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VO L . 5 2 N O . 8 | AU G U S T 2 0 2 0 | M C I ( P ) 0 6 6 / 1 2 / 2 0 1 9
The Courage Adapt to Fight a
to Serve Common Enemy
Stand Up for Singapore:
defending the
nation's health
news
CON T E N T S
Vol. 52 No. 8 2020
EDITORIAL
BOARD
Editorial
04 The Editors' Musings
Editor Dr Tina Tan and Dr Chie Zhi Ying
Dr Tina Tan
Deputy Editor
Dr Chie Zhi Ying Feature
Editorial Advisors 05 The Courage to Serve – Interview
A/Prof Daniel Fung
A/Prof Cuthbert Teo with Prof Low Cheng Hock
Dr Toh Han Chong Dr Ho Choon Kiat
Members
Dr Ganesh Kudva
Dr Lim Ing Haan President's Forum
Dr Jipson Quah 10 Weathering the Storm Together
Dr Tan Tze Lee Dr Tan Yia Swam
Dr Jimmy Teo
Dr Alex Wong
EX-OFFICIOS
Dr Tan Yia Swam 18 Adapting to Fight a Common Enemy
Dr Ng Chew Lip Prof Koh Tse Hsien
EDITORIAL
OFFICE 20 Lessons on Becoming Viral, Migrant
Senior Manager Justice and Activist Burnout
Sarah Lim Dr Sudesna Roy Chowdhury
Assistant Manager
Sylvia Thay 22 Forging Ahead through Fear and
Editorial Executive Infection: From SARS to COVID-19
Daryl Lai Dr Sneha Sharma and Dr Lim Hong Huay
ADVERTISING AND
Council News
12 Highlights from the 26 The Truth about Surgery: Personal
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Email: adv@sma.org.sg 13 Honouring Excellence
PUBLISHER AIC Says
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Opinions expressed in SMA News reflect the
views of the individual authors, and do not
necessarily represent those of the editorial
board of SMA News or the Singapore Medical
Association (SMA), unless this is clearly
specified. SMA does not, and cannot, accept
any responsibility for the veracity, accuracy
or completeness of any statement, opinion or
advice contained in the text or advertisements
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Editor of SMA News. Requests for reproduction
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editorial
Dr Tina Tan Dr Chie Zhi Ying
Editor Deputy Editor
The ongoing COVID-19 pandemic
Dr Tan is a consultant at the Institute has sent shock waves across global Dr Chie is a family physician
of Mental Health and has a special markets and plunged the world’s working in the National Healthcare
interest in geriatic psychiatry. She economy into a deep recession. Group Polyclinics. She enjoys
is also an alumnus of Duke-NUS Amid these difficult times, it is freelance writing and singing.
Medical School. Between work and heart-warming to see Singaporeans She writes for Lianhe Zaobao,
family life, she squeezes time out for from all walks of life stepping up, in Shin Min Daily News and Health
her favourite pastimes – reading a one way or another, to help in this No.1. She can be contacted at
good (fiction) book and writing. crisis. Our healthcare workers have chiezhiying@gmail.com.
risen to the challenges and I salute
their dedication to provide care and
Did you collect your NDP fun pack? comfort tirelessly for all our patients. the Singapore Armed Forces on
I stashed away the items I found In our August issue “Stand how they battled COVID-19 in
useful, like the masks, thermometer Up for Singapore: Defending their respective front lines.
and hand sanitisers, while my the Nation's Health”, in line with Dr Sudesna Roy Chowdhury
kids played with the handheld National Day, we are privileged to also shares more with us on her
flag and stick-on tattoos. Call me have Prof Low Cheng Hock share online translation portal to help
sentimental, but it’s always nice to with us his thoughts on the SARS migrant and healthcare workers
see Singapore flags everywhere and epidemic, the Courage Fund and communicate effectively during
hear National Day songs, at least for the current COVID-19 pandemic. consultations. Last but not least, we
this period of time. As the old saying goes, “Health are grateful to have various doctors
Readers will notice that this issue is wealth”. Only when a nation has share their personal reflections of
is a “feel-good” one, with articles healthy people can we achieve how the pandemic affected them.
that I hope will encourage each economic prosperity and happiness, As we celebrate National
of us in our various settings and and live to one’s fullest potential. Day this year, I feel proud to be
roles, and also promote a sense of We also hear from COL (Dr) Lo a Singaporean and for all that
unity among us in the healthcare Hong Yee, CPT (Dr) Russell Lim, Singapore has achieved as a nation.
community. It is truly in such times MAJ (Dr) Teo Kok Ann Colin and Wishing Singapore a very happy
that we must remember why we CPT (Dr) Tabitha Ang Xue Qi from birthday. Majulah Singapura!
are doing the jobs we do, and
not let disagreements divide us.
So, how was your National Day?
04 AUG 2020 SMA News
FEATURE
1
Courage
The
to serve
Interview with Prof Low Cheng Hock
Interview by Dr Ho Choon Kiat
Prof Low Cheng Hock graduated from the University of Singapore in 1968, followed
by obtaining the Master of Medicine in Surgery in 1972. He began his surgical career
in Changi Hospital before moving to Singapore General Hospital, and has been with
Tan Tock Seng Hospital (TTSH) since 1982. Prof Low was also the President of SMA
from 2001 to 2003, during which The Courage Fund was set up. Today, he continues
to teach and work as Emeritus Consultant, General Surgery in TTSH. Prof Low also
serves on the Board of The Courage Fund, as it continues to provide support and
recognition to those afflicted by SARS, and now by COVID-19.
Living and serving actively session a week at the Ministry of Health, LCH: I think at least 30 to 40% is spent
mainly in the finance department as a on teaching, either teaching medical
Dr Ho Choon Kiat (HCK): Hi Prof, what
surgical MediSave medical advisor. students and post-graduate students
have you been up to since your last
or facilitating hospital staff. I take the
interview with SMA News? I am grateful to my bosses for having
third year and final year students of both
me at this stage of my life, such that I
Prof Low Cheng Hock (LCH): I’ve been medical schools once a week, and I used
can continue to contribute in some way
working part-time for a couple of years. to conduct the "7 Habits of Effective
to the medical scene. It helps to keep
I now work about three and a half days Living" course once a month before the
my mind alert, my body active, and I can
a week in the hospital; this consists of COVID-19 situation.
continue learning even from the younger
two outpatient sessions, and teaching HCK: For the post-graduates, do you
ones. It is important to understand that
sessions for both National University still take the medical officers (MOs)
we can contribute in different ways at
of Singapore Yong Loo Lin School of and registrars?
each phase of our lives. In life, they say,
Medicine and Lee Kong Chian School
“don't worry about growing old, worry LCH: Yes, I still take residents, mainly for
of Medicine. I also facilitate a number
about thinking old.” tutorials. As you would know, we start at
of training courses, such as “Risk
Management”, “Grief Management” HCK: Given that your passion has always 7 am in the mornings.
and “7 Habits of Effective Living” in the been about teaching, what percentage At the moment unfortunately, most of
hospital. Additionally, I also have one of your time is now spent on teaching? these MO and resident training sessions
AUG 2020 SMA News 05
LCH: It’s a very interesting was when the mall started offering
life, and I must thank my discounts to TTSH staff.
2 bosses. Because they allowed This time around, I sense that the
me to go on part-time, I have public is more accepting and people
the free time to do other
are better educated. You go to Novena
things. Keep your mind
Square now and you can see HCWs in
active, otherwise your mind
uniforms as well as members of the
becomes lethargic.
public. Somehow, the public is more
HCK: Do you have any accepting of medical workers and
hobbies? What do you do in they're not so scared, although they do
your free time? take precautions. On the other hand,
LCH: I used to have a lot we HCWs also avoided big gatherings
of hobbies. I liked running, or friends' gatherings, just to not make
swimming and cycling. In anyone uncomfortable. People have
my younger days, I played all been very appreciative of the medical
kinds of games. I'm a jack of all workers and this is something that I'm
trades, master of none. During very happy about, that they're not as
my school days, I also played scared to talk to us. Whereas during
table tennis for the school. SARS, they were very scared.
Nowadays, I try to walk at Most hospitals had their protocol
least two to three kilometres a then, but in terms of TTSH, we only
day. That is actually very easy admitted SARS and emergency cases.
to achieve, because walking All elective cases were completely
from one end of this hospital cancelled. The doctors were then
are done via Zoom. We don't have much to the other is already half a kilometre. At designated to work in alternate teams;
bedside teaching because of everything home, I walk around my estate. one group will take charge of the wards
that's going on. At most, we would only and two weeks later, the next team
take two or three students at one time Learning from epidemics goes in. We took very good precautions
by the bedside. Big group teachings by and we wore N95 masks even when we
HCK: COVID-19 has been the dominant
the bedside cannot be done now. news for the past six months, not just went to the wards. Today, we don't wear
in Singapore but globally. I'm sure it N95 masks unless we are going into the
HCK: Do you still conduct weddings?
has brought back some memories acute ward or the infective ward. Just
LCH: Yes, in the afternoons. Initially, face masks would suffice for the general
about SARS which was the last serious
solemnisations were all cancelled but wards, but we would take all precautions
epidemic to hit Singapore. What do you
now, small gatherings are possible. donning our personal protective equip-
remember of those days?
Because of COVID-19, we have cut down ment when we visited acute wards.
on requests and only allowed very small LCH: SARS was a very challenging time
but our healthcare workers (HCWs) really During SARS, the infected numbers
gatherings. We all have to wear masks
stood up to the test. Not one single staff were smaller but it was more serious
during the ceremony, but when we are
resigned. In that period, Tan Tock Seng for those who got it. We lost quite a few
done with the solemnisation, we can let
Hospital (TTSH) was designated as the people then, including doctors. This time
the couple pull down their masks to kiss
SARS hospital, so most, if not all, of the round, we are lucky. I don't think we have
each other. [Everyone laughs]
SARS patients were warded here. Other lost any HCWs yet, hopefully not at all.
HCK: Prof, it sounds like you still have a But I know in some countries – China and
hospitals only had isolated cases.
pretty busy schedule. America – they have lost some HCWs, we
The major difference between then
LCH: Yes! I still do some volunteer work. are very fortunate in Singapore. And we
and now is that the public was very
Besides volunteering in St John, I also must not let our guard down.
scared of us HCWs during SARS. They did
volunteer with some committees and not like to go near doctors and nurses; HCK: You mentioned losing some
in some homes. I am also on the board if our nurses went out in their uniforms, doctors during SARS. I remember people
of Ang Mo Kio Hospital, and some the public avoided them. It was to the like Dr Alexandre Chao, the cardiology
other homes. extent that Novena Square was empty, MO, and a nursing officer during SARS.
HCK: You say you are getting old, but I almost like a ghost town because This time round, we have been able to
think you are still very young in spirit. nobody dared to come near TTSH. That avoid any fatalities in HCWs so far, either
06 AUG 2020 SMA News
because the disease is less fatal or the LCH: When SARS first started, I was at our first meeting, which I represented
system in place is robust enough. the tail end of my term as SMA President, SMA in and NHG took the lead on it. The
LCH: Our first loss during SARS was and somewhere towards the middle of SMA SARS Relief Fund was absorbed into
the young MO. And then we lost some SARS, we had a handover. But because this new Fund which was renamed The
nursing staff, Sister and some HCWs. It of SARS, we did not have our Annual Courage Fund, to reflect the courage and
was very sad, because they were people Dinner and could not have an official sacrifices our HCWs demonstrated during
whom we knew very well. Alex was handover. We simply handed over the the difficult and challenging times.
actually here until the very end. presidentship to Dr Lee Pheng Soon. HCK: What was the objective of the Fund
Both reasons you mentioned are Two groups of people started talking when it first started?
probably true, but it is also because about the Fund initially. One was here in LCH: In the beginning, The Courage
people are now more caring towards my own department. Dr Ho Choon Hou Fund was meant to just help those
HCWs. Singaporeans on a whole are was a young MO then and he suggested victims and their families financially.
more caring now. It is not just the that we do something for the healthcare But in the months that followed, the
doctors, nurses and HCWs, but the non- victims, to which I said was a good idea. committee sat down and thought
HCWs who are also helping in the front I spoke to SMA Council as well, and the about how we should use the Fund.
line. The policemen, first aiders, food Council was already thinking about Singaporeans were very generous and
delivery workers, they are all front-line it and was thus very supportive. The we began to collect donations into the
workers as well. They have all been very Government was also very supportive. millions. The committee, led by NHG
dedicated, and they are prepared to When we spoke to the Ministry about it, Chairman Mr Michael Lim (followed by
perform their duties despite knowing they said to go ahead. Mdm Kay Kuok who took over from him)
that there is a higher risk. then decided that we should expand
Credit must be given to SMA Council
HCK: Seeing how HCWs have responded the use to help the SARS victims, their
Member Dr Wong Chiang Yin, and
to this crisis, do you find this useful as a families, and their children.
Dr Ho Choon Hou along with his group
teaching material for the young doctors Especially for all the HCWs who died,
of doctors and nurses. These people
in the profession? like Alex and the Sister, their families
were the main initiators. They sat down
LCH: I think, for the young doctors, and they planned how to go about it, were automatically given a promise
whether it's SARS or COVID-19, they and Chiang Yin launched it officially that their children’s education will be
must be prepared to come to the through the SMA. They along with Dr Lee sponsored until tertiary level, either first
front and be prepared to work. Both Pheng Soon were all very active, with the
times, then and now, not a single support of the SMA full-time secretariat
doctor or nurse resigned; not a single staff, in setting up the Fund. They 3
houseman said, “I don't want to do my worked very hard during that first few
housemanship.” But for those who are
days, sending letters and talking to the
coming into this profession, they must
benefactors, and the response was very
open their eyes and know that one never
good. The Singapore Nurses Association
knows. You may have to face unexpected
(SNA) also joined in with SMA, and the
situations, sometimes risky situations,
and you cannot just lay down your tools SMA SARS Relief Fund was born.
and run. Of course, we cannot say that In less than a week, we raised about
for everybody, but I think most, if not all, $700,000. I must say that Singaporeans
of the HCWs and related workers have were very generous and supportive. And
been quite courageous and supportive. around that time, the two healthcare
They themselves work hard, and that is systems – SingHealth and
very important. National Healthcare Group 4
(NHG) – were also thinking
Setting up The Courage Fund about raising funds and
HCK: You mentioned the word they approached me about
"courageous", that brings us to The combining our efforts. So the
Courage Fund. The Courage Fund has idea was then mooted, to
again resurfaced now with COVID-19. I get NHG, SingHealth, SMA,
know that you were intimately involved SNA and the Singapore Press
in the setting up of the Fund. How did it Holdings to jointly form a
come about? new entity. We then had
AUG 2020 SMA News 07
graduate degree or polytechnic diploma. LCH: I think that is very good, because during this COVID-19. They have worked
And that is still ongoing until today. Most these are manpower and they are all very, very hard and they bring back
of their children have either finished or prepared to help. There should be no memories of those who sacrificed
entered tertiary education, and all the distinction between public and private, their time, sweat and lives during the
money came from this Fund. everybody can help, and I like seeing SARS period.
Secondly, the money was also used that. Having said that, we have to extend Our HCWs and those front-line
to finance infectious disease-related it to normal circumstances as well essential people are truly our heroes,
programmes, whether they were for and that is more challenging. I hope I salute them. To our young doctors,
conferences or to invite speakers. We also to see more partnership between the nursing staff and all HCWs, these are my
helped with some post-graduate studies. private and public sectors, to tap on the suggestions to them.
expertise in the private sector. There are
The third thing that we expanded so many infectious disease (ID) experts First, when you join healthcare
to was The Courage Fund Healthcare in the private sector, even beyond just professions, be prepared to face difficult
Humanity Awards. At first, it was only times and challenges. You never know.
ID, we should tap on them, so that we
for HCWs; those who not only worked This is not going to be our last epidemic;
become a nation for healthcare, with
as a doctor or a nurse, but have done in the next 20 or 30 years, there may be
everybody’s help. The private sector
something special. We awarded to some more to come – we cannot be sure.
doctors can come to hospitals to help in
about 40 to 50 people in the first year, So, when you enter the profession, you
normal times as well. Whether it's public
all of whom were nurses, doctors, HCWs must be prepared.
health specialists, or surgical specialists,
and front-line workers that have taken or medical specialists, as long as these Second, healthcare is sometimes in
extraordinary steps to serve the people. private practitioners have something a live danger zone. Even for this current
Some years later, we expanded the to contribute, we should use them in period, every doctor, except old men
award to carers – people caring for sick like us, have been posted and rotated to
the Government service. It makes lives
people, and also volunteers. So today, the front line. Even surgeons and heads
more interesting, and it is also beneficial
this Humanity Award is given not only to of departments have to do MO jobs and
for doctors who teach and train, so it
HCWs, but also to carers and volunteers conduct screenings. I really salute them.
helps both ways. I hope to see more
in healthcare service.
interaction and blurring of line between As I said, one of the best things in
private and government sector. We don't life is to be able to stoop down and lift
Stepping up in times of need have a perfect system yet, but I think we people up. In the service of medicine,
HCK: I'm not sure if you find it encoura- should emphasise on it. healthcare gives you that opportunity to
ging, but there's this initiative called the HCK: Perhaps COVID-19 will be the be able to help people up. To the young
SG Healthcare Corps asking for volunteers catalyst for this kind of close partnership doctors and nurses, I will tell them that
to return and join the public service to between private and public. it's better to serve than to be served, and
combat COVID-19. Many ex-nurses and it's more magnanimous to share than
doctors in the private sector volunteered LCH: I agree, absolutely! SARS and to keep. After all, the heart of medical
and came back to serve. COVID-19 will help us to blur the line, education is the education of the heart.
and as you mentioned, there are already Knowledge makes you a doctor, but
LCH: I think that's very good, because many nurses and doctors helping in
there's a lot of potential out there. Nurses it's compassion and empathy practised
the dormitories and specialists helping through the SARS and COVID-19 period
who are semi-retired or doing part-time
in those centres, so why not? Expand that makes you a healer.
work and HCWs doing part-time, even
that to normal times as well, so that the
those with nursing background who
whole of Singapore can benefit. It's not HCK: Prof Low, thank you once again for
may have entered other fields, we must sharing your insights with SMA News.
about you or me, it's all of us together as
tap on their experiences and bring them
healthcare service. Legend
back. Many have been very helpful in
coming back, but more can do so. When 1. Prof Low and Dr Ho pose for a shot during
it comes to such times, we should blur
Parting words of wisdom the interview
HCK: As someone who worked through 2. Prof Low and Dr Alexandre Chao (who
the line between public and private sacrificed his life during SARS) with Dr
service. I also know of some young the SARS crisis and now going through Benjamin Chew, the first doctor to administer
private GPs who volunteered to work in COVID-19, what parting words of wisdom the injection of penicillin in Singapore
the dormitories and in the community do you have for doctors who are now 3. Prof Glen Tan, a head of department who,
care facility at Expo. facing COVID-19? like many others, stepped in to help with MO
work during these challenging times
HCK: There are private specialists who LCH: I must say, I am totally impressed 4. Our doctors who continue to work in this
signed up as well. and encouraged by our front-line workers challenging climate
08 AUG 2020 SMA News
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Had not taken up similar clinic assistant position in their past career
PRESIDENT’S FORUM
weatherinG
Together
the storm
Text by Dr Tan Yia Swam
Illustration: Dr Justinian Zai
Every August, we celebrate Singapore’s premiums and tighten up definitions? of my area of practice. Do approach
independence. This month, SMA News Healthcare economics is beyond my your professional body (be it the SMA,
focuses on “healthcare defence” and I training and understanding, but I can Academy of Medicine, Singapore or
have three key topics to address: appreciate the complexity of the problem. College of Family Physicians Singapore)
1. Health insurance It is not going to be easily solved. and share your discussion points,
Off the cuff, I can summarise some concerns and proposals. Within SMA, the
2. Defence against dissension private practice committee is looking
key points that we (all stakeholders)
3. Strength in unity into this matter, but the committee
collectively should acknowledge
members are limited by time and
and discuss:
Health insurance breadth of knowledge of the problems.
a. Right-siting of care If you feel strongly about an issue, let’s
I have been aware of the issues with team up and reduce unnecessary overlap
b. Allow patients the freedom of choice
insurance companies and third-party of work.
administrators (TPAs) (read more at c. Education about the different access
https://bit.ly/SMAnews4808) since to healthcare (subsidised vs private
Defence against dissension
I joined the council in 2007. In the care in restructured hospitals, private
past year, after I stepped into private hospitals, or even overseas specialist My Facebook friends would have read my
practice myself, I have heard even more care) post in early July, about two social media
first-hand accounts. Many people have events that have directly affected me.
d. Respect fellow colleagues: in
strong opinions about the problems the appropriate remuneration of The first was a claim on WhatsApp
and some have proposed solutions. The services rendered and Telegram that the “SMA President”
challenge is, as always, in getting the wanted a survey done. We managed to
various stakeholders to the table for e. Understanding the different
track down the originator, who stated
amicable discussions.1,2 components of healthcare costs –
that it was misunderstood by other
hospital bills contribute a significant colleagues and he sent out a separate
As a consumer and a customer myself, I proportion as well
am dismayed by the unilateral insurance- amendment. The SMA also sent out an
related changes that took place in the f. Role of private practice in reducing email blast to inform our Members.
past months: by my provider in terms the load on restructured hospitals The second was also spreading
of premiums and coverage, and by the I am aware of several interest on Telegram, stating that the “SMA
whole industry in re-defining “critical groups gathering momentum. This President” will take action if “20
illness”. It seemed unfair, but I forced kind of ground-up initiative is deeply members” write in. The two friends
myself to look at the global problem. appreciated, as I need to know the who posted this were gracious
What caused the need for them to raise troubles faced by doctors outside in acknowledging that they had
10 AUG 2020 SMA Newscopied it from another forum. The for one another? I frequently hear how up personal time – time that could
originator later also apologised for the “SMA never does anything”, which is perhaps have been better spent with
misunderstanding. not what I have experienced in the family. Many of us continue serving
I am relieved that both incidents had Council. The amount of volunteer on the Council because we believe in
happy endings. Honestly, I don’t see any time that Council doctors, and all the serving our medical community, and
prevention nor defence against social other committee members (SMA News, we will put in the time. So, "asking SMA
media misrepresentation. I can only Singapore Medical Journal, Centre for to do something" isn't as easy as it
ask friends, acquaintances and SMA Medical Ethics and Professionalism, sounds. I have pondered this problem
Members to give me the benefit of the Special Interest Groups, CPR, etc) have for years and that is why, since I took up
doubt and seek the truth for yourself. put into the weekend events, night leadership in mid-April, I have actively
meetings, afternoon meetings and invited people to help by giving their
I have stated a few times since the time, energy and brains in sowing the
engagements with the Ministry of
start of COVID-19 in Singapore that seeds of change.
Health and other stakeholders, is not a
our greatest enemy is “fake news” –
small amount of time. The office bearers To my dear SMA Members, thank you
whether intentional or misguided. Let’s
of the other professional bodies have for your support. I hate to sound like a
think critically as we receive each piece
also sacrificed a lot of time to advocate loan shark, but please remember to pay
of information.
in different areas. the membership fees! The money goes
a. Is this a fact or an opinion? to paying the staff who support all the
People keep asking for “SMA” to solve
b. If
it’s a fact, what is the source? Is the problems. Who makes up the SMA? After different projects we do. For those who
source reliable? I was elected to be President, people are not yet members, I hope that I can
c. it’s an opinion, should I pass it on? Or started coming to me directly with show you what the SMA stands for and
should it stop here? complaints. I found myself considering: have you join the SMA in due time.
should I brush these complaints aside? It’s a time of change.4 Come help us
Finally, if unsure, ask the originator.
Why should it be MY problem to solve? make these changes stick. Be the change
Here are some fictional statements Well, I figured, the price of leadership that you want to see.
for you to read through, and to practise – holding office (even if it’s an unpaid
the skill of critical and logical thinking on: position that others may not want) – is
“TYS scolded me once when I was her that it IS indeed my problem now. The
house officer. She is a nasty woman.” doctors who attended the Annual
General Meeting unanimously voted for References
“I think TYS must be pregnant, because she
me for the post of the SMA President. 1. Ministry of Health. Comparison of integrated
looks like she put on weight.” shield plans. Available at: https://bit.ly/398Vs3L.
How could I let them down?
“TYS posted a photo with some guy 2. Life Insurance Association Singapore. Health
recently, I heard they are dating.” But I, alone, cannot do it all. Even the Insurance. Available at: https://bit.ly/2Zs2TQc.
Council, the 20 of us, cannot do THAT
I hope that the readers here are 3. BBC. Reading: Fact or Opinion. Available at:
much. Systemic problems need system https://bbc.in/2ZrSHXY.
discerning and can see how a statement changes. And system changes need
of fact coupled with an opinion can easily everyone to be on board.
4. Tan YS. A Time of Change in the World and SMA.
be taken to be factual. Being a netizen SMA News 2020; 52(5):8-9.
who gets most of my information from In the past decade serving on the
online sources, I am also continuously SMA Council, I have observed that
developing this essential skill.3 how active SMA is also depends on the
dynamics of the actual people serving.
More seriously now, whenever we Dr Tan is a mother to three kids,
Allow me to share again, what the 20
read any comments or articles that relate wife to a surgeon; a daughter
doctors in the SMA Council actually do: and a daughter-in-law. She
to healthcare, let’s not merely react,
We meet once a month, 9 pm to 12 trained as a general surgeon,
but be critical readers. We have a lot
and entered private practice
of real problems to try to sort out, and midnight, to review and run through a a year ago, focusing on breast
we should not be distracted by poor long agenda of various matters. When surgery. She treasures her
reporting, sloppy writing, or just plain we need things done, it is still the same friends and wishes to have
laziness which may place quotations out 20 people doing. These may involve more time for her diverse
of context. At this time, more than ever, meetings, drafting letters and projects. interests: cooking, eating,
music, drawing, writing,
the healthcare community must stand Most of these issues will need to be photography and comedy.
united – do not let third parties cause carefully managed over the subsequent
internal strife. Keeping an open line of weeks or months, with follow-up emails,
communication is key. meetings and calls.
Doctors in private practice need to
Strength in unity take time out from clinical work (to put
We use the hashtag #SGunited, but it bluntly, this means loss of income),
are we really? In our own medical and doctors in restructured practice
community, are we truly looking out may need to take leave. Everyone gives
AUG 2020 SMA News 11council news
From the Honorary Secretary
Report by Dr Ng Chew Lip
Dr Ng is an ENT consultant in public service. After a day SMJ 2019 impact factor rises
of doctoring and cajoling his two princesses at home to 1.359
to finish their food, his idea of relaxation is watching
a Netflix serial with his lovely wife and occasionally
throwing some paint on a canvas.
We are pleased to announce that
the journal impact factor of the
Singapore Medical Journal (SMJ)
for the 2019 citation year is 1.359,1
SMA statement on MOM advisory on COVID-19 testing up from 1.141 for 2018. The SMA
Council extends our heartiest
We have received several emails from Members who have expressed concerns congratulations to SMJ Editor-in-
about a speech made by Minister Lawrence Wong on 5 July 2020, in response Chief A/Prof Poh Kian Keong, the
to Prof Paul Tambyah’s comments made on 3 July 2020 on the Ministry of Editorial Board and the secretariat
Manpower (MOM) advisories on the testing of migrant workers. The comments for this notable achievement. We
and speeches by both Minister Wong and Prof Tambyah are now available on wish the journal every success
the internet. as it seeks to expand the body of
The SMA serves to uphold the image of the profession and to represent scientific knowledge in medicine
you in matters that concern you. In this matter, following your feedback, through publishing high-quality
the Council and Secretariat have conducted our due diligence and fact research for the benefit of doctors
finding, including speaking with some of you who have written in, and also and patients.
considering first-hand accounts and comments of doctors working in A&E
departments and in the National Centre for Infectious Diseases made to
Council Members. Rental relief framework
We are heartened by the statement made by the Director of Medical
Services (DMS), A/Prof Kenneth Mak, on 7 July 2020, in which he detailed the SMA recently received feedback
events and reasons that led to the issuance of advisories on migrant workers and queries regarding the rental
by MOM prior to the outbreak in the migrant worker dormitories. DMS gave relief framework.
a clear explanation of the reasons why the advisories were issued. The We recommend for SMA Members,
statement can be viewed at https://bit.ly/3083yoQ. who are tenants, to check the Ministry
Today, information dissemination is rapid and, unfortunately, often of Law web page below for details on
piecemeal. Providing clear and complete information is the best form of eligibility, duration of relief, amount
public communication, and that is exemplified by DMS’s statement. The SMA of relief, protection from legal or
stands for justice and fairness for the medical profession and our patients. enforcement proceedings, etc.
In all matters relating to professional image, we will spare no effort in Link: https://bit.ly/2CfjDBm.
determining and propagating the truth. In this matter, the SMA Council feels
that the matter is appropriately settled with the explanation from DMS on the
roles of the Ministry of Health and the medical profession on the advisories,
Reference
and nothing further from the SMA needs to be added.
1. Clarivate Analytics. Web of Science Journal
We encourage you to actively participate in the SMA, and to invite your Citation Reports 2020.
friends and colleagues to join the Association. We need more active members
who can volunteer your time and talents to help steer the profession through
a time of challenges and rapid changes. A larger and more active membership
gives you, our profession and patients a stronger voice.
Link to sign-up here https://bit.ly/SMAregistration and if you have a
membership query, do send them to membership@sma.org.sg.
This SMA statement can also be found online at https://bit.ly/30eL46j.
12 AUG 2020 SMA Newscouncil news
The Long Service Medal
Excellence
A/Prof Choolani, Mahesh A
Head & Associate Professor
Department of Obstetrics & Gynaecology
Yong Loo Lin School of Medicine
National University of Singapore
The 61st SMA Council warmly congratulates our Members Adj A/Prof Bernardine Woo Siew Choo
Senior Consultant, Developmental Psychiatry
who are recipients of the National Day Award 2020. Institute of Mental Health
National Healthcare Group
Dr Helen Leong Soh Sum
Family Physician-Sr Consultant, Clinical Services
The Meritorious Service Medal A/Prof Wong Merng Koon
National Healthcare Group Polyclinics
A/Prof Benjamin Ong Kian Chung Head, Department of Orthopaedic Surgery
Senior Consultant, Division of Ambulatory and National Healthcare Group
Immediate Past Director of Medical Services
Outpatient Care Surgery
Dr Gowri Doraisamy
The Public Administration Medal Sengkang General Hospital
Director, Family Physician, Senior Consultant
Singapore Health Services, MOH
(Silver) Care Integration
Dr Lew Yii Jen Dr Paul Goh Soo Chye National Healthcare Group Polyclinics
Chief Executive Officer Director, Polyclinics Development National Healthcare Group
National University Polyclinics Senior Consultant, SingHealth Polyclinics
National University Health System A/Prof Yong Khet Yau Vernon
Singapore Health Services, MOH
Senior Consultant, Ophthalmology (Eye)
Ministry of Health (MOH) Tan Tock Seng Hospital
Dr Kurugulasigamoney Gunasegaran
Senior Consultant, Cardiology National Healthcare Group
The Public Administration Medal
National Heart Centre Singapore
(Silver) (Military) Singapore Health Services, MOH
Dr Benjamin Ho Choon Heng
COL (Dr) Benjamin Tan Boon Chuan Senior Consultant
Chief Air Force Medical Officer A/Prof Tan Thuan Tong Respiratory and Critical Care Medicine
Headquarters Air Force Medical Service Head, Department of Infectious Diseases Tan Tock Seng Hospital
Republic of Singapore Air Force Senior Consultant, Division of Medicine National Healthcare Group
Singapore General Hospital
A/Prof Lim Wee Shiong
The Public Administration Medal Singapore Health Services, MOH
Senior Consultant, Geriatric Medicine
(Bronze) Prof Hsu Pon Poh Tan Tock Seng Hospital
Asst Prof Eu Pui Wai National Healthcare Group
Deputy Chairman
Chief Clinical Informatics Officer / Senior Consultant
Medical Board (Surgical Disciplines)
Institute of Mental Health Prof Goh Boon Cher
Assistant Chairman, Medical Board (Clinical
National Healthcare Group, MOH Group Chief Physician Leadership & Organisation
Development & Performance Excellence)
Development Officer / Senior Consultant
Dr Meena Sundram Chief, Department of Sleep Medicine, Surgery
Department of Haematology-Oncology
Director, Family Medicine Development and Science
National University Hospital
Family Physician, Senior Consultant Advisor, International Liaison Unit
National University Health System
National University Polyclinics Senior Consultant
National University Health System, MOH Otorhinolaryngology - Head & Neck Surgery Dr Yong Wei Sean
Changi General Hospital Senior Consultant / Deputy Chair
Clinical A/Prof Gerald Chua Seng Wee Singapore Health Services, MOH Division of Surgery & Surgical Oncology
Vice Chairman, Medical Board (Clinical Education) National Cancer Centre Singapore
Senior Consultant, Department of Medicine A/Prof Aaron Wong Sung Lung
Singapore Health Services
Ng Teng Fong General Hospital Head & Senior Consultant, Cardiology
National University Health System, MOH National Heart Centre Singapore Dr Michael Wang Lian Chek
Singapore Health Services, MOH Head/ Senior Consultant
A/Prof Peter George Manning Division of Radiation Oncology
Vice Chairman, Medical Board for Clinical Risk A/Prof Jack Tan Wei Chieh
National Cancer Centre Singapore
Management & Medico-legal Head, Cardiology
Singapore Health Services
Emeritus Consultant Sengkang General Hospital
Department of Emergency Medicine Deputy Head & Senior Consultant, Cardiology A/Prof Ching Chi Keong
National University Hospital National Heart Centre Singapore Senior Consultant, Cardiology
National University Health System, MOH Singapore Health Services, MOH National Heart Centre Singapore
Singapore Health Services
Prof Wong Hee Kit The Commendation Medal (Military)
Senior Consultant, University Spine Centre LTC (NS)(DR) Norhisham Bin Main A/Prof Josiah Chai Yui Huei
Department of Orthopaedic Surgery Head Medical Operations Cell Head / Senior Consultant
National University Hospital Headquarters 9th Division Neurology (TTSH Campus)
National University Health System Support Command National Neuroscience Institute
Professor, Department of Orthopaedic Surgery Singapore Armed Forces Singapore Health Services
Yong Loo Lin School of Medicine
National University of Singapore, MOH Dr Ong Wai Choung
The Public Service Medal Senior Consultant, Department of
Dr Quek Lit Sin Dr Eugene Shum Jin-Wen Gastroenterology and Hepatology
Deputy Chief Executive Officer / Vice Chairman Member Division of Medicine
Medical Board (Clinical Governance) South East CDC Singapore General Hospital
Senior Consultant, Emergency Medicine Singapore Health Services
Ng Teng Fong General Hospital Dr Patrick Goh Oon Leng
Group Chief Emergency Medicine Chairman A/Prof Ruban s/o Poopalalingam
National University Health System, MOH National Anti-Doping Advisory Board Chairman Medical Board, Medical Board
Senior Consultant, Department of
Adj A/Prof Chew Min Hoe Dr Tan Yew Oo Anaesthesiology
Chairman, Division of Surgery Board Member Division of Anaesthesiology &
Director, Operating Theatre Management Unit Singapore Health Services Perioperative Medicine
Senior Consultant, Department of Surgery Singapore General Hospital
Sengkang General Hospital Singapore Health Services
Singapore Health Services, MOH
This list may not be exhaustive. If we have inadvertently omitted the name of any recipient, we sincerely apologise for the oversight.100
HR=0.62
progression-free survival (%)
90
(95% CI, 0.49, 0.78; POPINION
S
eek
ave
erve
on Elves, Sisyphus and Gandhi
Text by COL (Dr) Lo Hong Yee, CPT (Dr) Russell Lim, MAJ (Dr) Teo Kok Ann Colin
and CPT (Dr) Tabitha Ang Xue Qi
Colonel (Dr) Lo has been Introduction Over the past few months, I visited
serving as Chief of Medical areas affected by the pandemic. I saw
As I drank from the tap, I thought about
Corps since 11 October the people at the water works, keeping many little elves in action; from public
2019. He is a general
a close watch in real time, and about and private sectors, from hospitals,
surgeon by training, but polyclinics and ministries, from the
much of his work now is the pioneering work that put fluoride
into our water.1 It prompts me to think Singapore Armed Forces (SAF),
focused on public health
and people development. about things that happen While We Singapore Civil Defence Force and the
He takes a keen interest Were Sleeping,2 so that in the morning, Singapore Police Force. They came, did
in medical education things work. their work without fanfare and left each
because he was taught by place a little better than they found it.
many inspiring teachers. Like the shoemaker who left pieces
of leather in his workshop and woke up This is an invitation to peek at three
to find a perfectly made pair of shoes, I such little elves. One from the Army who
am curious about the many little elves was thrown into the deep end, to set up
working tirelessly away from the public a hitherto unheard-of “swab isolation
eye, keeping COVID-19 infections at bay. facility (SIF)”; another from the Navy,
Ostensibly, this article is about pre- plucked from his neurosurgical residency
paredness in the healthcare community and plunged into the world of isolation
for such crises. Truth is, swooping in like at a “community care facility”. The third,
the cavalry is glamorous. Preparedness from the Air Force, reminded us that
is not. Preparedness is endless hours of despite COVID-19, other medical
menial, repetitive, and often unnoticed emergencies, including those on
and unappreciated work. This article is a the high seas, continue unabated.
tribute to the many who are involved in Each accomplished much by way of
the business of preparedness. preparedness and rose to the occasion.
AUG 2020 SMA News 15Isolated in place, yet united transforming the idyllic resort at Civil nights were spent fine-tuning
against adversity Service Club @ Loyang into a full- processes on the ground and
fledged SIF, ready for battle. gathering information.
CPT (Dr) Lim: The concept was elegant
– swab all suspect cases, house them SIFs bore the brunt of isolation Our efforts bore fruit, and SIFs
in Quarantine Order-level facilities, patients, with hundreds arriving by mushroomed throughout the island,
then disperse them based on swab the busload daily. They came from modelled after our processes. I am
results. The execution was anything dormitories, hospitals and clinics immensely proud of our medics and
but. Cherryloft Resorts was set up with island-wide. It was a challenge being the Army’s efforts in safeguarding our
plans to be operational by week’s end. commander, doctor, counsellor and nation from this invisible threat.
But with burgeoning spikes in cases, liaison officer all in one. Handling
the call was issued to stand up Loyang anxious, unstable patients, food
Captain (Dr) Lim currently serves as
by day three. and security concerns made SIF Brigade Medical Officer, 3rd Singapore
Constant readiness ensured that management uncertain and stressful. Infantry Brigade and Staff Officer, Centre
logistics, manpower and support Daily, even hourly changes to policy of Excellence for Soldier Performance.
meant that ground processes had to He was awarded the SAF Medicine
was prepared within half a day, Scholarship in 2013. He served as
be updated frequently, sometimes Commander of CSC@Loyang SIF, and
with incomplete information – a real Deputy Head HQ SIF. He was subsequently
challenge when wearing personal deployed in CCF@Expo as Deputy Head
protective equipment (PPE). The Medical Operations Cell.
experience harkens back to house
officer days when one’s phone would
be ringing constantly – from superiors,
peers and employers requesting for
information. Unfortunately, the volatile
situation meant that answers were
Russell in action anything but certain. Many sleepless
Standing on the shoulders of In the COVID-19 “fog-of-war”, we had
Harvey Cushing to draw clear boundaries for safety,
be punctilious with our processes and
MAJ (Dr) Teo: I have been inspired by
engender trust in our men through our
senior neurosurgeons to mould myself
decisions.
in the likeness of Harvey Cushing – the
father of modern neurosurgery – as the Similar to Cushing’s fight in the
epitome of excellence in medicine. I “Battle of Boston Common”,5,a we faced
anticipated similarities in our journeys, challenges mobilising our fight for
featuring obsessions with the pituitary. preparedness. While Cushing’s solo
Colin briefing Senior Minister of State Dr
However, I never imagined being effort failed, “we” as a team succeeded.
Maliki Osman on the automated Vital Signs
thrust into the command team for “We” comprised Tri-Service (Army, Monitoring station
the “field hospital” effort at the SAF Navy and Air Force) Full-time National
Community Care Facility (CCF) @ Expo3 Servicemen, Regulars and Operationally
Major (Dr) Teo currently serves as Head,
in the fight of my generation against Ready National Servicemen who Medical Doctrine and Training Branch,
COVID-19, just like Cushing did in stepped forward on the back of earlier Navy Medical Service, the Republic
World War I of his generation.4 deployments (within SAF and/or in of Singapore Navy. He assumed the
public hospitals) and readily threw appointment of Hall Commanding Officer
When the call of duty came, we in CCF@Expo as part of SAF’s efforts
our weight behind our teams to keep
were ready to serve at short notice. against COVID-19. He is concurrently
each other motivated and focused on Senior Resident in Neurosurgery at the
But the realities of the challenges that
the tasks ahead, as well as our partner National University Health System. He
lay ahead were daunting. Mission also holds post-graduate qualifications in
agenciesb who provided the resolute
success meant providing a robust Underwater Medicine.
“tail” to our “teeth”.
standard of care to patients while
achieving zero safety incidents, I may never be as accomplished as
including zero healthcare-acquired Cushing in my lifetime, but I consider
infections. Leading the team in the myself far more privileged to have
“trenches”, we needed to provide witnessed our sense of common purpose
our men with the information, and commitment to the nation’s defence
training and resources to succeed. play out before my very eyes.
16 AUG 2020 SMA NewsFlying over seas – one life saved milestone. I have always felt that
women are given equal opportunities
CPT (Dr) Ang: I had just taken over
the Search and Rescue (SAR) duty to serve in all roles in the SAF. For
from my colleague on 8 June 2020, that, I am truly honoured for the
when the call came for the day’s opportunity to serve in 1 Medical
duty team to respond. A severely ill Squadron, to be able to provide
individual on board a commercial medical assistance to people in
vessel within our flight information distress out at sea and ensure the
region had radioed for medical help. continued safety of our aircrew as
they take to the skies.
I was filled with both excitement The Search and Rescue team
and apprehension. This was my
maiden SAR mission. It was also Captain (Dr) Ang currently serves as
hand what team excellence was – the Operations Officer, 1 Medical Squadron,
the first time the newly developed collective desire to ensure mission Republic of Singapore Air Force. She holds
COVID-19 protocols would be carried success and safety outcomes, from both a post-graduate Diploma in Aviation
out in a live SAR mission. Prior to this, the medical professionals and aircrew, Medicine. She was awarded the SAF
we had identified the risk areas when was evident. It was no surprise that Medicine Scholarship in 2012 and joined
conducting winching operations and the Air Force Medical Service in 2018.
the SAR mission was completed safely,
medical resuscitation on board a without much fanfare.
helicopter, while in full PPE. We
recognised that performing a When I was informed that I was
helicopter-medevac was already the first female medical officer to be
challenging, and doing it in full PPE involved in a SAR operation for the
makes it a lot harder. Throughout Republic of Singapore Air Force, I was
the preparations, I witnessed first- pleasantly surprised at this significant
Conclusion
References Notes
The reward for their good work is more 1. National Institute of Dental and Craniofacial a. The “Battle of Boston Common” was Harvey
work. Some people see it as a curse, like Research. The story of fluoridation. Available at: Cushing’s effort in rallying national support for
Sisyphus, but I see it as merely our lot https://bit.ly/30xx1J9. military medical preparedness in the US prior to
– eternal vigilance, as a way of life. Not World War I. He faced significant challenges in
2. Hemenway D. While We Were Sleeping. Success
a siege mentality per se, but certainly mobilising support for this need, and considerable
Stories in Injury and Violence Prevention. Berkeley:
public outcry for his efforts in attempting to
not resting on our laurels. At the time of University of California Press, 2009.
exercise the setup of a field hospital in a large
writing, there is neither a second wave of 3. Lim MZ. 100 soldiers from SAF Medical downtown park known as Boston Common.
infections nor the prospects of a repeat Corps deployed to care for COVID-19 patients While the setup never happened, he was widely
circuit breaker. Crossing fingers doesn’t at Singapore Expo. Available at: https://bit. credited for facilitating the US military’s medical
ly/3fLT5X2. preparedness going into World War I.
work, preparedness does.
4. Doyle NM, Doyle JF, Walter EJ. The life and b. Examples of partner healthcare agencies
And to our healthcare colleagues work of Harvey Cushing 1869–1939: A pioneer of include Woodlands Health Campus and
who toiled in the past months and many neurosurgery. J Intensive Care Soc 2017; 18(2):157-8. SingHealth.
who are still facing the drudgery of the 5. Rutkow E, Rutkow I. Harvey Cushing and the c. The Singapore Armed Forces Medical Corps was
pandemic work, it is cliched but certainly battle of Boston common: military medical founded in 1967. Its motto is “Seek Save Serve”, a
timely and timeless to quote Gandhi: preparedness for World War One. Ann Surg 2010; testimony to the men and women who did exactly
“Every worthwhile accomplishment, 252(1):191-8. that over the years.
... has... a beginning, a struggle and
a victory.” We cannot decide the
beginning, nor are we ever confident
of the victory, but we can certainly own
every bit of the struggle.
Seek Save Serve.c
AUG 2020 SMA News 17ADAPTing TO
OPINION
A
fiGHT common
enemy Text by Prof Koh Tse Hsien | Photos by Department of Microbiology, Singapore General Hospital
On 31 December 2019, our associate now know that it is precisely because universal masking guidelines, it probably
consultant Dr Karrie Ko posted a Reuters many people experience mild (or no) was not a bad move.
report on the microbiology department symptoms that this virus is so successful
The Department of Microbiology was
junior doctors WhatsApp chat – “Chinese at spreading. This article gave the first
largely spared the initial flurry of activity.
officials investigate cause of pneumonia hint that if many people got infected,
However, it soon became apparent that
outbreak in Wuhan.” It didn’t elicit an there would be enough very sick
our molecular pathology colleagues
immediate response. At that time, most patients presenting in a short time to
overwhelm a healthcare system. were rapidly getting swamped
of us did not even know where Wuhan with work. Immediately after Lunar
was, or that it had a population of over New Year (28 January), we decided to
11 million. It all seemed very remote. Ramping up
deploy our microbiology trainees to
My regular tea-buddy is from the Every Friday morning, the Singapore help them. It was an easy decision to
Department of Molecular Pathology. infectious diseases community meets make. This was a once-in-a-lifetime
Through January, the Wuhan pneumonia at one of the larger public hospitals to (hopefully!) opportunity for the trainees
situation cropped up regularly in discuss interesting cases. On 7 February, to participate in a national effort during
our discussions. If there was a need we met virtually on Zoom for the first a pandemic of historic proportions.
to diagnose this new disease by time to discuss some of the earliest Whatever experience they acquired
polymerase chain reaction (PCR), his COVID-19 cases. We have not met would still be very relevant to their
department would bear the brunt of in-person since. training. So far, they have assisted in
testing. Even back then, they were the evaluation of three automated
already deciding on the choice of swabs, SARS-CoV-2 PCR test systems, and
and stockpiling reagents in anticipation the validation of pooled samples and
of future shortages. They detected the different swabs. They also assisted
first COVID-19 case in Singapore on 23 in data collection and statistics and
January 2020. At that time, I was just reporting of SARS-COV-2 results.
concluding a carefree holiday in Kyushu,
Japan. My wife said that there was a
noticeable change in my mood when
I got the news. I could tell from my
WhatsApp chats and work emails that
the hospital was mobilising, as if for war. The following day, the infection
prevention team required all staff to
On 6 February, my tea-buddy sent me wear masks in the laboratory. This
an article reprinted in the Straits Times seemed strange as we were not patient-
from Caixin Global titled “Reporter’s fronting, and we have been handling
Notebook: Life and death in a Wuhan all specimens in biosafety cabinets
coronavirus ICU”.1 Up till then, I still to reduce risk of infection since SARS
harboured illusions that this could be in 2003. I half-joked that this was to
a relatively mild illness like H1N1 in protect us from infecting each other. Above, Dr Kenneth Goh is seen
2009; in fact, the initial cases did not I don’t know if this was indeed the performing an evaluation of a SARS-
seem to be as bad as SARS. However, we original intention, but in light of present CoV-2 PCR test.
18 AUG 2020 SMA NewsYou can also read
