22
singapore he alth
NOV⁄ DEC 2011
People
KKH’s Paediatric Epileptologist By Angeline Neo
As the Head of Neurology at KK Women’s and Children’s Hospital (KKH), Dr Derrick chan and his team deal with a range of brain disorders in children – from serious paediatric neurological conditions such as stroke, nerve disorders and brain inflammation to common complaints like headaches and developmental delays. But the bulk of his work involves children with epilepsy. Dr Chan specialised in epilepsy at the Hospital for Sick Children in Toronto, Canada, returning with new skills which have already made a difference in the lives of patients here. As a paediatric epileptologist, he works closely with a team comprising a neurosurgeon, a psychologist, therapists, EEG technologists, neurology nurses and social workers to manage patients with complicated epilepsy, and select and evaluate those suitable for epilepsy surgery. Before epilepsy surgery is recommended, Dr Chan evaluates the patient and scans and studies the brain. He analyses the electroencephalogram (EEG) to map the location of seizures in the brain.
The team discusses the options and approach together with colleagues from Singapore General Hospital (SGH) and National Neuroscience Institute (NNI). Selected patients require a process known as Extraoperative Subdural EEG Monitoring which involves putting electrodes on the surface of the patient’s brain for several days, followed by surgery to remove the areas producing seizures. This allows detailed monitoring of the activity from the brain’s surface during seizures and, hence, pinpoints the exact location causing them. With such detailed mapping and planning, the surgeon Dr Ng Wai Hoe can go in and take out only the bits that are causing the problem and conserve the parts that perform important functions, Dr Chan said. Success stories include a 10-year-old girl who had weekly seizures since age one. Medication did not work and the seizures were getting more frequent. After surgery, the seizures were controlled with medication. Another was a nine-year-old girl who also had seizures from a young age. She had the temporal lobe on one side removed and is now seizure-free. Dr Chan said surgery is not the last option, but has to be the right one. “In selected patients, surgery is very valuable.”
Beyond the hospital Big-hearted nurse continues to show her care and concern even after her patients are discharged
Many patients suffering from liver, gall bladder and pancreatic illnesses come to rely on Ms Julianah Bee Abdul Latif’s care and attention long after they are discharged. They first meet Ms Julianah Bee, Nurse Clinician (Specialty Care), Singapore General Hospital (SGH), when they are admitted to SGH for surgery. She explains the operation and their condition to them, their families and caregivers, and teaches the caregivers how to look after the patients after they are discharged. “I tell them about their condition and what to expect from the operation. I also teach them and their caregivers how to look after wound dressings and tubes before they go home,” said Ms Julianah Bee. Often, her care extends beyond the hospital. One patient asked her for help to dress her wounds, so now, once a week after her shift, Ms Julianah Bee makes her way to the patient’s home to change her
dressing. “I just like to make sure that my patients are doing well when they are at home too,” said Ms Julianah Bee. “I jumped at the chance to take this role as it allows me to interact more with patients and teach them about the nature of their disease, care and treatment.”
Dr Derrick Chan specialised in epilepsy while in Canada and, since returning, has already made a difference in the lives of patients here.
And with the right patients, doctors prefer to operate sooner rather than later. “If we wait a long time, they tend to develop deficits. If the epilepsy is allowed to continue, they may get other cognitive, memory and behavioural problems.” Dr Chan, married with two children aged six and eight, chose paediatric neurology because he finds it extremely ful-
Not surprisingly, she takes a close interest in her patients’ health and life outside the hospital and often ends up forming a strong bond with her patients and their families. “I got to know a patient six years ago and became close with him and his family. We visited each other’s homes during festive seasons and became good friends,” said Ms Julianah Bee. But the patient died recently. “Working on a surgical ward, I see most of my patients leave here feeling better. But some, such as those suffering from liver
PHOTO: ALECIA NEO
By Ruth Loh
PHOTO: ALLEN TAN
Dr Derrick Chan Wei Shih explains the nature of his job and why he chose to specialise in this branch of medicine
Going beyond the call of duty to teach and help her patients is normal for Ms Julianah Bee, who does it all out of love for her profession.
filling to help children recover fully and go on to lead normal lives. “A child’s brain has a tremendous ability to repair itself, more so than in adults, so we can do more. Even when we can’t completely resolve their problems, like in cerebral palsy, we can make the quality of their lives better.” Epilepsy usually manifests in the preschool or primary school years. The severity ranges from a twitching of the lips to a generalised seizure that does not stop. “Those patients end up in intensive care and we have to do a lot of work to try and protect their brain, minimise the harm and improve the condition. But it’s worth it. We have patients who’ve been in intensive care for months and eventually walk, talk and return to normal life,” said Dr Chan. Neurology has benefited from technological advances and there is more improvement in store. “We’re working on automated video analysis for patients with seizures and quantitative analysis of brainwaves to help us pinpoint where the seizures start.” Dr Chan’s long-term goal is to build a comprehensive epilepsy programme in KKH. Since returning from Canada, he has set up a ketogenic diet clinic, a specialised epilepsy clinic and a dedicated epilepsy monitoring suite. He is also encouraging the team to include more diversity and subspecialties. “We have the building blocks – the clinics, the people and the skills. What we want to do is keep developing and advancing,” he said.
cancer, can come back for treatment and it’s difficult for me to cope when they pass on. Thankfully, this doesn’t happen often,” said Ms Julianah Bee. But despite these challenges, she remains passionate about her job, which her mother inspired her to pursue when she was young. “My mother trained to be a nurse back in the ’60s, but she never finished her three years of nursing school. So she looked to one of her children to fulfil her dream,” she said. Motivated by the many stories her mother shared about her nursing days with her and her siblings, Ms Julianah Bee enrolled on a nursing course at Nanyang Polytechnic after her O levels. Ever since she graduated from the polytechnic, she has been working at SGH. “I always say that to be a nurse, you must really love – not just like, but truly love – what you do. Like doesn’t cut it. You have to love your work before you can love the people who come to you,” she said. Her dedication to her patients has not gone unnoticed. Over the years, Ms Julianah Bee has been the recipient of 10 awards which recognise her contributions to patient care. “My motto is to surpass my patients’ expectations. I make sure I am an expert at what I do, so I can offer my patients the best advice and information. I want them to know I am there for them,” said Ms Julianah Bee.