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One-stop wellness hubs for families with young children
With the launch of Family Nexus, families with young children can conveniently access health and social services in the same location close to their homes.
by Goh Bee Lian
Ms Yan Yue Mei, 35, was worried that her three-yearold daughter’s picky eating habits could be affecting her development, as her child was smaller in stature than her peers. At a friend’s recommendation, Ms Yan made an appointment with the Community Nursing service of Family Nexus located at Our Tampines Hub (FamNex@OTH). An assessment by the community nurses reassured Ms Yan that her daughter did not show signs of developmental delays; however, they discovered that the daughter had oral cavities.
Ms Yan was encouraged to bring her daughter for a follow-up visit with a dentist, and also learned tips to involve her daughter in food preparation, such as using colourful fruits
and vegetables to make meals more appealing. As a first-time mother, Ms Yan appreciated the professional support and reassurance she received at FamNex@OTH, which is located just a train station away from her home in Simei. She was also keen to attend parenting workshops with her husband to strengthen their parenting skills and enhance their relationship with their daughter.
SingHealth launched two Family Nexus pilot sites in 2024. Besides the one at OTH, the other was at SingHealth Polyclinics (SHP) - Punggol. These one-stop wellness hubs for families with young children provide comprehensive support and offer programmes that span preconception health, maternal health, child development, marriage and parenting support.
Family Nexus aims to build stronger, healthier families by providing integrated health-social support for residents in their marriage and parenting journey.
The Family Nexus pilot is a collaborative effort among public healthcare clusters, the Families for Life (FFL) Council, and community-based service providers. It aims to build stronger, healthier families by providing integrated health-social support for residents in their marriage and parenting journey.
The first of SingHealth’s Family Nexus sites, FamNex@Punggol, was officially launched on 22 January 2024 at SHPPunggol. While the child is scheduled for his routine vaccinations in the polyclinic, the mother can receive lactation support services and be screened for post-natal depression, to ensure that both mother and child are well. Families can also receive development screening for their children, emotional health services for mothers, as well as sign up for marriage and parenting workshops held in the area through the Family Nexus Coordinator.
The Family Nexus pilot is a collaborative effort among public healthcare clusters, the Families for Life (FFL) Council, and community-based service providers.
Family Nexus partners Families for Life to provide a suite of marriage and parenting programmes such as the Prepare/Enrich Marriage Enrichment Programme for married couples, Purposeful Play workshops for parents with young children, and the Positive Parenting Programme (Triple P) for parents and grandparents.
Punggol residents, Mr Amparo Juan Carlos Camero, and his wife, Jasmine Tan, both 26, came across the booth of FamNex@ Punggol while taking their toddler son to SHP-Punggol for vaccination. “Having Family Nexus in the clinic brings comfort to us as young parents because it feels like we have a loving community supporting us on our journey,” said Mr Carlos.
In addition, Family Nexus partners FFL to provide a suite of marriage and
Through Family Nexus, we hope to raise awareness of programmes and resources available for families in the community to help them in their marriage and parenting journey.
Dr Elly Sabrina Binte Ismail Council Member, Families for Life
FamNex@OTH is strategically located within a community hub. Located at Levels 1 and 4 of OTH, the centre houses three consultation rooms and a group activity space. Besides FFL marriage and parenting programmes, regular topical workshops relevant for families are also conducted here.
parenting programmes such as the Prepare/ Enrich Marriage Enrichment Programme for married couples, Purposeful Play workshops for parents with young children, and the Positive Parenting Programme (Triple P) for parents and grandparents. FFL also provides resources such as support groups, articles, videos and tips on common parenting topics. “Through Family Nexus, we hope to raise awareness of programmes and resources available for families in the community to help them in their marriage and parenting journey,” said Dr Elly Sabrina Binte Ismail, FFL Council Member. Launched on 14 June 2024, FamNex@ OTH is the first Family Nexus centre to be
strategically located within a community hub. Located at Levels 1 and 4 of OTH, the centre houses three consultation rooms and a group activity space. Residents who need health advice and support related to family planning, maternal health and child health can make an appointment to consult a community nurse from the SingHealth Regional Health System for the eastern part of Singapore. Currently, this service is fully subsidised. Besides FFL marriage and parenting programmes, regular topical workshops relevant for families are also conducted here.
As the pilot progresses, SingHealth will work closely with the Ministry of Health and
Ministry of Social and Family Development to evaluate its long-term plans. To find out more about SingHealth Family Nexus, visit for.sg/shs-fn. Family Nexus pilot sites outside of SingHealth include Sembawang Polyclinic and Chua Chu Kang Polyclinic.
98 years — and counting
A kidney, donated by a father to his son, is nearing a century in age, underscoring the advantages of living organ donations.
by Chua Kim Beng and Timothy Wee
Can a 70-year-old man have a kidney that is almost a century old? Yes, it is possible!
When Mr Kong Fook Seng, then in his 20s, found his kidneys failing as a result of disease, his father stepped up to offer him one of his own healthy kidneys. “I had my transplant in 1980, when I was 26 years old. At the time, my father was 54 years old. Fortunately, he was healthy; if not, I don’t think they would have allowed him to give me a kidney,” said Mr Kong. Today, that precious gift lives on; it is nearly 99 years of age, older than its recipient.
Mr Kong had known since 1972, when he underwent a medical checkup for National Service, that he had a problem with his kidneys. But they only started to fail in 1980. Each step he took left him breathless, and he had to sleep sitting up. Lying down made him choke because, as he was to learn later, his kidneys were unable to pump water out of his lungs.
When he later consulted a general practitioner (GP) for a high fever, he was found to have alarmingly high blood pressure — “about 200 over almost 100 plus” versus the more normal 120 over 80mmHg. The GP immediately sent Mr Kong to the hospital. He was diagnosed with IgA nephritis nephropathy, a disease that causes the tiny filters of the kidneys to lose their ability to remove excess toxins, chemicals and fluids that accumulate in the body. When that happens, the wastes build up, causing
problems like spilling protein into the urine.
Dialysis — either peritoneal or haemodialysis — is an option for kidney failure, but it is life-long. Transplantation is often recommended for a better quality of life, with the kidneys coming from either deceased or living donors. Patients face a long wait for deceased organ transplantation, however, with nine years the average wait time currently.
“That’s a long time to be waiting for a life-changing treatment,” said Dr Sobhana Thangaraju, Senior Consultant, Department of Renal Medicine, Singapore General Hospital (SGH). At least 400 patients were on the wait list as of 2023. While the disease is fairly common, its cause still unclear, she said.
With advances in medicine allowing organs from people without matching blood or tissue groups to be donated, living donation is increasingly favoured.
“When we see a patient who is transplant-eligible, we would certainly push for a live donor transplant. With this treatment, patients live longer, and they would have a better quality of life. Their kidneys usually last for much longer than a kidney that comes from a deceased donor,” said Dr Sobhana.
Mr Kong Fook Seng as he is today (above), and (right) with his late father, Mr Kong Wing Hing.
“When we see a patient who is transplant-eligible, we would certainly push for a live donor transplant. With this treatment, patients live longer, and they would have a better quality of life,” says Dr Sobhana Thangaraju.
People still tend to be wary about donating their kidney, but donors “can actually live a very healthy and normal life with one kidney”, said Dr Sobhana. Mr Kong’s father lived a further 29 years after donating his kidney, passing away in 2009 at the ripe old age of 83 years.
In Singapore, the kidney from a living donor lasts 20 years on average after transplant. But, as can be seen in Mr Kong’s case, the kidney from his father, the late Mr Kong Wing Hing, is lasting far longer.
With a healthy lifestyle and diet not much different from normal, Mr Kong has led an active life. Grateful for a second chance at life, he decided to live life to the full and took part in three editions of the World Transplant Games — in 1984, 1986 and 1989 — representing Singapore in table tennis and swimming. He hopes to encourage potential donors to take that step towards giving so they can help their loved ones with kidney failure live normal lives.
According to the Singapore Renal Registry, the number of patients with kidney failure has increased by 40 per cent over the past decade, with six new patients being diagnosed every day.
PHOTOS: VERNON WONG
Aiming for shorter hospital stays for patients
SGH’s Acute Medical Ward moves to the new SGH Emergency / NNI building, benefiting from essential services and facilities under one roof.
To
ensure quicker patient recovery and shorter hospital stays, the ward frontloads rapid assessments, diagnoses and treatments.
The new SGH Emergency / NNI building on SGH Campus has welcomed its first tenants.
The hospital’s Acute Medical Ward (AMW), which is taking four floors of the building, moved into two of the floors in December 2024, with the other wards opening in the coming months. Housed in different buildings of the sprawling SGH complex before, the acute medical wards have been consolidated to operate in the same building as SGH’s other acute care services — the Emergency Department (ED) and stroke activation neurodiagnostic centre. (Emergency services still operate at SGH Block 1; the ED will only move into the new building later in the year.)
“AMW is designed to support the ED in receiving patients who need acute medical care but are not critically ill, to provide early assessment, diagnosis and treatment. It aims to improve patient journey in the hospital and facilitate early discharge,” said Dr Lim Wan Tin, Senior Consultant, Department of Internal Medicine, SGH.
The AMW offers subsidised multidisciplined care under senior doctors, nurses and allied health professionals to
ensure timely decisionmaking, efficient care, and optimal patient outcomes.
Simultaneously starting treatments, including rehabilitation, ensures earlier discharge for patients and and a faster bed turnover rate.
Siting the AMW in close proximity with the ED creates synergies and greater efficiencies through enhanced communications and collaborations.
AMW care is under the purview of the Department of Internal Medicine (DIM), the largest medical speciality department in SGH. The department receives a
wide range of medical patients with undifferentiated medical conditions from ED, often presenting with varied symptoms, added Dr Lim. Diagnostic tests are sometimes necessary, but they can involve long waits, which delay early diagnosis and hospital discharge. Dedicated imaging facilities at the new building, shared with the ED and NNI clinics, help fast-track essential
Ms
Osman, Dr Tharmmambal Balakrishnan, Ms Thurgathavi P Vellasamy, Dr Lim Wan Tin and Ms Siti Khadijah are members of the multidisciplinary AMW that also includes allied health professionals.
(From left)
Hartini
diagnostic imaging. “Reaching an early diagnosis means an earlier assessment of whether rehabilitation is needed. Under the AMW care model, there is improved ward processes, whereby a multidisciplinary team comprising nursing, allied health, pharmacist, social worker, and patient navigators (ward nurses who facilitate and coordinate patients’ discharge plans) work together concurrently to help patient recover faster and to be discharged back home,” said Ms Hartini Osman, Assistant Director, Nursing, SGH.
Processes have been improved and streamlined to waste as little time and resources as possible since the AMW began in 2015 as a pilot project, said Dr Lim, who leads the team in planning and carrying out the service. Staff, for instance, are trained in acute care protocols, communications, and handling high-pressure situations to promote a healthy, supportive work environment. “With an increasingly aged population, with its higher clinical care complexities, the AMW has morphed to meet the challenges of catering to the individual needs of each patient. Patients who need longer treatment for subacute to chronic care will be transferred out of AMW to the general wards or discharged home to receive further care through programmes like SGH@Home or Hospitalto-Home (H2H),” said Dr Tharmmambal Balakrishnan, Senior Consultant, Department of Internal Medicine, SGH. SGH@Home offers round-the-clock telemedicine access to the SGH medical teams, while H2H’s structured care plans include home visits by multidisciplinary medical teams.
A quick afternoon huddle, led by senior nurses, puts everyone on the same page regarding patients’ medical and discharge status.
Caregivers work alongside AMW nurses on rudimentary care so that patients get the same level of care at home. The larger space at the new Emergency / NNI building also allows patients to walk more to boost their mobility, aiding their recovery.
Caregivers are another key feature of AMW care to ensure patients get the same level of care at home. With the larger space in the new building, caregivers are encouraged to stay with patients in the AMW on admission and work alongside nurses and therapists on rudimentary patient care. They learn to feed patients food and medicine, help them with simple exercises, and the proper way of showering and transferring to and from bed to chairs. Patients, too, play their part by taking ownership of their own health. With their caregivers, they are encouraged to walk around the ward, or to sit up in their beds to do exercises to increase their mobility. “We want to empower caregivers to provide the same level of care that the patient receives in hospital when he returns home. We facilitate the caregiver’s involvement in caring for the patient as soon as they are admitted,” said Ms Hartini.
The hospital is able to offer this service with the larger space available in the new building. Besides dedicated imaging facilities, the new building also has a discharge pharmacy on the first floor, providing greater convenience for patients and caregivers to obtain their discharge medications and medication counselling.
PHOTOS: VERNON WONG
Seniors and caregivers associate frailty with physical condition, ageing and mental frailty, says Dr Lim Siew Hoon, who surveyed these respondents in the outpatient and bedside settings (staged here with colleagues, Senior Nurse Manager Kamsiah Jaafar as patient and Nursing Executive Ms Raden Nurheryany Sunari).
Coping with frailty
A new study offers a more holistic understanding of the complex interplay between frailty, resilience and selfefficacy, and their impact on patient care and recovery in older adults in an acute care context.
by Goh Bee Lian
Physical and mental well-being — fitness and health, state of mind, and willpower — can and do influence a patient’s ability to cope with illness and loss.
At the same time, knowing how these factors play a role in overall well-being helps nurses and caregivers to provide better care.
Dr Lim Siew Hoon says that knowing how older adults and caregivers perceive frailty and resilience can shed light on areas where interventions can improve patient outcomes and caregiver burden.
To understand better how older hospitalised patients experience and perceive frailty, which can affect their resilience and coping abilities, a group of Singapore General Hospital (SGH) nurses interviewed 24 SGH inpatients who were aged 65 years and above and 10 caregivers of inpatients between September 2020 and July 2021.
“We came to understand that frailty encompassed physical elements as well as manifestations of psychological traits, fear of the unknown, and being in control,” said Clinical Assistant Professor (Dr) Lim Siew Hoon, Nurse Clinician, Division of Nursing, SGH.
“Older adults and family caregivers shared that a considerable decline in physical health with age and level of perseverance can determine the level of frailty. They felt that one would be less frail when he or she had a better mental state and stronger willpower.”
In the study, led by Dr Lim, patients, relatives and caregivers were asked for
their understanding of the terms ‘frailty’, ‘resilience’ and ‘self-efficacy’. The group comprising patients was also asked specifically whether they considered themselves to be frail, what helped them cope with health issues, and what their health goals were. Meanwhile, the other group, comprising relatives and caregivers, was asked about their perceptions of the patient’s health status, whether the patient was frail, and how they helped the patient to cope and attain their health goals.
The mean age of the 24 older adults was 70.4 years old, comprising mostly females (92 per cent) and Chinese (96 per cent). The mean age of the 10 family caregivers was 51.4 years; 50 per cent were female and 80 per cent were Chinese.
Dr Lim had observed that, after years of working in SGH’s colorectal surgery unit, older patients were increasingly being admitted to hospital, often with complex medical conditions. “This raises the importance of understanding how frailty and resilience impact their care and recovery in acute care settings. Investigating how older adults and caregivers perceive their own self-efficacy in the acute care setting could also shed light on areas where interventions may improve patient outcomes and caregiver burden,” she said.
She had wanted to gain a more holistic understanding of the complex interplay between frailty, resilience and self-efficacy
as a way of examining how the quality of care and support for older patients and their caregivers can be enhanced. Earlier studies had focused on the individual factors in isolation.
Participants discussed frailty in association with their health beliefs and personal fears. For instance, both the older adults and family caregivers described frailty as being closely related to physical condition, was inevitable as people age, and would be accompanied by mental frailty. However, some also believed that a better mental state and greater willpower could to some extent mitigate growing frailty.
Many participants highlighted concerns about the unknown. Becoming frail and sick unexpectedly can lead to a loss of independence, thus becoming a burden to their families. “Hence, being in control appeared to be a common coping response of these older adults, through active involvement in the management of their own health,” said Dr Lim.
Nurses can help patients to be more involved in their own care during hospitalisation and in the community, and enhance their independence in response to coping with frailty, she added. “It’s important to understand the diverse conceptualisation of frailty, across psychological and social dimensions, which differed from the physical definitions of frailty. Resilience and self-efficacy play a pivotal role in the context of frailty in the older adults,” said Dr Lim. “Understanding resilience in this context will assist nurses to facilitate the use of individual and sociocultural resources that may improve how resilience is experienced by older adults. Nurses can provide guidance on coping strategies for older adults to help them be more involved in their own care and enhance their independence in response to coping with frailty.”
Findings from the study were shared at professional healthcare conferences, including the SingHealth Duke-NUS Conference 2023 and 5th SingHealth Nursing and APN Conference 2023.
Why the oral microbiome matters
It influences everything — from your dental health and immune system to systemic conditions like your blood pressure.
by Associate Professor Fabio Leite, Principal Investigator, National Dental Centre Singapore
Imagine a bustling city with millions of residents, each playing a unique role in maintaining harmony. This city exists right inside your mouth, and its citizens form what we call the oral microbiome. Composed of hundreds of bacteria, viruses, fungi and other species, the oral microbiome is not just a passive community; it is an active participant in your overall health, influencing everything from your dental health to your immune system and even systemic conditions like your blood pressure.
The unsung hero of oral defence
The oral microbiome is one of the body’s first lines of defence. A balanced microbiome prevents harmful pathogens from gaining a foothold by producing antimicrobial compounds and outcompeting invaders for resources. This protective barrier shields the teeth and gums, reducing the risk of oral diseases such as cavities and periodontitis.
But its impact does not stop there. Beneficial oral bacteria play an essential role in training our immune or body defence mechanisms to distinguish friend from foe. This education helps prevent overreactions, like allergies, and underreactions, such as chronic infections.
Oral health as a window to systemic health and well-being
Emerging research highlights a profound connection between one’s oral health and overall health.
For instance, the oral microbiome’s role in nitrate metabolism, converting dietary nitrates from vegetables and processed meats into nitric oxide, is crucial for cardiovascular health. Nitric oxide helps regulate blood pressure, enhances exercise performance, and protects blood vessels from inflammation and clotting.
However, modern lifestyles often disrupt this delicate balance. High-sugar diets and overuse of antiseptic mouthwashes can indiscriminately kill beneficial microbes, tipping the scales toward dysbiosis, or microbial imbalance. Dysbiosis leads to oral diseases, and is implicated in systemic issues.
Restoring balance: A path back to health
So how can we nurture this intricate ecosystem? The answer lies in a holistic approach that respects the microbiome’s complexity:
• Microbiome-friendly hygiene: Swap harsh antiseptic mouthwashes for gentler, targeted products that support microbial diversity while combating pathogens as prescribed by dentists. Even different toothpastes can contain different products, so discuss with your dentist on suitable oral products to use.
• Dietary choices: Consuming nitrate-rich vegetables like spinach and arugula feeds beneficial bacteria that produce nitric oxide, supporting cardiovascular and oral health. Reducing sugar intake can also limit the growth of harmful bacteria.
• Lifestyle factors: Stress, poor sleep, and
sedentary habits can weaken the immune system, indirectly affecting the oral microbiome. Addressing these factors promotes a supportive environment for microbial balance.
Why it matters
The oral microbiome is not just about healthy teeth and gums; it is a critical player in your body’s ecosystem. Understanding and caring for it could hold the key to preventing a host of chronic conditions. By maintaining its equilibrium, you are not just investing in your smile, but also protecting your overall well-being.
In a world increasingly aware of the importance of microbiomes, from the gut to the skin, it is time to bring the oral microbiome into the spotlight. After all, every good story starts with a strong foundation; for health, that foundation begins in the mouth.
Extending a friendly hand
Achaperone programme ensures that frail patients do not miss their medical appointments, but more volunteers are needed as demand for this service grows in line with an ageing population.
by Sol E Solomon
Patients like Mdm
Asnah Salim (in wheelchair) benefit much from the assistance rendered by Ms Ng Swee Leng (left), who is a volunteer with SGH's Medical Chaperone programme. The programme is supported by social service agencies, such as the Thye Hua Kwan Moral Charities, which provide transport to and from SGH Campus.
If not for community and social service providers like Thye Hua Kwan Moral Charities (THKMC), Mdm Asnah Salim would have a problem going for her medical appointments. The 62-yearold lives in a two-room rental HDB flat with her daughter and son, but the latter has cognitive challenges and is unable to accompany her on her twice-monthly Singapore General Hospital (SGH) clinic appointments. “I have no means to attend SGH medical appointments on my own. My mobility is restricted because of medical reasons, and I am grateful to THKMC for helping me meet my medical needs,” said Mdm Asnah.
THKMC arranges for transport to ferry her to SGH, where volunteers under the hospital’s Medical Chaperone programme meet residents like Mdm Asnah to accompany them throughout their hospital journey, from registration through to the blood test laboratory, consultation, and pharmacy to collect their medications. The THKMC
transport then takes them back home. Mdm Asnah’s story is not unusual. According to a THK Seniors’ Community Services spokesman, THKMC makes such arrangements for 200 needy residents in Singapore’s southeast region every week, or about 40 residents a day. Residents who live alone, are frail, and in need of medical support are eligible for THKMC’s Medical Escort and Transport service, the spokesman said.
Having the service and making it easier for elderly residents to attend clinic appointments mean fewer patients would miss their appointments. “Missing follow-up medical appointments can have significant implications for the patient’s health and overall well-being, as treatment can be delayed, leading to an increased risk of complications,” said Mr Wong Hoe Pang, Executive, Volunteer Management Department, Division of Population Health and Integrated Care (PHIC), SGH.
This group of patients also often have communication issues — explaining
symptoms to doctors, nurses, pharmacists and therapists, and understanding instructions on taking medications. The medical chaperone can sit in on the consultation to take notes for the patient so that information and follow-up instructions can be conveyed to the community partner.
SGH’s collaboration with social service agencies began in September 2022 after a pilot chaperone programme with 12 patients a year earlier met with positive feedback from beneficiaries, volunteers and community partners. Presently, this programme is only available for patients referred by the community agencies like THKMC and Touch Community Services, said Mr Wong.
“We are thankful for this collaboration with SGH Volunteer Management Department. Many of our clients now have additional assistance for their medical appointments. This partnership allows us to allocate more resources to help clients attending other hospitals and polyclinics, enabling us to expand our reach and support a broader community,” said the THKMC spokesman.
The SGH programme has some 90 regular volunteers, but more are needed as demand from elderly patients rises. The volunteers are trained in infection control, hand hygiene, medication collection, emergency management, safe wheelchair navigation, and the use of SingHealth’s Health Buddy app. They must also be physically able to push patients in wheelchairs across SGH Campus for appointments at SGH, as well as at SingHealth national centres like the Singapore National Eye Centre.
According to Mr Wong, people volunteer at hospitals and social service agencies for various reasons — from concern for the welfare of others and giving back to society, to learning new skills and fulfilling corporate social responsibility and school community involvement requirements. “Volunteering as a medical chaperone has been very fulfilling and meaningful for me as I’m able to understand what some of the patients have to deal on a daily basis, and I’m able to support their medical needs and contribute to their well-being,” said SGH staff volunteer, Ms Ng Swee Leng.
Patients at the heart of all we do. Really.
One would not be blamed for thinking the mother was the patient as she was old and frail. But it was the son — younger but in his 60s — who was the patient. With no other family support, Mdm Chua* had little choice but to accompany her son, who was mentally challenged, everywhere, including on his visits to SGH.
Not surprisingly, on their first visit to SGH, the pair found themselves in the sprawling Outram Park MRT station with little idea of the correct exit to take for the hospital. A Good Samaritan noticed their confusion and accompanied them from the MRT station to the right clinic in the hospital. When she realised that they would need help on subsequent visits, the Good Samaritan alerted the hospital, which assigned Ms Jarojah Narayansamy, Senior Patient Experience Manager (SPEM), to help them.
Although Ms Jarojah’s job as a SPEM included helping patients with directions around the huge SGH Campus, she decided to be their personal chaperone for subsequent clinic appointments. She reminded them of their appointments, took them to the pharmacy to collect the patient’s medications, arranged for their transport back, and even took them for lunch.
Jaro was very helpful when I met her in October 2023 while helping the patient’s aged mother with a doctor’s appointment. As I was not related to the patient and unable to help them in the long term, I approached Jaro to take over to remind him of his doctor’s appointment date (patient has no SMS app) and arranged to pick them up at the designated place and bring him for blood test medical appointment. The patient’s mother, who was also his caregiver, was very appreciative of Jaro’s care and patience. Thanks to Jaro for her kind assistance and support to the needy patient.
A Good Samaritan
Why did Ms Jarojah go the extra mile? “I saw their difficulties, as Mdm Chua spoke only dialect and some Malay. She always held onto me for support as she has painful knees and was frail. She reminded me of my late mum,” said Ms Jarojah, who is in her early 70s. “I knew that they would face the same challenges each time the son had an appointment at SGH. Helping them also helped me better understand and appreciate their challenges, and made me want to work harder to improve their healthcare experience. Helping them was both an enriching and rewarding experience.”
Ms Jarojah helps many other patients, including one with multiple medical conditions, consumed myriad medications, had many clinic appointments, and was frequently warded at SGH. Besides reminding the patient of her appointments and to take her medications, Ms Jarojah often brought her to SGH’s food court during her own lunch breaks.
SGH’s motto — “patients are at the heart of all we do” — rings true, as this sense of service and responsibility has become second nature to all SGH staff, not just Ms Jarojah, a nursing veteran of over 50 years. Many do not hesitate to volunteer at SGH’s many corporate events, like Project Groomover (an annual event where staff volunteer to clean and paint needy residents’ homes) and patient support group meetings.
The Good Samaritan who helped Mdm Chua and her son was so impressed by Ms Jarojah that she highlighted her good work to SGH’s feedback channel. “The Good Samaritan was surprised and appreciative of the hospital’s efforts to follow through on her request. She only left after I assured her that I would be with both the mother and son throughout their visit,” said Ms Jarojah.
For her many acts of kindness, Ms Jarojah was given the SGH Heart of Gold award, an honour reserved for just five people each quarter. *not her real name
Volunteering at SGH
If you are interested in volunteering, write to volunteer@sgh.com.sg. A chaperone session typically takes about two hours, but volunteers are advised to set aside four hours in case of delays. Chaperone sessions run during clinic operating hours (8am to 6pm) on Mondays to Fridays.
Volunteers must be willing to interact with patients, most of whom are elderly. Fluency in mother tongues and dialects is helpful, but not compulsory. Volunteers must also be vaccinated against COVID-19, MMR (measles, mumps, rubella), TDAP (tetanus, diphtheria, pertussis) and varicella (chicken pox).
Jaw-dropping joint
Experiencing discomfort in your jawline, especially around the ears? You could have an issue with your temporomandibular joints.
by Chua Kim Beng
Place your fingers in front of your ears, then open and close your mouth — that movement you feel on each side of your jaw is your temporomandibular joints (TMJ) in action, connecting your jawbone to your skull.
If pain develops in your jaw, it could be due to infection, trauma or dental diseases. Another possibility is temporomandibular disorder (TMD), which causes pain in the TMJ and in the muscles that control jaw movement.
According to Dr Amelia Chew, Consultant, Prosthodontics, Department of Restorative Dentistry, National Dental Centre Singapore (NDCS), TMD is a group of conditions that causes pain and loss of normal function to the TMJ. The joint is made up of the lower jawbone and the skull. A cartilage disk, which functions as a shock absorber and joint lubricant, separates these two bones. The TMJ and the muscles of chewing enable you to open your mouth, talk and chew. TMD can originate from the chewing muscles, cartilage disk or the joint bone. Symptoms of TMD include pain or tenderness of the jaw or TMJ joints, cheek or temple region, headaches, difficulty or pain when chewing, restrictions in mouth opening, or a clicking sound when opening or closing your mouth. Other signs include worn-down, cracked or fractured teeth. She added that TMD can occur if the cartilage disk is eroded, misaligned or damaged by arthritis or trauma.
In many cases of TMD, the exact cause is neither clear nor straightforward. “Frequently, pain at the TMJ may be due to a combination of factors, such as genetics,
parafunctional habits and/or jaw injury,” said Dr Chew. “It has been noted that some people who habitually clench or grind their teeth (bruxism) often present with TMD.”
From cross-sectional studies, approximately 20 per cent of the Singapore population has TMD. “The prevalence of TMD in Singapore has remained stable in recent years. However, there is some indication that the number of cases may be rising, especially among youths, due to increasing stress levels, better diagnostic tools, and greater public awareness,” she stated.
Globally, TMD affects approximately 11 per cent of children and 31 per cent of adults, with women in their 20s to 40s most affected, although the predominant patient profile can vary widely from country to country. For instance, Dr Chew shared that there is a prevalence of cases of TMD caused by joint degeneration due to the ageing demographic in Japan; whereas in India, the cause is mainly trauma, such as traffic accidents, and cultural, such as the chewing of betel nuts.
Good news for TMD patients: In most cases, the discomfort is selflimiting, and can be managed by self-care or non-surgical treatments. Surgery is
In many cases of TMD, the exact cause is neither clear nor straightforward, and is likely “due to a combination of factors, such as genetics, arthritis and/or jaw injury”, says Dr Amelia Chew.
the skull by a cartilage disk that acts as a cushion when the joint is functioning (chewing, speaking,
Effective management can improve quality of life
CASE 1: A young professional was experiencing severe jaw pain and headaches that adversely affected her corporate and personal life. After examination, it was revealed that her teeth grinding and TMD were linked to severe work stress. She responded well to physical therapy and a custom occlusal splint, and she was able to manage her condition with stressrelief techniques.
CASE 2: An elderly patient in their late 70s presented with TMD symptoms due to osteoarthritis in the TMJ. This case was notable for how age-related degeneration of the joint could mimic TMD symptoms. The patient responded well to a combination of medication and physiotherapy.
CASE 3: A middle-aged man had severe TMD for years. During investigation, it was revealed that his symptoms started when he lost a loved one. Screening tools revealed that he was undergoing depression. He was then referred for psychological management and was subsequently successfully treated with resolution of his TMD symptoms.
if
usually the last resort when conservative management fails. If you have persistent pain or tenderness in your jaw, or if you cannot open or close your jaw completely, consult your dentist or TMJ specialist. In general, 80 to 90 per cent of TMD cases are managed with non-surgical therapies including:
• Counselling and stress management: Studies have shown a high correlation between the psychological state of patients and TMD. Managing underlying anxiety or depression could have a positive impact on the outcome of TMD patients.
• Physical therapy: Jaw exercises, heat/cold therapy.
• Medications: Pain relievers, anti-inflammatory drugs, muscle relaxants.
• Therapies: The use of a bite guard can help patients who grind their teeth during sleep.
• Restoring natural teeth: Worn-down teeth may need to be crowned.
• Surgery: Surgery is usually only considered after extensive non-surgical interventions have been attempted unsuccessfully. Procedures range from washing of the joint with fluids (arthrocentesis) to inserting a small scope into the joint to examine and treat the joint (arthroscopy). Surgeries are managed by the Oral and Maxillofacial Surgeons at the NDCS.
In the normal closed position, the lower jawbone is separated from
yawning).
In the normal open position, the disk follows the lower jaw bone, moving in tandem up and down or side to side.
The joint is abnormal
the disk is displaced or torn.
Is 100 the new 50?
Is age just a number? Can diet, exercise, supplements, social engagement, and medical advances help make living beyond 100 years the norm for most people?
by Goh Bee Lian
Living forever, or at least past 100, might no longer be the stuff of science fiction.
A clean lifestyle, a healthy diet, and regular exercise are often cited as basic must-haves for a chance of good health and long life. But regular medical care, scientific and technological advances, and even supplements are some other considerations that might well tip the quest to live past 100 into reality.
Life expectancy in Singapore is already not far off the 100-year mark. Women live till 84 years on average, while men lead slightly shorter lives — 81 to 82 years on average. “This represents a jump of 20 years over the last 50 years,” said Professor William Hwang, Senior Consultant, Department of Haematology, Singapore General Hospital (SGH), and Co-director of the SingHealth Duke-NUS Regenerative Medicine Institute of Singapore. “In terms of healthy life expectancy, Singapore is one of the top countries at 74 years, meaning we have 10 years of less good health.”
Five regions — Okinawa (Japan), Ikria (Greece), Loma Linda (USA), Sardinia (Italy), and Nicoya (Costa Rica) — are considered to be ‘blue zones’, where people have a longer life expectancy than the rest of the world. Those places also boast of more people living to 100 years or older.
A high life expectancy in Singapore is a surprise to many as, unlike the blue zones, the island nation does not have natural attributes like beautiful scenery, mountains, rivers, and clean air thought to bolster health. Neither does Singapore have the sort
of naturally close-knit communities for social interaction, healthier diet, and physical activity associated with longevity. Instead, Singapore is considered a blue zone 2.0, or an engineered blue zone, a concept based on interventions, intentional or unintentional, that contribute to an extended lifespan.
Good genes may play an important part in good health and life expectancy. But like a computer from a respectable brand, genes only play one part. Just as how a computer is used and maintained by the owner, so too do variables like lifestyle, diet, supplements and accessible healthcare determine life expectancy, said Prof Hwang.
Another is Singapore’s healthcare system that emphasises early disease screening and interventions to control chronic diseases, and hence lowers the chance of serious illnesses. Prof Hwang is of the opinion that the early death of his grandfather of a heart attack at 60 is likely cholesterol-related, following the diagnosis of high cholesterol in his father at 40. A medication like statin, which lowers cholesterol, might have helped extend his grandfather’s life. “Sometimes pills are necessary, and important in life extension,” said Prof Hwang.
Supplements might also be a plus factor, with many researchers looking into the usefulness of products like collagen, probiotics and vitamin E. “The common theme is that many of these try to combat inflammation, which causes overdrive of the immune system,” said Prof Hwang, adding that an immune system that is constantly in overdrive can lead to infections, disease and ageing. “The immune system needs to be like the porridge in the ‘Goldilocks’ story —
neither too hot nor too cold; it has to be just right,” said Prof Hwang, a haematologist with special interest in blood cells and stem cells.
Next-generation science that involves the growing of cells, tissues and organs is an area that can help the immune system reach that Goldilocks state. While many nextgeneration science projects are at the stage of animal trials, the growing of skin cells, for instance, is already being done to help burns patients. So next-generation science working to repair cells or to ensure that the immune system stays in balance could well happen in this lifetime.
In cases where there is organ failure, transplant is one of the best methods to extend life. With next-generation science, the ability to grow the cells needed means overcoming the scarcity of organs that is today’s reality.
Just as how a computer is used and maintained by the owner, so too do variables like lifestyle, diet, supplements and accessible healthcare determine life expectancy, says Prof William Hwang.
For more on this issue, log on to https://for.sg/perfectlyimperfecthealth-100yo or scan the QR code to listen to the ‘Do you want to live to 100 years old?’ episode of Perfectly
Imperfect Health, a podcast by SGH.
The shaky truth
How to tell essential tremor from Parkinson’s disease.
by Thava Rani
Have you experienced shaky hands when you are stressed, sleep deprived, or have had too much caffeine?
Now imagine having to live constantly with the condition. Simple tasks like holding a cup of coffee, signing a document, and inserting a key into the lock become a huge challenge. Called tremors, they can hinder your daily activities and become a source of frustration and embarrassment. But what causes these tremors?
ET is 20 times more prevalent than Parkinson’s disease, says Prof Tan Eng King (top). “Based on our study, the tremor in ET is likely affected by brain structure," says Dr Thomas Welton (above).
Tremors are involuntary hand movements. Although common and not life-threatening, they can be a symptom of underlying conditions such as essential tremor (ET) and Parkinson’s disease (PD).
Of the two, ET is 20 times more prevalent than Parkinson’s disease, yet it is lesser known. This is probably due to the lack of scientific and clinical consensus on its causes and diagnosis, said Professor Tan Eng King, Deputy CEO (Academic Affairs) and Senior Consultant, Department of Neurology, National Neuroscience Institute (NNI).
ET is a movement disorder that causes tremors, affecting about 60 million people worldwide. Patients experience what is known as action tremor, which occurs during specific actions or postures. “For example, hand tremors occur when holding a cup or spoon, or when using a laser pointer during a presentation,” described Prof Tan. ET usually affects the hands but can occur in other parts of the body. “Around 10 to 25 per cent of patients with ET experience head tremors and 10 per cent experience voice tremors. It is common for tremors to occur in multiple parts of the body at the same time,” added Prof Tan.
In the case of PD, patients experience shakiness at rest, such as when the hand is resting on a table or lap. This is known as a rest tremor, and affects the hand, arm or leg.
Both types of tremors can be aggravated by stress and anxiety.
PD is, however, a more serious condition that results in brain changes that worsen over time. “The tremors associated with PD often occur with three other movement difficulties, such as slowness, stiffness and/ or poor balance. PD also causes other health problems, including depression, constipation, loss of smell and sleep issues,” said Prof Tan.
Similarly, ET worsens over time, with the tremors becoming more frequent or intense, and daily tasks become more difficult to conduct. The worsening of symptoms tends to accelerate in people whose ET strikes when they are older.
In Singapore, ET is more common in men than women, and the top risk factor is having a family history of the condition. “About 40 to 50 per cent of patients diagnosed with ET have a parent or sibling with ET or a history of tremor,” said Prof Tan.
A recent NNI study, published in the journal Movement Disorders, identified changes in gene expression relating to tremor in ET. “Based on our study, the tremor in ET is likely affected by brain structure, and that genes affect the specific brain networks that are linked to tremor. It is possible that, in future, by better understanding the genetic causes of tremor, we can intervene to preserve brain structure and limit the progression of tremor,” said Dr Thomas Welton, Junior Principal Investigator, Department of Research, NNI.
PD can also be passed on through genes, but this is less common than for ET. “A genetic link is more common when a family member has been diagnosed with PD when he or she was under 50 years old,” said Prof Tan.
Management of both ET and PD are tailored to each person’s symptoms. Patients are advised to get enough rest, have regular meals, and reduce consumption of caffeineenriched drinks. There are also medications and Botox injections to help control tremors. A surgery known as deep brain stimulation may be offered if symptoms cannot be controlled with medicines.
How to differentiate ET from PD
Body part shakes when it is performing tasks
Both hands are usually affected, but the tremor may be more obvious in one hand
Unlikely to cause problems with balance
Rarely causes other health problems
Shaking occurs when the body part is at rest
Usually occurs on one side of the body in the early stages
Other common symptoms include stiffness and slow movement Balance is often affected
Essential tremor
Parkinson’s disease
Ingredients
• 400g chicken thigh (remove skin and bone, cut into pieces)
• 2 dsp oil
• 2½ tbsp honey
• Marinade
• 1 thumbsize piece of ginger, chopped finely
• ¾ tsp curry powder
• 4 tsp oyster sauce
• 2 tsp cornflour
• 1 tsp light soy sauce
• ½ tsp pepper
• 2 tsp sugar
• pinch of salt
Method
1 Marinate chicken.
2 Place chicken on a baking tray and brush oil on chicken.
3 Bake at 180°C for 10 minutes.
4 Remove from oven and brush honey on chicken.
5 Bake for another 5 minutes.
6 Remove chicken from oven and serve hot.
Did you know?
Black and white pepper are derived from the same plant. Their different characteristics arise because they are harvested at different stages of maturity.
Black pepper is made from berries that are harvested half-ripe, just before they turn red. They are dried in this condition and, in the process, develop a dark, almost black colour. This is the most pungent and flavourful of the peppers. Black pepper is warm, woody and lemony, and has a hot and biting, clean, penetrating aftertaste.
White pepper is obtained when the ripe and completely red berries of the plant are harvested. They are then soaked in water for a few days to dissolve the dark hull (outer shell) to reveal the white inner seed. Due to this process, white pepper has less essential oil than the black variety, and is therefore less aromatic.
Baked chickenhoney
4 servings
Health Tip
Watch out for sugar in other forms — brown sugar, castor sugar, fructose and honey, for example. It is a common misconception that honey and brown sugar are more nutritious than white sugar. Honey is a mixture of sugars: fructose, sucrose and glucose. A teaspoon of honey weighs more than a teaspoon of table sugar, and therefore has slightly more carbohydrates and calories. It is also sweeter than table sugar, so less of it can be used to flavour foods.
Getting the baby blues
Pregnancy can be difficult for a woman, and this includes mental issues, such as antenatal depression.
by Chua Kim Beng, with contributions from Dr Chua Tze-Ern, Senior Consultant, Women’s Mental Wellness Service, Department of Psychological Medicine, KK Women’s and Children’s Hospital (KKH)
Depression is a mood disorder marked by persistent feelings of sadness and loss of interest in daily activities. Other symptoms include changes in sleep pattern, energy level, appetite, and sex drive.
While most people would have heard of postnatal or postpartum depression, which affects the mother after birth, less well known is antenatal depression, which occurs during the woman’s pregnancy.
In Singapore, one in five pregnant women is affected by antenatal depression. Left untreated, this is a major risk factor for postnatal depression, which can affect mother-child bonding. In the longer term,
the child’s neurocognitive development may be affected, putting the child at risk for cognitive, behavioural and emotional problems in the future.
In a year-on-year comparison, the KK Women’s and Children’s Hospital (KKH) saw a 47 per cent increase in patients who screened positive for postnatal depression, largely attributed to the COVID-19 pandemic. To tackle this, KKH introduced universal antenatal depression screening into the routine care programme for pregnant patients. A first in Singapore, the Psychological Resilience in Antenatal Management (PRAM) programme is designed to detect depression early in the pregnancy journey so that the patient can
receive the support required for a happy, healthy pregnancy while minimising the risks of developing depression in the near future.
“Under PRAM, screening is conducted during an obstetric check-up in the second trimester, making the process convenient for the patient. More importantly, it allows sufficient time to identify and manage depression issues early, before the baby arrives,” said Dr Chua Tze-Ern, Senior Consultant, Women’s Mental Wellness Service, Department of Psychological Medicine, KKH.
The PRAM programme is expected to benefit about 12,000 patients at KKH annually.
What is PRAM?
A programme designed to detect depression early in the pregnancy journey, including screening, diagnosis and treatment plans.
• feeling sad and anxious
• inability to sleep
Treating antenatal depression
“Antenatal depression is highly treatable. Awareness about the impact of mental wellness on maternal health and child development can empower women and their families to make lifestyle adjustments, starting even before pregnancy, to reduce their individual risk factors for antenatal depression, and give their babies the best start to life,” shared Dr Chua.
Antenatal depression has a good prognostic outcome. A review of 118 patients treated at KKH’s Department of Psychological Medicine over a five-year period found that eight in 10 patients, after a few months’ treatment, were discharged from outpatient care in a well and stable state; among patients who presented with depression for the first time, the discharge rate was even higher — nine in 10 patients.
Why antenatal depression is less well known than postnatal depression
• Symptoms of antenatal depression are often mistakenly attributed to the pregnancy itself
• Physical health, rather than mental health, is the main focus during pregnancy
• It may be difficult for some to raise the topic of mood changes during pregnancy
• Stigma about mental health conditions is causing some pregnant people to dismiss or feel ashamed of their depression symptoms
• being overwhelmed
• thoughts of self-harm
Signs that you may have antenatal depression
• Constantly anxious about your pregnancy
• Low self-esteem, eg doubts that you make a good parent
• Constantly feeling down for over two weeks
Result
• moderate to high risk of antenatal depression
• less severe cases
Treatment
• referred to a clinical counsellor or psychiatrist
• provided with educational information and counselling support over the phone
• Excessive feelings of guilt
• Thoughts about suicide or self-harm
• Little interest in the pregnancy
• Indifferent response to support from loved ones or healthcare professionals
• Not getting prenatal care, or not following a healthcare professional’s instructions
• Smoking, drinking alcohol, or using illicit drugs
• Poor weight gain due to not getting enough nutrition
Implications of high cholesterol levels
Why is it important to measure cholesterol levels, and what do the readings mean? Can lifestyle changes help to lower cholesterol levels?
An overly high cholesterol level can lead to a significantly higher risk of developing atherosclerotic diseases such as blockage of arteries in the heart, brain and legs. Blockages, in turn, can lead to chest pains, heart attacks, and ischaemic strokes.
Two types of cholesterols are displayed on a cholesterol blood test — high-density lipoprotein cholesterol (HDL-C) and low-density lipoprotein cholesterol (LDL-C). An individual’s cholesterol is considered high when the LDL-C reads more than 4.1mmol/L (millimoles per litre) for young and healthy individuals, and more than 3.4mmol/L for older individuals with one or two risk factors for atherosclerotic disease like hypertension and smoking.
Most of the cholesterol in the blood is due to excessive production or reduced clearance by the human body, not from the diet. Hence, improvements from lifestyle measures alone are limited. Typically, lifestyle changes can lower LDL-C by 10 to 20 per cent, with eight to 12 weeks as a good duration to assess the response to lifestyle changes.
Doctors would usually start cholesterol-lowering medications if patients’ LDL-C remains above the threshold levels despite lifestyle changes. Individuals with previous stroke, heart disease or long-standing diabetes are at a high risk of developing another episode, and would need to be treated with cholesterol-lowering medications and keep their LDL-C even lower.
Lifestyle and genetic factors both influence an individual’s LDL-C value. In addition, cholesterol levels tend to increase naturally with age.
Cholesterol-lowering medications can lower atherosclerotic events significantly. Some individuals can develop side effects like muscle ache, but most effects are mild and can be addressed by a change in the dose or type of medication. Serious side effects that result in death, disability and hospitalisation from cholesterol-lowering medications are very rare.
Taking cholesterol medications allows the LDL-C to be kept at healthy levels, thus minimising the chances of developing a heart attack or stroke. Conversely, stopping the medications will cause the LDL-C level and cardiovascular risk to go back up.
Dr Tan Hong Chang Senior Consultant, Department of Endocrinology, Singapore General Hospital
Q uestion & A nswer
Receding
gums and tooth sensitivity
Do receding gums lead to sensitive teeth as a result of exposed roots? What are the available treatment options? Can gums re-grow?
Receding gums that result in teeth sensitivity due to the exposed roots can be treated either surgically or non-surgically.
Non-surgical methods include placing a tooth-coloured restoration onto the exposed roots if there is a cavitation on the root surface. Alternatively, dentists can apply a desensitising agent (fluoride varnish or dentine bonding agents) onto the sensitive areas of the teeth.
On the other hand, surgical treatment of the receded gumline is done through gum grafting procedures, where the gum graft is obtained from the palate and sutured onto the receding gum areas for regeneration of the gumline to as close to the original gum level as possible.
However, not every type of gum recession can be treated surgically. You should consult a periodontist (gum specialist), who will be the best person to advise on the suitability of performing such gum-grafting procedures.
Dr Chee Hoe Kit Senior Consultant, Department of Restorative Dentistry, Periodontics,
National Dental Centre Singapore
that SingHealth is one of the three public healthcare clusters that is part of the newly inaugurated Singapore Emergency Medical Team (SGEMT)? This team will enable Singapore to deliver swift and effective medical support during emergencies, both locally and internationally. Sixty-six healthcare personnel from SingHealth have been trained under the SGEMT initiative. They include emergency department specialists, paediatric specialists, midwives and psychologists. This strengthens Singapore’s role in global and regional disaster relief efforts as well as the collective strength of our healthcare system.
As Singapore’s largest public healthcare cluster, SingHealth is honoured to contribute resources, expertise and experience to this national and global effort, reinforcing the shared commitment to respond swiftly in times of crisis.
that visitors have several options to get to Singapore General Hospital’s (SGH) Acute Medical Wards (AMWs) at the new SGH Emergency / National Neuroscience Institute (NNI) building? Two of the four AMWs are among the first facilities to open at the new building in December 2024. Taking up levels six to nine of the building, the short-stay AMWs deliver early assessments, treatment and rehabilitation interventions to facilitate earlier discharge for eligible patients.
Visitors taking the MRT can board the free Blue SGH Campus Shuttle service at the Outram Park station (Northeast, East-West and Thomson-East Coast lines). It is possible to walk from the station, although it takes a lengthy 30 minutes.
Visitors coming from the main SGH complex can cross the road, using the zebra crossing outside Block 3.
Drivers to the SGH Emergency / NNI building should enter SGH Campus via Hospital Boulevard from either Kampong Bahru Road or Jalan Bukit Merah. Parking is available in the building.
Besides the AMWs, supporting Pharmacy and Radiology services, as well as a large new purpose-built holding ward for ED patients waiting for admission to SGH wards, opened their doors in December. SGH emergency services, however, are still based at the existing Emergency Department (ED) at SGH Block 1, and will start operating on three levels of the building only later in 2025.
For more information, log on to https://www.sgh.com.sg/patient-care/visitorinformation/Pages/getting-to-sgh-emergency-nni.aspx
