Dover Park Hospice – Every Moment Matters 2017

EVERY MOMENT MATTERS DOVER PARK HOSPICE

1992 - 2017

Care is more than just medicine.

A leader and authority in Palliative Care, offering the highest standard of holistic care for our patients and their families.

Dover Park Hospice was founded in 1992 as a secular, non-profit organisation to meet the growing need in Singapore for hospice care for terminally-ill patients. It is Singapore’s first purpose-built hospice, designed to provide a serene environment close to nature.

Our two co-founders, Dr. Seet Ai Mee and Dr. Jerry Lim, persuaded a group of pioneer Volunteers to assist. Today, Volunteers continue to play an integral role in all aspects of hospice work from patient care to social activities and administrative support. They are an important complement to the permanent staff, working together for patients and their families.

Open to everyone regardless of age, race, religion or income level, Dover Park Hospice is dedicated to meeting the unique physical, emotional and spiritual needs of those who are nearing the end of life’s journey. The goal is to enhance the living, comfort the dying and support the grieving with compassion and dignity.

At Dover Park Hospice, Every Moment Matters. Since opening its doors to the first patient in 1995, we have brought care and comfort to more than 8,500 terminally-ill patients and their families through a programme of active and compassionate service.

2017 marks our 25 years of service to the community. With this book, we celebrate the vision of our pioneers; the contributions of our volunteers, donors, staff and Council members; and most importantly, the precious moments shared with our patients, caregivers and families.

Vision To be a Centre of Excellence for Palliative Care Services, Education and Research Mission To provide comfort, relief of symptoms and palliative care to patients with advanced diseases regardless of age, race or religion, and to support the grieving families

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M A K E E V E RY M O M E N T M AT T E R

The Dover Park Hospice logo features two forms—the Circle of Life and the Dove.

The Circle represents the passage of life—the trials and experiences from a life well-lived; a wisdom and certainty that come with age; a personification that death is but the natural completion of life’s cycle.

Significantly, the Circle is not enclosed, allowing the Dove to soar free from the Circle and take flight towards another realm, full of hope and dignity. A subtle shadow in the background hints at the care and compassion that has supported this journey.

A series of artistic brushstroke blends three key colours—Teal, Sky Blue and Dove Grey to form images depicting the Circle and Dove, signifying the graceful transition into timeless serenity.

Teal A symbol of trust, dedication and healing.

Sky Blue Evokes a sense of grace and peace; also brings to mind the “limitlessness” of a blue sky Dove Grey This warm neutral grey is associated with tranquility and timelessness; suggests of a peaceful state of being

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Making it our business to care.

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We cannot add days to life, but we can add life to days. — Dame Cicely Saunders, Founder of the modern hospice movement

TA B L E O F

CO N T E N T S

M A K E E V E RY M O M E N T M AT T E R

04 Foreword by the Chairman 05 Milestones 09 1. New Beginnings 21 2. Care 51 3. Community 83 4. Future 88 Acknowledgments

Copyright Š Dover Park Hospice 2017 All rights reserved; no part of this publication may be reproduced, stored in a retrieval system, transmitted in any form, or by any means, electronic, mechanical, photocopying, recording or otherwise, without the prior written permission of the copyright owner.

Designed by XXX ISBN: XXX

Printed by XXX

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F O R E WO R D B Y

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Prof Lionel Lee Chairman, Governing Council

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1992 DPH founded by Dr. Seet Ai Mee and Dr. Jerry Lim. In November, Dover Park Hospice was registered as a charity in Singapore

1995

Construction work on the 40-bed residential building was completed in August and DPH began admitting patients in September Dr. Rosalie Jean Shaw appointed as Medical Director of Dover Park Hospice (DPH) and DPH started operations on 19 September 1995 DPH’s first Charity Golf Tournament, was held on 26 November 1995, at Raffles Country Club The Skal Club and PATA Chapter (travel industries organisation) helped DPH organised “The Golden Ball” at the Shangri-La Hotel Ballroom, on 20 December 1995

1999

“An Autumn Love Story,”a Chinese Opera dinner helped DPH raised more than $300,000 in October

2001 DPH started its very own Memorial Service, “Rose for Remembrance,” as a meaningful way for bereaved families, caregivers, nurses, doctors, and volunteers, to remember patients who have passed away and seek closure together

2004

Ms. Sylvia Lee Ling Ling received the “Inaugural Healthcare Humanity Award,” in recognition of her contributions to Palliative Care Nursing

M I L E S TO N E S

1993

In June, DPH’s ground-breaking ceremony was held at 10/12 Jalan Tan Tock Seng, with then-President Wee Kim Wee as Guest-of-Honour

1996 First volunteers outing, organized by Mrs. Ong Kim Ling, Founder of the Emerald Group

1997

19 April Official opening of the Hospice Centre and DPH by then-Deputy Prime Minister & Minister for Defence, Dr. Tony Tan Keng Yam DPH was the lead agency for Singapore’s first Hospice Awareness Week, organised by the Singapore Hospice Council

2000

A novel fundraiser, “BCCS Millenium Charity Walk,” organised by the Board of Commissioners of Currency, Singapore, required participants to raised $10,000 each from their sponsors. The Walk, benefiting DPH and the Singapore Red Cross, entitled 17 participants to participate in a walk to Huangshan from Shanghai. More than $151,000 was raised

2002

DPH officially joined the Asia Pacific Hospice Network (APHN) in January. The Hospice celebrated its 10th Anniversary with a Celebration Open House and Food Fair, with then-Prime Minister, Mr. Goh Chok Tong, as Guest of Honour

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2006 DPH became the first in-patient hospice to be accredited for the Palliative Medicine Sub-Specialty Education

2010 Commencement of the MOHH ILTC Innovation Programme to integrate DPH as part of the national Electronic Medical Record In October, planning started for upgrading of DPH to meet increasing and evolving palliative needs in rapidly-ageing Singapore; an Alteration & Addition team comprising representatives from DPH, DP Architects Pte Ltd, and Sunray Woodcraft Construction Pte Ltd, was established to manage the project In line with its upgrading plans, DPH embarked on a brand consultancy search for a new logo and tagline to reflect the new direction that the Hospice was moving towards

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2005

Singapore Soka Association Volunteer Group members began offering befriender services and visiting for coffee sessions with the patients every first and third Sunday of the month

Staff Nurse Sarojini Ponnampalam received a 2005 Healthcare Humanity Award

Ms. Sylvia Lee Ling Ling awarded the prestigious “President’s Award for Nurses”

2009 2011

In February, President Dr. Tony Tan Keng Yam became DPH’s Patron DPH was again acknowledged with the National Volunteerism & Philanthropy Award, for Best Volunteer Management System DPH entered into partnership with National Cancer Centre and Ngee Ann Polytechnic to develop the Specialist Diploma in Palliative Care Nursing Dr. Ong Wah Ying, then-Associate Consultant for DPH, presented the Healthcare Humanity Award (2011) by then-President S. R. Nathan, in May DPH started providing free Wi-Fi to patients and their families.

It created its very own Facebook page on 13 June DPH Volunteer Group, EMERALD, received the President’s Social Service Award in the Informal Group Category from then-President S. R. Nathan, at the Istana, on 2 August DPH obtained license to operate an additional 10 beds (total of 50 beds) after an expansion renovation in September DPH started its 24–hours Home Palliative Care Service and debuted its new, revamped corporate logo that is still in use In December, DPH implemented the National Electronic Health Record (NEHR) which allowed acess to patients’ records across institutions and care settings, resulting in cost savings, facilitated care integration by eliminating duplication of unnecessary tests

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2012 In January, then newly-appointed Health Minister Gan Kim Yong opened DPH’s new wing and announced the Ministry of Health’s plans as part of the National Strategy for Palliative Care in Singapore In March, DPH received a grant from Community Healthcare Fund for the development of Home Care Services, and started Home Care Services for referrals from Tan Tock Seng Hospital. Also established a multi-disciplinary Home Care team consisting of resident physicians, nurses, medical social workers, admin and operations personnel DPH launched the Nursing Specialist Diploma in Palliative Care with the National Cancer Centre and Ngee Ann Polytechnic. It also collaborated with Lien Centre for Palliative Care (LCPC) to organise the inaugural End-of-Life Nursing Education Consoritum (ELNEC) International Curriculum and Train-the-Trainers Workshops in Singapore

2017

Construction work on the new Dover Park Hospice, started after 21 March 2017, following the ground-breaking of the Integrated Care Hub (ICH) site. The ICH, located within HealthCity Novena, will open in 2022. The new facility will bring family-friendly care and comfort to terminally-ill patients One DPH staff member and two DPH Volunteers were presented with the HHA Awards in April, for the following categories: For Home Based, Centre Based and Residential ILTC/Social and Community Care Services, Intermediate and Long-Term Care (ILTC) Category - Ms. Chin Soh Mun (Head of Nursing) Volunteer Category - Ms. Marlene Foo (Volunteers Committee Chairperson) and Mrs. Ong Kim Ling (Leader of the DPH Volunteer Group - Emerald)

M I L E S TO N E S

2013

Then-Resident Physician Dr. Karen Liaw awarded The Courage Fund-Healthcare Humanity Award, presented

by President Dr. Tony Tan Keng Yam in April

2014 The Hospice started a 3–years pilot initiative, Programme Dignity for Advanced Dementia, funded by Temasek Foundation Cares

2016

In August, DPH IT started improvement works on the Integrated Hospice Management System (IHMS) processes, followed by an enhancement of the Hospice’s Network Infrastructure, implementing a two-tier firewall protection protocol, which can prevent internal services on its Local Area Network (LAN) from hacking and attacks from the perimeter firewall, in November Dr. Ong Wah Ying, who rose from the ranks at DPH, appointed as Medical Director of DPH in September

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The entrance to Dover Park Hospice at 10 Jalan Tan Tock Seng, 2017

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NEW BEGINNINGS For the past 25 years, this three-storey red-brick building has stood quietly at Jalan Tan Tock Seng, its koi pond, garden and cream-coloured corridors a familiar sight for many patients, their families and friends.

Visit it on any given day, and you might hear the chatter of volunteers and patients preparing for their weekly outing; the rattling Happy Hour trolley packed with free drinks and snacks; pianists playing popular hits from the 60s; or even the occasional excited bark of visiting therapy dogs.

It is the life within its corridors that continues to make Dover Park Hospice (DPH) a place of vibrance and warmth, even as it provides care and comfort to patients in their last days.

The Vision DPH first opened its doors to patients in September 1995, but its story begins much earlier.

In the 1950s, as a young houseman in a Chronic Sick and Geriatric Unit in Edinburgh, Scotland, Dr Jerry Lim was part of a team of doctors who looked after 120 beds for chronic sick rehabilitation and terminally ill patients. He saw the importance of a special unit for palliative care, and this conviction stayed with him for the next few decades of his practice as a family doctor in Singapore.

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In my family practice, I occasionally looked after patients who were terminally ill and required 24-hour medical and nursing care—but unfortunately, logistically I could not supply that myself.

Then in 1988, my late wife passed away from cancer. Although we had an excellent team of doctors, none of them had the specialised skills and training in palliative care. Traditional medical training ended with the provision of medical care, and it lacked the human aspect of empathy and compassion. So again, the seeds of wanting to start something like a hospice were planted.

In 1990, while on vacation in New Zealand, I met a close friend’s wife who was a nurse from South Auckland Hospice, and I was invited to visit her workplace. When I went there, people were having a birthday party with beer, wine and cake, they were singing songs and someone was playing on a piano accordion. I said to myself, this isn’t a place of death, with doom and gloom—this was truly a celebration of life!

I was so impressed with the happiness and cheerful ambience that prevailed there.

Coupled with the experience of managing my late wife’s terminal illness, I was convinced that this type of hospice must take root and grow in Singapore.”

— Dr Jerry Lim, Co-founder of Dover Park Hospice

But Singapore was not ready. Palliative care was not yet a priority for the Ministry of Health, which was busy improving other aspects, such as the quality of general hospitals, outpatient clinics, and child and maternal healthcare.

Nevertheless, there was a growing demand for end-of-life care, and by the late 1980s, some ground-up efforts had sprung up to care for patients in their last days. In 1985, 16 beds in two rooms were set aside for terminally

ill patients at St Joseph’s Home for the aged. Resources were scarce, and they had only two nurses and a part-time volunteer doctor, who were not able to provide 24hour care.

In 1986, in an article titled “In Singapore, a place to die peacefully”, The Straits Times reported on St Joseph’s work while keeping them anonymous, so that they would not be overwhelmed with requests for help. Instead, The Straits Times called for volunteers, and received offers from 144 people after the article was published.

“In Singapore, a place to die peacefully” (at TOP Right corner article of Straits Times )

- Excerpt from Page One of The Straits Times, Tuesday, 1 July 1986 Courtesy of The Straits Times

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By 1987, this pool of 144 volunteers grew to provide the first volunteer home hospice care, which become the Hospice Care Group (then housed with the Singapore Cancer Society), and later independently registered as the Hospice Care Association in 1989.

At the same time, other nursing homes also started setting aside beds for the terminally ill, such as Assisi Home in 1988, and Agape Home and Hospice in 1989.

THE FOUNDING OF DOVER PARK HOSPICE In 1991, the hospice movement gained a burst of energy through the efforts of Dr Seet Ai Mee, who was persuaded by Dr Jerry Lim and then-Permanent Secretary of Health, Dr Kwa Soon Bee, to support hospice work—and specifically to start a new inpatient hospice.

Together with Dr Lim, Dr Seet threw herself into the project that eventually became DPH. It was a massive whirlwind effort. By 1992, Dr Seet, as the first Chairman of the DPH Council, had gathered a volunteer Council and fundraising Committee, registered DPH as a charity in November 1992, hired its first staff, liaised with Ministries, and secured an office and land space.

NEW BEGINNINGS

Dr Jerry Lim, my general practitioner and a very good friend, had returned from a visit to a hospice in New Zealand and was very impressed by the work there. He rang me up and said ‘How about doing hospice work?’

I had not made up my mind whether to work on a nursing home or hospice or something else, so I prayed and thought about it. I consulted the thenPermanent Secretary of Health, another good friend of mine, the late Dr Kwa Soon Bee. In his wisdom, Soon Bee came up with two reasons why I should pick hospice work. The first was I am a Christian, so the taboo and superstition of death does not exist for me. The second reason he gave was, ‘Because you are you’. Dr Kwa told me that I was a very passionate but impatient person, and that an aged home is a very long slow process of degeneration.

With a hospice, the timeline is shorter, you do the best for them and you just carry on.

So I picked up the phone one morning and phoned Jerry, and said, “Okay Jerry, it’s hospice, I will work on it.’ And that’s how the whole thing started.”

— Dr Seet Ai Mee, Co-founder of Dover Park Hospice

But things were far from smoothsailing. When news first broke in October 1992 that DPH would be built at Dover Road, people protested, with a barrage of appeals to the Urban Redevelopment Authority and letters to the press.

In those days, the term “hospice care” still conjured images of ‘deathhouses’ along Sago Lane—a space

considered depressing, unhealthy and inauspicious, because sick people were left to die, surrounded by funerals on a regular basis.

Rather than fight against the public uproar, the Ministry of Health quietly allocated another plot of land to DPH by end 1992—this time, at Jalan Tan Tock Seng.

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NEW BEGINNINGS

Mourners playing mahjong outside ‘death houses’ at Sago Lane, 1962. Photo credit: National Archives of Singapore

Residents at one of the ‘death houses’ at Sago Lane, 1950s.

Photo credit: Singapore Press Holdings

In those days, we were looking at the UK hospice model—most of them are between 5 and 28 beds. You don’t really want to have anything larger than 40 beds otherwise it will become a death house, you will have people dying everyday. But LTA said, you must be joking, you can’t get land for 40 beds, nothing less than 200 patients.

So the Ministry of Health officer, I think it was Dr Clarence Tan, asked, how many patients does HCA look after? I said, in our first year, 250 patients; in about 2 to 3 years’ time, 500 patients. So he said, we’ll put you together with DPH and we can justify the land. So we shared the land; the land title actually goes through the fish pond.

We formed a joint building committee, which was represented by both organisations, and designed the building together, without duplicating anything. For example, DPH doesn’t have any kitchens to cook food; the kitchen is in HCA in the daycare. DPH didn’t have large training rooms, because we had an auditorium at HCA. And that was how we ended up where we are right now.”

— Dr Cynthia Goh, HCA’s founding President and DPH Council member from 1992-1993

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NEW BEGINNINGS

Adjacent to Tan Tock Seng Hospital (TTSH) and formerly the carpark of the National Skin Centre, this new plot of land was now the blank drawing board for architect Mr Ernesto Bedmar, who had to discard his initial designs at Dover Road, and design a new Hospice Centre housing both DPH and HCA Hospice Care (HCA). Like the Council members, he too was volunteering his services as a way to contribute to the community.

To ensure his design would best fit the hospice’s needs, Mr Bedmar observed and spoke to nurses from the Assisi Home on several occasions, studied local hospitals, visited hospices in Australia and Europe during his personal travels, and regularly discussed design iterations with Dr Seet Ai Mee and Dr Cynthia Goh. It was an intense six months of hard work and study to inform his creative process.

Proposed design for DPH, hand-drawn and coloured by architect Mr Ernesto Bedmar, 1993

Gradually, the design of Singapore’s first purpose-built hospice took shape. To reflect the individual but complementary functions of DPH and HCA, he designed separate entrances, but with a bridge to link the two buildings on a higher level.

And weaving in his love for nature, gardens and water features, Mr Bedmar designed a brick building

It is the last moments for the patients. Whether it is for a few days, or several months, we wanted to create a building that enriched the lives of its residents. Given the limited time left to experience the world, we wanted to ensure that the patients’ last days were spent not only in physical comfort, but also in spiritual and emotional wellness.”

— Mr Ernesto Bedmar, DPH architect and volunteer

with greenery, a central courtyard, pavilions and a koi pond for patients, families and visitors to enjoy. Besides their aesthetic value, these features also brought good ventilation, openness and lots of natural light to the hospice, allowing patients to have a good view of nature outdoors.

Every six to eight weeks we would have a meeting with one of the doctors, the architect, myself and the quantity surveyors, and as we finished the job, it became more frequent because there were more things to discuss. Like the finishes to the building—what colour are we going to paint this wall? Do we want some timber rails along that wall or this wall? Do we need a slight change in orientation of the baths, so people could walk in and sit down, or be lifted in and sit down?”

— Mr John Sanderson, DPH building project manager and volunteer

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BREAKING NEW GROUND After the building design was finalised, the Ground-Breaking ceremony was held at Jalan Tan Tock Seng in June 1993; it would take another two years for construction to be completed.

Meanwhile, DPH operated out of a small room in the Home Nursing Foundation at 26 Dunearn Road. It had only enough funds to hire one full-time administrative officer—Ms Jeanthi Arunasalam, so the bulk of the work was done by volunteer Council members—accountants, lawyers, doctors, PR professionals, engineers, teachers, nurses and many others who gamely rolled up their sleeves, and devoted hours each week to plan the hospice from scratch.

Ground-Breaking ceremony of the Hospice Centre on 5 June 1993. This was attended by Guest-of-Honour President Wee Kim Wee, Council members of DPH and HCA, and guests from other hospices.

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At the Dunearn Road office, I was the only staff.

There were no fancy things; I was still using the manual typewriter for months until someone donated a computer to us. The Council meetings would normally be held after 7pm, till 8 or 9pm, but I still looked forward to going back to work at 7am the next day. I enjoyed it because it was something new and worthwhile.”

— Ms Jeanthi Arunasalam, DPH administrator from 1993-2008

NEW BEGINNINGS

I advised Dr Seet, Dr Jerry Lim and Dr Cynthia Goh that DPH should register as a society and write a Constitution. So we had to discuss details like who the members would be, whether votes would be by majority, how many to form a quorum, so my assistants and I could write these terms into the Constitution.”

— Mr Tang See Chim, DPH Council member from 1992-1998

It was an exciting start-up environment, and the Council members met regularly after work to sort out all the details—managing the construction; putting in accounting and administrative systems; organising fundraisers and public outreach events; managing donations; setting up medical, audit and hiring processes; gathering and training volunteers; and even writing the Constitution for DPH.

A meeting at the DPH office at 26 Dunearn Road, to organise a charity golf tournament

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One major decision was about whether DPH should have any religious affiliation.

The other inpatient hospices in Singapore were affiliated to churches or temples, although they took in patients of any religion. But to ensure that patients of different religions would feel welcome, the Council unanimously agreed that DPH was to be a secular hospice, the first and only one of its kind in Singapore.

Dover Park is a secular hospice, but it’s not aspiritual. Secular means that we do not subscribe to one individual religion, but if patients want, we try to arrange for the priest or counsellor to come— could be Catholic or Christian, Muslim, Buddhist, or Hindu. I also want to build a volunteer force of chaplaincies from the different religions so that the end-of-life care is total care.”

— Professor Lionel Lee, DPH Council Chairman from 20092011, 2013-Present and DPH Council member from 1994-1996, 20052009, 2012-2013 The building of DPH: a work in progress

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The building of DPH: a work in progress

Over two years, the steady construction of the building mirrored the setup of DPH’s administrative processes. When the Hospice Centre was finally completed in August 1995, DPH was ready to admit its first patients a month later.

By August 1996, all wards were fully operational—the planning was done; the work of DPH had finally begun.

Soft opening of DPH in November 1995

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The Official Opening of the Hospice Centre and Dover Park Hospice

It was a Saturday morning, 19 April 1997, at Jalan Tan Tock Seng. The air was filled with excited chatter, hearty congratulations, speeches and performances, as a crowd of Council members and well-wishers thronged the new Hospice Centre. This was the official opening of DPH, and to loud cheers, the Guest-of-Honour Dr Tony Tan released a dove to mark that moment.

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NEW BEGINNINGS

L-R: ??, Dr Elsie Yu, Mrs Wee Kim Wee, President Wee Kim Wee, Dr Reggie Thein, Dr Seet Ai Mee, Dr Tony Tan

To celebrate the official opening, a bimetallic sculpture “Flight to Peace” was also created and donated by Dr Elsie Yu, and installed in the garden adjoining the koi pond.

DPH Council Chairman Dr Seet Ai Mee later wrote in the 1996/1997 Annual Report that “we are the only hospice I know of with an original sculptured work of art in our garden!”

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CA R E When DPH was first registered in 1992, palliative medicine was still barely understood; in fact, it would take another 14 years for it to be recognised as a medical subspecialty in Singapore.

Under such challenging circumstances, it took a special kind of person to join its ranks: people with a heart for caring for the terminally ill, who were also keen to forge new paths in a new field.

The first medical professional to join DPH was Dr Moses Yu. He was Dr Seet Ai Mee’s former boss at the Singapore General Hospital Pathology Department, and also a good friend of Dr Jerry Lim; together, they persuaded him to join DPH as its first Medical Director on 1 June 1994. While he was not trained in palliative care, he was an experienced leader, bringing much wisdom, compassion and a patient-centric focus to the fledgling organisation.

Dr Moses Yu with DPH staff at a Christmas Party in the Hospice

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CA R E

We needed a Medical Director, otherwise we wouldn’t have been able to register as a hospice with the authorities. So with the help of Dr Goh Keng Swee, who was also a great friend of Dr Moses Yu, we persuaded Moses to take on the post as our very first Medical Director. Every month, he would receive his salary—and generously give it back to us as a donation.

He was that sort of man, very revered and loved in the hospice.”

— Dr Jerry Lim, Co-founder of Dover Park Hospice

Of course, DPH also needed an experienced palliative care physician to take the helm. Dr Rosalie Shaw was at that time already a well-known palliative care physician who had started a hospital-based palliative care unit in Perth, Australia. From 1989, she had been running three-month residential courses on palliative care, and through these courses, had met Singaporeans from HCA and St Joseph’s Home.

One thing led to another: these Singaporeans connected her to Dr Cynthia Goh, then-Chairman of HCA, who managed to persuade Dr Shaw to come to Singapore in April 1992 to professionalise HCA. A few months after her arrival, Dr Shaw was then roped into discussions with Dr Seet Ai Mee, Dr Cynthia Goh and Dr Jerry Lim about what would later became DPH. Intending to stay in Singapore for only a year, Dr Shaw would eventually also join DPH as its Medical Director—and stay in Singapore for the next 18 years.

I came to Singapore in April 1992, and it was only a couple of months later that meetings started about the idea of a hospice was which secular, not based on race or religion or money. It would be for the people. It was a very exciting prospect!”

— Dr Rosalie Shaw, DPH Medical Director from 1996-1998

Drs. Koo and Dr Rosalie Shaw

From 1996 to 1998, Dr Shaw was Medical Director at both HCA and DPH, often juggling the day shifts at DPH and night calls from HCA, while managing both organisations. It was a gruelling schedule, and she did it with an incredible amount of passion and energy.

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In the early days when Dr Rosalie Shaw was running DPH, I was there as a locum. We didn’t have a computerised patient management system where you can input details of the patient and churn out reports for admission, discharge—so she wrote it using DOS. Whatever there wasn’t, she built.

I was very inspired by her because not only was she an incredible clinician, she’s what we call a multi-disciplinary team rolled into one—she was a nurse in the past, a teacher, administrator, and fantastic communicator. She taught me that you don’t need language to be able to communicate, because many of the people she was communicating with did not speak English. But she knew how to connect with people across social stratas, across language and countries.”

— Dr Noreen Chan, DPH CEO & Medical Director from 2004-2009

There are wonderful stories about how we got the right people. One day, a nursing matron walked up the stairs of the outpatients’ headquarters at Dunearn Road, which is also where the DPH office was. Dr Moses Yu saw her and said, what are you doing? She said, I am just coming up to sign my retirement papers. So Moses said, you are going to retire? You still got so much energy, come and work with us! So that’s how we got our first Nursing Director—Grace Lim, a very caring and unusually energetic lady.

Dr Rosalie Shaw was then HCA’s Medical Director, and when I asked her if she would come and also help us start up Dover Park Hospice, she agreed. So I approached HCA to ask. The President of the HCA Council was Dr Sethi, and the Council decided that they would ‘lend’ Rosalie to us for the start-up year. Dr Sethi, who is a radiotherapist, took one year of no-pay leave to work in HCA as the Medical Director, so Rosalie could come across to us.”

— Dr Seet Ai Mee, Co-founder of Dover Park Hospice

The initial public uproar and switch in location from Dover to Novena also turned out to be a blessing in disguise.

DPH’s proximity to TTSH and other healthcare organisations meant that it was now able to use their services, be supported by their doctors, and grow in partnership with the healthcare community at Novena.

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When Dr Rosalie Shaw stepped down, I became the Medical Director at DPH. Dr Shaw had established a very big service, and organised both DPH and HCA, so it wasn’t easy to fit into her shoes! But she had laid down the infrastructure, and she was still around guiding the nurses and doctors, so that allowed me more free time to do other things in DPH. I think it was Dr Jerry Lim who was keen to bring out a more academic flavour for DPH, so we started running structured training courses for doctors and medical students, creating scholarships for overseas training, and thinking of ways to develop palliative medicine into a recognised specialty. We also talked to the Dean of the medical school, and started rotating medical students to the hospice for exposure.

One of the things we thought was very important was to be recognised in terms of academic work. At that time we had doctors who were rotated to us six months each time, and I tried to make everybody publish something in an academic journal. I just guided them on how to collect data and identify things that they could write on, and help them to put it in print— so they eventually published.”

— Professor Koo Wen Hsin, DPH CEO & Medical Director from 1998-2004

Prof Koo Wen Hsin

Also in the early DPH team was Nursing Director Grace Lim; part-time Registrar Dr Robin Bowman who set up much of the medical documentation and pharmacy procedures; Senior Registrar Dr Jim Ng; and Dr Pang Weng Sun, consultant from TTSH, who shared the on-call roster with the other DPH doctors.

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We used TTSH to supply DPH with various services, medication and manpower. We arranged for medical officers to be posted to the Department of Geriatric Medicine, and then sent to DPH on rotation; some consultants also did part of their training at DPH, and volunteered to be on call coverage.”

— Professor Philip Choo, Group CEO of National Healthcare Group, DPH Council member from 1994-1998

We found it hard to retain and attract medical staff in DPH, because the restructured hospitals have a career structure where they get consultancy, interaction with academics, they can write up cases, interact with people of different disciplines—we can’t match them.

So Lionel Lee, Jerry Lim and I sat down with Lim Suet Wun, CEO of TTSH to discuss this issue. We eventually did this matrix where someone from TTSH will help out DPH while they are still part of TTSH, to solve DPH’s difficulty of retaining a Medical Director.”

– Professor Tay Boon Keng, DPH Council Chairman from 2007-2009, DPH Council member from 2000-2006

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NATIONAL ACCREDITATION FOR PALLIATIVE MEDICINE When DPH was registered in 1992, palliative medicine was not accredited as a medical subspecialty in Singapore, nor part of the undergraduate curriculum.

This was, as described by Dr Jerry Lim in his 2000/2001 Chairman’s Message, a chicken-and-egg situation: there were not enough palliative care specialists in Singapore, so it was hard for palliative medicine to be accredited as a medical subspecialty—but if palliative medicine was not accredited as a medical subspecialty, few doctors would end up training or working in this area.

In spite of this lack of recognition, the DPH Council stood firm by its belief that palliative medicine was much needed for Singapore.

For years, they pushed hard on many fronts: for palliative medicine to be recognised as a medical subspecialty; for undergraduates, doctors and nurses to have structured exposure and training in hospices; and for doctors and nurses to be given opportunities for training overseas.

Slowly but surely, their hard work paid off. In 2002, the National University of Singapore Medical Faculty agreed to include palliative medicine in their undergraduate curriculum. The DPH doctors and Registrars also gave lectures to medical and nursing students, and DPH itself offered fellowships for doctors and nurses to be trained overseas.

Recognition grew, and finally in 2006, 14 years after DPH’s registration, palliative medicine was officially recognised as a medical subspecialty in Singapore, and DPH became the only inpatient hospice to be accredited as one of the training centres.

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DPH nurses Elf Chiang, Pa Pa Tun and Mya San Kyi were among the first batch of graduates from the Specialist Diploma in Palliative Care Nursing.

This new part-time diploma was launched by DPH in conjunction with the National Cancer Centre and Ngee Ann Polytechnic in 2012.

LEARNING FROM THE PATIENTS

I started a hospice programme for the undergraduate dental curriculum. 99% of our curriculum focuses on their hands and head, but we need to develop their hearts too, or rather to keep their first love, the heart.

The programme evolved from giving students a professional exposure and training for the terminally ill patients, to include having heart-to-heart talks about humanity and the meaning of life, and letting students have a first-hand experience interacting with patients. Then I encourage them to share what meanings they have obtained in this hour’s interaction with different patients.

Once, the students started singing to a patient, they were songs he liked. Halfway through, he said, ‘Stop singing!’ We were surprised.

Then he said ‘Don’t sing! Stop! Don’t sing! But sing with your heart!’

And that sent a message to the whole group. We’re supposed to live every day with our hearts, and not just go through the motions of take the test, pass the exam, get the degree, have our luxurious lifestyles, and close our eyes to needy people and simple things.”

NUS dental students at a DPH visit in 2017 Photo courtesy of Assoc. Prof. Stephen Hsu

— Associate Professor Stephen Hsu, Faculty of Dentistry, National University of Singapore

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A HOLISTIC APPROACH The pioneer DPH team set in place the holistic, patient-centric care that would set the tone for years to come.

They felt it was important that the staff care not just for the patients’ medical and physical needs, but also their emotional, psychosocial and spiritual needs—because these needs are often intertwined.

Over the years, DPH staff and volunteers have often gone the extra mile to care for patients, whether it is bringing them their favourite food or item, or even helping to organise family gatherings and special events.

When a patient wants a bird, Dr Moses Yu will go and search everywhere for the bird, bring the bird with the cage. Even fish he will buy and put in the fish tank. He will do everything nicely and send to the patient.

He’s such a nice man.”

— Ms Joyce Lee, DPH Assistant Manager, Patient Affairs and administrator from 1996-Present

Then-Resident Physician Dr. Vincent Tai and Staff Nurse Sarojini Ponnampalam with a patient

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There was one time we helped to organise a Malay wedding here. The mother was in critical condition, but she wanted to see her daughter get married, so we had the solemnisation at the HCA auditorium and then helped to prepare some ‘makan’ after that for their family.”

— Mr Agus bin Othman Muhammad, Leader of Diamond Volunteer Group from 1996-Present

The late Madam Maimon’s last wish was to see her daughter get married—but she was too ill to go home to attend the wedding, so the wedding was held at DPH, with the help of staff and volunteers.

DPH patient Mdm Tung Gek Lang and her partner Mr Goh Chye Thiam exchanged marital vows at DPH with friends and family in attendance. Her patient ward was converted into a bridal suite by the clinical team and staff for this special day.

Photo courtesy of Sui Naing

From time to time, we got referrals for foreigners who were too sick to return home—but they did not qualify for any government subvention at all.

Being a charity meant that we could still choose to take them in.

I remember a case of a young Vietnamese girl who had HIV and a brain tumour. By the time we accepted her, she was already in a coma. Her mother came from Vietnam, and with the help of a local church which gave her a small stipend, she was able to stay with her daughter for the remaining few weeks of her life. Being a charity means we’re allowed to do this—and because the public knows that we do this, that adds to the goodwill.”

— Dr Noreen Chan, DPH CEO & Medical Director from 2004-2009

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I once met a patient who was not used to talking about himself, so it was difficult to know what he was thinking, and how he would like to be helped. We had a few art therapy sessions—I showed him how to use the materials, and he used colours, lines, and shapes to create a very simple image to reflect his thoughts. And from there, he was able to talk more about what death and dying means to him.

Copyright © Laura Lewis

Being able to holistically care for patients also means seeing them not just as patients, but as individuals with their own stories, lives and dignity. DPH introduced music and art therapy to provide alternative ways for patients to express themselves and their individuality, especially for those who have lost the ability to talk. Through music and art, patients are also able to create something to leave behind for their loved ones, be it a simple painting, or a personalised song.

I think something happened in this art therapy for me… I need to be better, and it got better. I feel fresh now, nothing heavy… before like got stone, coconut in my head.”

— Mr Yusoff Mohamad, DPH patient

Once he drew this picture of a person on a boat in the sea. It was very calm, very dark at night. That was his way of sharing with me that ‘I’m okay with death, but I’m just wondering where I am going after this. Is there anything else?’ He also started to think about his life, his family, his regrets, and whether he could reconcile with all these things.

Eventually at the last session, his images became more hopeful. He was more at peace with himself. Before that he was accepting of death, but the readiness was not necessarily there. But now he was more ready.”

— Ms Gillian Ong, DPH art therapist

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I still remember one of my patients had dementia and dysphagia, so he could not talk and was confused, not knowing what’s going on. He fidgeted a lot, so I thought, maybe he’s looking for some stimulation for his fingertips. I brought in the ukulele, which is a plucked string instrument, to make the fidgeting movement meaningful—it could be a movement for him to create certain sounds and to communicate through another language with the world.

He responded quite well to the ukulele and he explored different creative ways to play the instrument. He started to hand the instrument to others to invite them to play with him as well. Sometimes when I brought in another instrument, he would play and then gesture and make eye contact with me to invite me to play that instrument to accompany his music.

Through that experience I found that even being unable to communicate through words, there is certainly another way for them to communicate, to stay connected with people and society, so that they don’t feel so isolated and stuck in the body.”

— Ms Yang Shu Ting, DPH music therapist

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Right from the start, it was also part of DPH’s core mission to support the grieving families and caregivers. This has been the aim of “Rose for Remembrance”, a half-yearly non-religious memorial service held to remember DPH patients who have passed away. It was started in 2001 and has since been a simple meaningful way for the bereaved families, caregivers, nurses, doctors and volunteers to mourn their loss and seek closure together.

Rose for Remembrance

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During a Rose for Remembrance memorial service, a family member and nurse shared a story which really touched me—actually I started crying. It was about a husband and wife who were separated. They had not seen each other for many years. But the husband, who was the dying patient, had one request. He said, see if you can encourage my ex-wife to come and visit me before I pass on.

The trouble is, no one had any record of who his ex-wife was. So our staff went the extra mile, not only to find out who the ex-wife is, where she lives, but also to convince her and the children to come back and see him.

In the end, they reconciled. Our staff and volunteers helped to organise an anniversary celebration for them, and the volunteer beauticians helped them dress up and take pictures. I think their children were very happy for that, and the man passed away very peacefully.”

— Mr Robert Chew, DPH Council Vice-Chairman from 2016-Present

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Despite facing death everyday, there is no overhanging gloom or resignation at DPH. On the contrary, staff and volunteers work towards maximising life, by trying to make the most of each day for patients. In hospitals, patients hope for complete recovery and cure, and when that does not happen, they may become disappointed and depressed; doctors may feel a sense of failure. A hospice is quite different and expectations more realistic—patients and families can accept deterioration better. Although they are not cured, they are generally happier with the total care and treatment provided.

Forum letter by Seah Yam Meng, The Straits Times, 19 May 2017

My father liked this ‘home’ more than our home, and even wanted to spend his Chinese New Year and last moments here. He went home only to give ‘angpows’ to his grandchildren. To old folks, where they choose to spend their Chinese New Year is very important, and this is the place he chose—Dover Park Hospice. Thank you for creating such a wonderful place.”

— Ann Wong, daughter of late DPH patient Mr Wong

Reply to Seah Yam Meng by Dr Jerry Lim, The Straits Times, 26 May 2017

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Our Patients’ Stories Leong Keng Peng

Mr Leong Keng Peng, 53, was diagnosed with nasopharyngeal cancer in October 2008. His disease progressed despite undergoing more than 60 sessions of combined chemotherapy and radiotherapy, and he became dependent on a feeding tube for food.

Losing hope and unwilling to be a burden to his 80-year-old mother, Keng Peng decided to spend his last days at DPH. But undeterred by his condition, the clinical team and volunteers worked with Keng Peng. From being bed-bound, he learnt to wheel himself in a motorised wheelchair; from being fed, he learnt to feed himself through the feeding tube;

from feeling alone, Keng Peng found new friends in the hospice.

His passion for photography was revived when he joined the weekly outings, clicking away for volunteers and fellow patients.

He also found a new hobby in painting, and was able to express his emotions through his drawings with the encouragement of our art therapy intern. He felt a great sense of achievement and satisfaction for each completed art piece. He said: “I have never felt so at ease before. In the past, I just wanted to die; now I am experiencing life again!”

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Our Patients’ Stories Bee Cheng

Mdm Bee Cheng, 34, was living life to the fullest. Blessed with two bubbly children, aged nine and 12, she enjoyed her passion for music, singing and watching DVDs. All that ended when she was diagnosed with cervical cancer in May 2009. After multiple hospital admissions, she came to DPH in pain, struggling with fear for her children’s future.

But that proved to be a turning point. With her pain controlled, she was able to do the things she loved like singing, and even watching DVDs till late at night in the hospice. Despite being unable to fulfill her children’s wishes of going to Disneyland, she was still able to enjoy precious moments with them.

She celebrated Mother’s Day at the hospice with her children making

decorative cards for her, while a nursing intern gave her a special makeover. Another team organised a surprise party, and they arranged for her favourite food to be prepared by her mother-in-law. This was topped with karaoke, which she enjoyed the most. All this was captured on video, but more so, in the hearts of her loved ones. Another wish of hers was fulfilled when the hospice arranged to have a portrait taken with her husband.

A few days later, she took her last breath surrounded by the loving embrace of her loved ones.

At DPH, it is about creating precious memories and living life to the fullest, even as we do our best to provide comfort from pain with the dedicated effort of our clinical team and volunteers.

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Our Patients’ Stories Chow Yew Weng

Mr Chow Yew Weng, 61, had fought his cancer bravely for three years. When treatment did not work anymore, he wanted some peace to have quality time with family, and to die comfortably.

Mr Chow was one of the rare patients who was aware of his condition and clear about the level of care he wanted.

His family members shared that he had been preparing for end-of-life issues since his diagnosis, giving them instructions on how to settle his affairs.

He made the decision to decline home care in favour of being placed in a hospice—DPH. His wife, Madam Leow, said: “He had signed an Advance Medical Directive

when he was first diagnosed. He never wanted to prolong his life unnecessarily.

But we had always assumed he would be in a terrible state and die in hospital.”

It was only at the hospice that she realised death did not have to be that way.

“He had happy times with us. We had parties, with food and drinks, and even children running around. He also managed a short mahjong session with volunteers,” she said. “Because he made all his decisions and the hospice supported him so well, I did not feel stressed from having to decide what to do for him. His death was very peaceful for him and for me.”

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Our Patients’ Stories Tan Kia Poh

Mr Tan Kia Poh, 94, was the stern patriarch of a large family and prided himself on being an independent man. He worked hard all his life, gained a level of success, and kept himself active even after his retirement.

Unfortunately, he was diagnosed with liver cancer and despite undergoing various treatments, the cancer spread to his spine. For the first time, Mr Tan was unable to carry out simple daily activities on his own. When treatment did not work anymore, Mr Tan decided that he wanted to spend peaceful quality time with his family. At his doctor’s suggestion, he was admitted to DPH. The DPH multi-disciplinary team of doctors, nurses, physiotherapists and other allied health workers helped to keep his pain and symptoms under control, and through advance care planning, managed to discover and understand his and his family’s concerns.

Knowing that one of Mr Tan’s final wishes was to have a complete family photograph, the DPH team together with his family arranged for his children and grandchildren to return from other parts of the world.

Even though he struggled physically, he was able to attend his wife’s birthday celebration in a restaurant in town dressed in his finest suit, and also managed to take a complete family photograph during his last days at DPH. And as the usually stoic old man fiercely hugged his eldest son, whom he ha not seen in 12 years, it made for the most touching scene that the DPH doctor in attendance would never forget.

With the DPH team working hand in hand with his family, Mr Tan managed to fulfill his last wishes, maintain his dignity and create precious memories that his family can hold dear to.

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Celebrating DPH’s 10th Anniversary at the Hospice

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Dr Seet and Dr Lim, with DPH volunteers, waiting for the Guest-of-Honour, then-Prime Minister Goh Chok Tong, to arrive at its 10th Anniversary Open House & Food Fair

from left: Dr Jerry Lim, then-Deputy Prime Minister Lee Hsien Loong, Mdm Ho Ching & Dr. Seet Ai Mee at the Hospice’s 10th Anniversary Gala Dinner

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The DPH Pet Therapy Group at DPH’s 10th Anniversary Open House & Food Fair

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Snapshots from DPH’s 10th Anniversary Open House & Food Fair

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NEW FRONTIERS

More people in Singapore are coming down with long-term debilitating diseases like organ failure, dementia, stroke and Parkinson’s disease, and many hospices may encounter limitations in capacity. With DPH extending beyond its current inpatient services into home palliative care, it will be helpful to Singaporeans who choose to spend their last days at home among loved ones in familiar surroundings.”

— DPH Patron Dr Tony Tan, in the Annual Report 2010-2011

Over the last decade, DPH has evolved from providing standard inpatient hospice care to an increased range of services, catering to more patients, more diseases, with more integrated care between hospital, hospice and home.

First, it was clear that the need for inpatient palliative care was growing. So in mid-2011, DPH underwent renovation to increase capacity from 40 to 50 beds, with more single rooms, patients’ activity areas, meeting rooms and a patientfriendly environment to encourage them to be out of bed. This was done by the Alteration and Addition (A&A) team, with representatives from DPH, volunteers from DP Architects Pte Ltd, and sponsored by Sunray Woodcraft Construction Pte Ltd.

Health Minister Gan Kim Yong opening DPH’s new wing in January 2012, accompanied by DPH Chairman Chey Chor Wai

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DPH’s new wing

Council members and staff also visited other hospices overseas to learn from their best practices and bring good ideas back home. In 2009, the DPH Task Force funded their own study trips to San Diego Hospice and the Institute for Palliative Medicine, and to palliative care settings in Perth.

I think the main game-changer was end of 2008, when DPH Council Chairman Tay Boon Keng initiated a Task Force to look at the future of DPH. We visited palliative care hospices in San Diego and Perth. With that and Medical Director Dr Angel Lee’s visions of what palliative care should be, we came up with a plan. We realised the plan needed a lot of details and budgets—that was in 2009, and we planned for budgets all the way until 2016! We planned for home care and daycare, as well as research and education. I think a lot of what we’re doing now, the thinking and direction of the work, originates from this Task Force study.”

— Mr Chey Chor Wai, Chair of DPH Task Force and DPH Council member from 2004-2010, 2011-Present

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In March 2011, another DPH team of 11 Council members, staff and volunteers visited five medical institutions in Hong Kong to learn about their palliative care services and management. It was a fruitful trip, and their insights about Hong Kong’s development affirmed that DPH is moving in the right direction— that providing a continuum of care and management of non-cancer cases is the next step in hospice care development.

We started the DPH Institute Task Force because while our core work is clinical, we saw the need to have a bigger training centre and research institute.

We need to train people, and in order to grow and to do better, we definitely need to do more research. So we have agreed that we should grow in all three arms—research, clinical, and training.”

— Dr Ong Wah Ying, DPH Medical Director from 2016-Present

A token of appreciation to the hosts at Shatin Hospital, Hong Kong

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One way in which DPH expanded its continuum of care was to provide a higher level of sub-acute palliative care. Previously, sub-acute interventions like intravenous antibiotics, blood transfusions or other pain relief procedures could only be done in an acute hospital—but this was not ideal, because such transfers were highly inconvenient for patients.

However, patients increasingly required such care. Recognising this need, DPH upgraded its equipment, increased its number of care staff, and equipped them with the skills to provide this subacute nursing and psychosocial care.

This has reduced unnecessary transfers to acute hospitals either from DPH or from home, and also allows patients in acute hospitals who require sub-acute palliative care to come to DPH earlier.

But no matter how good the services of an inpatient hospice, most patients still prefer to spend their last days in the comfort and familiarity of home. To further expand its care services, DPH started the 24-hour Home Care Service for the central areas of Singapore in February 2011. This offered nursing, medical and psychosocial care to patients who had been discharged from DPH, or who chose to remain at home after being seen by specialists from TTSH’s Palliative Medicine Department.

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Whenever we visit a patient at home, we bring a big bag with infusion, drugs, oral medication, anything patients may need. Clinically there isn’t any difference between home care and the inpatient setting, but the challenge for us is being alone in managing physical symptoms of the patient, or having difficult conversations with the patient and family, and also that ultimate control lies with the caregiver.

But I also feel that home care is extremely satisfying, because you are really the primary healthcare professional they connect with, and you help the patient navigate the situation, and journey with them.”

— Ms Sylvia Lee, DPH nurse from 1999-Present

My negotiations with the Ministry was a lot about funding to increase the number of beds. The other thing was about home care—we felt that the current way that home care was delivered could be improved by better integration with the inpatient services like DPH, as well as the hospital. And because we have jurisdiction within the acute hospitals, inpatient hospice and home care, hopefully patients’ needs can be met better without so many barriers. The Ministry of Health was keen for us to do that, and part of the initial funding was given through the Agency for Integrated Care.”

— Dr Angel Lee, DPH Medical Director from 2009-2013

Our home care team taking care of a patient at home.

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DPH home care nurses supporting caregivers at home

The caregivers too, have been not forgotten. DPH also initiated the monthly Caregivers Support meetings in January 2011, to provide caregivers with the opportunity to meet and share experiences with one another, and with medical and social work staff.

Patient Mdm Lek and her husband sharing their experiences during a DPH caregivers support meeting

Music therapist Melanie interacts with a patient during a DPH caregivers meeting

SSN Felicia Nam and Resident Physician Dr Erwin

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Another major shift DPH had to contend with was Singapore’s evolving disease profiles and the rise of chronic conditions—from predominantly cancer cases to an increasing number of non-cancer terminal illnesses, like end-stage heart, lung and kidney failure; long-term dementia; HIV; and motor-neuron diseases. With the vision and support of the Council, DPH created new programmes to meet these changing palliative care needs.

One of these programmes is Temasek Cares - Project Dignity, which piloted in 2014. The first of its kind, Project Dignity is a 3-year partnership between Temasek Cares, TTSH, DPH and the Agency for Integrated Care, to provide holistic palliative home care service for patients with long-term dementia.

Project Dignity’s Advanced Dementia Palliative Home Care Team comprises of a resident physician, geriatrician/palliative physician, nurse clinician and a medical social worker, all working together to provide patients with 24-hour access to the Care Team.

TTSH and DPH have always been neighbours, we have always had patients transferred to DPH. In the last decade, we found that we would benefit from a closer tie, so we started looking at programmes that facilitate easier transfer of patients from one institution to another.

For example we have a project called Program Dignity. It’s meant to be anchored in the community because it’s actually a home palliative care service for patients with end-stage dementia. So Dover Park Hospice has been an ideal organisation to anchor this, while we work together to provide the services.”

— Prof Chin Jing Jih, TTSH Divisional Chairman (Integrative and Community Care) and DPH Council member from 2011-Present

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DPH started as a volunteer-run project in 1992, and it has since changed a great deal—growing in services and capacity, bringing together nurses, doctors, medical social workers, music and art therapists, volunteers and many others to care for terminally ill patients and their families. But what has not changed is its steadfast vision to provide quality palliative care to patients, and support for their families and caregivers.

The patients here may have only short days to months and there is often a sense of urgency as we race to control their symptoms and help them and their families as they face the closing chapter of their lives. When a pain that had seemed impossible to control releases its hold on the patient, the sense of satisfaction makes this job, which can be at moments draining and stressful, seem like the best in the world.

When the social worker organised a funeral for a patient who has no kin except for a brother who is challenged intellectually and a “kampong” of volunteers sat throughout the 3 days of the wake and even trailed the cortege as part of “family”… I can only be awed with the magnanimity of the human heart.

I also smile at moments of madness. How else can one describe it when an MO decides to start an aquarium of goldfish and guppies just because a patient had said he misses his fishes at home?

Through the years, I have seen the hospice handling more and more ‘complex’ patients. It is with pride that we find ourselves rising up to the challenge of what is traditionally thought to be only available in the “big” hospitals.”

— Dr Ong Wah Ying, DPH Medical Director from 2016-Present, writing in The College Mirror, March 2013

DPH’s team of dedicated doctors, nurses and allied healthcare professionals

Enjoying the Koi Pond at DPH

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Hospice of the Future?

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The “Hospice of the Future” project, a Lien Foundation initiative, was completed in August 2013. This project was undertaken by Fuelfor, a design-thinking company based in Barcelona, to help conceptualise the hospice design which the Palliative Care community hopes to see in the future.

This project involved DPH, Assisi Hospice and St Joseph’s Home, and the results were published in a handbook titled “A Hospitable Hospice”.

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NATIONAL ACHIEVEMENTS

BY DPH STAFF

2004

• Staff Nurse Sarojini Ponnampalam received the Nurses Day Merit Award • Nursing Officer Sylvia Lee and Director of Nursing Edward Poon both received the Healthcare Humanity Award • Director of Nursing Edward Poon received the President’s award for nurses

2005

• Staff Nurse Sarojini Ponnampalam received the Healthcare Humanity Award

2006

• Assistant Nurse Daw Kyi received the Healthcare Humanity Award

2007

• Training Officer Serene Tan received the Healthcare Humanity Award

2008

• Senior Staff Nurse Halijah Bte Jantan received the Healthcare Humanity Award

2009

• Advanced Practice Nurse Sylvia Lee received the President’s award for nurses • Ang Boon Yang received the Ministry of Health Nurses’ merit award

2011

• Associate Consultant Dr Ong Wah Ying received the Healthcare Humanity Award

Staff Nurse Nge Ting Ting, Dr Noreen Chan, Nursing Director Edward Poon, then-President S. R. Nathan & Mrs Nathan, and Nursing Officer Sylvia Lee Photo courtesy of Prof. Edward Poon

• A DPH team consisting of former Head of DPH’s Allied Health Services Maureen Fung and music therapist Melanie Kwan submitted a poster on caregiver support at the SPCC Poster Competition; they received the 2nd Prize.

2012

• Senior Staff Nurse Phua Joo Keow received the Nurses’ Merit Award • Enrolled Nurse Sui Hniang received the Healthcare Humanity Award • DPH won a Merit Prize in the ILTC Quality Festival 2012 Poster Competition. This was for a project titled “Honey I Fed My Patients!” which examined strategies to improve compliance to dysphagia preventive measures; this new feeding programme is now part of the orientation for all new doctors and nurses at DPH.

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2013

• DPH won the Gold Award for Best Poster at the ILTC Quality Festival. This was for a poster titled “Strengthening the Foundation, a Brick at a Time”, which showcased DPH’s quality-improvement journey over the last five years.

• A case series on the use of parenteral lignocaine in cancer neuropathic pain received the First Prize at the Asia Pacific Hospice Conference Poster Competition.

This was a collaboration between DPH and TTSH’s Department of Palliative Medicine.

• Senior Staff Nurse Pa Pa Tun received the Nurses’ Merit Award • Resident Physician Dr Karen Liaw received the Healthcare Humanity Award

2014

• Head of Allied Health Services Chee Wai Yee received the AIC ILTC Service Quality Award (Silver).

• A few members of the DPH Home Care Team—Dr Ho Sek Yew, Senior Staff Nurse Tan Li Kuan, NC Susan Chan, Advanced Practice Nurse Chen Wei Ting—were winners in the “Productivity & Innovation” category for Good Practice Award.

• A poster of the audit on the use of antibiotics in DPH, led by Dr Lo Tong Jen, won the First Prize at the Singapore Palliative Care Conference 2014.

A snapshot of the “Honey, I Fed My Patients!” poster, which won the Merit Award, at the ILTC Quality Festival in 2012

• A poster by DPH Home Care team titled “Breakthrough Project” was the Good Practice Award Winner at the AIC Quality Festival 2014.

• Senior Staff Nurse Tan Li Kuan received the Dover Park Hospice Top Student Award from the Specialist Diploma in Palliative Care Nursing course • Staff Nurse Mya San Kyi received the Ministry of Health Nurses’ Day Merit Award

2017

• Head of Nursing Services Ms Chin Soh Mun received the Healthcare Humanity Award

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Photo courtesy of Ms. Sharlene Leong

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True to DPH’s beginnings as a volunteer-run project, it is not just the healthcare professionals but the hundreds of dedicated volunteers who are an integral part of its holistic, patient-centric care.

Even before DPH opened, Ms Marlene Foo, Chairman of the Community Relations Committee, conducted recruitment talks at community centres, clubs and schools, helping to raise awareness of hospice work, as well as recruit volunteers for DPH. This cause resonated with many, and in that first year alone, DPH gathered over a hundred volunteers from all walks of life, who brought their own special skills and interests to the hospice.

Before the DPH building was ready, we met the volunteers at the Dunearn Road office. It wasn’t classroom-style training; we just had a chat with them, interviewed them, and prepared them mentally.

I also remember the excitement of the first volunteers coming in to be hands-on with the patients when DPH opened in 1995. They were smiling and saying, wah this is it, we are here already, after all these years!

Ms Marlene Foo, Chairman of the Community Relations Committee, at a volunteer recruitment drive at Moulmein CC, 1995.

They felt this place is more like a resort or home rather than a hospital or hospice. There is the flow of fresh air, openness, and the koi pond where patients can feed the fish and spend more time with family. We thought it was good that patients on their last journey can enjoy their stay, and that motivated the volunteers to give more care to the patients.”

— Ms Marlene Foo, DPH Council member from 1992-1997, 1998-2001, 2002-2010, 2011-2017

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A HOLISTIC APPROACH One early volunteer initiative was the outing for patients, started in 1996

by Mrs Ong Kim Ling and Medical Director Dr Moses Yu. At first, the outings were a small affair, with Mrs Ong bringing out a few patients in her own car, accompanied by Dr Yu, a nurse, and a few other volunteers.

Gradually, with more volunteers and the donation of vans, these weekly outings grew to include a bigger group of patients. Under the watchful eyes of nurses and volunteers, the patients visited reservoirs, parks, beaches, the zoo, the airport and many other places where they were able to enjoy the sunshine and sights of Singapore. It was a welcome distraction from their routine bed rest, and they eagerly looked forward to this every week.

One of the weekly outings for patients, with Mrs Ong Kim Ling, Medical Director Dr Moses Yu and Director of Nursing Ms Grace Lim

When DPH started in 1995, they advertised in the newspaper for volunteers. So I came to join in. No what idea what it was like. It’s something new in Singapore.

I saw that the patients were bored to death, nothing to do. So the doctor said, ‘You take them out for a ride.’ I took four of them out in my own car to MacRitchie Reservoir and the coffeehouse at Thomson Road. Oh, they enjoyed it! So I say, I do it every week. After a while, more people joined me, I need a nurse, every patient the doctor would have to approve. We keep it organised like what it is now.”

— Mrs Ong Kim Ling, DPH volunteer from 1995-Present

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Once, during Chinese New Year, we brought the patients shopping. Each of them was in a wheelchair with a basket on their lap, and they could choose what they wanted to buy—sweets and things like that. Some of them were not buying things for themselves but for the nurses. It gave them the autonomy to go out and do shopping like everybody else.

Sometimes we even bought clothing for patients to wear for their Thursday outings, because back in the hospice they always wore pajamas, and some didn’t have extra clothes. Whampoa Market was the place where I went and shopped for blouses or pants for them.”

— Ms Jeanthi Arunasalam, DPH administrator from 1993-2008

These days, the weekly outings continue to be organised by a group of volunteers who still bring food for the patients, and end the outing with a rousing singing session of favourite tunes.

As I wheeled patients along for the outing, I would sing. Later, people wanted to join in, so I photocopied song sheets, stapled them together, and made a book for people to sing along. I think songs make people happy and reminisce the old days.

It’s good for them, good for the soul.

Sometimes other people watch us sing and start clapping, and the patients feel like, oh I’m a celebrity or whatever. One of the uncles said, 他们喜欢我们的歌—they like our songs—so I feel happy that he feels happy being a singing star now.”

— Ms Kemmy Lim, Leader of Emerald Volunteer Group from 2009-Present and DPH Council member from 2016-Present Mrs Ong Kim Ling, Medical Director Dr Moses Yu and Director of Nursing Ms Grace Lim (1995-2000)

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When we go on outings with the patients, we take photos and make it a point to print and give it to them on the same day. That’s because around five years ago, when we went to Upper Peirce Reservoir, one of the patients was accompanied by his wife—and we found out they used to go there to paktor when they were young! He died the next day, and we regretted that we did not give them their photo on the day itself.

But their family members saw the photo, so it was the last memory for them. I guess it was closure for the uncle as well, because he and his wife were very happy that day.”

— Winston Tse, member of the DPH Volunteer Group, Emerald, since 2009 Mr Muhd Yusuf bin Mohaman enjoys an afternoon out in the sun during an outing with volunteers

Today, DPH has many more volunteers and activities, and they continue to be the life force of the hospice— befriending patients; organising outings and festive celebrations; and providing massage services, pet therapy, Happy Hour snacks and drinks, hairdressing, gardening, home-cooked soups, musical performances and much more. The hospice is jam-packed with good cheer and fun—a far cry from what the public had initially imagined to be a depressing and listless ‘death house’.

When I visited a hospice in Honolulu in 2000, I was so impressed. The American system is that you cannot be registered as a charity unless volunteer hours exceed executive staff hours. I said, that’s wonderful, I think I will start that in Dover Park Hospice.

So when I came back, I set up the system where everybody who volunteered at the hospice recorded their time, their name, what they did. That’s when we divided them into specific groups, gave them names, group leaders, and we started calculating the volunteer hours. That was important because we cannot call ourselves a charity unless the public sees us as an institution worth helping.”

— Ms Maria Mah, DPH COO and administrator from 1996-2002

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Amethyst A singing group who performs for DPH’s patients

GEMS

Aquamarine

Jade

Crystal Handicraft group who creates arts and crafts items to help DPH fund-raise

Lapis Lazuli

Diamond A Malay-speaking activity group who organises monthly birthday celebrations for patients alongside the annual Hari Raya celebrations

Opal

Emerald

Pearl

Garnet

Ruby

Ukelele performers from the Moulmein Citizens Consultative Committee

Conducts weekly excursions for patients to various places of interests around Singapore

Ambassadors who support DPH with various public awareness campaigns and outreach activities

An in-house choir who performs during special events and celebrations

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Sapphire This Volunteer group focuses on befriending patients and providing refreshments during Happy Hour, as well as music entertainment for patients

SOKA Prepares local delicacies for patients

A Chinese-speaking group who organises celebratory events for patients, including the Lunar New Year and Mid-Autumn festivals

Befrienders to our patients and their family members. They also conduct yearly outreach activities, including Vesak Day celebrations at the Amitabha Buddhist Centre

Professionally-trained masseuse who provide relieving massages to patients, easing their aches and pains

Prepares nutritious home-cooked soups for patients

Pet-lovers who bring their beloved companions to interact with patients under the Pets-Assisted Therapy (PAT) Program

Sunstone Provides hairdressing and grooming services for our patients

Tanzanite Student befrienders from the Nanyang Techonological University’s Lee Kong Chian School of Medicine (LKCMedicine) Topaz A gardening group who helps maintain the lush greenery at DPH

Turquoise Provides and coordinates home care services

The 18 volunteer groups at DPH are named after gemstones, to reflect how precious they are to DPH, patients and families

Volunteer Brochure-FA_4Jul-PRT.indd 1-3

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The Volunteers Registration Form in 1999

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Volunteers from the DPH Volunteer Group, Diamond, organised monthly birthday celebrations for patients

DPH Medical Director Dr Ong Wah Ying with medical students on attachment and a volunteer from DPH Volunteer Group, Ruby, during one of the Pets-Assisted Therapy sessions

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A Lunar Chinese New Year celebration at DPH with the Yew Tee Community Club Chinese Orchestra

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At some point, DPH said we should have a name for our volunteer group.

Dr Seet Ai Mee was the one who put forth quite a few, and I chose ‘Pearlie’s Angels’ because at the time, ‘Charlie’s Angels’ was very popular on TV. The red apron we wear also has the words ‘Pearlie’s Angels’ in the same font as ‘Charlie’s Angels’!”

— Mrs Pearl Lim, Leader of Pearlie’s Angels Volunteer Group from 2000-Present

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Members of DPH Volunteer group, Pearl, serving patients with their nutritious home-cooked soup for patients

7 Members of DPH Volunteer groups, Aquamarin and Amethyst, at the hospice performing for patients

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Members from the Sunstone Volunteer group provide bedside grooming services to DPH patients. Some of our patients were unable to visit a barber even prior to their admission to DPH due to mobility issues.

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We do holistic massage, which is very gentle. Unfortunately some of them are not suitable for massage, but if the patient likes to be held and feel a human touch, we may just do a very light one, just oil the person. You know, a touch represents more than a thousand words.”

— Ms Mabel Pek, Leader of Opal Volunteer Group from 2006-Present

Every time I come here, it’s a selfreminder of how fragile life can be, and to cherish every moment with my family. Sometimes even at work, when I’m very stressed, I will reflect, why should I keep stressing myself? Don’t bear grudges, just take a leap of faith and carry on with life when things get tough.”

— Gilbert Lew, member of the DPH Volunteer Showchoir Group, GEMS, since 2014

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I grew up in the Mumbai suburbs, and my mother was working as a gardener in one of the government offices. Whatever she learnt during her gardening classes, she shared with us, like how to plant the tree or vegetables, how to grow them, how much sunlight and water is required. So when I heard about DPH, I said, ‘If I can join this gardening group, I can contribute something.’ Whenever I get the chance, I’m here now.”

— Suraj Shantaram Piste, member of the DPH Volunteer Group, Topaz, since 2016 What was most encouraging and humbling was to see people volunteer whatever they could. They would stay till really late at night for events and take the last bus home. I thought, if they can, why can’t I? Why am I even thinking second thoughts about doing what I can? Those people really inspired me.”

— Mrs Diana Quek, DPH Council member from 2003-2008

Our volunteers put in a lot of effort, because they always feel that this might be the patients’ last Chinese New Year, last Christmas, last birthday party, last outing. And it’s sad when you know that this person just celebrated it and passed on that week. But they also feel happy because they know they’ve made it better for the patients, that they blew out the birthday candle, or went for an outing. So it’s always in the hearts and minds of the volunteers to make it a happy place for the patients.”

— Ms Marlene Foo, DPH Council member 1992-1997, 1998-2001, 2002-2010, 2011-2017

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But it was not always fun and games.

Equally pressing were the emotional needs of patients who were nearing their last days and wanted company.

In 2013, inspired by the Nobody Dies Alone (NODA) programme in America, DPH Volunteer Programme Manager Mr Allard Mueller organised a group of experienced volunteers who were willing to accompany patients in their final hours. This was especially needed for those who were alone, or whose family members were not able to be present.

And it didn’t stop there. Besides lay volunteers, there were also professional volunteers who offered their skills for free. Some of the longstanding volunteers included Dr Peter Yu and other dentists who came to DPH weekly to provide dental care to patients. They became so well-known that other nursing homes began sending their patients to DPH for probono dental care as well.

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Once a request for vigil comes in, I send out a Whatsapp message to this group of experienced volunteers, and they register via the automatic scheduling system. Sometimes we had volunteers doing midnight shifts and staying until 3am, or they would start at 3am and afterwards still have a full work day. It’s really quite amazing.

All the volunteers do is just sit there, be present. Sometimes the patients are religious—they want the volunteer to read from the Bible, or chant mantras, whatever they prefer. But at the end of the day, all that’s needed is just to be present.”

— Mr Allard Mueller, DPH Volunteer Programme Manager 2009-2014, Community Outreach Manager 2014-Present

There was once I made a denture for a patient who smiled gratefully, then kept it and wouldn’t wear it! I was quite offended and frustrated because it took so much effort. Making a denture takes six visits, and she was bedridden so we were doing dentistry at the bedside—it’s very messy and you come out drenched in sweat because you are trying not to fall onto the patient.

A week later, she passed away, then the family came and said she was so grateful, they were so happy, because she was terrified she would go into the afterlife without her teeth. She never intended to wear it, she just wanted to be buried with it. I was grateful that at least some good came out of it. I was thinking that if that’s all she wanted, I could have just given her a recycled one in 30 seconds... but no, this one was custom made.

I realised also it was important that it fit. It wasn’t a physical benefit that they were looking for—it was peace of mind and preparation for what they valued as important. And I was only beginning to learn that there was more to the physical dimension; you had to treat the person, which is a lot more intangible.”

Volunteer Dentist Dr Peter Yu treating a patient

— Dr Peter Yu, Volunteer Dentist

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These days, the weekly outings continue to be organised by a group of volunteers who still bring food for the patients, and end the outing with a rousing singing session of favourite tunes.

When I was President of the Pharmaceutical Society of Singapore, I bumped into Dr Rosalie Shaw one day, and I asked her, is there anything we can do for Dover Park Hospice? She said, it’s recycling of medicine, very boring, just pharmacy assistant work—I don’t think it’s something you would want to do.

But I said, no, if that’s what you need, then I and my pharmacist colleagues and friends can come and do this for you. So she showed us the medicine store, and we reorganised it, labeled the containers and shelves, and we also came out with medication guidelines for DPH covering proper storage, use, disposal, and management of medicines. I was very happy that in one of the years, we saved about $50,000 of medication costs through our recycling efforts.

A lot of us have preconceptions about wanting to do big things for the patients, but to me, it is the small things done consistently that is important. So what has kept me going is that I am fulfilling a need that the hospice has.”

— Mr Wu Tuck Seng, Volunteer Pharmacist and Leader of the Professional Volunteer Group from 1996-Present

Volunteer Pharmacist Wu Tuck Seng at work

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In 2000, a scheme was also set up with the Law Society of Singapore where volunteer lawyers provided patients and families with free legal advice on important issues such as making a will, Medisave withdrawal and other matters.

so the DPH volunteers continually endure the pain of losing a dear friend. The emotional intensity of this volunteer work has meant that only the most committed ones stay—and what is amazing is that so many of them have stayed for years.

But beneath the cheery mood of volunteer-run activities, both lay and professional, the fact remains that this is emotionally difficult work. Most patients pass away after a few weeks,

And what keeps them motivated? They all have their own reasons, but with much common ground: a deep desire to help others, to learn, to contribute, and to live a meaningful life.

我来这边好像变成我生活的一部分了，我已经习惯了， 这个就是我不可以缺少的东西。其实真正讲，我觉得我 来这边学到的东西，真的是任何一个地方学不到的 ，所以我很感恩有这样的地方。 我学到的就是: 当然你的自信心很重要，爱很重要。最重要一点我学到的就是病人的情绪 ，因为病人在这个时 候，他们的情绪是比较不稳定的。就是跟他们学习我要怎么样去跟他们相处 ，我要怎么样改变自己去配合他。 我现在照顾我妈妈，我懂得怎么样去配合，这个是我最大的收获。不可以讲是义工啦，就是说来这边学习，让 我了解很多，了解自己的性格。” “Coming to DPH has become a part of my life, a habit. And the things I learn here are things I can’t learn anywhere else, so I’m really grateful that such a place exists.

What I’ve learnt are: the importance of having confidence, and giving love, and most of all, growing to understand the emotional state of patients. Their moods can be quite unstable. So I learn how to interact with them, how I can change to accommodate their needs.

I’m now taking care of my own mother at home, and I better understand how to manage and care for her—that’s my biggest reward. So I can’t really call this ‘volunteer work’, rather, I call this a ‘learning process’, because coming here has helped me learn so much, and made me understand myself better.”

— Alice Hon, member of the DPH Volunteer Group, Jade, since 2002 Alice has been visiting patients at the Hospice almost everyday, for the past 15 years

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NATIONAL ACHIEVEMENTS

BY DPH VOLUNTEERS 1996

• Ms Marlene Foo was awarded a Certificate of Commendation in conjunction with the NCSS Volunteers Campaign 1996

2002

• DPH received the inaugural Best Volunteer Management System Award by the National Volunteer Centre.

DPH Co-founder Dr Seet Ai Mee receiving the Best Volunteer Management System Award from then-Prime Minister Goh Chok Tong

2010

• DPH received the National Volunteer and Philanthropy Centre’s Non-profit Organisation of the Year Award (Volunteer Management) from President S.R. Nathan • The DPH gardening programme received Gold for the Community in Bloom Award

2011

• DPH’s Emerald Volunteer group received the President’s Social Services Award in the Informal Group category

2017

• Ms Marlene Foo and Mrs Ong Kim Ling both received the Healthcare Humanity Award

Members of DPH Volunteer outing group, Emerald; Anthony Wong Choong Hoong, Chan Yoke Wan, Lim Hsiu Mei, Ong Kim Ling & Patricia Teo, with then-President S. R. Nathan, received the 2011 President’s Social Service Award

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RAISING FUNDS My experience with the DPH Council is that they are very forward-looking. They really want to do good for patients.

I think the ethos is that if it’s something good for patients, do it first. Don’t worry about the money, we’ll raise the funds.”

— Dr Wu Huei Yaw, DPH Medical Director from 2013-2016

Besides willing hands, DPH also needed funds for building costs, day-to-day expenses and generous subsidies for needy patients. In XXyear, the Khoo Foundation offered DPH seed funding of XX million, substantially funding its 40-bed residential building. Other longterm supporters included the Lee Foundation, Singapore Pools, Shaw Foundation and the Ministry of Health, which foot the bill for half of DPH’s annual operating costs.

many external fundraisers, for example, the Sylvia McCully Ballet Company’s performance of Sleeping Beauty; the Chinese Swimming Club’s water ballet performance and ‘swimmathon’; MobileOne’s Golden Numbers Auction; the ANZA Women’s “New World Fashion Show”; the Italian Charity Fair on the grounds of the Italian ambassador’s residence; and even a charity opera performance of Madame White Snake by the Chinese Theatre Circle.

But DPH still needed more, mostly because many patients were either fully or heavily subsidised, due to the Council’s vision of providing quality palliative care regardless of the patients’ financial ability.

Besides these donations from external groups, the DPH Fundraising Committee has also continued to organise walkathons, gala dinners and golf tournaments, using their professional expertise, networks and creativity to raise over a million dollars every year for the hospice.

In its first few years alone, DPH was the fortunate beneficiary of

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We were fortunate that Sunny Low Dance Studio came in to provide entertainment for our fundraising gala—they are international ballroom dancing champions. The Fundraising Committee wanted to involve the patients as well, and obviously they couldn’t come for the dinner, but we arranged for Sunny’s son—I think Melvyn and his wife—to come to DPH in their costumes and dance! Some of the patients were out in the garden that afternoon and I remember one particular lady was glowing, she was just so happy to watch their performance.”

— Mrs Sheryn Mah, DPH Council member and Fundraising Chair 1996-1998

DPH organised a variety of golf tournaments, art sales and charity galas to raise funds

The DPH Sunflower Ball 2011 raised a record S$1.2 million. Representatives from key donors DP Architects and Sunray Construction present a mock cheque to DPH Council Chairman Mr Chey Chor Wai and DPH Co-founder Dr Seet Ai Mee, on behalf of other contributors. DPH Patron and President of Singapore Dr Tony Tan witnessed the presentation.

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In 2013, DPH sent a team led by Medical Director Dr Angel Lee to participate in the 42-km mass cycling OCBC Cycle - Business Times Charity Challenge 2013. The event raised more than $100,000 in donations for its beneficiaries, including DPH.

We’re not just fundraising but raising awareness of what a hospice is about. There could be people facing tough times, difficult decisions and just raising awareness and letting them know that they can come to the hospice for help and excellent palliative care—that’s a big plus point. And if they have the means and choose to give back later, it’s an added bonus. It’s not something we look for but would be happy to receive, so that the care can be further extended to other people who need it.”

— Dr June Goh, DPH Council member and Fundraising Co-Chair from 2012-Present

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Did You Know?

The Board of Commissioners of Currency of Singapore (BCCS) organised a very successful DPH-BCCS Charity Draw in 1999, which raised over $800,000 for DPH. This charity draw featured novelty tickets printed to look like $10,000 currency notes. It was done so realistically that a man later used his lottery ticket as down payment for a car! $10,000 Note Specimen photo: Photo courtesy of Monetary Authority of Singapore

BIBIKS GO BROADWAY! Cast and guests of Bibiks Go Broadway (L-R: Chee Hood Siong, Kenny Chan, Richard Tan, Alicia Ang, Jessie Cheang, Irene Ooi, Mrs Teo Chee Hean, Defence Minister RAdm (NS) Teo Chee Hean, guest of Mr & Mrs Abdullah Tarmugi, Mrs Tarmugi, Mr Tarmugi, Mr Lee Kip Lee, Mr Tan Tee Jim, Dr Jerry Lim, Dr Seet Ai Mee, Dr Koo Wen Hsin) Photograph by Photo Impressions Pte Ltd and Studio One Photography.

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“Madcap humour and Peranakan pandemonium” is how The Straits Times described “Bibiks Go Broadway”, a Peranakan musical comedy commissioned

by DPH in 2003, and written by Mr Richard Tan, artistic director of Dance Circle Studios and cultural chairman of the Peranakan Association, with help from stage actor Mr Ivan Heng.

In a case of art imitating life, the musical revolved around a group of squabbling Peranakans auditioning for a fundraising musical!

Mr Tan’s grandmother had been well taken care of by DPH, and with this

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personal connection, he readily volunteered to help raise funds for the hospice, especially since it had a $400,000 deficit after the 2003 Sars crisis.

He then roped in other well-known names, like Malaysian actors Kenny Chan and Chee Hood Siong, and Singaporean actors Francis Hogan, Georgie Lee, Tony Quek and Henry Heng.

Talking to The Straits Times, Mr Tan said: “They gave me a call and I gave people a call—that’s basically been our approach to the entire project.

We are all volunteering and planning a warm-hearted event to connect with people, and not just taking donations.”

“Aside from creating awareness for the hospice, we also want to use this play to promote Peranakan culture, to make it more accessible,” he added.

Besides the writers, directors and cast, a total of 166 volunteers lent a helping hand to the event—as ushers, ticketing personnel, carpark marshalls, stall assistants, hosts and waiting staff.

The wider community also got involved in creative ways, with Tangs

Food, ceramics and weighing machines adorned with beaded Peranakan slippers—all sold for a good cause

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Department Store having a Peranakanthemed Christmas and collaborating with Mattel to organise a Peranakan Christmas Barbie Costume Creation competition. Student fashion designers were invited to create costumes for 12 Barbie dolls, and the dolls were then auctioned online to raise funds for DPH. The Ministry subvention, philanthropic donations and large-scale fundraising projects were all crucial to the setup of DPH. But most heartening were the donations from ordinary people, many of whom gave not from wealth but from sheer generosity and a desire to support the hospice.

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These ordinary donors included the char kway teow hawker from Changi Airport Terminal 2 who gave $800, the housewife who pledged her CPF in memory of her good friend who was well-cared-for at DPH, and countless others who chose to remain anonymous.

Whenever it rained, the outings group would go to Changi Airport, and bring the patients to the food court. The char kway teow man had a stall in that food court—he always gave them food for free, and from time to time, he would make a cash donation. It really keeps us going that there are supportive and grateful people, many hands helping and being with our patients.”

— Dr Seet Ai Mee, Co-founder of Dover Park Hospice

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CHANGING HEARTS AND MINDS 28 countries, 230 choirs, all raising awareness of hospice care. One of the biggest events DPH participated in was “Voices for Hospices”, an international choir performance to raise funds and public awareness for hospices around the world.

On 8 October 1994 at the World Trade Centre, DPH was part of the 350-strong choir in Singapore that sang Handel’s Messiah, with the other 229 choirs around the world singing the same oratorio on the same day.

This was a resounding success, with the event receiving much local and international media coverage.

On 18 October 1997, “Voices for Hospices” returned bigger and better—this time, as a 24-hour relay of 500 choirs worldwide, taking turns to sing Handel’s Messiah yet again. The singing started in New Zealand and Australia, handing over to Singapore’s 400-strong choir at 7.30pm, then moving through every time zone, and eventually ending with a choir in Hawaii.

“S’pore Chorus joins worldwide singing relay” (ST, 1997) Photo courtesy of The Straits Times

I had the privilege of interviewing Dame (Dr) Cecily Saunders, founder of the modern hospice movement in Britain. This was for a video I was producing in early 1990s for HCA and DPH to screen during a mass choir performance at the World Trade Centre, as part of an international hospice event. Choirs from around the world sang in relay; as one choir finished singing, another one in another part of the world would take up the chorus, until the entire world had been covered with their singing!”

— Mr Peter Yeo Toon Joo, DPH Council member from 1992-1994

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What was special about the 1997 “Voices for Hospices” performance was that it also marked the start of Singapore’s first Hospice Awareness Week, from 18 to 25 October 1997.

DPH took an active role in organising this large-scale event and closing walkathon, which brought the cause of hospice care to the Orchard Road crowd.

Then-Minister for Information and the Arts George Yeo, and Dr Cynthia Goh, at the walkathon of Singapore’s first Hospice Awareness Week in 1997

These were just some of the many outreach events that DPH would have over the years, which were crucial in countering the social stigma against hospice care.

Five years ago, the word ‘hospice’ was little understood. Through the unstinting efforts of its founding Council members and the work of other hospices, in particular the Singapore Hospice Council, the awareness of hospice work is today much higher.

Championing this heightened awareness is DPH’s Public Education Committee which sees its mandate as raising awareness of palliative care amongst secondary students and professional groups who are all possible recruits for DPH in the future either as professional staff or volunteers.”

— Mdm Tan Siok Sun, Chairman’s Message in the DPH Annual Report 1999/2000

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Closer to home, the DPH Public Education Committee also developed outreach messages and media presentations for visiting schools and organisations—and as always, the community stepped in to help. One of its first few projects was the DPH video produced in 1999, with the sponsorship of Cathay Organisation Holdings Ltd. Around the same time, the DPH bookmark was designed by a patient Madam Wee Mui Chin, with 5000 bookmarks sponsored by advertising agency McCann Erickson and a printing house, for distribution to visitors to the hospice.

Another special outreach programme was the first-ever MediaCorp Radio 65-hour Charity Marathon, which was held from 17 to 20 January 2001.

DPH was one of 12 beneficiaries of this programme, which saw TV personalities, celebrities, and even DPH co-founder Dr Seet Ai Mee joining radio presenters on air to appeal for donations and raise awareness of hospice care. At the end of 65 hours, the radio presenters had barely slept—but their sacrifice was well worth it, having raised over $560,000 for the charities.

<Include screenshot of that DPH video and/or picture of that bookmark?>

Excerpt from “MediaCorp Radio’s charity drive exceeds target” (TODAY, 22 January 2001)

In 2001, Mediacorp News’ documentary series “Two Hearts” featured DPH on an episode on the care of terminally ill patients. (TODAY, 26 November 2001)

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These outreach events soon developed into more targeted public education sessions. In August 2003, DPH Council Vice-Chairman Mr Tan Tee Jim introduced a series of “At Home in the Hospice” events, which brought small groups of leaders from both the public and corporate sectors into the hospice for dinner and an informal walk-around, during which they could interact with staff and Council members.

Group—a group of volunteers trained in public speaking and communication.

At public roadshows, health talks and other grassroots events, these ambassadors added their personal touch to the topic by passionately sharing information and answering questions about DPH and hospice care.

Writing in the 2003/2004 Annual Report, DPH Council Chairman Dr Jerry Lim reflected that “this personal touch had more impact than brochures and flyers could ever have.”

Also part of the DPH calendar were the Open Houses, to showcase activities in the hospice to potential volunteers, stakeholders and wellwishers. These were mostly volunteerrun events, with information booths set up in the HCA auditorium and also spilling out into the carpark, almost in the style of a festive street party!

Here, the volunteers were at their ambassadorial best, giving out food and flyers, while chatting with visitors about the work at DPH. In October 2012, DPH’s outreach efforts received an added boost with the formation of the DPH Ambassadors

Our volunteer ambassador engaging a member of the public at a DPH roadshow, 2012.

Today, DPH’s outreach events are titled “Every Moment Matters”, targeting organisations interested in Corporate Social Responsibility (CSR).

Recognising that there may still be many misconceptions or personal discomfort about hospice work, these events are typically held outside DPH, for example at the National Library or the Lee Kong Chian School of Medicine. Attendees would then be encouraged to visit DPH in person, or bring the information back to their company for potential CSR efforts.

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For our faithful donors, we have our Gala Dinner. Then we developed the Dover Park Open House, so that we invite the community. When they come in, they say, oh my goodness, we have weddings, we celebrate birthdays, we bring them on outings, we even have Happy Hour and singing sessions. It’s an eyeopener for them.

Then we have the ‘Every Moment Matters’ event where we bring in the organisations, and we recognise corporations and schools who have been our faithful supporters for 5, 10, 15 years. So we have developed three constituencies of supporters, and we hope that it will grow and become successful.”

— Professor Lionel Lee, DPH Council Chairman from 2009-2011, 2013-Present and DPH Council member from 1994-1996, 2005-2009, 2012-2013

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Still, what is most heartening for DPH is in coming full circle, back to its own community. It took time for people in the neighbourhood to warm up to the hospice at their doorstep—but they finally did. In XXyear, the residents of Moulmein, Novena, Newton and Goldhill came to embrace DPH as a valued neighbour, and a place for them to volunteer in hospice care.

One of the grassroots advisors from Newton had come to one of our open houses. He was impressed with what we did, and suggested adopting DPH at one of their grassroots meetings. This suggestion was approved by the Moulmein grassroots advisor, Mr Lui Tuck Yew, so the neighbourhood committees of Novena, Newton and Goldhill—all under Moulmein—adopted Dover Park Hospice as their charity. So one group plays the ukelele, some volunteer as befrienders, and some organise movie nights, and Chinese New Year, National Day celebrations.”

— Mr Allard Mueller, DPH Volunteer Programme Manager 2009-2014, Community Outreach Manager 2014-Present

Transport Minister and Advisor to Moulmein CCC, Mr Lui Tuck Yew, at the Hospice’s Open House

Transport Minister and Advisor to Moulmein CCC, Mr Lui Tuck Yew shaking hands with DPH patient Ms Lee Whye Ngor

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The personal touch and face-to-face outreach is irreplaceable, but in the 21st century, the next lap of public education includes the world of digital outreach and social media as well.

The DPH website www.doverpark.org.sg was first set up in 1999, revamped in 2006, and again in 2012.

DPH Facebook page

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This shift in mindset may have seemed almost impossible to the DPH pioneers in 1992, but they held firm to their vision, and inspired the hard work of public outreach by staff and volunteers over the past 25 years.

As a result, DPH has come a long way—from outright rejection from its original Dover Road community, to widespread appreciation of hospice care in its neighbourhood, in Singapore and beyond.

27-year-old Lawrence Lam ran 100km barefoot at the 2011 Sundown Marathon to raise funds and awareness for DPH and hospice care.

There is always a negative association with hospice care and death, so I want to raise awareness that hospice care is about living life well and giving people a comfortable place to spend their final moments.”

— Mr. Lawrence Lam, barefoot marathoner DPH Council Chairman Chey Chor Wai sharing information on DPH and hospice care during a media interview at the Business Times Charity Ride 2012. The BT adopted DPH as its beneficiary, raised more than S$76,000, and also helped bring about greater awareness of palliative care.

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WORK, HOME AND PLAY One cannot talk about the DPH community without mentioning our nurses, who, for over a decade, called this building home. From 1995 to 2011, the entire third storey of DPH was home to many nurses from Myanmar, Philippines and Malaysia, and also former Medical Director Dr Rosalie Shaw.

It was surely not easy for the nurses to adjust to a new work environment, new country and communal living all at the same time, but living together deepened their bonds of friendship, and gradually helped them adjust.

Because many of the nurses were from Myanmar, their unique food, cultural practices and festive celebrations became an integral part of DPH culture. The Water Festival was part of the Burmese New Year celebrations in mid-April, and it was a well-loved, highly anticipated event for the entire DPH family. Just for the day, the Myanmese nurses would turn the entire third storey into a riotous playground, spraying water at each other and everyone who came to join the festivities. No one could escape, and no one wanted to miss the fun!

DPH nurses celebrate Nursesâ&#x20AC;&#x2122; Day with Medical Director Dr Noreen Chan and Director of Nursing Edward Poon

Water Festival at DPH

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Our New Year is in April, we do our Water Festival party. We tell everyone, tomorrow our Water Festival, doctor, so you bring extra baju. Everybody want to happy, they want to join, they will bring their own extra baju.

We cook, after that we play with the water, we use small tub to throw water. All staff downstairs, all the doctors or volunteers, everyone join. Now slowly everybody never scared water, because every year they know already.”

The good thing is, if anything happen, they all come to room, come to the person facing something. Then if they need to go back urgent, they send to the airport and they taking care of each other. Even though you got fight, today if something happen, they all have each other. Sometimes dinner or lunch we all eat together in small groups. If you want to join, you can join. Also we have a small TV room, we watch TV and then we enjoy.”

— Ma Myat Myat Maw, DPH Senior Healthcare Assistant, joined 2000-Present

— Roi Lai, DPH Staff Nurse, joined 2003-Present

Photo courtesy of May Moe Tun Many of our nurses are foreigners but they can gel very well. Even though they may not speak the local language, they learn a little bit—they will say ‘makan’, 早 安 (zao an), and we learn to say which is ‘thank you’ in the Myanmar language, so they feel like they are one of us.”

— Ms Marlene Foo, DPH Council member 1992-1997, 1998-2001, 2002-2010, 2011-Present

For the two years that Dr Rosalie Shaw was joint Medical Director of DPH and HCA, she too lived in a small room on the third storey of DPH. This was her only home in Singapore, having moved from her home country Australia to help develop hospice care in Singapore.

I had a small one-bedroom flat, a little kitchen, a bathroom. The round room was the sitting room. In one corner was a pile of cases and boxes with my possessions, and a computer set up with Skype, because my husband was in Australia, and we talked everyday on Skype... I loved that little tower at the top.

I used to sit out at the verandah which faces TTSH, and write my journal in the early morning, and the birds were in those trees nearby. It was really helpful to be on site and not have to scramble through the traffic and MRT.” — Dr Rosalie Shaw, DPH Medical Director from 1996-1998

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DPH at the Outward Bound School, Pulau Ubin That DPH was literally home for so many years added to the warm cosy environment for staff, nurses, doctors and volunteers alike. This deep bonding was aided by team events, such as adventure camps at the Outward Bound School in the 2000s, which saw staff members kayaking, rock-climbing, abseiling and looking out for each other in team games.

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Joyce Lee:

Dr Jerry Lim got his friend to give a special discount for all the staff to go. It was really fun! We stayed there 1 night 2 days.

Edward Poon: I think the interesting thing about OBS is Saro. She was the only one

who could climb up the wall.

Joyce Lee:

That time she was 70 years old.

Edward Poon: Oldest could climb up and then we were all so ashamed.

Sarojini:

They didn’t expect me to climb, you see. Even the facilitator, he says, no I don’t think you can climb up. I say, never mind, if I fall you hold me. The anchor man is there what. In the end I managed to climb up.

Joyce Lee:

It was really fun. Everybody was together and at night we could walk to the seaside and all lie down and talk. It was very nice.

Sarojini:

We were in a group and then divided into three teams. We had games, rock-climbing...

Joyce Lee:

We went out to sea in kayaks.

Sarojini:

Ah kayak, we had to build our own boat and go.

Edward Poon: We had to ‘earn money’ before we could build. Had to do exercise,

skipping rope...

Joyce Lee:

We tied all the things together, then pushed it out to the sea to make sure it wouldn’t sink. One of the girls was really tough, she tied everything such that it didn’t sink.

Edward Poon: The thing is, because we needed to go and get our flag, it bonded all

of us in terms of our mission.

Photo credit: Joyce Lee

Professor Edward Poon, DPH Director of Nursing from 1999-2010; Ms Sarojini Ponnampalan, DPH Staff Nurse from 1995 - 2013; and Joyce Lee, DPH Assistant Manager, Patient Affairs and Administrator from 1996 to Present.

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A group photo of DPH staff by the Koi Pond at the Hospice

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Happy volunteers bonding at DPHâ&#x20AC;&#x2122;s annual volunteersâ&#x20AC;&#x2122; outing to Bukit Tinggi, Malaysia, 2013

DPH Showchoir GEMS, comprising Hospice staff and Volunteers, all dressed to perform for the various gala balls

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DPH Team Building Programme, January 2013

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Turquoise Group

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Garnet Group at Every Moment Matter

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Crystal Group

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FUTURE

Back in 2008, then Health Minister Khaw Boon Wan said Singapore might score an A-minus for acute care services but was probably “below C” when it came to palliative care. It has come a long way since. The World Health Organisation and Worldwide Palliative Care Alliance this year ranked Singapore among the top 20 countries in the world for its palliative care.”

— Excerpt from “Getting from C to A in palliative care”, The Straits Times, 1 August 2014

When DPH first opened its doors, it was a modest inpatient hospice with 4 administrative staff and 20-odd nurses to take care of 20 terminally-ill patients.

In 2017, DPH celebrates its 25th anniversary as an established palliative care facility of 50 beds, and major contributor to Singapore’s growth in palliative medicine.

Keeping pace with the advancement in medical science and psychosocial interventions, it also offers new services such as integrated home care, bereavement support, caregiver training and many others, now serving more than 500 patients a year.

Looking back, we see just how far DPH has come, in shaping the palliative care scene and radically shifting mindsets in Singapore. But what does the future hold?

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An artistâ&#x20AC;&#x2122;s impression of HealthCity Novena. Picture credit: ST Graphics

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A NEW HOME Imagine stepping into a cool lobby, with lifts quietly taking you up to a high-rise hospice. Arriving at the reception, you might stand at the glass windows to take in a bird’s-eye-view of Novena: up close, a cluster of tall healthcare institutions linked by aerial bridges; in the distance, residential blocks; and a sweep of land dotted with trees, gardens and eco-trails.

Then the receptionist might tap you on the shoulder, tell you which localised pod you’re looking for, each with its own cluster of nurses, doctors and patients.

As you walk to the pod, you may pass by patients resting in quiet spaces; or volunteers and patients preparing for their weekly outing; or see the Happy Hour trolley packed with the latest favourite drinks and snacks. If you’re lucky, there might be a pianist playing oldies from the 2000s; you might even spot the therapy dogs visiting friends.

This is a likely future for DPH, which is set to double in capacity to 100 beds and join the Integrated Care Hub, a rehabilitation complex scheduled to open in 2022. This hub will be situated in the 17-hectare HealthCity Novena, Singapore’s largest integrated healthcare complex which will be completed by 2030.

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When I joined DPH as Medical Director, it was in the midst of planning for its move to the new Integrated Care Hub. I had to represent DPH in the discussions, and I spent a lot of time working with architects, hospital planners, looking at the building.

We will be co-locating with TTSH, so we had to negotiate for certain facilities, a prominent front for DPH at the lift lobby, a rooftop garden, more single rooms, and even space for having a day care centre—currently we don’t have one, but we want to have a one in future.”

Within pods, you can have a separate group of patients and staff, grouped around a particular nurses’ station or office. So even in a big hospice, you can have a sense of staff belonging, and the patients and families feel they belong to this family in this little localisation. It’s not about having an environment look like home; it’s about people behaving as though they belong to a family.”

— Dr Rosalie Shaw, DPH Medical Director from 1996-1998

We had to give a full brief to the Ministry of Health—how many rooms we need, the sizes, music therapy room, volunteer rooms, massage rooms. These are requirements that are not typically provided for in a hospital, so we had to justify why we need it. We also made sure that our family room, our waiting areas, and our congregation spaces are directly linked to the roof terrace, so that you feel a sense of openness, a living room kind of space.”

— Ms Angelene Chan, DPH Council member 2010-2016

—Dr Wu Huei Yaw, DPH Medical Director from 2013-2016 It’s wonderful that DPH will continue to be a purpose-built hospice in the Integrated Care Hub. But aside from the physical environment, the key to our expansion is the continuation of our core values and the way we interact with our patients, so that the quality of care is not compromised.”

— Mr Timothy Liu, DPH CEO from 2016-Present

As the impending move draws near, no doubt there will be many feelings of nostalgia and loss from everyone who has grown to love the red-brick building with its greenery, open spaces and peaceful koi pond. But, as anyone who has been a part of DPH knows, loss is part of life—and that is why we treasure the moments we have.

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NEW CHALLENGES, NEW OPPORTUNITIES For DPH, the loss of our building heralds a new beginning that will bring both challenges and exciting opportunities for hospice care.

The future may be uncertain, but the need is clear. In the 2017 Committee of Supply debates in Parliament, Senior Minister of State for Health Chee Hong Tat spoke of the Ministry’s priority to “increase capacity, accessibility and quality of palliative care services” so that “more Singaporeans with terminal illnesses can benefit from palliative care services”.

The doubling of DPH’s inpatient capacity will allow us to better meet the challenges of Singapore’s fast-ageing population. More space also allows for more services, like the provision of daycare which DPH hopes to pilot in 2018.

The increase of home palliative care places is also on target—from 3,800 places in 2011, to 5,500 places in 2017, to an aim of 6,000 places by 2020.

And what about having more satellite sites? Rather than having one large hospice, there could be many smaller hospices run by the same DPH governing structure, sharing resources, processes and manpower.

I’ve always believed that we should keep hospices fairly small, because if it’s a large hospice, you get back to the cluttered, rushed environment. But to overcome our critical mass, we could establish smaller hospices within the Dover Park family. So if there were about 3 hospices, each of them about 40 to 50 beds, but run by the same overall governing structure, you have enough critical mass and you can distribute your capability to various sites.”

— Professor Lionel Lee, DPH Council Chairman from 2009-2011, 2013-Present and DPH Council member from 1994-1996, 2005-2009, 2012-2013

Then throw into this mix the rapid advancement of healthcare technology, like telemonitoring and telemedicine, cloud-based seamless care models, artificial intelligence, and many more developments that have yet to come.

How might this change our model of care? And what does palliative care of the future look like?

If the past and present is anything to go by, we can be confident that this new generation of DPH staff and volunteers will keep that same spirit of serving the community with holistic, patient-centric palliative care, always evolving to meet Singapore’s changing needs.

As we celebrate our first 25 years, we honour the vision and contributions of our DPH family, and we look ahead to many more precious moments of caring for patients, families and our community.

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Acknowledgments We wish to thank all those who have provided photographs, advice, information and other invaluable assistance to the writing of this book.

All photographs are credited to Dover Park Hospice unless otherwise stated.

INTERVIEWEES Mr Agus bin Othman Muhammad Ms Jeanthi Arunasalam Mr Ernesto Bedmar Ms Angelene Chan Ms Chan Choo Lin Dr Noreen Chan Charis Choir Dr Chen Ai Ju Ms Diane Chen Ms Cheong Kim Fan Mr Chey Chor Wai Prof Chin Jing Jih Mr Robert Chew Prof Philip Choo Ms Marlene Foo Mr Patrick Foo Dr Cynthia Goh Ms Gracia Goh Dr June Goh Mr Rupert Gwee Prof Stephen Hsu Ms Audrey Jansen Prof Koo Wen Hsin Dr Lai Kok Fung Dr Angel Lee Ms Joyce Lee Prof Lionel Lee Ms Sylvia Lee

Ms Betty Lim Ms Lim Hsiu Mei Dr Jerry Lim Ms Kemmy Lim Mrs Pearl Lim Mr Timothy Liu Ms Ma Myat Myat Maw Ms KL Mah Ms Maria Mah Mrs Sheryn Mah Mr Allard Mueller Naing Naing Win Ms Ong Ai Hua Ms Gillian Ong Mr Hunter Ong Mrs Ong Kim Ling Dr Ong Wah Ying Ms Mabel Pek Ms Phua Joo Keow Ms Sarojini Ponnampalam Prof Edward Poon Mrs Diana Quek Ms Roi Lai Mr John Sanderson Dr Seet Ai Mee Dr Rosalie Shaw Mr Sia Ooi Kong Ms Gillian Tan

EDITORIAL TEAM Prof Lionel Lee Mr Timothy Liu

Ms Lisa Li Mr Ian Yip

Mrs Tan Heem Juay Baba Richard Tan Mr Tan Seng Hock Ms Tan Siok Sun Mr Tan Tee Jim Mr Tan Yong Soon Mr Tang See Chim Prof Tay Boon Keng Mr Anthony Wong Dr Wu Huei Yaw Mr Wu Tuck Seng Ms Yang Shu Ting Mr Yeo Toon Peter, Peter Dr Peter Yu San San Tanu (outings group) Pat (outings group) Winston (outings group) Li Yean (gardening) Gek (gardening) Suraj (gardening) Bernard (pet therapy) Gilbert (GEMS) Happy Hour (3 people) Alice (volunteer) Helen (volunteer)

10 JALAN TAN TOCK SENG, SINGAPORE 308436 +65 6500 7272 UEN: S92SS0138D WWW.DOVERPARK.ORG.SG