Going the Distance - National Healthcare Group

Jul/Aug 2014 Issue 52

WINNER

Hepatitis Helpsheet

AWARD OF EXCELLENCE APEX 2014

Lifewise

WINNER

AWARD OF EXCELLENCE APEX 2014

Staying informed is as easy as A-B-C

NHG Corporate Yearbook 2012/2013

Going the Distance Keep it moving and lose the weight, like Maria, So Chow and Daniel do! Healthcare humanity awards

• face the music • the future of fitness

Lifewise

contents Jul-Aug issue 52

features 08 cover story Digesting the Dangers Think you know all there is to know about hepatitis? Think again.

10 Getting A Move On

NHG jumps on the national 1 Million KG Challenge bandwagon!

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14 Answers About Antibiotics What do these drugs really do? Lifewise debunks the common myths.

16 Stepping Up to the Plate Leadership lessons from Tan Tock Seng Hospital’s CEO, Prof Philip Choo.

18 A Record Number of Awardees This year, more outstanding healthcare workers were given a Healthcare Humanity Award than ever before.

22 In Person

Up close and personal with A/Prof Lim Tock Han and A/Prof John Abisheganaden.

18 26 26 Not Just ‘Growing Pains’ Emotional or behavioural problems in children point to something more serious.

Jul - Aug 2014 lifewise

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Lifewise

Jul-Aug issue 52

contents 28 A Change to Do you good

30

You can’t turn back the hands of time, but you can certainly slow down some of its effects.

30 Facing the Music We know music is good for the soul, but can it also be bad for you?

32 The Future of Fitness The key to a healthier lifestyle could be in your smartphone.

34 Feast Like the French Indulge in a fat-rich diet and still stay slim? Find out how the French get away with it.

28

regulars

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EDITOR’S NOTE NEWSROOM ASK THE EXPERTS Spotlight/NHG news Spotlight/NHG directory

03 04 36 38 48

On the cover: (from left) Maria van der straaten, Lee So chow and Daniel Lee Photographer Kelvin Chia Art direction Don lee styling Sheh Hair Kenneth ong Makeup Manisa Tan clothes Maria & Daniel: Sports attire by Mizuno. So Chow: top by Mizuno. Mizuno is available at World of Sports outlets.

A Challenge to Yourself For many of us, incorporating exercise into a

National Healthcare Group

EDIT O RIAL Wong Fong Tze, Tania Tan, Diana Ong, Praveen Nayago, Ng Si Jia, Audrey Wong, Elizabeth Sim

L ifew is e Advis ory Panel A/Prof Lim Tock Han, A/Prof Thomas Lew, A/Prof Chua Hong Choon, A/Prof Chong Phui-Nah, Prof Roy Chan

MediaCorp Pte Ltd

EDIT O RIAL & DESIG N Senior Editor Agatha Koh Brazil Supervising Editor Ronald Rajan Editor Amir Ali Art Director Don Lee Writers Gene Khor Alex Ngai Executive Photographer Ealbert Ho Senior Photographer Kelvin Chia Photographer Mark Lee

CONT RIBUTORS Wanda Tan, Elisabeth Lee

Busines s Development Senior Business Relationship Manager

Michele Kho

For advertisement enquiries, please email: [email protected] For subscription enquiries, please email: [email protected]

E ve r y c a r e h a s b e e n t a k e n i n t h e p r o d u c t i o n o f t h i s m a g a z i n e , b u t N a t i o n a l H e a l t h c a re G ro u p ( N H G ) , t h e publisher, editor and employees assume no responsibility for any errors, inaccuracies or omission arising thereof. Opinions expressed by contributors and advertisers are not necessarily those of NHG, the publisher or the editor. The information produced is for reference and educational p u r p o s e s o n l y. A s e a c h p e r s o n ’s m e d i c a l c o n d i t i o n i s unique, you should not rely on the information contained i n t h i s m a g a z i n e a s a s u b s t i t u te f o r p e r s o n a l m e d i c a l at te n t i o n , d i a g n o s i s o r h a n d s - o n t re a t m e n t . I f yo u a re concerned about your health or that of your child, please consult your family physician or healthcare professional. Copyright © is held by the publishers. All rights reserved. Reproduction in whole or in part without permission is prohibited. Printed in Singapore by Times Printers, www.timesprinters.com. MCI (P) 056/11/2013.

routine requires too much of a sacrifice — what with the realities of family and career — so we end up neglecting our bodies. But in light of the rising tide of obesity around the world, there is no time like the present to get up and do something about it because, as you will read in our cover story on page 10, health problems can sneak up on you. And more importantly, the rewards are worth it! Just ask the five National Healthcare Group (NHG) staff enrolled in the national 1 Million KG Challenge — getting into shape has changed their lives for the better. Change is also something our bodies naturally experience with age, as you will read on page 30 — our noses and feet get longer, while our hormones slow in production. What can be done to slow down the process? The answer: yet again, diet and exercise play a major role in adding years of healthy life. In contrast, throughout history, countless numbers of people succumbed to various bacterial diseases that would have been easily treated with the antibiotics we have today. Have you ever wondered how they work and why we have to finish the prescribed course each time? Lifewise investigates on page 14. Besides antibiotics, hepatitis is another term we have heard of at some point. But do you really know what it is? For example, did you know that there exist hepatitis D and E, in addition to the common A, B and C viruses? So if you thought you knew all there was to know about it, think again (page 8). Beyond the realm of diseases and drugs, though, healthcare is very much a human endeavour. Evidence of this humanity is abundant in the book Our Shared Stories: Same Same Yet Different. Our Shared Future, published earlier this year by the National Healthcare Group (NHG). In the book, Deputy Group CEO (Regional Health) of NHG and CEO of TTSH Professor Philip Choo recounts his desire to serve and make a difference, and the story is reproduced on page 16. But it’s not just leaders who make NHG and other healthcare systems tick. Meet the winners of the annual Healthcare Humanity Awards on page 18. And speaking of awards, you might have noticed on the cover that Lifewise has won an APEX Award for Publication Excellence. In addition, another NHG publication, the NHG Corporate Yearbook 2012/2013 also won an APEX Award of Excellence. This is the second year Lifewise has won the APEX award; an extraordinary achievement. You might find it within yourself to be fabulous too. Experiment with a new way of getting into shape by downloading a fitness app and set yourself some goals, but first, flip to page 32 for tips on choosing a health app. Go ahead and challenge yourself to be like our fit and fab cover models and take charge of your fitness. Have fun!

The Editorial Team Jul - Aug 2014 lifewise

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(newsroom) s n i p p e t s f r o m t h e h e a lt h c a r e w o r l d // c a l e nda r o f e v e n t s GERONTOLOGY

SOMNOLOGY

BETTER SLEEP ON IT

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cientists from around the world warn that reduced sleep is leading to serious health problems, and that governments and people need to tackle the problem. Professor Russell Foster of Oxford University in England warned that people are getting one to two hours’ less sleep than 60 years ago, and that is going to lead to problems in the future. Cancer, heart disease, diabetes and obesity have all been linked to insufficient sleep. “We are the supremely arrogant species; we feel we can ignore the fact that we have evolved under a light-dark cycle,” he told BBC News. Prof Charles Czeisler of Harvard University in the United States blamed technology. LED lights and smartphones have high levels of blue light which can disrupt the body’s internal ‘clock’ that regulates sleep. “Exposure to short-wavelength blue-ish light in the evening will reset our circadian rhythms to a later hour, postponing the release of the sleep-promoting hormone melatonin and making it more difficult for us to get up in the morning,” he said.

CARDIOLOGY

People are getting one to two hours’ less sleep than 60 years ago, and that is going to lead to problems in the future

Researchers at Stanford University in the United States have discovered that injecting the blood of young mice into older rodents boosted brainpower, according to a study published in Nature Medicine. Mice who received an injection of blood plasma from mice 15 months younger performed better on memory tests. “There are factors present in blood from young mice that can recharge an old mouse’s brain so that it functions more like a younger one,” said Dr Tony Wyss-Coray of the Stanford University School of Medicine. “We are working to find out what those factors might be and from exactly which tissues they originate.” Scientists at Harvard University have also found a factor in young blood that not only had an antiageing effect on heart muscle. It also boosted the growth of brain cells in old mice and restored their sense of smell. Clinical trials are planned to determine if the same holds true for humans.

FIBRE CAN FIX YOUR HEART Eating fibre can improve your long-term chances of recovering from a heart attack, claims a study published in the British Medical Journal. Researchers at Harvard University in the United States found that heart attack survivors were more likely to be alive nine years later if they adhered to a diet high in fibre — increasing fibre intake by 10g per day was linked to a reduction in death risk of 15 per cent. Among more than 4,000 men and women surveyed, the 20 per cent of those who ate the most fibre had a 25 per cent lower chance of dying from any cause during the nine years. They were 13 per cent less likely to have a fatal heart attack.

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photos: Getty images, istockphoto, shutterstock

Young Blood Gives New Lease Of Life

PSYCHOLOGY

calendar

A SENSE OF DIRECTION IS GOOD FOR YOU

Jul/Aug National Skin Centre 25th Anniversary Charity Walk

Researchers in the United States and Canada have found that having a sense of purpose — regardless of what that purpose is — can stave off an early demise, according to a study published in the journal Psychological Science. Doctors tracked the physical and mental health of more than 7,000 people aged between 20 and 75 years of age. When followed up on 14 years later, they found that purposeful people lived longer, even when taking into account other factors such as bad moods, age and employment. Dr Patrick Hill of Carleton University in Canada said, “Our findings point to the fact that finding a direction in life and setting overarching goals for what you want to achieve can help you actually live longer, regardless of when you find your purpose.”

finding a direction for life and setting goals can help you actually live longer

Join the National Skin Centre for a 3-kilometre walk around Gardens by the Bay for a good cause. Proceeds go towards the SANA-NSC Laser Tattoo Removal Programme. DATE Saturday, 23 Aug 2014 Flag-off timE 8am Venue Gardens by the Bay (Silver Leaf garden) Fees Adults — $10, Students — $5, Children below 5 years old — free Registration and donations Email [email protected] or call 6350 8244.

ONCOLOGY

Spot Tumours With Goggles

Photos: getty images, shutterstock

A

team of scientists at Washington University School of Medicine in St Louis in the United States have developed new high-tech goggles that help surgeons spot cancer cells, increasing the surgeons’ ability to ensure that the entire tumour is removed during one operation. The goggles have a sensor that captures the glow of cancerous tissues stained by a unique dye, said Dr Samuel Achilefu who invented both the dye and goggle technology. “This creates an augmented reality that allows the surgeons to see cancer cells glowing, providing real-time guidance during surgery,” he explained. Being able to precisely remove tumours could reduce the need for further operations. “The tech is amazing; it’s like having a microscope to guide your surgery,” said Dr Ryan Fields, who was involved in a pilot study of the device.

Singapore mental health conference 2014

The Singapore Mental Health Conference (SMHC) 2014, themed “Mental Health and Resilience — It Takes a Whole Community”, will emphasise the need for collaboration in developing a model of integrated care that can build resilience and meet the population’s mental health needs. Jointly organised by the Institute of Mental Health, National Council of Social Service, Agency for Integrated Care and Health Promotion Board, SMHC 2014 will focus on the entire mental healthcare framework and emphasise the need for collaboration. DATE 17 and 18 Oct 2014 (Fri & Sat) VENUE MAX Atria @ Singapore EXPO ENQUIRIES For more information, visit smhc2014.com.sg or email the SMHC Secretariat at [email protected].


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PSYCHIATRY

A Helmet To Beat The Blues

D

anish researchers have created an electromagnetic helmet that may help treat people with depression, according to a study published in the journal Acta Neuropsychiatrica. In trials conducted by Copenhagen University and the Psychiatric Centre at Hillerod in North Zealand, two-thirds of patients with treatment-resistant depression reported that their symptoms had disappeared within a week after using the new device. The device uses seven coils to deliver tiny electro-magnetic pulses that activate capillaries in the brain. Patients do not feel anything except for occasional slight nausea. According to Professor Steen Dissing of Copenhagen’s Faculty of Health Sciences who designed the helmet, “The device mimics electrical fields in the brain and triggers the body’s own healing mechanism.” Scientists hope to study if the device can also alleviate the symptoms of Parkinson’s disease.

PHYSIOLOGY

FIGHT TO THE DEATH


Dealing with worries and demands from close family was also linked to a higher mortality risk photos: Getty images

D

anish researchers have found that frequent arguments with family or friends can raise your odds of dying in middle age, with men and the unemployed the most vulnerable, according to a study published in the Journal of Epidemiology and Community Health. The study examined data on 9,875 men and women aged between 36 and 52, and found that constant arguing increased mortality risk by up to three times the normal rate. Dealing with worries and demands from close family was also linked to a higher mortality risk, the study found. Although the team from the University of Copenhagen could not fully explain the factors behind these findings, they said the physiological impacts of stress were the most likely cause of the increased risk. The body responds to stress by increasing the levels of ‘stress hormone’ cortisol, which in turn can increase the risk of adverse health outcomes by raising blood pressure.

NUTRITION

Is The Party Over For Wine And Chocolate? EPIDEMIOLOGY

WHO calls POLIO A ‘PUBLIC HEALTH EMERGENCY’ Just months after India celebrated its polio-free status, new cases of the crippling viral disease have surfaced in a number of countries. As a result, the World Health Organization (WHO) has now declared polio a public health emergency of international concern. Said WHO Assistant Director-General Bruce Aylward, “If unchecked, this situation could result in failure to eradicate globally one of the world’s most serious vaccine-preventable diseases.” New cases of the virus was discovered in 10 countries, including three where it is still considered endemic: Afghanistan, Nigeria and Pakistan. So far this year, 74 cases have occurred worldwide — 59 of them in Pakistan alone. Vaccination against polio is available at Tan Tock Seng Hospital’s Traveller’s Health and Vaccination Clinic. Call 6357 2222 or email [email protected] for information.

EPIDEMIOLOGY

Photos: getty images, shutterstock

MERS Cases Still Rising The World Health Organization convened an emergency meeting in May 2014 to decide whether the rise in Middle East Respiratory Syndrome (MERS) infections constitutes a “public health emergency of international concern”. As of May, almost 600 cases of MERS have been identified worldwide, and more than 150 have died, mostly in Saudi Arabia. In April, a Malaysian man who went on a pilgrimage to Saudi Arabia became the first in Asia to die from the disease. To date, no cases have been reported in Singapore, although there has so far been one case confirmed as far afield as the United States. The virus that causes MERS comes from the same family of viruses as SARS (severe acute respiratory syndrome) which swept through Singapore in 2003. MERS causes fever and kidney failure but is not considered highly contagious at this point, though there is no known cure.

A

glass of red wine or a few blocks of dark chocolate can be good for you, right? Until now the answer was yes, though they may not be as beneficial to your health as you were led to believe. Scientists have found that resveratrol, the ingredient in red wine, chocolate and berries that is said to confer health benefits, may not actually stop heart disease or prolong life, according to a study published in JAMA Internal Medicine. Professor Richard Semba of the Johns Hopkins University School of Medicine in the US studied 783 elderly Italians in Tuscany for a period of nine years and found no link between resveratrol levels and the risk of death, heart disease or cancer. It was also not associated with any markers of inflammation. Any benefits from drinking wine or eating chocolate must instead come from other shared ingredients. Said Prof Semba, “These are complex foods, and all we really know from our study is that the benefits are probably not due to resveratrol.”

no cases have been reported in Singapore, although it has spread as far away as the USA


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(HEPATITIS)

g n i t s Dige the D N

Think you know all there is to know about hepatitis? Think again... by WANDA TAN Every year on 28 July, World Hepatitis Day is observed across the globe with events such as free virus screenings and vaccination drives to raise awareness of this viral disease. The theme for this year’s World Hepatitis Day is ‘Think Again’, so with that in mind, now is a good time to revisit this global public health problem. Hepatitis is a group of infectious diseases that comprises hepatitis A, B, C, D and E — each of which is caused by a different virus and can occur in conjunction with other types of hepatitis. The danger of hepatitis arises when the liver — a vital organ that aids digestion, removes toxins from the body and regulates metabolism — becomes inflamed. The World Hepatitis Alliance says that, 500 million people around the world live with hepatitis. It also kills 1.5 million people globally each year. Obvious signs of hepatitis are jaundice (yellowing of the skin and the whites of the eyes), dark urine and pale stools. Fatigue, fever, nausea, loss of appetite, abdominal pain and diarrhoea are other symptoms. But many carriers have very mild or no symptoms at all and thus unknowingly spread it to others. The only way to confirm the presence of hepatitis is through diagnostic blood tests and a liver biopsy, depending on the severity of the disease. Most people who get any form of hepatitis have an acute short-term infection. In these cases, the symptoms tend to subside after a few weeks and the virus is cleared within six months of treatment. There is no lasting liver damage and most patients then develop a lifelong immunity to that particular virus. However, some hepatitis B and C sufferers continue to be carriers and develop chronic hepatitis, which often leads to cirrhosis (permanent scarring of liver tissue), hepatocellular carcinoma (liver cancer) or even death. The good news is that hepatitis is preventable — you just need to get vaccinated and be vigilant about your health. Here is what you need to know about hepatitis and its prevalence in Singapore, with the guidance of Dr Smriti Pathak, an Associate Consultant at Tan Tock Seng Hospital’s Travellers’ Health and Vaccination Clinic, and Ms Agatha Chai, a Senior Staff Nurse at the National Healthcare Group Polyclinics.


IN CONSULTATION WITH DR SMRITI PATHAK ASSOCIATE CONSULTANT // TRAVELLERS’

HEALTH AND VACCINATION CLINIC // TAN TOCK SENG HOSPITAL AND MS AGATHA CHAI SENIOR STAFF NURSE // NATIONAL HEALTHCARE GROUP POLYCLINICS

FACTS ABOUT

Hepatitis A (HAV) >

Singapore has low infection levels due to good sanitary conditions. Says Dr Smriti, “HAV incidence in Singapore was estimated at 0.7 cases per 100,000 population in 2009 and is continuing on a downward trend since then.”

>

HAV is a food-borne virus.

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Typically contracted while travelling to developing countries with poor sanitation and hygiene, especially those in South-east Asia and the Indian subcontinent.

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ransmitted through contaminated food and water — mainly raw T or undercooked shellfish in Singapore — or through close contact with an infected person.

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Only 10% of children show symptoms, compared to 90% for adults. Symptoms appear two to six weeks after infection.

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Less than 1% of patients — particularly the elderly — experience severe symptoms, resulting in liver failure or death.

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There is no specific treatment for HAV. Patients should get plenty of rest, stay hydrated, eat a well-balanced diet and avoid alcohol.

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A vaccine is available for uninfected people aged one year and above.

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Other preventive measures include frequent hand-washing and cooking food thoroughly.

S R GE

DON’T FORGET D AND E Although rare, hepatitis D and E do exist. The bloodborne hepatitis D virus only occurs in people who already have chronic hepatitis B. It causes more serious complications compared to HBV infection alone, such as a greater likelihood of liver failure. Like HAV, hepatitis E virus is spread through consumption of contaminated food and water and causes an acute infection. Pregnant women who are infected tend to have more severe forms of the disease.

FACTS ABOUT

Hepatitis C (HCV) >

Hepatitis infection affects roughly 10,000 Singapore residents (according to The Straits Times).

>

HCV is a blood-borne virus.

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HCV is spread via contact with the blood of an infected person, e.g. intravenous drug use, blood transfusions received before 1992 (before blood donations were screened for HCV), and use of unsterilised equipment for tattooing or body piercing.

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0% of patients develop a 8 chronic infection. Risk factors include kidney failure and co-infection with HIV.

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Both acute and chronic infections are treated with a combination of interferon injections and ribavirin tablets for 12 months. These drugs eradicate the virus, with cure rates ranging from 50% to 90%, and also slow the progression of cirrhosis and liver cancer.

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In chronic cases, anti-viral drugs can be added to the combination therapy.

>

There is currently no vaccine against HCV.

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reventative measures include P going to reliable tattoo parlours, and avoiding illegal drug use.

FACTS ABOUT

photos: getty images, shutterstock

Hepatitis B (HBV) >

HBV prevalence has been estimated at 3.6% in the last decade, and Dr Smriti says this is declining due to the National Childhood Immunisation Programme.

>

HBV is a blood-borne virus.

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Most cases occur through mother-infant transmission at birth. Also possible through direct contact with infected blood and bodily fluids during sex and intravenous drug use.

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The human immunodeficiency virus (HIV) shares similar modes of transmission, so persons infected with HBV may also have higher risk of HIV infection.

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Adults are more likely than children to show symptoms.

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Up to 90% of infected newborns remain HBV carriers and go on to develop chronic disease, compared to just 10% for those who are infected as adults.

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For chronic HBV, anti-viral therapies are prescribed for six to 12 months. Regular check-ups are necessary.

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In severe or fulminant cases, indefinite therapy or a liver transplant may be needed.

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HBV vaccine is recommended at birth and generally affords lifelong protection. Uninfected adults can be vaccinated. Ms Chai adds that annual screening is advised for healthcare workers or those in a high-risk setting; people who engage in unsafe sex; or those who have a family history of liver cancer.


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(Losing It) The Health Promotion Board’s

NHG jumps on the national 1 Million KG weight-loss challenge bandwagon! Interviews BY Fairoza Mansor AND Wanda Tan IN CONSULTATION WITH Dr Audrey Tan

Senior Consultant // Health Promotion // National Healthcare Group

1 Million KG Challenge is Singapore’s first incentive-based national weight management movement, and by 2016 it is hoped that the nation will have collectively lost a million kilogrammes of body weight. Open to residents aged 18 to 64 who have a body mass index (BMI) of 18.5 to 37.4, the challenge offers prizes that include a car and a holiday package. The National Healthcare Group (NHG) is supporting the 1 Million KG Challenge by encouraging its staff to participate. Dr Audrey Tan, Senior Consultant in the Health Promotion Department, is leading the charge. Says Dr Tan, “Within NHG HQ, about 160 staff have signed up, including people of normal weight. Of the total participants, 76 are in NHG’s weight

management challenge for those with a body mass index (BMI) of 23 or above.” As Dr Tan points out, “It’s a challenge even for healthcare workers to find the time to exercise!” “It’s an uphill battle to get people motivated, as there are many competing needs, such as career and family commitments. But people need to realise that their health is important for their work and family, and that it is possible — with some creativity — to integrate a healthier lifestyle into their work and family time.” Indeed, for those who have made the effort to incorporate physical activity into their day, the payoff has certainly been worth the effort. Lifewise talks to five of NHG HQ’s weight-loss champions.

Getting a

Move on 10 lifewise Jul - Aug 2014

MS LEE SO CHOW

50, DIRECTOR, CORPORATE SERVICES

photos: Kelvin Chia Art direction: Don Lee Styling: Sheh Hair: Kenneth ong Makeup: Manisa Tan clothes: ON Daniel and Maria: Sports attire by Mizuno. ON So chow: top by Mizuno, Wearing her own bottom. All wearing own shoes. Mizuno is available from World of Sports outlets.

“I decided to join the challenge

I carry a pedometer wherever i go and my aim is to walk 10,000 steps a day

after finding out that my cholesterol level was very high. Although I haven’t lost much weight yet, I believe I have lost inches from my waist since the start of the programme. My exercise regimen consists of gym sessions three times a week, where I walk on the treadmill for at least 40 minutes and lift weights. I also join a yoga class once a week. I carry a pedometer wherever I go, and my aim is to walk 10,000 steps a day. To keep track of my calorie consumption, I keep a food diary in which I record my every meal. Crucially, I have given up one of my biggest vices — snacking on potato chips and ice cream after dinner. It is a daily challenge to manage my food intake and make time for exercise. Thankfully, my family — especially my 19 year-old son, who used to be overweight himself but now looks like a jock — is on hand to stop me whenever I try to sneak in a snack. My friend and exercise buddy Adelina Thian Wei also helps me stay motivated.”

MR DANIEL LEE

37, ASSISTANT MANAGER, GROUP HUMAN RESOURCE “Early last year, I weighed 90kg and

suffered severe sleep apnoea. This sleep disorder caused me to snore very loudly at night and fall asleep involuntarily during the day — once even while driving, which almost resulted in an accident! I realised I had to improve my health, so after undergoing surgery in March 2013 to treat my sleep apnoea, I started jogging and swimming regularly and avoided hawker foods like char kway teow. By the end of the year, I was down to 74kg. But in January 2014 my father sustained a serious spinal injury from a fall and was hospitalised, so I spent a lot of time with him instead of exercising. When I signed up for the challenge in April, my weight had gone back up to 80kg. I have only managed to shed three kg so far under the programme due to my tight schedule. My father is now living with me, so I need to take care of him. But I still jog on alternate nights for an hour after my father and children — aged four and eight — have gone to bed. There are times when I feel too tired to exercise, but my wife is a great source of support and encouragement.” Jul - Aug 2014 lifewise

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(Losing It) ‘There is no such thing as easy weight loss’ Obesity is a global epidemic — it is estimated that more than two billion people around the world are overweight with a BMI exceeding 25. In Singapore, HPB’s National Health Survey showed that in 2010, one in nine adults aged 18 to 69 were obese, with BMI above 30. But these BMI thresholds as defined by the World Health Organization don’t paint the full picture at the local level. Says Dr Audrey Tan, “Asians are at risk of cardiovascular diseases and diabetes mellitus at lower BMI points. Our criteria for moderate risk is 23.0 to 27.4, and high risk is 27.5 or higher.” This is a cause for

concern, as it is estimated that the proportion of overweight people in Singapore is rising at one percentage point per year. Being overweight can lead to a host of lifelong health problems such as high blood pressure, coronary heart disease, stroke, type 2 diabetes, bone and joint problems and some cancers. Dr Tan says, “Many chronic diseases take years to develop and do not show symptoms in the early stages. We may be lulled into thinking we are fine and thus don’t see the need for a healthy lifestyle.” The danger is that we may continue with

MRs Maria van der Straaten

unhealthy eating habits in line with a sedentary and more affluent lifestyle. At the end of the day, though, there is no getting around the need to exercise and follow a healthy diet. “There is no such thing as easy weight loss,” says Dr Tan. Thus, it is important to have support, be it at the workplace or at home.

63, Personal Assistant to the Group Chief Corporate Communications Officer “I’ve gone down two UK dress sizes — from 20 to 16 — since I started exercising regularly a little over a year ago. The most difficult part for me is turning down food offered by family and friends, especially when they’ve taken me to their favourite restaurant. I don’t want to appear rude and unappreciative by saying ‘no’. And now that I am part of the challenge, it has made me more resilient, so I’ve managed to find a way around that — the trick is to insist on sharing! walking for This way, I can try all the recommended dishes by just taking small bites. Everyone is happy. about an hour Exercising is now a big part of my life, and at labrador park I would like to thank my boss for allowing me to leave work early on my exercise days. is now a part of Occasionally, she even cooks healthy nutritious soups for me and the team! my weekend activity In addition to this, walking for about an hour at Labrador Park is now a part of my weekend activity, and I’ve managed to rope family members in as well! It has become a family affair for my husband, sister-in-law, her husband and my two grandkids, aged nine and seven. In fact, they’ve became more gung-ho about exercise than me! My new, healthier habits have been quite infectious. Besides taking up walking with me, my husband — who is a meatlover — is now eating more fish and vegetables. And instead of having Milo at breakfast, we now have black coffee without sugar or milk.” 12 lifewise Jul - Aug 2014

“Family members, colleagues and bosses have an important role to play.” They need to support a healthy work-life balance so that there is enough time to devote to exercise. Dr Tan emphasises the need to limit the sharing of unhealthy tidbits at work, especially with colleagues who are overweight.

I frequent the gym on as many weekday evenings as i can and also on saturdays Ms Adelina Thian Wei (right)

Ms Kee Hui Yu

24, Accounts Assistant “Losing weight has been my goal for the last

two years, and it has been a challenge — I’d lose some, and then put the kilos back on. I believe anyone who is attempting to shed weight can relate to my experience. Deciding to be healthier and slimmer is a good first step, but sticking to the plan requires discipline and determination. That’s why I welcome the challenge. The programme, as well as colleagues around me who have also signed up help me stay on-track. We motivate one other! This diet and exercise regime was tough in the beginning, but it does get easier. I’ve started running and attending fitness classes like kickboxing organised as part of the Workplace Health Improvement Programme (WHIP). I’ve also changed my diet by cutting down on fried food and carbohydrates. I eat more steamed or boiled foods now. My family has been extremely supportive, always encouraging and reminding me to eat only what’s good for me. The people around me notice changes in my weight, so to hear compliments from friends, colleagues and families who have noticed my weight loss serves as my biggest motivation to continue on with my ‘mission’.”

Ms Adelina Thian Wei

45, Executive, Corporate Services “I used to be slim before having my three

boys, now aged 20, 18 and 14. Now that they have grown up, I can focus on getting back in shape. The challenge has made my workout efforts more regular and rigorous. I’ve joined a walking group formed by colleagues who have also joined the challenge. I’ve also gotten a gym membership. I frequent the gym on as many weekday evenings as I can and also on Saturdays. I swim, walk on the treadmill and join organised fitness classes such as Zumba. I’ve also paid more attention to my diet and make a conscious effort to eat healthily. Breakfast is usually two half-boiled or boiled egg whites, and carbs are only allowed in one meal a day. Keeping a food diary has been helpful in keeping my meals in check. I want to thank the NHG management for endorsing the 1 Million KG Challenge and encouraging staff across the Group to take part. I am very fortunate to have Dr Audrey Tan and Ms Pauline Xie — a Senior Dietitian at the National Healthcare Group Polyclinics — to provide advice on how to lose weight successfully. Also many thanks to my boss So Chow, who is both my exercise buddy and personal trainer!” LW Jul - Aug 2014 lifewise

13

(MEDICAL MARVEL) When you fall sick with a common ailment like a cold, you might start self-medicating with some off-the-shelf medicines. If that does not ease your symptoms, you might think about going to the doctor and asking for antibiotics — medicines that destroy or stem the growth of bacteria. But what if you were told that in the case of these viral illnesses, antibiotics would not work for you? When the antibiotic properties of penicillin were discovered in 1928 by Scottish biologist Alexander Fleming, it was a major breakthrough in medicine. After all, this was the start of being able to cure diseases such as tuberculosis, typhoid, syphilis and bubonic plague — which throughout history have cumulatively killed hundreds of millions of people. Antibiotics, it seemed at the time, were the be-all and end-all of medicine, and by the 1940s, were being touted as a miracle drug. This, however, has resulted in many misconceptions about antibiotics, of which there are now dozens of different types. Associate Professor Lim Poh Lian, Head and Senior Consultant at the Department of Infectious Diseases in Tan Tock Seng Hospital, dispels some of these myths.

What do antibiotics really do? LIFEWISE DEBUNKS COMMON MYTHS ABOUT THESE IMPORTANT MEDICATIONS. by ALEX NGAI IN CONSULTATION WITH associate Professor LIM POH LIAN

HEAD & SENIOR CONSULTANT // DEPARTMENT OF INFECTIOUS DISEASES // TAN TOCK SENG HOSPITAL

Answers about

MYTH 

Antibiotics can be used to cure all diseases. FACT: Antibiotics are only effective against illnesses caused by bacteria. They have little to no effect on diseases caused by viruses like the common cold. A/Prof Lim says: “If you have a severe streptococcal skin infection, penicillin can be life-saving. However, if you have a viral bronchitis, antibiotics will not help.”

MYTH 

Antibiotics only affect ‘bad’ bacteria. FACT: Antibiotics don’t discriminate. They affect all sorts of bacteria they find, but in so doing, can lead to complications. A/Prof Lim says: “Antibiotics kill the bacteria causing the infection, but also the other bacteria which are ‘bystanders’, that may be performing important functions, such as bacteria in the gut which make vitamin K [that is] necessary for blood to clot normally.”

MYTH 

You can stop taking antibiotics before you finish the whole course if you feel better. FACT: Some people stop taking their antibiotics when they feel that they have recovered. They do this in the belief that it will prevent them from developing a resistance to antibiotics. This is wrong because a full course of antibiotics is usually prescribed to prevent infections from relapsing. If you stop short, you might allow the infection to not only come back, but also to be resistant to the antibiotic used. A/Prof Lim says: “This is particularly important for tuberculosis which requires at least six months of treatment. Drugresistant tuberculosis is now a serious worldwide concern, and it is a product of patients not completing their treatment.” What matters is to use the antibiotic long enough to fully treat the infection, and not a day longer.

ANTIBIOT

14 lifewise Jul - Aug 2014 14 lifewise Jul - Aug 2014

MYTH 

There is nothing wrong with taking antibiotics, even if you do not need them. FACT: If you take an antibiotic when it is not necessary, the healthy bacteria in your body can become resistant to this type of antibiotic and continue to multiply in spite of the medication. If and when you are subsequently infected with disease-causing bacteria, this resistance gets transferred from the bacteria in your body to the newcomers and makes them resistant to the antibiotics as well. A/Prof Lim says: “Bacteria can transfer resistance genes to different bacterial species, like people sharing recipes with each other. Eventually, at a population level, it is very likely that diseases will evolve to become resistant to antibiotics. If you play a cat-and-mouse game with bacteria, only the smart mice survive and thrive. Resistant bacteria are the smart mice.”

Take the right antibiotic for the right infection, at the right dose, for the right amount of time. MYTH 

Antibiotic resistance only affects the person who is resistant. FACT: When one person develops resistance to a certain type of antibiotics, it is possible for him to spread this resistance to other people. A/Prof Lim says: “Some people stop tuberculosis treatment after two months when they feel better, and when their tuberculosis comes back, it can be resistant. When they cough and spread it to other people, those who catch that strain of tuberculosis don’t even know they have drug-resistant tuberculosis from the start. If they take the normal tuberculosis antibiotics, they may be doomed to failure.”

MYTH 

All types of antibiotics are useful for any bacterial infection. FACT: Some antibiotics are wide-

photo: Shutterstock

spectrum, affecting a large range of bacterial infections. Some are narrowspectrum, designed specifically to combat a certain type of bacteria. It is important to take the correct one for your specific problem. A/Prof Lim says: “Take the right antibiotic for the right infection, at the right dose, for the right amount of time.” LW

TICS

Jul - Aug 2014 lifewise Jul - Aug 2014 lifewise

15 15

(A Leader’s Story)

STEPPING UP to the plate

Tan Tock Seng Hospital (TTSH) celebrates its 170th anniversary in 2014. Over its illustrious history, TTSH has been home to many great medical leaders who, together with its staff, have dedicated their lives to building a community of care for patients. NHG Deputy Group CEO (Regional Health) and TTSH CEO, Professor Philip Choo, shares his thoughts on what makes TTSH unique. This story first appeared in Our Shared Stories: Same Same Yet Different. Our Shared Future, which was launched earlier this year by the National Healthcare Group.

Many would consider

Professor Philip Choo a stalwart of Tan Tock Seng Hospital (TTSH). The current Deputy Group CEO (Regional Health) of NHG and CEO of TTSH previously served as the hospital’s Chairman Medical Board from 2003 to 2011. The now-54-year-old was also one of the youngest Heads of Department, having taken up the reins of Geriatric Medicine after only two years as a consultant. Yet despite his illustrious career, public service was never a calling. As a young medical student, Prof Choo and his friends planned to start their own private practice, paving the way to “a different and quite wealthy life”, he says with a chuckle. Fate intervened instead.

When you work at a hospital of this calibre, it is no longer just about healthcare, it is about the chance to touch greatness. Professor Philip Choo


Prof Choo first joined TTSH as part of Medical Unit 1 for a six-month posting during his National Service. It was then that he met and served under Dr F J Jayaratnam, the hospital’s thenHead of the Department of Medicine (I) — one of the doctors who would eventually shape his career. “Dr Jayaratnam was very quiet and soft-spoken, but also very firm. He had extremely high expectations and demands, but was also very supportive,” recalls Prof Choo. “He challenged us to be better and if you lived up to his expectations, you would see yourself improving. “He was a role model with his behaviour and code of ethics — he taught us to put others before self. I realised that sometimes it’s the quiet heroes who leave a more lasting legacy, more so than the very vocal and prominent ones.” In fact, Dr Jayaratnam was the reason Prof Choo entered Geriatric Medicine after completing medical school. By his own admission, the move to Geriatrics was considered by many at the time to be

Left: Prof Philip Choo (second from right) pointing out the location of Tan Tock Seng Hospital amid the rest of the models of the upcoming Health City Novena. Health City Novena is a modern integrated healthcare hub set to be completed by 2030.

Right: Prof Philip Choo with his dear mentor Dr F J Jayaratnam, TTSH’s former Head of the Department of Medicine.

“foolish”, especially when the discipline was barely heard of at that time. But Prof Choo had made a commitment to his former mentor and intended to fulfil it. It was again Dr Jayaratnam who played ‘matchmaker’ for Prof Choo and another great physician — Dr John Dall, Head of the Victoria Geriatric Unit in Glasgow. As one of Europe’s first geriatricians, Dr Dall was known as the “physician of last resort” whom doctors would seek out when they were stumped by a patient’s case. “He was the one people went to when they had a medical problem they could not solve,” says Prof Choo. Arrangements were made for Dr Dall to train registrars in geriatric medicine under the sponsorship of the Royal College of Physicians of Glasgow — and the first registrar to enter the programme was a young Dr Choo in 1988. The first four weeks in Glasgow were nothing short of gruelling, he recalls. “In the beginning, Dr Dall grilled me in front of everyone for every case I saw. It was like taking an exam every day.” But the intensive training helped hone good judgment and an acute clinical sense, skills that would be integral to Prof Choo’s future role as a geriatrician and clinician-administrator. Prof Choo also developed a newfound appreciation for allied health professionals

(AHPs) during his year-long training — a key lesson that would go on to form the basis of team-based care at TTSH. Under the instruction of Dr Dall, he shadowed occupational and physiotherapists, who later gave their patient assessments to the young doctor. He felt that the AHPs were better at assessing the patients’ needs than the doctors, thanks to the amount of interaction they had with the patients. These observations and lessons were incorporated into the first Geriatric Medicine specialist training programme which Prof Choo helped write after his return from Scotland, as a second-year registrar. “Today it is unthinkable to imagine registrars writing training programmes, but in those days we had to step up to the plate,” he muses. The course included structured rotations to palliative care, psychiatry and rehabilitative medicine which were designed to help give trainees a more well-rounded understanding of patients’ needs.

Since then, the Department of Geriatric Medicine at TTSH has grown and is now the largest in Singapore. In 2012 the hospital together with the National Healthcare Group launched the Institute of Geriatrics and Active Ageing which will help boost research and manpower capability in caring for Singapore’s rapidly ageing population. Having had the chance to learn from some of the greats, Prof Choo now aims to spur his staff and the hospital to new heights — a difficult task, he concedes, but not impossible. He hopes that staff will work towards achieving their own levels of greatness through better patient care, innovation, self-improvement, systems thinking and teamwork. His belief is that “the most important job of a leader is to make your people better — by giving them value, responding to their needs and reinforcing their reasons for work within the environment they operate in”.

Our Shared Stories: Same Same Yet Different. Our Shared Future is produced by NHG Group Corporate Communications Office. To request a copy, email [email protected] Jul - Aug 2014 lifewise

17

(Healthcare Heroes)

A record number of

Awarde 76 extraordinary healthcare workers were honoured for their efforts at this year’s Healthcare Humanity Awards.


in the aftermath of SARS

Winners of the Honourable Mention with Singapore President Dr Tony Tan Keng Yam. On President Tan’s left is NHG Group CEO Professor Chee Yam Cheng.

es Guests holding windmills during the grand finale of the ceremony, where they sang along to A Time Like This! — a song dedicated to Singapore’s Pioneer Generation. The original song was produced by NHG Group Corporate Communications, and exemplifies NHG’s vision of Adding Years of Healthy Life.

in 2003, The Courage Fund was established from public, private and government donations to help the many victims of the deadly virus. Since then, the fund has been used to reward the selfless efforts of healthcare workers who go above and beyond the call of duty to provide quality care to patients. Now in its 10th year, the annual Healthcare Humanity Awards — as this award is now known — saw the highest number of recipients this year, a solid 76 awardees from 26 organisations. (Last year, there were 54 winners.) Winners receive a silver medallion and a cash prize. On 14 May, at The Matrix@Biopolis, these hardworking individuals were lauded at a ceremony attended by Guest-of-Honour and President of Singapore Dr Tony Tan Keng Yam; Health Minister Mr Gan Kim Yong; Senior Minister of State for Health Dr Amy Khor; and Permanent Secretary for Health Mrs Tan Ching Yee, as well as management and staff from the healthcare industry from the public and private sectors.

Said Professor Chee Yam Cheng, Group CEO of the National Healthcare Group (NHG), “Fortunately, Singapore has not suffered from another outbreak like SARS. But we want to be ready. For now, we must also reward healthcare workers who do their jobs tirelessly.” NHG is the secretariat for the awards, and Prof Chee sits on the Courage Fund’s Board of Trustees. New to the awards this year is the Honourable Mention category which recognises extraordinary effort in providing healthcare. One recipient of this new award is paramedic Nurulelfyana Badrulhisham, 24. On 8 Dec 2013, she held up under the pressure of the Little India riot to help extricate the body of construction worker Sakthivel Kumaravelu who was pinned under a bus. Mdm Kay Kuok, Chairman of the Board of Trustees and NHG Chairman, said of the Honourable Mention, “The award recognises those who have gone beyond their call of duty and ventured into humanitarian efforts — either locally or beyond our shores, some of whom have demonstrated immense courage.”

Dr Tan Kok Leong 46, Senior Consultant, Tan Tock Seng Hospital

Dr Tan Kok Leong is one of many HHA recipients from the National Healthcare Group. Dr Tan, a family physician, firmly believes in teamwork and never hesitates to approach other healthcare partners to engage their help in providing holistic care for his patients. In 2012, he spearheaded the Virtual Hospital Programme for patients suffering from chronic diseases. As a result, these patients’ readmissions to TTSH’s Emergency Department dropped significantly and they were able to recover in the comfort of their own homes. Dr Tan always listens to his patients and their caregivers to better understand their issues and challenges. He would go the extra mile to help them and also to ensure that his patients receive timely treatment. For example, Dr Tan would personally visit patients at home after office hours to persuade them to be admitted for treatments, where necessary.

Effective teamwork is the core of healthcare. It entails empathy, respect, and the willingness to learn from each other. Jul - Aug 2014 lifewise

19

(Healthcare Heroes)

Healthcare Humanity Award Winners 2014 Honourable Mention Ms Katherine Tan Gek Tee

Mr Abdul Farouk Bin Abdul Latiff

Ms Esther Chong Pei Wei

Jurong Health Services

HCA Hospice Care

Nurse Clinician

Registered Nurse

Ms Annie Lau

Ms Felicia Tang Yun Li

Singapore General Hospital

Tan Tock Seng Hospital

Senior Nurse Manager

Staff Nurse

Dr Anton Cheng Kui Sing

Ms Goh Chai Hoon

Alexandra Health System


Senior Consultant

Senior Pharmacy Technician

Senior Staff Nurse

Ms Chen Wei Ting

Ms Grace Sim Pek Hong

National Healthcare Group Polyclinics


Bethany Methodist Nursing Home

Ms Lim Kim Yan Nurse Clinician


Ms Low Pey Yun Paramedic

Singapore Civil Defence Force

Ms Nor Aisyah Binte Johari Paramedic


Ms Nur Hidayah Binte Bujang Paramedic


Ms Nurulelfyana Binte Badrulhisham Paramedic

Unistrong Technology Pte Lte

Dr Puneet Seth Consultant

Advanced Practice Nurse

Manager, Allied Health

Ms Cheung Pui Leng

Ms Hazel Lee Mung Fong

National Heart Centre


Senior Staff Nurse

Senior Staff Nurse

Ms Chong Lai Foong

Ms Hoon Lay Yuet

KK Women’s and Children’s Hospital


Nurse Clinician I

Senior Staff Nurse

Ms Chor Swee Suet

Ms Janet Chong Ngian Choo

Health Promotion Board


Head Nursing & Deputy Director

Nurse Clinician (Specialty Care)

Ms Chow Wai Shin

Ms Janet Teng


NHG Diagnostics

Nurse Clinician

Senior Medical Technologist

Ms Clara Su Yan Ling

Ms Jasmine Yong Yoke Cheng

National University Health System

St Luke’s Hospital

Senior Staff Nurse

Assistant Manager

Mr Clifford Xu De Sheng

Ms Jennifer Wong Chee Mei



Senior Staff Nurse


Dr Constance Teo Ee Hoon

Mr Jeremy Lim Kheng Chye



Consultant

Nurse Clinician


Dr Dhanesh Kumar

Ms Jerist Lew Fong Lin

Ms Shek Mei Poh

Institute of Mental Health


Senior Occupational Therapist

Institute of Mental Health


Consultant

HIV Specialist Nurse

Ms Doris Ang Chye Lian

Ms June Tan Soi Muay


Changi General Hospital

Health Attendant

Senior Nurse Manager

Ms Karen Wong Kai Sim

Ms Mumtaaz Bevi d/o Said Sulaiman

Ms Santhi d/o Baloo




Senior Staff Nurse

Princial Enrolled Nurse

Principal Enrolled Nurse

Mr Kevin Chiam Tow Meng

Ms Ng Chiew Hong

Ms Seet Soh Cheng

Ang Mo Kio – Thye Hua Kwan Hospital



Ward Manager

Senior Nurse Clinician

Nurse Clinician I

Ms Lai Mee Horng

Ms Ng Huoy Ling

Ms Sonia Binte Abdullah

Assisi Hospice



Nurse Clinician

Nurse Manager

Principal Enrolled Nurse

Ms Latipah Binte Mohd Noor

A/Prof Ng Kee Chong

A/Prof Steven Thng Tien Guan




Patient Care Assistant

Chairman, Division of Medicine

Senior Consultant

Ms Lee Siew Kum

Ms Nicole Wong Huay Sze

Ms Sun Tao




Assistant Director of Nursing

Senior Medical Social Worker

Nurse Clinician

Ms Liang Min

Ms Noni Binte Yusran

Ms Tan Chooi Peck


Health Promotion Board


Staff Nurse

Senior Enrolled Nurse

Senior Staff Nurse

Dr Lieu Ping Kong

Ms Noreen Binte Taha

Ms Tan Kim Eng


Jurong Health Services


Senior Consultant

Senior Staff Nurse

Senior Staff Nurse

Mr Lim Kong Beng

Ms Nur Jelita Remie

Dr Tan Kok Leong

Ren Ci Hospital



Deputy Rehabilitation Manager

Senior Staff Nurse, Clinical Instructor

Senior Consultant

Ms Loo Min Min

Ms Png Gek Kheng

Ms Tan Sin Yain




Care Coordinator


Nurse Clinician

Ms Loo Sook Ming

Ms Prema Harrison

Ms Tan Zi Hui





Nurse Clinician

Senior Staff Nurse

Dr Low Kang Yih

Ms Rachel Soh Tzer Shiang

Ms Tay Huei Ping




Family Physician

Principal Physiotherapist

Senior Staff Nurse

Ms Martha Mabel Chia Jia En

Ms Radin Nur Faridah Ali

Dr Vivien Lim Chin Chin




Nurse Clinician

Senior Staff Nurse

Consultant

Ms May Chan Siew Fong

Mr Richard Low Sai Yin

Ms Yeo Liew Soo

Agency for Integrated Care


Singapore National Eye Centre

Manager, Allied Health

Nurse Manager

Senior Staff Nurse

Mr Mok Chee Peng

Ms Sandy Goh Bee Peng

Ms Yoong Lee Chiang


TOUCH Home Care



Senior Occupational

Senior Staff Nurse


21

In Person

Grow With The Flow

For A/Prof Lim Tock Han, 49, striving to improve healthcare in Singapore is worth investing time in, even if hobbies take a back seat. Interview Fairoza Mansor

research and educate themselves. Learning cannot stop the moment we obtain our medical degree, because technology is always advancing. Education is fundamental to all doctors because the public deserves the best healthcare. That’s why I always urge resident doctors to ‘grow and flow’. In that sense, becoming this involved in the Education and Research arm of the National Healthcare Group (NHG) was a natural transition. I’ve been with NHG since 2000 and a consultant in the Eye Clinic of Tan Tock Seng Hospital (TTSH) since 1992. I might not have ventured into medicine if not for the influence of my elder brother who was studying medicine. Before university, I was very much into Computer Engineering, obsessing over the family’s old monochrome Apple IIe computer. But my brother always raved about the exciting things he was learning in NUS Medical School. His final pitch to me was that if I were to become a doctor, I could still dabble in Computer Engineering, but if I went into Computer Engineering, I couldn’t practise medicine. To be frank, Ophthalmology — the branch of medicine that deals with the eyes — is not my first love. I first plunged into General Surgery but boy, was the pace too fast and furious! I decided to specialise in Internal Medicine but discovered it wasn’t my forte, which led me to Ophthalmology. The more I delved into that, the keener I got. I believe it had to do with my love for photography and the similarity between the camera and the human eye. But these days there’s no time to pursue photography. Workdays start at 8am when I teach residents at the NHG Eye Institute. From 9am to noon, I see patients. After that, my time is dedicated to my role at the Group Education and Research Development Division. I usually get home to my wife, a General Practitioner, and our five kids — three boys and two girls ranging from four to 12 — by 7pm for dinner. Weekends are spent with the troop, which involves ferrying the kids to swimming lessons and supplementary classes. I used to work weekends, but now I try as much as possible to not let it overlap with family time so as to achieve a healthier work-life balance.” A/Prof Lim Tock Han is Deputy Group CEO (Education and Research) of NHG and a Senior Consultant in the Ophthalmology Department of TTSH. 22 lifewise Jul - Aug 2014 22 lifewise Jul - Aug 2014

As a doctor, I could still dabble in Computers, but if I went into Computer Engineering, I couldn’t practise medicine

photo: Ealbert Ho photo: Ealbert Ho

“ALL doctors should continually read,

In Person

Building Brick by Brick Toys help A/Prof John Abisheganaden, Head of Department and Senior Consultant of Respiratory and Critical Care Medicine at TTSH, see the bigger healthcare picture for NHG’s role as the regional health system (RHS) for central Singapore.

photo: Mark Lee

Interview Alex Ngai

I like construction toys because of how everything fits together As one integrated piece of work. All the bricks are equally important

“I have always had an interest in the arts

and all things creative. I think it fulfills a different part of me since my work as a doctor is grounded in hard science. However, I only started taking an active interest in creative pursuits around 10 years ago when I picked up painting to deal with my frustration at my mother’s illness. This led to a passion for toys and plastic bricks. It may seem like a strange progression, but I consider such toys as three-dimensional pieces of art, similar to sculptures. I have a room at home dedicated to them — I have so many that I am running out of space! My wife of 12 years and my nine-year-old daughter are both toy enthusiasts as well; our common passion translates into quality time for us when I am off work. One of the main reasons I like construction toys is because everything fits together into one integrated piece of work. All the bricks are equally important, and any misplaced brick ruins the whole piece — the sum is greater than its parts. I bring this ‘sum greater than parts’ philosophy to my work in the Regional Health System (RHS) at the National Healthcare Group (NHG). As an RHS, NHG’s mandate is on improving overall health issues among the population of Central Singapore. What we are setting out to achieve is not easy because it is a whole different way of looking at healthcare. With a rapidly-ageing population, there is now more to be concerned about than just treating a patient while they are in the hospital. For example, once the patient leaves our care, is he taking medication in the proper dosage and on-schedule? Is the diabetic patient keeping to a strict diet? Is the elderly hip surgery patient living in a hazard-free home? Often, the re-hospitalisation of frail patients can be prevented. In an ideal world, at-risk and frail patients who have been discharged would receive follow-up care from a community caretaker or social worker. Polyclinics would have access to their records and treat them for minor problems. Funding would be provided from either corporate or government level, which would allow needy patients to maintain their required lifestyles. For this goal to be achieved, we would require many agencies to come together, from hospital doctors to social workers, grassroots volunteers and government agencies. This cooperative effort is like a piece composed of plastic toy bricks. When everything comes together, we can hopefully make great strides in improving healthcare — and the sum can be greater than its parts.” A/Prof John Abisheganaden heads the Respiratory Care and Critical Care Medicine Clinic at TTSH. He also plays a critical role in the NHG Regional Health System. Jul - Aug 2014 lifewise Jul - Aug 2014 lifewise

23 23

NHG publications clinch Apex Awards for Publication Excellence Lifewise — the bimonthly publication of the National Healthcare Group (NHG) — has done it again, winning an Award for Excellence for Custom-Published Magazines, Journals and Tabloids at APEX 2014. Last year, Lifewise won an Award for Excellence for One-of-a-Kind Health & Medical Publications. The APEX Awards are an international competition recognising outstanding publications. Lifewise is available to GP clinics nationwide as well as online at HCARE www.nhg.com.sg and at all NHG QUALITY HEALT institutions. In addition, the  NHG Corporate Yearbook 2012/2013 won an Award for Publication Excellence in the Annual Reports – Print over 32 pages category. Lifewise and the NHG Corporate Yearbook 2012/2013 are publications of NHG, jointly with the publishing agent MediaCorp Pte Ltd. ORE CENTRA L SINGAP SYSTEM FOR ARBOOK REGION AL HEALTH P O R AT E Y E

G COR 2012/13 NH

U CLOSER TO YO

Read Lifewise online! Learn about health with advice from experts, and introduce Lifewise to your friends. Visit www.nhg.com.sg for our free archive of past issues.


The Singapore Mental Health Conference (SMHC) 2014 will focus on the entire mental healthcare framework and emphasise the need for all partners to collaborate on developing a model of integrated care that can build resilience and meet the mental health needs of our population. SMHC 2014 targets mental health professionals, professionals in the social service, healthcare, intermediate and long-term care (ILTC) sectors, community-based workers, as well as caregivers. See you there! For more information, please e-mail the SMHC Secretariat at [email protected] or visit www.smhc2014.com.sg.

(Wellness) is a sensitive topic associated with stigma and fear. People with mental health disorders are often ostracised by even their closest family members and treated with suspicion by strangers. That would be bad enough for adults; now, imagine how bad this could be for a child. Mental health disorders in children can be classified into three categories, says Associate Professor Daniel Fung, Chairman of the Medical Board at the Institute of Mental Health (IMH). First, emotional disorders are conditions in which children are unable to control their feelings, such as anxiety disorders where children experience fear and dread when exposed to certain things. Secondly, there are children with behavioural disorders, such as Attention-Deficit Hyperactivity Disorder Mental health

(ADHD), who are unable to follow instructions in structured environments and perform tasks as required. Thirdly, there are developmental disorders which involve a child’s ability to understand things, and can range from dyslexia to autism and severe intellectual disability. The mental health of children has been an increasingly important topic worldwide. The Public Health England agency of Britain’s Department of Health reports that 30 per cent of British adolescents have subclinical mental health problems — issues that surface but are not severe enough to necessitate immediate clinical help for the child. In the United States, the American Psychological Association (APA) estimates that there are 15 million infant, teenage and adolescent Americans who can be diagnosed as having a mental health disorder. Singapore has its share of children with

t s u j t o N

mental health issues. A 2007 article in the Singapore Medical Journal reported that one in eight Singaporean children has an emotional disorder, and one in 20 suffers from behavioural disorder. It is estimated that 10 per cent of the Singaporean population below 15 years of age suffer from various mental health disorders. According to a 2012 report in The Straits Times, the Response, Early Intervention and Assessment in Community Mental Health scheme or REACH, which set up a hotline

‘GROWING

WHEN CHILDREN HAVE EMOTIONAL OR BEHAVIOURAL PROBLEMS, CHANCES ARE these point to something MORE SERIOUS. by Alex ngai

IN CONSULTATION WITH ASSOCIATE PROFESSOR DANIEL FUNG

CHAIRMAN MEDICAL BOARD // INSTITUTE OF MENTAL HEALTH

26 lifewise Jul - Aug 2014 26 lifewise Jul - Aug 2014

The environment has a big part to play in mental health disorders, and good parenting can definitely help with the prevention and treatment of mental health disorders in children. A/Prof Daniel Fung, Chairman medical board, Institute of Mental Health

in 2007, saw an increase in the number of callers from 306 in 2007 to 8,336 in 2011. In addition, 739 children were referred to the scheme in 2011 compared to 14 in 2007. The increase in referral numbers can be attributed to the increase in the number of REACH teams being set up over the different zones throughout the years. From 2009 to 2013, IMH’s Child Guidance Clinic saw 2,200 to 3,000 new patients a year aged six to 19 who are facing emotional or behavioural problems.

Instead, they ascribe the problems to typical children’s issues. As the result of improved education and increased awareness, however, parents have become more open to seeking treatment for their children’s mental disorders, hence the increase in reported cases. Still, researchers at the Johns Hopkins Bloomberg School of Public Health in the United States estimate that only half of children with mental health issues are diagnosed. In order for this problem to be tackled, education and awareness need to be improved. “Like physiological illnesses, there is a very wide range to mental health disorders. Some cases are severe, while others can be dealt with easily,” says A/Prof Fung. “In schools, additional resources, like allied educators who are trained to help students with special educational needs, can help keep the students on track in their learning and development.” Awareness can help remove the negative stigma associated with people who suffer from mental health disorders. “Not only are mental health disorders more common than people think, but they are also more controllable than they think,” A/Prof Fung explains. “Many disorders can be treated successfully, and children with mental health disorders can often grow into well-developed adults.” More education and information for parents can also go towards improving the mental health of children. “The environment has a big part to play in mental health disorders, and good parenting can definitely help with the prevention and treatment of mental health disorders in children,” he says. “Parenting programmes can help parents to not only create a safe environment for their children, but also teach them about the different mental health problems that children may face and how to deal with them.” Speaking as a father of five, A/Prof Fung’s advice is to practise age-appropriate parenting — nurture and care for children while they are young, but give them more responsibility as they get older so as to foster independence. As he told The Straits Times in an interview earlier this year, “Don’t over-parent or overprotect your child — give him or her space to grow. Children have an innate ability to deal and cope with stress; let them learn from mistakes.” LW

PAINS’ photos: Corbis, Wilson Pang (A/Prof Fung)

Overcoming Stigma

The obvious solution to improving children’s mental health is to improve the quantity and quality of treatments available, but this in itself is difficult. “There are still many things that we do not know about children’s mental health, things that can only be explored with better research,” says A/Prof Fung. Mental health disorders deal with feelings and emotions, things that can be very unreliable when dealing with adults, much less children. “The only way for mental health professionals to improve treatment is through better and more thorough research into the mental health disorders of children,” he says. A major obstacle to improving mental health for children is social stigma, which has been listed by the APA as a reason for the sudden spike in reported mental health disorders in children worldwide. Traditionally, parents may have resisted seeking treatment for their children due to the stigma of mental health disorders.

REACH OUT

Here are some helpful resources for your child’s mental health

£ Child Guidance Clinic

IMH runs two Child Guidance Clinics — one at the Institute of Mental Health located at Buangkok Green Medical Park, and the other at the Health Promotion Board Building at Second Hospital Avenue. Patients up to 19 years old can seek consultation at either location for emotional or behavioural problems.

www.imh.com.sg

£ REACh

This is a mental healthcare service set up to work closely with schools, voluntary welfare organisations (VWOs) and general practitioners to help students with emotional, social or behavioural issues. Its website also has a list of resources and reading materials for students, teachers and parents alike.

reachforstudents.com

£ Positive Parenting Programme

Organised by the Ministry of Social and Family Development, the Triple P programme is designed to help parents promote children’s development and manage children’s behaviour in a constructive way.

msf.gov.sg


27

(SILVERGLOW)

A

CHANGE to do you good

While you can’t turn back the hands of time, you can certainly slow down some of its effects. by GENE KHOR

DR CHEW AIK PHON

in consultation with

ASSOCIATE CONSULTANT // DEPARTMENT OF GERIATRIC MEDICINE // TAN TOCK SENG HOSPITAL

The first signs are always at least a little worrying, be it greying or thinning hair, or crow’s feet around your eyes. But as you age, these bodily changes are perfectly normal. In fact, there are all sorts of signs you might not know about such as your ears, feet and nose growing bigger. As Dr Chew Aik Phon, Associate Consultant at the Department of Geriatric Medicine in Tan Tock Seng Hospital explains, “Our feet become longer and wider with age as the tendons and ligaments lose elasticity. This causes the toes to spread out and the arches of the feet to flatten. “Our ears and nose are made up of cartilage which, unlike bones and muscle, continue to grow with age. Cartilage also becomes thinner as the years go by, causing stretching and sagging of the skin so that the ears may stretch down and the tip of the nose lengthens and droops.” However, there are other changes which are not as obvious but which, if left unaddressed, could lead to problems that will be difficult to deal with in your golden years. Here is what to expect and what you can do to lower the chances of these problems accelerating.


The Cardiovascular System

According to Dr Chew, blood vessels naturally lose their elasticity over time and stiffen as a result. Also contributing to this is atherosclerosis, in which fat is deposited on the inner walls of the arteries. This will cause the heart to work harder to pump blood through them and can lead to cardiovascular problems like high blood pressure. American medical research group The Mayo Clinic suggests physical activities like brisk-walking and swimming to stave off these Swimming is a good exercise problems. A healthy diet that includes to prevent cardiovascular problems later in life. plenty of vegetables, fruits, whole grains and lean sources of protein is also recommended.

The elderly body loses muscle mass and bone density. Weight-bearing exercises and A healthy diet can prevent this.

Bones, Joints And Muscles

As a natural part of ageing, bones shrink in size and density, which makes them more susceptible to fracturing. Meanwhile, muscles lose strength and flexibility with age, making coordination or even balancing more difficult. To combat these issues, a healthy intake of calcium is recommended, as is vitamin D which helps the body absorb calcium from food. For adults aged 19 to 50, the Health Promotion Board (HPB) recommends consuming 800mg of calcium a day to strengthen and maintain bone density. This increases to 1,000mg a day for adolescents aged 10 to 18, adults aged 51 and above, or for expectant or breastfeeding mothers. Good sources of calcium include low-fat milk, ikan bilis, green leafy vegetables like chye sim, calcium-fortified orange juice and silken tofu. Vitamin D, on the other hand, is generated by the body when exposed to ultraviolet UVB rays from the sun, so HPB recommends letting the sun shine on your arms and legs twice a week for five to 30 minutes each time, between 10am and 3pm. For people with paler skin, just a little sun does the trick but stay out a little longer if you have darker skin. Food sources of vitamin D include oily fish such as tuna and sardines, egg yolks, fortified milk and supplements. Weight-bearing exercises in which the body works against gravity should also be included as part of a routine to stave off bone density loss and muscle weakness. These exercises include walking, jogging, tennis and climbing stairs. Strength training like weightlifting can also help.

photo: getty images, istockphoto, shutterstock

The Digestive System

The Mayo Clinic says that infrequent or difficult bowel movements — better known as constipation — is more common in older adults, and a diet low in dietary fibre, not drinking enough Constipation becomes fluid and a lack of exercise are all contributing more common as we age, factors. Medications like iron supplements So it is important to consume enough dietary fibre. or medical conditions like diabetes and irritable bowel syndrome can also cause constipation. Make sure your diet includes high-fibre foods such as fruits, vegetables and whole grains. Cut down on meats and dairy products that are high in fat (low-fat dairy is fine); avoid sugary sweets; and drink plenty of water. And keep in mind not to fight the urge to pass a bowel movement, as holding it in for too long can cause constipation. LW

GOOD FOR GROWTH; LESS SO FOR AGEING Growth hormone — which fuels childhood growth and helps maintain tissues and organs thereafter — is produced by the pea-sized pituitary gland at the base of the brain. But from middle age, the gland slows production of the hormone, leading to decreased muscle and bone mass. Some people have turned to human growth hormone therapy to slow these effects, but this might not be the best course of action. “Such therapy has produced modest improvements, with increased lean body muscle mass and reduced weight gain,” says Dr Chew. “But this has been associated with joint pain, tissue swelling, carpal tunnel syndrome, development of insulin resistance and possibly diabetes. It has also been linked with a small risk increase in colon cancer and Hodgkin’s disease.” Dr Chew says, “More long-term studies are required before conclusions can be drawn about the utility of hormone therapy as an anti-ageing treatment.”


29

(Lifespaces)

MU

Facing the We all know music is good for the soul, but can it also be bad for you? by Fairoza Mansor Ms Janis Yeo Siew Ting

in consultation with

Principal Occupational Therapist // Occupational Therapy Department // Tan Tock Seng Hospital

The list of famous people who have sung their praises about the power of music is extensive. Bono, lead singer of rock band U2, is certain that “music can change the world”; the late author and poet Maya Angelou called music her refuge; and William Shakespeare once said, “If music be the food of love, play on.” The positive impact of music has long been well-known. Specifically, music affects our psyche and state of mind. It sets the cinematic mood and builds suspense in film. In politics, music is a tool used to garner votes, with United States President Barack Obama even releasing his campaign playlist the day after his 2012 election victory. Competitive athletes are often seen before a race with headphones on, blasting tunes to put them in a competitive mood. And for us mere mortals, multiple studies have shown that up-tempo music inspires equally upbeat workouts. In the realm of healthcare, the concept of music therapy is steadily catching on, with the number of qualified music therapists in Singapore rising from 11 in 2007 to more than 20 in 2013, reported The Straits Times in January last year. These therapists work with autistic children, people with dementia and the terminally ill. In palliative care, music is not only used to comfort patients but empower them as well. Therapeutic songwriting is encouraged as a form of creative expression for terminal patients who otherwise find it difficult to express themselves, such as bidding farewell to loved ones. At Dover Park Hospice, for example, cancer patients play instruments like the guitar and learn lyrics to their favourite songs. The hospice management has found that familiar melodies and rhythms help patients relax and manage their


pain better. Music therapy is also used to help patients with dementia, as familiar songs can sometimes jolt their memories. Music also has a therapeutic effect on children, especially those who have been victim to or witnessed domestic violence. In one social care shelter in England for example, children record themselves making music. This gives them a sense of achievement and confidence, as it boosts communication and listening skills which had been affected by their bad experiences. Finally, music also has a soothing effect on premature babies, studies have

found. Live music helps to slow at-risk infants’ heartbeats, calm their breathing and improve their ability to feed.

Musical Maladies

But despite the many benefits of music, it is not without some downsides. Musicians have long complained of medical problems such as fiddler’s neck (inflammation of the jaw where the instrument is held), horn players’ or Bell’s palsy (partial paralysis of facial muscles), trumpeter’s lip (characterised by swelling), cellist’s dermatitis (irritation of the skin

USIC

acute flexing of the thumb and commonly seen in guitarists who play excessively. Guitarists also experience painful lateral epicondylitis in the elbow due to overuse and frequent poor positioning of the arm while playing. Symptoms of inflammation include localised pain, fatigue, and soreness that may begin during practice, or between one to 48 hours after, warns Ms Yeo. Carpal tunnel syndrome is numbness in the hand due to pressure on the nerves. But such injuries can be prevented, says Ms Yeo. To avoid repetitive stress injuries, musicians should take frequent breaks when practising. Outside of practice, they should take up endurance training with weights, elastic bands or tubing, or exercise machines as these will prepare the musician for long hours of practice and performance. Exercises ensure that the muscles and joints are able to accommodate the stresses and strains. In addition, pre-practice and performance warm-ups are recommended.

photo: getty images

Play It By Ear

in contact with the instrument), harpist’s cramps and bagpiper’s fungus (harmful spores that grow inside the instrument). Constant and repeated practice on musical instruments, whatever they may be, can lead to repetitive stress injuries, says Ms Janis Yeo Siew Ting, Principal Occupational Therapist at Tan Tock Seng Hospital. Common music-related injuries include tendonitis, lateral epicondylitis and carpal tunnel syndrome. Tendonitis, which is the inflammation of a band of fibrous tissue that connects muscles to bones, is often result of the

Constant and repeated practice on musical instruments can lead to Repetitive Stress Injuries, but strength exercises can help

The destructive side of music was also revealed in the United States’ notorious Central Intelligence Agency’s interrogation techniques used against Guantanamo Bay detainees. Prisoners were subjected to music played repeatedly and at excruciating volumes aimed to disorientate and “break” them into confessing. Besides the stressful sounds of heavy metal band Metallica, other songs used to compel prisoners included the theme from Barney the Dinosaur and some of Britney Spears’ greatest hits. Even outside the grim setting of detention camps, sustained exposure to loud music can cause hair cells within the ear to become disarranged and to degenerate, resulting in hearing loss. Once hair cells die, they do not regrow and auditory sensitivity is permanently damaged. Sensitivity to high-frequency sounds is first to go, followed by an inability to hear the frequencies of speech. According to the US Centers for Disease Control, listening to a personal music player at high volume — about 105 decibels or so — for more than five minutes can cause irreversible hearing loss, as can 90 seconds at a rock concert without ear protection. It would be a shame to avoid music because of its potential detrimental effects though. Ultimately, how good or bad music is for you depends on how it is applied, enjoyed and practised. Besides, why deny yourself the joy music brings? LW Jul - Aug 2014 lifewise

31

(Workout)

The future of

FiTNESS Could the key to a healthier lifestyle lie in your smartphone? by GENE KHOR IN CONSULTATION WITH MR RAY LOH

EXERCISE PHYSIOLOGIST // SPORTS MEDICINE AND SURGERY CLINIC // TAN TOCK SENG HOSPITAL


QUALITY CONTROL Not all apps are made the same — here are some tips from health technology experts at The University of Texas MD Anderson Cancer Center on identifying an effective health app.

 SET REALISTIC EXPECTATIONS

photos: istockphoto, Shutterstock

So what’s your excuse

for not getting enough exercise? Common reasons include a lack of time, not knowing where or how to start, or the feeling that hiring a personal trainer would be too expensive. But in this age of technology, such obstacles are becoming a thing of the past, given the proliferation of smartphone applications built around sports and health. These range from apps that give you workout ideas suited to your unique lifestyle and schedule, to those that help you count the calories burned. Whatever your fitness fancy, it is likely to be but a finger tap away. Some might feel that having a gadget as a workout partner would make us lazier; that we would be immersed in our devices rather than focus on being active. But, it turns out, the opposite might be true. In a study published in medical journal JAMA Internal Medicine in January 2013, it was found that using a mobile device to track diets was more effective than doing so using pen and paper. In the year-long study, researchers studied 70 overweight adults. Some logged their daily meals and workouts with pen and paper, while others were given a mobile tracking device and twice-weekly telephone calls from a personal coach. All participants were offered group nutrition classes. The results showed that participants who used the mobile app and attended nutrition classes lost the most weight — an average of almost 7kg. Those who used the app but didn’t attend the classes lost around 4kg, while the group who tracked their diets manually and without external support barely lost any weight. So do not be surprised if healthrelated apps become a staple in all new smartphones soon. According to a report released in July 2013 by American research firm IHS, there were 156 million downloads worldwide of such sports and fitness apps in 2012. And by 2017, these downloads are predicted to rise to 248 million. As a related effect of this, the report foresees a boost in demand for wearable health devices like heart-rate monitors which communicate with these apps to track exercise progress.

Before downloading an app, consumers should first decide what they need to do to achieve their health goals, then figure out how an app can help.

 RESEARCH THE APP’S

DEVELOPERS Find out whether they have designed other health apps, how long they have been developing such apps, whether they consulted health professionals, and whether any reputable hospitals or health organisations endorse the app. If the answer is ‘no’ to any of these questions, it should be a cause for concern.

 TEST A FEW BEFOREHAND Try several apps before choosing to stick to one, and look for those that are convenient to use. This is a good way to both learn about personal preferences and to find what works best for you.

Exercise 2.0

The wide variety of programmes and related gear out there could be overwhelming to the uninitiated. But Mr Ray Loh, Exercise Physiologist at the Sports Medicine and Surgery Clinic at Tan Tock Seng Hospital, advises that choosing an app should start with deciding on what you want from it. “People who are more interested in monitoring their health can use apps and devices that can track their amount of sleep, stress level, daily step count and amount of exercise,” he says. “Or those wanting to keep track of the effectiveness of their training can use devices that monitor their heart rate and measures their VO2 max — the maximum rate of oxygen consumed.” In addition to tracking and calculating, many apps also give the option to publish their performance on social media, like how far or fast they have run, or if they

have achieved a new goal. This allows them to compare results with their friends and challenges them to maintain or improve their record.

Supervision Still Recommended

With increased popularity and evolution of fitness apps, the demand for gyms and personal trainers might experience a decline. Some fitness trainers and studios even live-stream their workout programmes and regimes online to reach more people. Access to these videos usually costs a fraction of a gym membership and can be viewed in the convenience of your home, anytime you want. Be it a yoga session or Zumba routine, all sorts of classes are available. But as useful — and cheap — as these alternatives are, Mr Loh advises that it is still safer to consult a qualified fitness professional first, especially if weight training is involved. “The responsibility of a trainer is to ensure exercise is personalised according to individual goals, fitness levels and progression speed,” he says. “They are to motivate and make sure every exercise session is performed effectively and safely, in good form and at the right intensity level. And for those looking to progress to heavier weights, it would be good to hire a personal trainer who understands proper weightlifting techniques.” Jul - Aug 2014 lifewise

33

(eat well) The French have long been envied for somehow

managing to stay svelte despite a diet famed for its liberal helpings of butter, cream, cheese and meat. According to Eurostat, the statistics office of the European Union, just 15 per cent of the French population suffer obesity — half the proportion of affected people in the United Kingdom. Together with Japan, Korea, Italy and Switzerland, France has one of the lowest overweight and obesity rates in the world. So where do the calories from all that buttery brioche, steak frites, foie gras and Chantilly cream go? Weight aside, France has a low incidence of coronary heart disease (CHD) and mortality. Compare this with the United States, where CHD is the biggest killer. This “French Paradox”, in which the people of France seem to stay healthy despite a national diet of unhealthy food, is no mystery. Because while delectable dishes like confit de canard — duck cooked in its own fat — look horrendously unhealthy on paper, in practice the secret to staying slim also has a lot to do with customs, traditions, lifestyle and a positive eating philosophy.

Fresh And Fab

The French certainly enjoy their food. After all, the “French gastronomic meal” — a festive meal where people get together to enjoy the art of good eating and drinking — was added to the UNESCO World Heritage list of protected traditions in 2010. Occasionally rounding dinner off with wine, nibbling on cheese

and pastries are not always bad for health. Wine, for instance, has been said to support heart health, says Ms Estonie Yuen, a dietitian from National Healthcare Group Polyclinics. This has been attributed to certain compounds contained in wine that help to increase high-density lipoprotein cholesterol (LDL, or “good” cholesterol), and which have antioxidant effects — although there is insufficient evidence to conclusively state that wine protects the heart. In any case, any benefits are best

reaped through drinking moderately. The American Heart Association and Singapore Health Promotion Board recommend no more than two drinks a day for men and one drink a day for women. One standard alcoholic drink is defined as 220ml of regular beer, 100ml of wine or 30ml of spirits. And if you don’t normally drink, it is advisable not to start. Another French staple best enjoyed in moderation is fromage, or cheese. Few things are as embedded in the French food culture as cheese, and while often high in fat and sodium, Ms Yuen also points

Indulge in a fat-rich diet and stay slim and healthy — how is that possible, or fair? Put your envy aside and find out how the French get away with it. by Fairoza Mansor

in consultation with Ms Estonie Yuen Dietitian // Collaborative Care, Clinical Services // National Healthcare Group Polyclinics

e k i l t s a e F theFRENCH 34 lifewise JUL Jul - Aug AUG 2014

photos: Getty images, istockphoto

out that it is a good source of calcium and phosphorus which are important for bone formation and maintaining bone density. In addition, a fat-rich diet stimulates the production of cholecystokinin, a satiety signal which promotes an extended sense of satisfaction after eating even small amounts, according to doctors in the French Committee for Health Education. Still, Ms Yuen recommends seeking out low-fat low-sodium cheese as a healthier option. The freshness of food and ingredients is also of paramount importance in French

Certain compounds found in wine help to increase ‘good’ cholesterol — though alcohol is best enjoyed in moderation cuisine — fast food and frozen food is frowned upon. A bill approved by French lawmakers was introduced in June 2013 requiring restaurants to designate fresh dishes prepared from raw ingredients with a “fait maison” (homemade) logo. Superstar chef duo Alain Ducasse and Joel Robuchon also introduced their own “Restaurant de Qualité”, a seal granted to food establishments that meet certain standards on product origins, freshness and diner satisfaction.

Quality Over Quantity ‘Regular’, ‘slow’ and ‘steady’ are some of the words that have been used to describe French conventional eating habits. Everyday life in France is marked by three traditional meals that properly fill the tummy, thus minimising the need

to snack. The French also tend to spend more time savouring their courses as compared to their fellow Europeans, reported British newspaper The Guardian in April 2014 — the average lunch break in France is two hours long! Meals are often associated with good company, so sharing of food is common. In fact, according to the Crédoc consumer studies and research institute, 80 per cent of meals in France are taken with other people. This sense of togetherness at meal times helps to limit overeating as diners share what’s on the table and are less inclined to take excessive helpings, so as to avoid appearing greedy in front of others. Portion control, if not already naturally exercised, is encouraged as a result. A recent survey by France’s National Institute of Statistics and Economic Studies on how French people spend their time found that “eating procures almost as much pleasure as reading or listening to music”. This makes eating a discrete activity not to be combined with other pastimes such as television watching, which has been known to lead to an increase in food consumption. There is a key lesson here — enjoy good foods in moderation, and respect your meal times. Just take it from the French, who have embraced eating as a pleasurable exploit, not an errand or a chore. And certainly not a guilt trip. Jul - Aug 2014 lifewise

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(Q&A)

ask the experts

yo u r m e d i c a l q u e s t i o n s a n s w e r e d

Q1) Simple Sleep Solutions I have trouble falling asleep, even after a long day awake. I try and include exercise into my routine, but the lack of sleep often makes me too tired to do so. How can I improve my situation without resorting to medication?

Dr Chua Sze Ming Associate Consultant // Dept of General Psychiatry // Institute of Mental Health

Q2) A Bite

Won’t Heal

I had an insect bite on my ankle six months ago. Now, the skin where the bite was is darker than the surrounding skin and still itches sometimes. Why won’t this itch go away?

You may be suffering from insect bite hypersensitivity. When new bites occur, the old ones come up again and itch intensely. Another possibility is that the skin in the affected area has thickened with time in response to repeated scratching, leading to development of a “prurigo nodule”. Steroid creams and antihistamines can relieve the itchiness in both cases. The darkening of the skin is expected as a response to any inflammation or irritation, and will slowly fade with time. Remember to use insect repellents and to keep exposed skin covered when you are in environments that may put you at risk of being bitten. If the problem persists, you should see a dermatologist for an evaluation. Dr Emily Gan Associate Consultant Dermatologist // National Skin Centre


photos: shutterstock

The persistent lack of sleep or a reduced ability to fall asleep — insomnia — is said to be chronic if these problems last three or more days a week for at least a month. Studies indicate that 10 to 15 per cent of adults have chronic sleep problems. If you have sleep problems, start improving your habits before bed. Avoid exposure to the light from electronic devices as this light can significantly lower levels of the hormone melatonin which regulates our internal clocks. Chart your progress with a sleep diary. Include the time you went to bed and woke up, total sleep hours and perceived quality of sleep. Also record the time you spent awake and what you did — for example, “got up, had a glass of milk” or “stayed in bed with eyes closed”; types and amount of food consumed before bed and time of consumption, your feelings and mood before bed and medications taken. The diary will soon reveal how certain behaviours affect your chances of having a good night’s sleep. If your sleep problems persist, you should consult your GP or a sleep specialist who might be able to help. Cognitive behavioural therapy and pharmacological treatments are available.

Q4) Heart Pain I have chest pains that come and go. My GP has ruled out a lung infection. I am a woman in my late 20s and although I don’t exercise much, I recently started doing yoga. Might I have a heart condition that I don’t know about? There are many reasons for chest pains. Other than heart-related pains, one of the most common causes is musculoskeletal in origin. Being a female in your 20s and with no cardiac risk factors makes the probability of significant heart disease low in your case. Nevertheless, if the chest pains recur or persist, please consult your doctor for a 12-lead electrocardiogram (ECG) and consider a visit to a cardiologist if the ECG is abnormal.

Q3) Gluten Fears I’ve recently heard reports about some people who refuse to consume gluten, but what is it exactly and who is sensitive to it? I don’t have food allergies, but should I worry about eating gluten? Is a gluten-free diet good for losing weight? Gluten is the main protein found in some grains such as wheat, oats, rye, barley, spelt and their by-products starch, semolina, wheat germ and hydrolysed protein. Gluten is found in common foods such as bread, noodles, pasta, cakes and biscuits, as well as other products such as gluten wheat-based mock meat. Individuals with coeliac disease and dermatitis herpetiformis are sensitive to gluten. Coeliac disease is a life-long dietary intolerance to gluten. Dermatitis herpetiformis is a severe, itchy and blistering skin condition whereby the ingestion of gluten causes skin rashes and itching, as well as damage to the small intestines. Therefore the management of these conditions is to follow a gluten-free diet under the advice and close monitoring of a doctor and dietitian. For a normal healthy individual with no gluten intolerance, there is no need to reduce gluten intake, as a gluten-free diet tends to be more costly, restrictive and deficient in several vitamins and minerals. Furthermore, giving up gluten-containing foods will not necessarily aid in losing weight. Gluten-free foods tend to be higher in sugars and fats, which often results in a higher caloric intake. They tend to be lower in fibre and many vitamins and minerals; namely, calcium, iron, folate and vitamin B including thiamin, riboflavin, niacin, B6 and B12. Ms Ong Hui Wen Dietitian // Nutrition and Dietetics Dept // Tan Tock Seng Hospital

Adjunct Assistant professor David Foo Head & Senior Consultant // Dept of Cardiology // Tan Tock Seng Hospital

ask the Sexperts

in the hot seat

I’m a man in my early 40s, and I have recently picked up cycling as a hobby. I am worried that this could affect my sexual vitality as after long rides, I experience numbness in my groin. Should I stop cycling? The numbness you are experiencing is due to pudendal nerve entrapment, as well as pudendal arterial insufficiency. The pudendal nerve has three important roles: £ Sensory: providing sensation to the penis £ Motor: acting on the perineal muscles for good erections £ Autonomic: important for penile erections. The nerve runs from the pelvis along Alcock’s canal and emerges in the perineum (between the scrotum and the anus). Cyclists often complain of groin numbness after long rides using a slim hard saddle. Repetitive impacts from the seat generate extreme perineal pressure, which indirectly compresses the pudendal nerve. The nose of the saddle also presses on the perineum. Your numbness could be due to decreased blood flow into the penis due to compression of the blood vessels that carry blood to the penis. With decreased blood flow, there is indeed a risk of erectile dysfunction. However, don’t trash your bicycle just yet. By improving your cardiovascular fitness, cycling can help keep erectile dysfunction at bay! But use an ergonomic wide saddle — Studies have shown that wide, noseless saddles minimise the loss of blood circulation to the penis. Should symptoms worsen, come to our Men’s Health Clinic for a check-up.

Dr Ronny Tan Associate Consultant // Dept of Urology // Tan Tock Seng Hospital


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C O R P O R AT E N E W S + C A L E N DA R O F E V E N T S + F O R U M S

Working As One Team NHG’s ongoing Care Transformation journey continues with the implementation of an electronic records system.

Representatives from across NHG discussed their various needs of the electronic health record system.

as part of the National Health IT Masterplan and will help realise NHG’s mission of developing comprehensive care integration within its Regional Health System (RHS). he healthcare ‘landscape’ in Singapore is evolving, with Associate Professor Thomas Lew, Chairman growing challenges — such as an ageing population as of NHG’s Care Transformation Project Steering well as an increasing disease burden — necessitating Committee and Chairman Medical Board at TTSH, an evolution of the way patient care is delivered. called for all of NHG HQ and its institutions to work as In 2013, the National One Team. “We are building Healthcare Group (NHG) embarked relationships across our We are building relationships on a Care Transformation journey whole cluster and RHS and across our whole cluster and Regional in which the wider health system is also with our partners to being reorganised into integrated achieve our collective vision Health System, and also with our clusters. In this way, healthcare of Adding Years of Healthy partners to achieve our collective becomes about managing Life,” he said. populations instead of just patients, Last year, staff from vision of . and managing relationships instead across NHG undertook A/Prof Thomas Lew of episodes. Care extends beyond an analysis of how eEHR the clinic or hospital walls into society and the community. can best serve all needs, big and small. In 2014, the Specifically, NHG seeks to provide coordinated journey will continue with further discussion, as well healthcare, with all its institutions and divisions — as more defining and documenting of the system. including Tan Tock Seng Hospital (TTSH), the Institute of From March to April, all the Group’s units and Mental Health (IMH), National Healthcare Group Polyclinics institutions assessed 20 focus areas, and on 11 April, (NHGP), the National Skin Centre (NSC), NHG Pharmacy a first cut of everyone’s requirements was discussed and NHG Diagnostics — working together as at a meeting, the objective of which was to come One Team. up with a vision of how the Care Transformation The Care Transformation Journey has been in journey will translate into better outcomes for constant development since the first visioning patients and the NHG team alike. exercise in 2013. It has emerged that certain new Future steps include the search for facilities were required. An enterprise Electronic an effective eEHR in May 2014, with Health Record system (eEHR) has been incorporated implementation targeted for 2017 onwards.

T

Adding Years of Healthy Life


A Step Forward for Medical Research

Professor Ivy Ng, SingHealth Group CEO with NHG Group CEO Prof Chee Yam Cheng (right).

NHG and SingHealth establish mutual recognition of research ethics review boards.

T

Photo: Shutterstock

Below (in blue): Mrs Tan Ching Yee, Permanent Secretary (Health), Guest-of-Honour at the CIRB-DSRB MOU Signing ceremony.

he topic of ethics in the realm of healthcare is an important one that aims to protect the rights and safety of human subjects involved in medical studies. In the Singapore context, institutional review boards (IRBs) look after such research and the people being studied. And on 22 May 2014, the individual IRBs of Singapore’s two largest public healthcare clusters — SingHealth and the National Healthcare Group (NHG) — established a mutual recognition of each other’s respective IRB with the signing of a Memorandum of Understanding (MoU). The two IRBs are known as the Centralised Institutional Review Board (CIRB; under SingHealth) and the Domain Specific Review Board (DSRB) under NHG. Since their inception, the two boards operated independently, providing strict ethical review and oversight for research done in their respective institutions. Multi-centre studies across the two health systems’ institutions thus used to require ethics approvals from both boards. In 2013, CIRB reviewed 1,141 studies, and DSRB reviewed 1,124. This MoU is a milestone for medical research in

Singapore, as clinicians and scientists doing multicentre studies in public hospitals or institutions no longer have to undergo multiple ethics reviews from different review boards. The two individual boards will also exchange expertise. Ultimately, this mutual recognition will save time, effort and costs, which in turn benefits patient care. Mrs Tan Ching Yee, Permanent Secretary in the Ministry of Health, attended the MoU signing. She said, “A harmonised ethics review system will increase efficiency for everyone engaged in medical research. This is important to enhance the translation of research outcomes from bench to bedside, to benefit our patients and citizens.” Dr Aw Swee Eng, Chairman of CIRB, said, “This reduces the time and effort taken to initiate multicentre studies, better facilitating medical research. More importantly, it promotes research collaborations across institutions, and such collaborations are important to advance medicine through research.” Of the mutual agreement, Associate Professor Chin Jing Jih, Chairman of NHG’s Research Ethics Committee, added, “This is a necessary change to encourage and facilitate collaborative research between institutions. This will minimise unnecessary duplication, thereby improving the efficiency of the review process, and overall benefiting the research community.” One example of time-savings is in the application process for cross-cluster studies. For new studies involving both SingHealth and NHG institutions, only one IRB application is required. An online system is being developed and will be ready in September 2014. Until the online system is ready, DSRB will review all new cross-cluster study applications.


39

NHG, NTUC Unity Healthcare jointly open family medicine clinic (FMC) in Serangoon new town NTUC Unity Family Medicine Clinic brings one-stop community care to residents.

T

Below: NTUC Unity Chairman Ms Tan Hwee Bin, NHG Chairman Mdm Kay Kuok, NTUC SecretaryGeneral Mr Lim Swee Say, NTUC Enterprise Group CEO Mr Tan Suee Chieh, and NHG Group CEO Prof Chee Yam Cheng opening the clinic.

A ‘Win-Win’ Partnership

Mr Lim Swee Say, NTUC Secretary-General and Minister in the Prime Minister’s Office officially opened the clinic on 23 May 2014. “NTUC Social Enterprises are committed to keep doing more good in support of our working people and their families. The opening of Unity FMC expands the healthcare footprint of NTUC Social Enterprises into the Singapore heartlands. It will strengthen the quality, capacity and affordability of community healthcare in an ageing population,” said Mr Lim. “NHG is committed to supporting Singapore’s vision of achieving high-quality healthcare and a healthy population,” said Professor Chee Yam Cheng, Group CEO of NHG. The opening of Unity FMC will further strengthen NHG’s Regional Health System to provide accessible and integrated healthcare services to the population in the central region of Singapore. “The collaboration is a win-win partnership. Together, we look forward to adding years of healthy life to our population.”

Comprehensive All-round Care Unity FMC combines an excellent team of healthcare professionals with good facilities, thus making it ideally positioned to offer patients — particularly those with chronic conditions — comprehensive care


Photo: Shutterstock

he National Healthcare Group (NHG) has partnered Singapore’s largest healthcare cooperative, NTUC Unity Healthcare, to open the NTUC Unity Family Medicine Clinic (Unity FMC) in Serangoon Central. This clinic provides one-stop affordable healthcare for residents of the Serangoon New Town and Braddell Heights housing estates. Unity FMC leverages on the clinical and administrative strengths of NHG through its primary care arm, the National Healthcare Group Polyclinics (NHGP), to provide integrated and comprehensive health and community care to serve more families. Patients from NHG institutions such as Tan Tock Seng Hospital, the Institute of Mental Health and NHGP can be referred to Unity FMC if they choose to seek treatment there, and if they are deemed suitable for follow-up care in their community. These patients’ doctors will communicate medical information and test results to the doctors at Unity FMC so as to ensure continuity of care. Doctors from other healthcare institutions can also refer their patients to Unity FMC for further treatment.

Prof Chee Yam Cheng says the clinic is the product of a win-win partnership between the National Healthcare Group and NTUC Unity Healthcare.

to help them manage their illnesses and improve their overall health and well-being. Located in Serangoon Central, the clinic is convenient for patients living nearby and those who require regular check-ups. And because patients see the same doctor at each visit, they receive care that is personalised and which goes beyond clinical care. The clinic provides all-round management of chronic conditions such as high blood pressure, high cholesterol, asthma, chronic lung diseases, thyroid conditions, hepatitis, arthritis, as well as sexual and mental health conditions. Basic laboratory tests and electrocardiogram services are also available. In particular, Unity FMC offers comprehensive management of diabetes. This includes more specialised management strategies such as diabetic foot screening to identify potential issues early and reduce risk of amputation; diabetic retinal photography to prevent blindness; and services to provide nutritional therapy to patients with various conditions and development of customised plans for their nutritional needs.

The FMC will strengthen NHG’s Regional Health System to provide accessible and integrated healthcare services to the population in the central region of Singapore.

Clinic Information

Above: Mr Lim Swee Say having his eyes checked.

Opening hours Mondays – Fridays: 9am to 6pm • Last registration for morning consultation at 12 noon • Closed for lunch from 1pm to 2pm • Last registration for afternoon consultation at 5pm

Saturdays: 9am to 1pm • Last registration at 12pm

Sundays and public holidays: Closed

Contact Tel: 6281 2638 Fax: 6281 2745 Email: [email protected] unityfmc.com.sg

Location Blk 264 Serangoon Central #01-205 S(550264) Unity Family Medicine Clinic is located at the Braddell Heights Community Hub, beside Nex Shopping Mall.

How to get there By MRT: Serangoon MRT Station By Bus: Bus stop #66351 (Serangoon MRT Station). Bus service numbers: 22, 43, 53, 70, 70M, 81, 82, 315

NHG GROUP CEO prof Chee Yam Cheng

Affordable Community Care

Patients subsidised under the Community Health Assist Scheme (CHAS) or Public Assistance (PA) Scheme can use these at Unity FMC. Patients can also tap their Medisave to manage chronic diseases under the Medisave Chronic Disease Management Programme (CDMP). For convenience, advance appointments to see the doctors can be made, significantly reducing waiting time at the clinic.


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Two high tea sessions were held, during which hopeful students got to meet senior faculty members.

Welcoming A New cohort The Lee Kong Chian School of Medicine prepares to welcome its second batch of students.

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n August 2013, the Lee Kong Chian School of Medicine (LKCMedicine) — Singapore’s third medical school — opened its doors to the pioneer cohort of 54 students. These students were chosen from more than 800 applicants. This year, interest in the programme was similarly high, with 800 applications for 78 places in the school’s second cohort. Of the applicants, about 300 were shortlisted to undergo Multiple Mini Interviews (MMI), the final hurdle in the enrollment process. The MMI phase ran from 11 to 21 April 2014 at the Nanyang Technological University’s Nanyang Executive Centre. These interviews are a relatively new format of the selection process for an undergraduate medical degree in Singapore. Last year’s inaugural cohort found the scenarios and questions challenging but manageable. During MMI, candidates were sent through eight stations in a timed series of interviews. At each station, each candidate was presented with a scenario which they had two NHG Group CEO minutes to read through. They then Prof Chee Yam discussed the scenario with the Cheng addressing prospective interviewers and answered related LKCMedicine questions. The interviewers included students. faculty members, clinicians and laypersons to give candidates a range of different scenarios to react to. The candidates’ unique responses helped to showcase candidates’ personal qualities and non-cognitive skills, with some questions having no wrong or right answer. The key, according to last year’s


successful candidates, was to consider a variety of perspectives when formulating a response.

MEET-and-greet

As a welcoming gesture, LKCMedicine held a pair of High Tea events in May for prospective students and their parents. About 80 prospects attended the first event, while 30 or so attended the second. The sessions gave the candidates a glimpse of their future lives as doctors-in-training. Besides briefings by LKCMedicine Vice-Dean for Education A/Prof Naomi Low-Beer about “A First Class Education at LKCMedicine”, the students met other senior faculty members. At both tea sessions, Professor Chee Yam Cheng, Group CEO of the National Healthcare Group (NHG), underlined the importance of the prospective students’ roles as Singapore’s future doctors. NHG is LKCMedicine’s primary clinical training partner. Other guest speakers at the two events included LKCMedicine Senior Vice-Dean Professor Jenny Higham of Imperial College London, as well as Professor Freddy Boey, Provost of Nanyang Technological University. On both occasions, a pair of students from LKCMedicine’s pioneer batch gave presentations about the school’s house system, team-based learning, hostel life and ongoing preparations for the inaugural IntroDOCtion — LKCMedicine’s freshman orientation camp to be held in early July 2014. To round off both events, question-and-answer sessions were held, with the LKCMedicine faculty members engaging the students and their families.

Getting The Formula Right A new book gives valuable pointers on managing medication lists and their use.

T

With Prof Chee Yam Cheng (holding book) are (from left) Ms Lin Liang, Ms Monica Teng, Mr Lim Boon Peng, Dr Khoo Ai Leng and Dr Zhao Ying Jiao of NHG’s Pharmacy and Therapeutics Office.

he high cost of new drugs, rising numbers of patients with chronic conditions and a rapidly-ageing population are major healthcare challenges ahead, particularly when it comes to the affordability of healthcare. The most common medical intervention is medication, and the rational use of medication can be achieved through effective formulary management. Formulary management is a combined effort on the part of physicians, pharmacists and other healthcare professionals to promote clinically-sound and costeffective medication therapy and positive outcomes for patients. It is thus an integral part of the patientHealth, the National Healthcare Group Polyclinics and care process. National Skin Centre. Input was also sought from In April 2014, the National Healthcare Group (NHG) the National University Hospital (NUH). Pharmacy and Therapeutics (P&T) Office published a Also included in the book are recommended 156-page book to support formulary management — best practices from reputable international where formulary refers to the list of medications kept in agencies like the National Institute for Health the institution — in public healthcare institutions. and Care Excellence in the United Kingdom, Titled Formulary Management — A Practical Guide, the and professional organisations like the American volume incorporates principles to guide the assessment Society of Health-System Pharmacists. and selection of medication NHG Group that is safe and effective CEO Professor Chee The book incorporates while offering the best value Yam Cheng contributed for money. the foreword to the principles to guide the assessment The guide includes book. He wrote that and selection of medication that is inputs from all NHG the development of the institutions including book is an “important safe and effective while offering Tan Tock Seng Hospital, step towards integrating the best value for money. the Institute of Mental the concepts of health technology assessment into formulary management for evidence-based decision-making”. Head of the NHG P&T Office, Mr Lim Boon Peng, believes that the book is the first of its kind to offer support for healthcare professionals actively involved in managing the formulary. Professor Paul Anantharajah Tambyah, Chairman of NUH’s Pharmacy and Therapeutics Committee says the book is an excellent introduction to formulary management and should be in any pharmacy student’s collection. “It is full of useful references and practical tips which are very helpful to someone starting out in preparing dossiers for formulary reviews and evaluating proposals for inclusions or exclusions to any healthcare pharmacy,” says Prof Tambyah.


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More than just diagnoses National Healthcare Group Diagnostics is about much more than just X-rays and blood tests.

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he National Healthcare Group (NHG) has under its umbrella a number of institutions specialising in different areas. One of these business divisions is National Healthcare Group Diagnostics (NHG Diagnostics), which is the leading provider in primary healthcare for one-stop imaging and laboratory services. These services are available via an extensive network of 25 static imaging and laboratory centres, six professional service centres and seven mobile services around Singapore. The mobile radiography services include general X-ray, mammogram, ultrasound and bone mineral densitometry. NHG Diagnostics also provides teleradiology reporting services (the reading of X-ray images remotely via digital transmission), laboratory and radiology management, and consultancy services in setting up imaging centres and clinical laboratories.

Accessible and Seamless Diagnostic Services

Part of NHG’s mission is to be the Regional Health System (RHS) for the Central Singapore region. The population of elderly people in Singapore is growing, which is necessitating an evolution in the delivery of healthcare across the spectrum from primary to tertiary care. Healthcare in the future needs to become more community-based to cope. By making basic diagnostic services more accessible, NHG Diagnostics minimises the need for patients to visit acute hospitals. Besides relieving some of the burden on hospitals such as Tan Tock Seng Hospital (TTSH, NHG’s flagship institution), this saves patients’ time and travel costs. They are also spared the anxiety and inconvenience of waiting to be seen by a clinician. NHG Diagnostics supports also general practitioners (GPs), community hospitals and nursing homes with basic diagnostic services on-site or nearby. Being conveniently located also reduces results turnaround time for patients. For example, portable ultrasound is available for GPs and polyclinics without on-site ultrasound facilities to offer this service. It can also be used to support home care. NHG Diagnostics supports the Ang Mo Kio Family Medicine Clinic, as well as GPs working with TTSH to provide care for stable patients once they are discharged from hospital. In making diagnostic tests available


The five pillars of

NHG Diagnostics’ services are: Imaging

X-ray, Mammography, Ultrasound

Laboratory

Laboratory testing, Phlebotomy Electrocardiography (ECG) Spirometry

All nine National Healthcare Group Polyclinics are equipped with X-ray, mammography, The latest service to be ultrasound, laboratory offered is Community testing, phlebotomy, Phlebotomy. It allows blood electrocardiography samples to be collected at and spirometry services. community health screening NHG Diagnostics also has events and/or patients’ on-site biochemistry analysers, home for screening and making comprehensive on-site diagnosis purposes. lab tests possible. With 95% of tests processed at four NHG polyclinics, turnaround time has been reduced to X-ray imaging. two hours (down from up to six hours previously) for normal tests. Critical results can be reported within the clinic operating hours for better patient care management. By the end of 2014, more polyclinics in NHG will also have on-site biochemistry analysers.

outside of the hospitals and instead, closer to patients homes, NHG Diagnostics aids the ‘right-siting’ of care.

A Refreshed Mobile Fleet

NHG Diagnostics also operates a fleet of vehicles that provide door-step radiography services such as mobile X-rays, mammography and bone mineral densitometry. These services support community health screening events organised by grassroots groups. The vehicles are also available for corporate health screening exercises, medical support at national events and even health screenings for employers or schools. Within Central Singapore, NHG Diagnostics supports the RHS to provide seamless care. As part of population health management, it performs screening for body mass, blood pressure and vascular screening. The services can also support other RHS’ health screenings for their populations.

Portable ultrasound has been a boon for patients’ convenience. Professional Services.

The medical courier fleet.

Mobile Services

Medical Courier

Professional Services

With its updated fleet of screening vehicles, NHG Diagnostics provides door-step mobile X-rays, mammography, and bone mineral densitometry services. The fleet supports community health screening events organised by grassroots groups. The various vehicles are also available for corporate health screening exercises, medical support at major events and screenings for employers or schools. Portable ultrasound has allowed GPs and polyclinics without on-site facilities to offer this service. It can also be used to support home care.

The Medical Courier service transports specimens from polyclinic laboratories to hospital labs for processing. Specialised equipment are installed in all the vehicles to maintain a cold chain at the right temperature. The service now supports the transportation of medical reports and films to GPs, specimens from external clients and community screening events to labs for processing, and delivery of medication to patients’ homes.

NHG Diagnostics offers professional consultancy services in setting up imaging centres and clinical laboratories.

X-ray, Mammography (Mammobus), Bone Mineral Densitometry, Ultrasound

Lab specimens, Drugs, Medical reports and films

Teleradiology reporting (the reading of X-ray images remotely via digital transmission) Management of radiology and laboratory clinics Healthcare consultancy services

www.diagnostics.nhg.com.sg

The new-look Mammobus.

NHG Diagnostics also operates a fleet of vehicles that provide door-step radiography services such as mobile X-rays, mammography and bone mineral densitometry. Continued on page 46


45

Continued from page 45

YEARS OF SERVICE

Mr Tan Liang Sheng (below) spent his 51 days aboard the SSEAYP ship making friends and learning from other youths from Japan and ASEAN nations. This year’s SSEAYP sets sail at the end of October and will head to Brunei, Cambodia, Myanmar, Indonesia and Japan.

NHG Diagnostics, founded in 2000, has made many improvements to medical diagnostics services. 2004 All nine NHG polyclinics equipped with X-ray, mammography, laboratory testing and ECG. Ultrasound introduced at 3 polyclinics.

2005 NHG Diagnostics introduced

Teleradiology to Singapore. The digital sending and receiving of images made online radiology reading services possible, and reduced the report turnaround time to an hour.

2006 The Mammobus was launched, making it convenient for eligible women to undergo breast screening. It is the first and only mobile mammography unit under the National BreastScreen Singapore (BSS) programme. 2007 NHG Diagnostics implemented

the Laboratory Information System (LIS) which allows electronic transmission of lab orders and results.

2012 NHG Diagnostics launched

Singapore’s first Mobile Bone Mineral Densitometry service.

2006 The Mobile X-ray service was launched, enabling chest X-ray screenings to be performed at workplaces and schools. It has also supported major events like the Youth Olympics and Singapore Grand Prix. 2008 All nine polyclinics were equipped with Spirometry services for testing of lung functions. 2009 NHG Diagnostics’ Medical Courier service was set up to transport blood specimens from polyclinics to hospital laboratories for processing. Specialised equipment is installed in all the vehicles to maintain a cold chain at the right temperature.

2010 NHG Diagnostics implemented

on-site biochemistry analysers, making comprehensive on-site lab tests possible. Turnaround time is reduced to two hours for normal tests.

2013 New portable ultrasound devices

allowed the remaining polyclinics and GPs to offer on-site services.

2014 The latest service is Community Phlebotomy which allows blood samples to be collected at community health screenings and/or patients’ homes for screening and diagnosis.


Sailing through diverse cultures NHGP senior Podiatrist Tan Liang Sheng goes aboard the ship for southeast asian youth Programme.

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rom 28 October to 17 December 2013, Mr Tan Liang Sheng, a Senior Podiatrist from the National Healthcare Group Polyclinics (NHGP), boarded the Japan-registered Nippon Maru ship on an exchange programme with some 300 other young delegates from ASEAN countries and Japan. The vessel sailed from Tokyo to Ho Chi Minh City, Bangkok, Singapore, Manila and Okinawa before returning to Tokyo. Mr Tan was one of 28 Singapore participating youths (PYs) in the annual Ship for Southeast Asian Youth Programme (SSEAYP), sponsored by the Japanese government and supported by the 10 ASEAN countries. Young leaders aged 18 to 30 with a proven track record of youth, community or public service are eligible to join. For Mr Tan, it was an effective learning experience. Recalls Mr Tan, “I participated in a ‘cross-cultural understanding and promotion’ discussion to exchange our views on our individual customs and practices.” But the homestays at each port-of-call were the highlight. Says Mr Tan, “The host families went to great lengths to make us feel at home.” Indeed, the experience made him realise “we often forget to appreciate and affirm the good work of others”. Thus, in May, Mr Tan and other Singapore participants launched a campaign to promote a culture of appreciation among Singaporeans. “The learning experience bears similarities to the Way of Being culture in NHGP. I have learnt to think from a global perspective. I am encouraged to think out of the box in the way I view my work, colleagues and patients, and I respond to their needs as if they are my own. I would encourage my colleagues to apply for the SSEAYP.”

How Good Are You At Reading The Signs? IMH Begins Study On Local Mental Health Literacy.

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ental health issues are often regarded with fear and mistrust by many people. Therefore, finding out just how much most people know about these issues is one of the aims of a study the Research Unit of the Institute of Mental Health (IMH) is embarking on. Mental health literacy has been described as the “knowledge and beliefs about mental disorder which can help in their recognition, management or prevention”, and finding out how literate Singapore is will be key to future health promotion campaigns.

Photo: corbis, Shutterstock

Mind Matters: A Study of Mental Health Literacy is a two-year study that

Poor collective Understanding

Assistant Professor Mythily Subramaniam, Director (Research) IMH and Co-Investigator of the Mind Matters study, said that people generally have a poor understanding of mental illness. “They may not be able to correctly identify disorders, do not understand the causes, and have poor knowledge and misconceptions about the effectiveness of treatment. They are fearful of those perceived as mentally ill and are apprehensive about helping them.” With improved mental health literacy, people will be able to better recognise common illnesses, leading to more timely treatment. The study will also help to identify the conditions that require more public awareness. The research team’s leader, Associate Professor Chong Siow Ann who is also Vice-Chairman Medical Board (Research) of IMH, said that crucial data like gender, education level, religion, race and personal experience with mental

was launched in February 2014. By the time it is concluded, the survey will include the responses of some 3,000 randomlyselected Singapore residents from the three main ethnic groups aged 18 to 65. The $1 million study is being funded by the Ministry of Health’s Health Services This important study will generate Research Competitive Research Grant (HSR CRG). actionable findings that can be used to help Mind Matters will focus specifically on identify and address misconceptions relating five mental disorders: to mental illnesses and treatment.  Major depressive disorder (MDD)  Obsessive compulsive disorder (OCD)  Alcohol abuse illnesses would impact and shape people’s attitudes  Schizophrenia toward such issues. He explained, “This important  Dementia study will generate actionable findings that can be used These five disorders were specifically chosen partly to help identify and address misconceptions relating to because of their prevalence, significant treatment mental illnesses and treatment. Upon completion, we gap, early age of onset and/or their adverse effects on will share our findings with the general public, and also quality of life, as revealed by past studies including reach out to them to improve public awareness.” the Singapore Mental Health Survey, which was a Besides A/Prof Chong and Asst Prof Mythily, population-based survey conducted in 2010. the team is comprised of Ms Janhavi Vaingankar, The latest study will include questions relating to Dr Edimansyah Abidin, Ms Louisa Picco, Mr Boon respondents’ attitudes towards people with mental Yiang Chua and Ms Jenny Tay, all from IMH, as well as disorders as well as their thoughts about seeking A/Prof Kwok Kian Woon from the Sociology Division professional psychological help. of Nanyang Technological University.


47

directory

We’ve made it easy for you to contact or locate us.

National Healthcare Group Corporate Office 3 Fusionopolis Link #03-08, Nexus @ one-north Singapore 138543 Tel: 6496-6000 / Fax: 6496-6870 www.nhg.com.sg

The National Healthcare Group (NHG) is a leader in public healthcare in Singapore, providing care through our integrated network of nine primary care polyclinics, acute care hospital, national specialty centres and business divisions. NHG’s vision of “Adding Years of Healthy Life” is more than just about healing the sick. It encompasses the more difficult but more rewarding task of preventing illness and preserving health and quality of life. As the Regional Health System (RHS) for Central Singapore, it is vital for NHG to partner and collaborate with other stakeholders, community advisers, volunteer welfare organisations and others in this Care Network together with our patients, their families and caregivers to deliver integrated healthcare services and programmes that help in “Adding Years of Healthy Life” to all concerned.

Tan Tock Seng Hospital 11 Jalan Tan Tock Seng Tel: 6256-6011 / Fax: 6252-7282 www.ttsh.com.sg

The second largest acute care general hospital in Singapore with specialty centres in Endoscopy, Foot Care & Limb Design, Rehabilitation Medicine


and Communicable Diseases. It covers 27 clinical specialties, including cardiology, geriatric medicine, infectious diseases, rheumatology, allergy and immunology, diagnostic radiology, emergency medicine, gastroenterology, otorhinolaryngology, orthopaedic surgery, ophthalmology and general surgery.

Institute of Mental Health Buangkok Green Medical Park, 10 Buangkok View Singapore 539747 Tel: 6389-2000 / Fax: 6385-1050 www.imh.com.sg

Specialist mental health services are provided to meet the special needs of children and adolescents, adults and the elderly. There are subspecialty clinics such as the Neuro-Behavioural Clinic, Psychogeriatric Clinic, Mood Disorder Unit and an Addiction Medicine Department. The treatment at IMH integrates evidence-based therapies, supported by the departments of Clinical Psychology, Nursing, Occupational Therapy and Medical Social Work, to provide holistic care for patients. IMH also provides a 24-hour Psychiatric Emergency Service.

National Skin Centre 1 Mandalay Road Tel: 6253-4455 / Fax: 6253-3225 www.nsc.gov.sg

The centre has a team of trained dermatologists to treat patients with various skin problems. To serve patients better, there are sub-specialty clinics for the different skin disorders and laser surgeries.

National Healthcare Group Polyclinics Contact centre: 6355-3000 www.nhgp.com.sg

National Healthcare Group Polyclinics (NHGP) forms NHG's primary healthcare arm. NHGP's nine polyclinics serve a significant proportion of the population in the central, northern and western parts of Singapore. NHGP's one-stop health centres provide treatment for acute medical conditions, management of chronic diseases, womenand-child health services and dental care. NHGP also enhances the field of family medicine through research and teaching. NHGP has also been awarded the prestigious Joint Commission International (JCI) accreditation under the Primary Care Standards. Through the Family Medicine Academy and the NHG Family Medicine Residency Programme, NHGP plays an integral role in the delivery of primary care training at medical undergraduate and postgraduate levels.

ang mo kio polyclinic

Blk 723 Ang Mo Kio Ave 8 #01-4136 Fax: 6458-5664

bukit batok polyclinic

50 Bukit Batok West Ave 3 Fax: 6566-2208

NHG College Tel: 6340-2362 / Fax: 6340-3275 www.nhg.com.sg/college

The unit develops healthcare professionals to their maximum potential so that they will provide quality, cost-effective and safe evidence-based care to patients.

NHG Diagnostics Call centre: 6275-6443 (6-ASK-NHGD) / Fax: 6496-6625 www.diagnostics.nhg.com.sg

National Healthcare Group Diagnostics (NHG Diagnostics) is a business division of NHG. It is the leading provider in primary healthcare for one-stop imaging and laboratory services that is accessible, cost effective, seamless, timely and accurate. NHG Diagnostics supports polyclinics, community hospitals, nursing homes, general practitioners and the community at large via its extensive network in Singapore, Indonesia and Vietnam. Its services are available in static and mobile centres. Mobile services include general X-ray, mammogram, ultrasound, bone mineral densitometry, and medical courier. It also provides tele-radiology service, laboratory and radiology management, and professional consultancy services in setting up of imaging centres and clinical laboratories.

choa chu kang polyclinic

NHG Pharmacy

clementi polyclinic

Tel: 6340-2300 Fill your prescription online: www.pharmacy.nhg.com.sg

2 Teck Whye Crescent Fax: 6765-0851

Blk 451 Clementi Ave 3 #02-307 Fax: 6775-7594

hougang polyclinic 89 Hougang Ave 4 Fax: 6386-3783

jurong polyclinic

190 Jurong East Ave 1 Fax: 6562-0244

toa payoh polyclinic

2003 Toa Payoh Lor 8 Fax: 6259-4731

woodlands polyclinic 10 Woodlands St 31 Fax: 6367-4964

yishun polyclinic

30A Yishun Central 1 Fax: 6852-1637

NHG Pharmacy manages the dispensary and retail pharmacies at all nine NHG Polyclinics. Services include Smoking Cessation Clinics, pharmacist-led AntiCoagulation Clinics and Hypertension-DiabetesLipidemia Clinics, where pharmacists monitor and help patients optimise their medication. Patients may also consult our pharmacists for treatment of minor ailments or for travel

or nutritional advice. NHG Pharmacy also provides comprehensive medicationmanagement services to Intermediate Long Term Care facilities (ILTCs) such as nursing homes. Under the ConviDose™ programme, medication is conveniently packed into individual sachets for patients according to the stipulated quantity and time the pills need to be consumed.

Primary Care Academy Tel: 6496-6681 / Fax: 6496-6669 www.pca.sg

The Primary Care Academy (PCA), a member of NHG, was set up to meet the professional training needs of primary health care professionals in Singapore and the region. PCA aims to be a platform for sharing of expertise and capacity building among community healthcare leaders and practitioners in and around ASEAN.

Johns Hopkins Singapore International Medical Centre 11 Jalan Tan Tock Seng Tel: 6880-2222 / Fax: 6880-2233 www.imc.jhmi.edu

Johns Hopkins Singapore International Medical Centre (JHSIMC) is a licensed 30-bed medical oncology facility located in Singapore, a joint venture between the NHG and Johns Hopkins Medicine International (JHMI). It is the only fully-branded Johns Hopkins facility outside the United States, providing inpatient and outpatient medical oncology care, medical intensive care, laboratory services, hospital and retail pharmacy, general internal medicine and health screenings.

NHG IS THE REGIONAL HEALTH SYSTEM FOR CENTRAL SINGAPORE