is a weekly soup and exercise programme (read more on page 14), while Repair Kaki brings together handy residents with DIY skills to fix household appliances. “These social activities do more than generate good times, but good health too,” says Dr Wong. “By building better social networks and raising the level of participation in social activities, we can lower the
Home care is more comfortable and convenient for the patient as they have more autonomy and freedom. There is less risk of acquiring hospital infections. DR ANG YAN HOON, SENIOR CONSULTANT, GERIATRIC MEDICINE, KTPH
risks associated with cognitive decline and raise levels of psychosocial and physical health.” Social connections can also be used to reinforce positive health messages indirectly. Dr Wong calls this ‘stealth health’. She shares, “Traditionally, smoking cessation counselling has not been as effective as we would have liked. However, we encountered an ‘epidemic’ of quitting among our Repair Kaki uncles.” It turned out that one of them had a heart attack scare and required surgery. This led to several of the other senior gentlemen smokers to quit.
A BETTER WAY FORWARD For Dr Ang Yan Hoon, these new approaches in healthcare delivery are an important evolution to keep care cost-efficient and sustainable. Hospital-based acute care is not always the answer to managing chronic illness. “Hospitalisation in an acute-setting is expensive to the patient as well as the system,” she points out. “There is also an opportunity cost for family members.” By empowering patients, family members and caregivers to tackle simple medical issues at home, it saves them time and money, and reduces the burden on the hospital system. It also greatly improves the quality of life for patients. “Home care is more convenient for the patient as they have more autonomy and freedom,” she assures. “There is also less risk of acquiring hospital infections.” So while the hospital continues to invest resources and enhance processes to integrate care in the acute setting, just as much effort is being invested in building community care initiatives. Managing health and medical issues in the community is the way forward, says Dr Ang,
especially in light of an ageing population and increasing prevalence of chronic illnesses. “The goal is to build a selfmanaged community, and to cut down on hospital utilisation, including admissions and emergency department attendances,” Dr Wong notes. “To do this, we will continue efforts to support patients in the community and empower them to manage their own health.”
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potlight
Losing it A for health
Yishun Health’s new Integrated Care for Obesity and Diabetes (ICOD) programme is a one-stop platform for patients who would like to lose weight and manage their co-morbidities, and find holistic longterm support after metabolic surgery.
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bout a year ago, Mr Mohd Nizam Bin Ahlip, 52, suffered a third fall within several months. “It was my lowest point,” he admits. He was severely obese, unemployed, depressed and homebound. “I had to make a change.” At 168kg then, the excess load caused knee and back pains that made it tough for him to move, and put him at risk of health problems. In June 2018, Mr Nizam decided to undergo bariatric surgery. Having lost 20kg two months after surgery, he is well on the way to a more active lifestyle — which he is confident of sustaining, thanks to support from a team of doctors, nurses, dietitians and therapists from a transdisciplinary programme in Yishun Health.
‘DIABESITY’ CARE The ICOD programme boasts specialists equipped to manage obesity and diabetes, explains Dr Tan Chun Hai, Bariatric and Metabolic Consultant Surgeon, General Surgery, KTPH. As obesity increases the risk of diabetes, these two diseases are best dealt with in tandem. Dr Benjamin Lam, Consultant, Department of Family and Community Medicine, oversees medical weight management, which is non-surgical weight loss managed by a clinical team. It includes medical assessments and advice from doctors, dietitians, with psychological, nutritional, and physical therapy — and sometimes weight loss medications. He points out that diabetes management, medical weight management, and weight loss surgery are offered in conjunction with psychological, nutrition, and physical therapy to customise the right type and level of treatment plan. This is more sustainable because of the continuity of care. Managing diabetes and obesity is more than advice on eating and exercise, Dr Lam shares. “We deliver holistic care that comprises the medical side of things as well as tackle lifestyle, social and psychological aspects.” Being co-located also means the team can more easily consult with each other, assess cases, develop care plans, and optimise medications.
eat less, lose weight, and gain energy. This, and the reduction of stress on their joints, means they can move more easily and better endure sustained periods of exercise. Bariatric surgery is just one aspect of the long-term weight loss programme, emphasises Dr Tan. “As a surgeon, I can help them with the first step, but they have to stay committed to the lifestyle and diet changes.” The ICOD team provides comprehensive pre- and postoperative support for this. In Mr Nizam’s personalised care plan, the ICOD team visited him at home prior to his surgery. He even spent a month in KTPH to do prehabilitation, going on a special diet and exercising to lose weight and strengthen his body in preparation. Dr Tan notes that this team of physiotherapists, dietitians, medical weight management consultants, endocrinologists and psychologists are still working with patients like Mr Nizam to follow-up on long-term care needs, such as diabetes management or monitoring
INTEGRATED CARE SERIES PART 3 OF 3
for nutritional deficiencies. Surgeons may also step in to address issues such as excess skin folds and other needs as patients lose weight. For Mr Nizam, this change is not just about losing weight — it is about regaining his independence, selfesteem, and health. “My wish is to go home, find a job, and take care of my parents.”
Opening Picture: The transdisciplinary ICOD team with Mr Nizam post-surgery Right: Mr Nizam did exercises at his home in preparation for his bariatric surgery in July
METABOLIC SURGERY While some patients benefit from lifestyle changes and weight management regimes, others like Mr Nizam require more intensive interventions, such as surgery. Bariatric surgery is a recognised treatment option for obesity. New evidence also shows that it can help metabolic conditions such as diabetes. “As a person’s weight decreases, his or her metabolic parameters — high blood pressure, cholesterol levels, diabetic control — will improve,” Dr Tan explains. Patients
WHAT IS BARIATRIC AND METABOLIC SURGERY? Bariatric and metabolic surgery — mostly done through laparoscopic techniques — aims to reduce the amount of food absorbed and changes the body weight set point. Many changes in the body relate to gut and hormonal changes that affect the whole body weight set point. Some types reduce stomach capacity, physically limiting the amount of food the stomach can hold. Other types bypass part of the small intestine, reducing the calories and nutrients absorbed.
To find out more, scan this QR code!
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Things About...
5 Things About
oral Health & Ageing
Daily brushing and flossing, together with regular visits to the dentist, are important to keep teeth healthy at any age. This is particularly important for the elderly, as good oral hygiene also maintains good health. In consultation with Dr Sylvia Tay, Senior Consultant, Dental Surgery, KTPH & Dr Sophia Yee, Registrar, Dental Surgery, KTPH
YOUR TEETH AGE, JUST AS WE DO The enamel on our teeth is one of the hardest tissues in the body. However, years of wear and tear, erosion caused by acidic foods, and poor brushing techniques can wear down this hard, protective layer. Gum tissue recedes with age, exposing the soft dentine along the roots, which is the prime target for tooth decay among seniors.
AGE-RELATED CHANGES CAN AFFECT ORAL HEALTH Physical changes associated with ageing may result in limited hand dexterity or poor vision, which can affect daily oral hygiene, resulting in accumulation of dental plaque, leading to poor oral health. In addition, reduced
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salivary gland function or use of multiple medications among senior adults can result in dry mouth (called xerostomia). Dry mouth is uncomfortable and can impair taste, speech, swallowing, and increase the risk of tooth decay.
POOR ORAL HEALTH IS LINKED TO SERIOUS ILLNESSES The well-being of your mouth is tied to the health of the rest of your body. Bacteria in neglected mouths may be inhaled into the lungs, causing lung infections such as pneumonia. Bacteria can also be carried in the bloodstream to the heart, increasing the risk of heart disease. In persons with diabetes, uncontrolled blood sugar accelerates gum (periodontal) disease, resulting in loosening of teeth and eventual tooth loss. On the other hand, poor oral health can complicate the medical management of diabetes.
eat, and enjoy a variety of nutritious food. It is all part of maintaining overall quality of life, self-esteem, and social confidence.
KEEP YOUR MOUTH LOOKING AND FEELING YOUNGER! Teeth (even false ones!), gums, and the rest of the oral cavity need extra care and attention if you want them to stay healthy in your later years. • Brush your teeth a least twice a day and floss at least once
• Rinse your mouth after every meal • Reduce your intake of sweet or acidic foods and drinks • If you wear dentures, clean them daily to remove plaque. Remove dentures overnight and store in tap water Visit a dentist regularly, even if you wear dentures. Everyone has different needs and regular dentist appointments are essential to spot and treat gum disease, oral infections, and tooth decay.
A HEALTHY MOUTH IMPROVES QUALITY OF LIFE A healthy mouth is an asset! It is essential for general health and well-being as it enables you to communicate effectively, socialise,
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ive Well
IT’S IN THE LITTLE THINGS The simple pleasures of life keep Aunty Betty’s days and heart full!
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W
hether it is making time for a weekly walk, opting for healthier food alternatives, or spending quality time with her family, 62-year-old Aunty Betty is proof that they all add up to a meaningful and enriching life. Every morning, Mdm Tan Mui Chin — fondly known as Aunty Betty — greets the day with a smile. Her amiable personality and cheerful greetings make her a welcome presence at KTPH, where she has worked for the last six years as a cleaner with the Environmental Services Department. “I like working here. The hospital is very beautiful. And the people are all very nice,” Aunty Betty says. She greatly enjoys her work, as it keeps her active physically and socially. Compared to her previous job in hotel housekeeping, there is less time pressure and heavy lifting in her current role. Her duties include keeping both wards and administrative offices across three levels of Tower A clean and tidy. Aunty Betty shares that her job gives her the opportunity to meet people of many ages from all walks of life. She often talks to patients, especially if she senses that they are feeling bored, lonely or ill. Reaching out, saying “hi”, and just checking in on their well-being makes a difference and brings comfort. The moment of connection makes her days more meaningful — it’s one of the reasons why the independent lady is still working. “My daughter has asked me to retire, but I enjoy working because it gives me something to do each day. I can’t stay home all day — I’d be bored!” In her leisure time, Aunty Betty likes to catch up on Korean TV drama serials, and cook simple and healthy
meals for her family. She adds that working at KTPH has had a positive influence on her dietary habits, which she has passed on to her family. When asked for healthy eating tips, she quickly chimes, “Less salt, less oil, less sugar!” She reveals that she and her family now consume organic brown rice instead of white rice because of the former’s better effect on blood sugar levels. “It’s also more fragrant,” she enthuses. She even uses brown rice and olive oil to make her own healthy version of chicken rice and a veggie-laden bibimbap. While her work keeps her sufficiently active on weekdays, Aunty Betty still sets aside time on Sundays to take part in brisk walking and other activities run by her Residents’ Committee. Weekends are also for spending time with family, and going window shopping. These simple pleasures are what keep her days and heart full. It’s her secret to healthy and happy living. “It’s important not to worry so much; that keeps you young!”
Apart from regular Sunday walks, Aunty Betty also takes part in weekly workplace group exercises with her colleagues at KTPH before they start work in the morning
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akan Time
Cheesy Mushrooms on Toast cut & keep
This tasty toastie has 266mg of calcium per serving. It also has vitamin D, which helps your body absorb and use calcium for strong bones and teeth. Recipe provided by Chef Ho Shok Fong, Food Services, KTPH, and in consultation with Nutrition and Dietetics, KTPH.
INGREDIENTS Serves 4 • 245g fresh shiitake mushrooms, sliced • Half a large onion, sliced into thin rings • 3 cloves garlic, chopped • 100ml low-fat milk • 1 hard-boiled egg, chopped • 10g coriander, chopped • 40g shredded mozzarella cheese • 12 slices wholemeal bread
METHOD 1. Heat a non-stick pan and stir-fry the sliced mushrooms. 2. Add the onions and garlic and sauté the mixture till fragrant. 3. Pour in the low-fat milk and simmer on low heat till the mixture thickens into a sauce. 4. Mix in the chopped hard-boiled egg. Turn off the heat.
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5. Arrange six slices of bread on a tray. Divide the mushroom mixture into six portions and spread each portion on a slice of bread. 6. Sprinkle shredded cheese and top with another slice of bread.
NUTRITIONAL INFORMATION (1 SERVING)
Energy
308kcal
Carbohydrates
44g
Protein
18g
Fat
6g
• Saturated
3g
• Polyunsaturated
1g
• Monounsaturated 2g Cholesterol
48mg
Fibre
8g
Sodium
333mg
7. Toast both sides of each sandwich in a clean non-stick pan till golden brown. 8. Slice and serve.
CELEBRATING WORLD OSTEOPOROSIS DAY 20 OCTOBER 2018 Good bone health starts in the kitchen. Natural sources of calcium from dairy products are one of the best ways to ensure an adequate intake of the bone-building mineral each day. Non-dairy sources of high-calcium products include beancurd, edamame, almonds, spinach, chye sim, fish with edible bones (e.g. sardines), and products fortified with calcium.
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aily Dose
Help for hurting heels Are you forced to walk on tiptoes every time you get out of bed due to the pain in the underside of your feet? You may have a condition called plantar fasciitis. In consultation with Dr Dinesh Sirisena, Consultant, Sports Medicine, KTPH
P
lantar fasciitis (pronounced ‘plan-tur fas-ee-aye-tis’) is one of the most common causes of heel pain. It presents as a sharp pain beneath the heel and usually occurs when you take your first steps in the morning. The pain typically decreases with movement, but may return after long periods of standing or sitting. According to Dr Dinesh Sirisena, Consultant, Sports Medicine, KTPH, this is due to inflammation of the plantar fascia, which is the thick band of tissue that runs across the bottom of the foot. This band connects the heel bone to the toes. Plantar fasciitis is common in runners, in people who have tightness in the calves, or people who are overweight. Inappropriate footwear can also make the symptoms worse. To alleviate the pain, try these simple home remedies. However, if the pain persists, do see a doctor. 30 |
STRETCH
Seated bent-knee stretch: Rest the ankle of the affected foot on the opposite knee, then flex the foot towards that knee. Standing wall stretch: Position your toes 45° against a wall, with your heel on the ground, and lean forward.
ROLL Roll a filled and frozen water bottle or a tennis ball under the affected foot, focusing on the painful area.
SOOTHE In the short-term, medication can help to address the pain, provided you are not allergic to them and have not been advised against taking them.
ind & Health
Crossword time! Test your word skill and memory with this fun puzzle. (Psst! The answers can be found scattered through this magazine.)
ACROSS 3. _____ surgery is also known as weight loss surgery (page 22) 4. Tasty when melted (page 28) 6. Held on 1 August (page 10) 7. Medical term for dry mouth (page 24) 9. Our kampung â&#x20AC;&#x201D; where we live, work and play (page 16) 10. Sour secret to a healthier soup (page 15)
DOWN 1. Where Aunty Betty can be found (page 26) 2. A band that causes foot pain when inflamed (page 30) 5. New safety net for low-income Singaporeans (page 4) 8. Mental warfare or Yishun Healthâ&#x20AC;&#x2122;s award-winning eye health programme (page 7)
DOWN 1. tower A 2. plantar fascia 5. elderfund 8. chess ACROSS 3. bariatric 4. cheese 6. nurses day 7. xerostomia 9. community 10.vinegar
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Community Nurse Post
Wellness Kampung
Wellness Kampung is an initiative comprising three wellness and care centres for residents in the north. They provide a suite of health and social programmes, creating a support network for residents to inspire each other to adopt healthier lifestyles in a close-knit 'kampung' setting. Opening hours: Mondays to Fridays, 8.30am to 5.30pm (closed on Saturdays, Sundays and all Public Holidays)
115 Chong Pang
260 Nee Soon East
765 Nee Soon
Blk 115 Yishun Ring Road #01-495, Singapore 760115
Blk 260 Yishun Street 22 #01-87, Singapore 760260
Blk 765 Yishun Street 72 #01-366, Singapore 760765
6257 4702
6257 4802
6257 4842
Admiralty Medical Centre (AdMC) AdMC is a one-stop medical centre for specialist outpatient consultation, day surgery, rehabilitation and diagnostic services, as well as community health outreach activities.
Khoo Teck Puat Hospital (KTPH)
KTPH is a 659-bed general and acute care hospital serving more than 800,000 people living in the north of Singapore. It combines medical expertise with high standards of personalised care in a healing environment, to provide care good enough for our own loved ones.
Yishun Community Hospital (YCH)
YCH provides intermediate care for recuperating patients who do not require the intensive services of an acute care hospital. Situated beside KTPH, the two hospitals provide an integrated care experience for patients.
676 Woodlands Drive 71, #03-01 Kampung Admiralty, Singapore 730676
90 Yishun Central Singapore 768828
2 Yishun Central 2 Singapore 768024
6807 8000
6555 8000
6807 8800
www.admiraltymedicalcentre.com.sg
www.ktph.com.sg
www.yishuncommunityhospital.com.sg
www.fb.com/admiraltymedicalcentre
www.fb.com/khooteckpuathospital
www.fb.com/yishuncommunityhospital | 31
