AHA magazine Sep - Oct 2021

aha

Issue 4: SEP-OCT 2021

Strengthening Frailty Readiness

MCI (P) 047/07/2021

Yishun Health has an integrated, campus-wide plan aimed at addressing frailty among older patients

5 THINGS ABOUT...

SARCOPENIA

28

NURTURING & GROWING RESILIENCE

30

WHEELING GOOD TIMES

34

ontents

10

COVER STORY Strengthening Frailty Readiness A look at the steps Yishun Health has taken to support the frailty needs of its ageing patients

4

WHAT’S UP Community events, outreach efforts, and more

16 Q&A

Health and wellness questions asked and answered!

18 SPOTLIGHT

The Breath of Life

The COVID-19 pandemic has underscored the vital role Respiratory Therapists play in critical care

22 25 LIVE WELL Recovery, Second Chances & The Wheels to Go On

Despite being wheelchairbound, Zhar has a zest for life that sees him being active in sports and giving back to the community

22 EVERYDAY HEROES 28 5 THINGS ABOUT…

Enabling Communities to

Sarcopenia Smile With Confidence

Getting old is inevitable,

Dr Wong Kuan Yee’s selfless but we can learn to tackle volunteer work with Project the accompanying loss of Sa’bai has enabled communities muscle mass to build their strengths

Part 1 of 3

FRAILTY, ACTIVE AGEING & LEAVING WELL 2 |

To meet the needs of Singapore’s ageing population, Yishun Health is gearing up our competencies and capacities to provide multifaceted and coordinated care tailored to address the issues of frailty, ageing, and end of life. In this issue, we cover how we are getting frailtyready — by bolstering our skills and improving processes so we can manage frailty successfully.

PUBLISHER Yishun Health is a network of medical institutions and health facilities in the north of Singapore, under the National Healthcare Group. It comprises Admiralty Medical Centre, Khoo Teck Puat Hospital and Yishun Community Hospital. It also includes community extensions such as Wellness Kampung.

EDITORIAL TEAM

32 30 DAILY DOSE

Nurturing & Growing Resilience

Here are some tips to strengthen your mental toughness and look on the bright side, especially during these times of crisis 32 MAKAN TIME

Brown Rice Noodle Laksa

Our higher-in-fibre, lower-in-fat version of this hawker favourite packs a spicy yet healthy punch!

34 FIT & FAB

Wheeling Good Times

Keen to take up cycling? Here’s advice on attire, equipment and locations to think about Maskless photos in this issue were taken before COVID-19 or with safe management measures in place

Hannah Wong Sabrina Ng Sharon Ng Albert Foo

EDITORIAL COMMITTEE

The editorial committee — made up of clinical, nursing, allied health, population health & community transformation, and administrative heads of department — advises aha’s direction.

A/Prof Tan Kok Yang Bastari Irwan Caroline Tan Fatimah Moideen Kutty Shirley Heng Teresa Foong

www.ktph.com.sg/ about-us/media/publications aha@ktph.com.sg

PUBLISHING AGENT THINKFARM PTE LTD www.thinkfarm.sg M A N AG I N G D I R E C T O R

Christopher Tay

H E A D, E D I TO R I A L

Chua Kim Beng

C O N T R I B U T I N G E D I TO R

Sheralyn Tay E D I TO R

Dang Hui Ling H E A D, C R E AT I V E

Sean Lee

W

hy aha?

The name aha holds much significance for us at Yishun Health.

In part, it is a nod to our history; it also stands for ‘Advocates for Health in Action’.

Through these pages, we hope to empower you to take charge of your own health and discover those ‘aha!’ moments that lead to a healthier, happier you.

H E A D, C L I E N T R E L AT I O N S H I P

Jessie Kek

C O N T R I B U TO R S

Justin Loh Lee Lily

aha is the official bi-monthly publication of Khoo Teck Puat Hospital (Co. Reg. No. 200717564H) and is produced by ThinkFarm Pte Ltd. All rights to this publication are reserved and no part may be reproduced without the expressed written consent of the publishers. While every effort has been made to ensure that the information in this newsletter is accurate and up to date, the editorial team will not be responsible for errors due to information received. Opinions expressed are that of the writers and do not necessarily represent the views and opinions of the publishers. Printed by Mainland Press Pte Ltd. MCI (P) 047/07/2021

| 3

hat’s Up

Together, We are Stronger!

C

EO Prof Chua Hong Choon and key members of our COVID-19 Taskforce held a series of virtual Townhalls across end-April and early-May 2021 to keep the Yishun Health family apprised of the ongoing efforts in the fight against COVID-19, especially in light of escalating community infections, including the first hospital cluster.

In all, six Townhall sessions were conducted, with more than 1,500 staff Zooming in.

These Townhalls served as a platform for Prof Chua and the management team to interact with staff from key job functions, get a sense of their sentiments and concerns on the ground, as well as share tips for self-care. Four areas of focus were highlighted:

Keeping staff and patients safe with Rostered Routine Testing.

Staff were also reminded to: • Adhere strictly to infection control protocols • Minimise interactions both in and outside work • Use TraceTogether to facilitate contact tracing • Tighten patient and visitor screenings Supporting national efforts to fight COVID-19 as a concerted healthcare system. Besides taking on a higher patient load in wards and clinics, Yishun Health must play its part and be prepared to be deployed to other work areas and institutions when the need arises.

Continuing to provide clinical services for patients by adapting quickly to ensure that timely care is given to patients in urgent need and respond to evolving demands. This means being able to carefully prioritise patients and defer non-urgent appointments to free up capacity and resources, as well as convert spaces to decongest the A&E. Managing and conserving resources prudently by ensuring there is minimal wastage of our hospital supplies, such as PPE and equipment. Just as important is the management of personal reserves and emotional capacity through self-care and care for each other so that energies can be maximised, allowing optimal performance.

Apart from sharing the strategies for navigating the ongoing pandemic, the series of Townhalls served as a platform for staff to share what makes them feel supported and appreciated at work

4 |

Recognition for Improving the Skills, Wages and Prospects of Workers

COO Yen Tan (second from right) has played a vital role in union relationships and job improvements for Yishun Health staff

Y

ishun Health’s Chief Operating Officer, Ms Yen Tan, was presented with the prestigious Medal of Commendation at the NTUC May Day Awards 2021, held on 27 April 2021.

The event was hosted by NTUC President, Mary Liew, and Secretary-General, Ng Chee Meng.

The annual May Day Awards recognises individuals and organisations for their exemplary contributions to the labour movement. This year, a total of 143 awards were given out. The Medal of Commendation, which was conferred on Yen, is an award for Senior Management personnel in the labour movement network.

It acknowledges those who contribute by promoting and supporting outcomes that improve workers’ wages, welfare and work prospects.

A strong advocate of harmonious union-management relations, Yen has actively engaged with the union. She was instrumental in helping the branch locate a convenient spot within KTPH premises for the union office to operate.

She also personally saw to it that it was well equipped so

as to make its services readily accessible to Yishun Health members. This has facilitated many meetings between union representatives and members.

Over the years, Yen has supported and collaborated with the union in many other ways, particularly in various job redesign projects. Her dedication to improve the well-being of employees is exemplified through many upskilling initiatives, which have added value to job roles and uplifted the wages of lower-income employees.

This includes spearheading the Basic Care Assistant (Chaperone) job redesign project, which has upgraded the skill set of 40 porters so that they are now more involved with direct patient care and can assist nurses in the wards.

At the height of the COVID-19 pandemic in 2020, Yen rolled out a new job role inspired by the Singapore Care Ambassadors concept. The Patient Care Officer (PCO) role was designed to lessen the workload of nurses, and at the same time provide greater work prospects for job seekers who have no background in healthcare. | 5

hat’s Up

Reducing Admissions and Improving the Patient Journey Through an Ambulatory Emergency Care Service K

TPH’s Ambulatory Emergency Care (AEC) Service received the Best Practice Medal under the Care Redesign category at this year’s National Healthcare Innovation and Productivity (HIP) Awards.

The AEC Service consists of a multidisciplinary team, spanning General Medicine (Gen Med), the Acute & Emergency Care Centre (A&E), Pharmacy, Patient Service Centre, and Operation Administration.

It is the first service of its kind in Singapore to care for patients with acute illness in a dedicated facility.

Instead of being admitted for days, their average length of stay is reduced to one day at the AEC Unit, with a follow-up at the AEC Clinic, and outpatient appointments, if necessary. This new process means patients with acute medical conditions can be cared for without a hospital admission.

Spearheaded by General Medicine Senior Consultant Dr Thofique Adamjee (centre in photo

above), this model of care is based on similar approaches overseas.

It was developed in response to the increased number of Gen Med patients referred from A&E from 2015–2018. The AEC Service has made an impact over the last 14 months since it was implemented — with a cost savings of $456 per patient, and a 29-hour reduction to the average length of stay. Readmission rate also

decreased by 0.5%. This translates to an annual 475 inpatient bed day savings and $308,880 cost savings.

The Ministry of Health’s National HIP Awards fosters hands-on initiatives in productivity and innovation. It is sponsored by the Ng Teng Fong Healthcare Innovation Programme, and managed by the Tan Tock Seng Hospital Community Fund and Centre for Healthcare Innovation.

Empowering Our Nurses I

n July 2021, Yishun Health retitled the position of Assistant Nurse to that of Enrolled Nurse, aligning the position name across all NHG institutions. This move was proposed by the NHG Nursing Council and approved by NHG Human Resource. This muchawaited development is an empowering move towards a more professional title that recognises the roles and contributions of our Enrolled Nurses in their delivery of clinical care. Enrolled Nurses play an integral role in supporting the nursing and care teams in the healthcare system. There are increased opportunities for Enrolled Nurses to upgrade to Registered Nurses through licensure examinations and formal nursing diploma programmes.

6 |

Honouring Our Exemplary Nurses

CEO Prof Chua Hong Choon, CHRO Cynthia Lee, Chief Nurse Ms Shirley Heng, and Nursing Directors Mdm Chua Gek Choo and Ms Low Beng Hoi joined in the ceremony. Each award recipient received a badge and a cute rabbit ‘bouquet’

O

n 6 July 2021, seven Yishun Health nurses proudly received the Nurses’ Merit Award (NMA), which recognises and celebrates nurses in Singapore for their outstanding performance and contribution to the profession. The award affirms their unwavering care to patients, even in the midst of a pandemic. Congratulations to our winners!

• Ramanathan s/o Perumal, Senior Staff Nurse, Ward B65, KTPH • Tan Si Hui, Nurse Clinician, Renal Centre, KTPH • Zheng Dexin, Nurse Clinician, Ward B66, KTPH • Lu Qiaoxian, Nurse Clinician, Peri-Ops, KTPH • Nuraini Binte Mamon, Nurse Manager, Ward B66, KTPH • Tan Yi Xue, Senior Staff Nurse, Ward D48, YCH • Ernie Yanty Bte Borhanudin, Assistant Nurse Clinician, PHCT

Working Hand-in-Hand for Patient Safety O

ur commitment to patient safety includes a commitment to good hand hygiene practices. This is a principle that we reaffirm each year on Global Hand Hygiene Day. This year’s event was held on 5 May, and saw CEO Prof Chua Hong Choon emphasising that, while hand hygiene is a basic step, it takes effort to do it correctly, consistently and together. As part of the day’s celebrations, awards were given out to wards that achieved high levels of hand hygiene compliance.

Dr Chris Willis, Chairperson of the Infection Control Committee, nudged staff to continue cultivating the habit of handwashing. He encouraged everyone to make use of UV light boxes easily accessible across KTPH and YCH. | 7

hat’s Up

Kaizen Fest: A Time to Learn, Share & Celebrate!

T

his year, our annual Kaizen Festival entered its sixth run, and evolved into a fully virtual event to overcome the restrictions of safe distancing and infection control — an evolution in the spirit of the festival itself. Another improvement of this edition was the launch of the new Kaizen@Yishun Health graphic, which reframes kaizen as a way of life in our pursuit of clinical and operational excellence.

Despite the pandemic, Yishun Health’s kaizen spirit was not dampened; rather, it was spurred, with a total of 143 projects submitted this year, 20% of which were related to COVID-19.

In all, 40 awards were given out, including 26 Kaizen Competition Awards, six Kaizen Team Awards, and eight Kaizen Individual Awards.

In addition, 33 prizes were also awarded to various staff for their participation in the Virtual GembaWalk, Top Poster Readers, and Most Enthusiastic Departments.

8 |

Our staff were happy to receive a delivery of cookies and copies of the newly published kaizen booklet for the year!

As part of the fun, this year’s top contenders for the grand poster Better, Faster, Cheaper, Safer (BFCS) award participated in an elevator pitch showdown reminiscent of the reality TV show, Shark Tank. In joint first-place were Enhanced-Supplementary Primary Eye Care Clinic and Use of Stabilised Ozonated Water for Infection Control, followed by Beyond the Walls – Promoting Safe Transitions Home.

In his closing remarks, CMB A/Prof Pek Wee Yang reaffirmed Yishun Health’s commitment to continuously making kaizen our way of life.

To add to the festivities, the Organising Committee collaborated with Human Resource to bring some cheer by distributing bags of freshly baked cookies to all staff to thank them for their hard work and resilience, while also supporting social enterprise, Project Dignity.

Embracing an EPIC Way Forward

W

ith the planned implementation of the Next Generation Electronic Medical Record (NGEMR) into our systems, Yishun Health has paved the way forward to truly develop healthcare of the future.

The NGEMR is an integrated Electronic Health Record software application, known as EPIC, that is being used nationwide by all public health institutions.

This harmonises all IT systems to the NGEMR, and will fully integrate and improve access to patient information for greater care efficiency, patient safety, and convenience.

The benefits of this move by Yishun Health were shared in a ‘sell-out’ webinar on 1 July 2021.

The panellists shared how this system will better enable our mission of better care and better health for our patients and the population we serve.

While the overhaul of familiar systems will be a challenge, mastering the NGEMR presents many opportunities for progressing and transforming our healthcare system.

It will enable us to improve the quality of healthcare by improving clinical outcomes, preventing medical errors, facilitating care coordination, increasing administrative efficiencies, and tracking data over time.

Chief Clinical Informatics Officer (CCIO) A/Prof Terence Tang (left) shared that the NGEMR system will connect almost every single part of the Yishun Health system electronically, opening up many possibilities and breaking down age-old barriers.

Yishun Health Stands Up for Safety!

Y

ishun Health holds Patient Safety Month (PSM) every July. The theme this year, ‘Stand Up for Safety’, is aimed at encouraging staff to unite towards a common goal of preventing errors and harm in the delivery of patient care.

CMB A/Prof Pek Wee Yang launched the month’s activities on 9 July 2021. In a Clinical Forum hosted on Zoom, he talked about the shift from traditional piecemeal reaction to a coordinated system-wide approach to ensure safe care. This requires being more critical in measuring work and taking an evidence-based, data-driven stance. He also spoke on learning and embracing change by being open to new knowledge and evidence. He reiterated

the importance of collaboration to build a high performing team in order to achieve a system of high reliability.

PSM ended on 30 July with the announcement of the top three winners for the Speaking Up for Safety Short Stories Contest. CEO Prof Chua Hong Choon closed the event and shared some personal tips to encourage all ways to make patient safety a priority.

He encouraged all staff to stay aware of errors and recognise that everyone, including oneself, can contribute to errors. He also stressed the importance of being present and focused, and to practise selfcare and discover the sweet spot where there is commitment and joy in work. | 9

Cover Story

Strengthening

FRAILTY READINESS 10 |

FRAILTY, ACTIVE AGEING & LEAVING WELL PART 1 OF 3

Improving acute care for frail older patients is a priority for Yishun Health; it is an important aspect of our mission to deliver care that is good enough for our own mothers. Since 2020, work has been underway to develop an integrated plan for a campus-wide understanding of what needs to be done, the skills needed to accomplish these goals, and the initiatives that help us support frailty needs.

W

hat does frailty look like, and what are the specific ways that teams across Yishun Health can adopt to address this multifaceted issue in a concerted manner? These are some of the questions that the Frailty Ready Workgroup is asking in order to develop wide-ranging strategies that also enable healthcare providers to offer coordinated care tailored to specific needs and individual treatment goals.

According to Dr Angeline Seah, Chairperson of the Workgroup, “The goal of the Workgroup is to develop a Frailty Competency Matrix, to look at the work that needs to be done in order to be ready to cope with frailty in the acute care setting.” Dr Seah, who also heads KTPH’s Geriatric Medicine department and is Director of its Geriatric Centre, explains that it is a critical strategic thrust for Yishun Health. “We have a very big ageing tsunami

therefore is to be ready for that and enhance our ability to address the problem in a safe, consistent manner.”

To ensure that the whole campus is frailty-ready, the Workgroup aims to identify key operational processes and skill sets that will be required to address frailty gaps and needs.

that’s coming upon us, and our job

responsive with high-care needs.”

A COMMON UNDERSTANDING OF FRAILTY One of the first steps has been to establish a common understanding and language of ‘Clinical Frailty’ across Yishun Health. Frailty itself refers to a highly heterogeneous group of differing levels of function and varying chronic and acute conditions. Each older adult thus has very individual needs and reserves. Dr Seah explains, “Ailments range from those that are highly responsive to timesensitive treatment, to poorly

| 11

Cover Story CLINICAL FRAILTY SCALE To set a foundation of what frailty means across the campus, the Clinical Frailty Scale was adopted and cascaded through e-learning for the staff. “This helps us to achieve common understanding; we avoid underor over-treating the patient. It also sets a baseline for decision making in complex situations,” says Dr Seah.

THE SHAPE OF NEEDS Building on the campus-wide understanding of frailty, based on the Clinical Frailty Scale, the next strategy has been to deploy this knowledge in developing a Frailty Heat Map. This has been important in helping create a visual representation of the density of frailty within and across departments.

“It helps us to have a good sense of what degree of frailty exists, and where these patients are in the wards,” Dr Seah advises.

This in turn helps the Frailty Ready Workgroup assess where needs are the greatest and where to allocate resources, support, staff training, and operational process improvements for optimal impact.

At Yishun Health’s A&E, this approach has been used to enhance the care of geriatric and frail patients in the emergency care setting. Prior to this, geriatric patients who visited the A&E were treated the same way as other non-geriatric patients despite more complex-care circumstances. Under a Geriatric Emergency Medicine (GEM) initiative, their specific needs are recognised and addressed right at the start of their care journey when they enter the A&E.

12 |

The Clinical Frailty Scale is validated for those aged 65 years and above, and grades them on their level of physical frailty. To assess cognitive frailty, an additional falls questionnaire is used to assess mental confusion.

1 2 3 4 5 6 7 8 9

Very Fit: People who are robust, active, energetic and motivated. These people commonly exercise regularly.

They are among the fittest for their age.

Well: People who have no active disease symptoms but are less fit than people in Category 1. Often, they exercise or are very active occasionally.

Managing Well: People whose medical problems are well controlled, but are not regularly active beyond routine walking.

Vulnerable: People who are not dependent on others for daily help, but have symptoms that limit activities.

A common complaint is being ‘slowed up’, and/or being tired during the day.

Mildly Frail: People who have more evident slowing, and need help in high-order Instrumental Activities of Daily Living (IADL), such as managing finances, transportation, heavy housework, and taking medication. Typically, mild frailty progressively impairs shopping and walking outside alone, meal preparation, and housework.

Moderately Frail: People who need help with all outside activities and with keeping house. Inside, they often have problems with stairs and need help with bathing, and may need minimal assistance with dressing.

Severely Frail: People who are completely dependent on others for personal care, whether physically or cognitively. Even so, they seem stable and are not at high risk of dying (within ~6 months).

Very Severely Frail: People who are completely dependent on others, and approaching the end of their life cycle. Typically, they may not recover from even a minor illness.

Terminally Ill: People approaching the end of life. This category applies to people with a life expectancy of <6 months, who are otherwise not evidently frail.

SCORING FRAILTY IN PEOPLE WITH DEMENTIA

The degree of frailty corresponds to the degree of dementia: • Common symptoms in mild dementia include forgetting the details of a recent event, though still remembering the event itself, repeating the same question/story, and social withdrawal.

• In moderate dementia, recent memory is very impaired, even though they seemingly can recall events that took place long ago.

They can do personal care with prompting.

• In severe dementia, they cannot do personal care without assistance.

FRAILTY, ACTIVE AGEING & LEAVING WELL PART 1 OF 3

“We are taking a step-by-step, whole-of-hospital approach that will build capacity and capabilities that enable our healthcare providers to offer coordinated geriatric care that is appropriately tailored to our patients’ specific needs and individual treatment goals.”

DR ANGELINE SEAH CHAIRPERSON, FRAILTY READY WORKGROUP HEAD, GERIATRIC MEDICINE DEPARTMENT DIRECTOR, GERIATRIC CENTRE

This means geriatric patients are given priority triage and care

by GEM nurses trained to perform geriatric assessments and identify complex care needs. In addition to acute medical management, they also do frailty and confusion assessments. This helps to build a holistic understanding of each patient, and enables the GEM team to create an appropriate and tailored care pathway, and more effective discharge care plans.

To cater to the follow-up care needs of GEM patients, dedicated slots have been created for direct referrals as well as earlyreview clinic and the community care team. A pathway for direct transfer to Yishun Community Hospital is now also in place for patients who require intermediate care and/or rehabilitation. Medical Home Services run by the Ageingin-Place Community Care Team work with the A&E to identify patients whose care needs could be met by their enhanced services, so as to avoid the need for acute admissions.

A TEAM APPROACH TO FRAILTY With common ground and a clear sense of needs, the Frailty Ready Workgroup has begun to bring clinicians together to nurture a trans- and multidisciplinary approach to frailty care. “We must build ownership from all clinical disciplines, supported by nursing, allied health, and social workers.”

To this end, the Workgroup has been using the heat map to conduct an engagement series with Yishun Health doctors across General Medicine, Cardiology, Orthopaedics, and more. “This starts a conversation to understand the degree of need for each and every department,” Dr Seah shares. From this engagement and understanding of needs, the goal is to work with them further and develop programmes to address frailty across the campus.

This could take the form of: • Knowledge- and skills-building programmes for all staff to build competency;

| 13

Cover Story

“This project is a collaborative effort of various teams towards the target of ‘Our Food, Right Food, Safe Food’.

We strive to ensure our patients have a pleasurable dining experience through to the taste and presentation of our texture-modified diet without compromising nutrition.”

FOODS REGULAR

TR

7

EASY TO CHEW

AN SIT IO

SOFT & BITE-SIZED

NA

6

LF

CHOW PEK YEE HEAD AND PRINCIPAL DIETITIAN, NUTRITION & DIETETICS; AND GHAZALI BIN MOHAMAD HEAD AND SENIOR MANAGER, FOOD SERVICES, CO-LEADS OF THE FRAILTY READY NUTRITION SUBGROUP

The Frailty Ready Workgroup formed a transdisciplinary team — including Food Services, Nutrition & Dietetics, and Speech Therapists — to review the existing menu for elderly patients

OO DS

MINCED & MOIST

5 4

PUREED

•

•

•

Strengthening existing and/or developing new healthcare delivery processes to support clinical teams; Developing a clinical core group to provide direct care for more challenging patients, and to support other frail patients with integrated care and expert advice; A steering group to drive

education, quality improvement and research in Frailty.

14 |

3

LIQUIDISED 2 1 0

Copyright: The International Dysphagia Diet Standardisation Initiative 2016 @ http://iddsi.org/resources/framework/.

EXTREMELY THICK EXTREMELY THICK MILDLY THICK SLIGHTLY THICK THIN

DRINK

FRAILTY, ACTIVE AGEING & LEAVING WELL PART 1 OF 3

ADOPTING A NEW INTERNATIONAL DIET STANDARD: ‘EASY TO CHEW’

And even as the Workgroup lays a strong foundation for the development of frailty-ready plans, their efforts have already led to the successful implementation of a Frail Diet (see sidebar); plans are also underway to improve care, strengthen environmental infrastructure, and reduce human care requirements. The road ahead is a long one, but the Workgroup is ready for the task at hand. While many frailty interventions have tended to develop in pockets, the Workgroup’s goal is to develop a cohesive and consolidated framework to guide the campus.

“We are taking a step-by-step, whole-of-hospital approach that will build capacity and capabilities that enable our healthcare providers to offer coordinated geriatric care that is appropriately tailored to

With an ageing population comes growing issues related to frailty, dementia, and other conditions, all of which increase the risk of choking. This is a significant problem: choking is a growing concern for seniors, and the second-highest cause of accidents after falls.

As part of its work, the Frailty Ready Workgroup reviewed the existing menu for elderly patients, with an eye towards enhancing its safety.

Working as a transdisciplinary team, Yishun Health’s Food Services, Nutrition & Dietetics, and Speech Therapists looked at adopting a new diet level that is benchmarked against the International Dysphagia Diet Standardisation Initiative (IDDSI).

The IDDSI offers a global standardisation of the various diet textures and consistencies, and uses terms that are universally understood, regardless of language and literacy. The current food texture for soft diets (Level 6 on the IDDSI) is a uniformly chopped or minced form, which can be visually unappealing and is limited in dish options. This can result in nutritional imbalances.

To include a more palatable option, the team identified the ‘Level 7 — Easy to Chew’ texture from IDDSI. This level lies between ‘regular’ and ‘soft’, and refers to food that breaks off easily when cut with the side of a fork or spoon. This allows for more variation in dish options to improve patient appetite. It is safer for frail patients with presbyphagia (before dysphagia), as well as patients with impaired judgement, including those with dental issues or have had oral procedures. By increasing the palatability of food, the menu also better meets nutritional needs to avoid sarcopenia (turn to page 28 to read more about sarcopenia). Importantly, the kitchen team has integrated the ‘Easy to Chew’ consistency into its food preparation processes, so meals are served ready-to-eat. This reduces the time that nurses would need to modify the food when feeding patients.

In July 2020, Yishun Health management and staff had a chance to see and sample the attractive and tasty modified meals. By September 2020, the ‘Easy to Chew’ diet was rolled out in KTPH in a soft launch, and implementation scaled up to YCH in April 2021.

As of 19 April 2021 — after nine months of development — the menu was implemented into Yishun Health’s inpatient meal plans.

Feedback from patients has been positive: “Very nice; good mix of vegetables and meat”; “Food looks very good and well prepared”; and “Texture just nice, not mushy, not too hard, not too soft” are some of the comments that have been received. Since these meals were launched, there has been an average increase of between 3.5% and 4% of ‘Easy to Chew’ meals served per month.

our patients’ specific needs and individual treatment goals.” | 15

&A

PROTEIN

POWER

Yishun Health experts answer your frequently asked questions about health, well-being and medical conditions.

In consultation with Chow Pek Yee, Head and Principal Dietitian, Nutrition & Dietetics, KTPH

My 70-year-old father is in good health, but he has been advised to include more protein in his diet as a way to maintain his well-being and energy levels. How do we calculate the amount of protein he needs, and what are some healthy ways to include more protein in his diet?

As an older adult, your father actually has a higher protein requirement than someone who is younger.

Protein needs increase with age because we need to maintain physical function and preserve muscle mass.

Those aged 65 years and above require about 1.2g of protein per kilogram of body weight per day. This is compared to about 0.8g per kilogram of body weight of a healthy young adult. Exceptions would be for those who have undergone surgery and are at a recovery stage, or anyone who has had kidney failure.

16 |

Listed below are examples of foods that contain one recommended serving of protein. For your father, the Health Promotion Board advises three servings of protein per day.

2 small blocks of soft tofu (170g)

3/4 cup cooked pulses (peas, beans, lentils) (120g)

2 glasses of low-fat milk or soy milk (500ml)

1 palm-sized piece of lean meat, fish or poultry (90g)

5 medium-sized prawns (90g)

3 eggs (150g)

I’m a 55-year-old woman who is a small eater, but I’m trying to include more high-protein options and snacks into my meals. What are some good meal options for me?

You need to focus on fortifying your meals, and snack in between, in order to achieve your daily needs:

FORTIFY

BY ADDING

plain porridge or rice

eggs, tofu, braised peanuts, minced meat, canned sardines, cooked sliced fish, canned tuna in water

plain bread

canned tuna in water, sliced cheese, eggs, peanut butter, chicken floss

oats or cereals

yoghurt, milk, soy milk, peanut butter, eggs

hot beverages e.g. tea, coffee, malted drinks

milk, soy milk, milk powder

HIGH-ENERGY, HIGH-PROTEIN SNACKS chicken pau, boiled chickpeas, sandwiches with chicken, tuna, eggs, peanut butter, cheese, tausuan, red or green bean soup, peanut soup, peanut paste, black sesame paste, walnut paste, tofu

However, we recommend that you speak to your father’s doctor or dietitian before increasing his dietary protein. In the meantime, follow the Health Promotion Board’s My Healthy Plate concept to ensure balanced meals. The plate should comprise of:

Here are some ways to add more protein in each meal: • Add an egg or a piece of firm tofu to your breakfast noodles • Include two soft-boiled eggs to eat with toast • Swap out jam for peanut butter or low-fat cheese spread • Have peanut or fish porridge instead of plain porridge with pickles • Make hot drinks with low-fat or soy milk instead of water • Opt for rice dishes with fish and meat instead of plain fried rice or noodles • Have tofu, red or green bean soup, or tausuan instead of plain crackers for your teatime snack • Instead of snacking on potato chips or popcorn, eat a handful of unsalted roasted nuts, a bit of low-fat cheese, or low-fat yoghurt * For those with diabetes, some of these foods may contribute to higher blood sugar levels, so do consult your dietitian or diabetes nurse educator for adjustment of meals and/or medication for better sugar control. | 17

potlight

THE BREATH OF LIFE

Armed with unique skill sets, Respiratory Therapists stay calm in the heat of the moment, stepping in during a patient’s most dire hour to offer life-sustaining oxygen. Their contribution in critical care has been especially underscored during the pandemic as Yishun Health ramped up its intensive care capabilities to treat COVID-19-associated respiratory failure.

Yishun Health’s team of 12 RTs is led by Principal RT Blesilda Ongsing Ramos (in white coat)

18 |

O

ne of the most devastating outcomes of COVID-19 is the threat of severe pneumonia that progresses into respiratory failure. As the air sacs in the lungs fill with fluid due to inflammation and infection, breathing becomes laboured and may progress into a form of lung failure.

It is in these moments that intubation — a procedure where a tube is inserted via the mouth

into the airway — is required. The tube is linked at the other end to a ventilator to assist with breathing.

Undertaking this task are specially trained allied health professionals called Respiratory Therapists (RTs).

“We are there to help with the airway intubation when patients enter the most critical phase of their illness, and we will also remove the intubation tube when they are out of the woods,” explains Joselito Aure Biong, Senior RT. Suffice to say, the work of an RT in critical care is an essential one — it is a job that can be highly stressful, yet rewarding.

IN TIMES OF CRISIS The critical nature of the work became all the more apparent during the pandemic, shares Blesilda Ongsing Ramos, Principal RT. Having worked through SARS in the past, she was cognisant of the dangers and consequences that could arise from a new outbreak.

Intubating and extubating patients — one of the core skills of RTs — is a life-saving procedure that exposes healthcare workers to a greater risk of germ-laden respiratory droplets. It was a hard lesson that was experienced during SARS, when a number of healthcare workers contracted the disease during intubation procedures.

“We were prepared in our training and well-trained in our mask and Personal Protective Equipment (PPE) fitting, but we still did not know what COVID-19 was at the time,” she recalls. “Some of my colleagues were worried, but we supported each other and took extra precautions for infection control.” After all, she notes, the team faces similar infection risks in the course of their daily work,

“We are there to help with the airway intubation when patients enter the most critical phase of their illness, and we will also remove the intubation tube when they are out of the woods.”

JOSELITO AURE BIONG, SENIOR RESPIRATORY THERAPIST, RESPIRATORY THERAPY SERVICES, KTPH which they mitigate with meticulous attention to safety.

This fortitude and preparedness put them in good stead when COVID-19 case numbers began to rise. The increasing demands of the pandemic meant that Yishun Health’s team of 12 RTs was stretched thin.

To support the RTs, general ward nurses were brought on board to be trained in managing critical care patients. The RTs also helped conduct ventilator training, guiding and mentoring their colleagues in the care of ventilated patients.

There were times when things got quite overwhelming and both professional work pressures and personal fears came to the fore.

“It was a frightening time, but our main mission is to help our patients.

And in these moments of need, we don’t have any space for fear,” says Joselito.

| 19

potlight

Two RTs helping a patient with his breathing

During this time, the unconditional support from Yishun Health’s leadership, Human Resource department, and other colleagues boosted their morale and spirits.

The RT team also appreciated the trainings and courses that kept them consistently up-to-date on new modalities that could improve their management of COVIDventilated patients in the Intensive Care Unit (ICU).

activities,” she says.

It makes the years of dedicated training worth it. RTs undertake a four-year programme that comprises a mix of theory and practice in physiological knowledge and technical know-how before they can take the licensure exam to

become certified. And there is also more to RT work than in critical care. Blesilda points out that, apart from working in the ICU, RTs also work in the general wards and outpatient settings. For instance, they help patients with chronic obstructive pulmonary disease

A MEANINGFUL AND EXCITING PURSUIT Although the experience of working in a pandemic has been a challenging one, it has cemented the purpose of RTs such as Mary Maybelle Gonzales. She not only enjoys being in the “middle of the action” amid the intense environment of critical care, but also the teamwork required of a multidisciplinary care team.

“The goal is inspiring: to give our patients quality care, help them become well, get out of the hospital, and return to their daily

20 |

Some of Yishun Health’s RTs at a training session

— a chronic inflammatory lung disease caused mainly by smoking — to manage their oxygen use. They also work with those suffering from obstructive sleep apnoea on how to use their continuous positive airway pressure machines.

In all these settings, the goal of care is the same: to relieve discomfort, improve quality of life, and support the patient’s wellbeing. Blesilda says, “When you see patients struggling to breathe, you really empathise and feel their pain. In our role as RTs, being able to help them and make them feel better is truly an accomplishment.

It’s a very fulfilling job.”

Regardless of the setting, RTs have a true heart for patient care, adds Joselito. “If your heart is with those who are suffering, this is the job for you. Whether we care for patients in the general ward or in critical care, seeing them out from the ventilator and journeying with them as they get well is truly priceless.”

WHAT IS INTUBATION?

Intubation is a procedure that helps a patient breathe and keep oxygen and carbon dioxide at healthy levels. This involves guiding a tube down the throat and into the windpipe. The other end of this tube is connected to a machine called a ventilator, which pumps in air with extra oxygen and pumps out carbon dioxide.

Breathing is more than inhaling life-giving oxygen; it also expels carbon dioxide. If excessive levels of carbon dioxide build up in the blood, the blood becomes more acidic (a condition known as respiratory acidosis), and this can lead to more health problems.

Intubation is needed in several scenarios: • During surgery under general anaesthesia to help you breathe • If there is an injury or illness that makes it hard to breathe • If there is severe illness and the body is too sick to breathe on its own

A WIDE BREADTH OF WORK Respiratory Therapists work in more than critical care; in fact, they play an important role in many medical teams.

Some intervention and therapeutic areas of practice include:

• Emergency and intensive care • Asthma management • Neonatal and paediatric intensive care Their scope of work is also wide; it can involve administering oxygen therapy, management of mechanical ventilators, monitoring of cardiopulmonary systems, and measuring lung function.

Many respiratory therapists are also involved in patient and caregiver education; for example, in teaching how to use medications and equipment properly, and how to self-manage.

| 21

veryday Heroes

ENABLING COMMUNITIES TO

SMILE WITH CONFIDENCE

For Dr Wong Kuan Yee, prosthodontics is more than the restoration of teeth, but of confidence, function and quality of life. Dentistry, too, is more than medicine — it is a way to connect with, educate and empower people from all walks of life. This mindset underpins her volunteer work with Project Sa’bai, which takes a preventive and empowering approach to enable communities to build their local strengths.

Dr Wong applying fluoride on a hostel student during one of her missions with Project Sa’bai

22 |

A

Registrar at KTPH’s Dental Surgery department, Dr Wong recalls how eye-opening it was as a first-time volunteer in 2008. Then a second-year dental student, she was taken aback by the extent of need in the Cambodian villages she visited while on a mission with Project Lokun. “Many of the children had mouths full of rotten teeth; some even had mild fevers due to the infection. Yet, they were so resilient and simply ran around and played despite the pain.”

Dr Wong also remembers how helpless and inadequate the volunteers felt during the trip. “We were only students, so the most we could do was teach tooth brushing.

For the more serious cases, we brought the children to the nearby dental clinic for extraction.” That trip left a very strong imprint, she says. “I realised that my degree is something that equips me with the skill sets that can change lives.”

The experience inspired Dr Wong and her friends to start what would evolve into Project Sa’bai, an overseas community-involvement

Toothbrushing in a kindergarten in Cambodia

Role playing as dentists during a dental carnival for the kindergarten children

programme that provides free clinics and health screenings in Cambodia.

Since 2008, Dr Wong has returned to Cambodia twice a year under the aegis of Project Sa’bai, leading a team of dental undergraduates and registered dentists to provide care to impoverished communities.

A DIFFERENT APPROACH For its first seven years, Project Sa’bai took a conventional treatment-based model, focusing on tooth extractions and fillings, but this was not sustainable. “When you have a hammer, everything looks like a nail,” Dr Wong points out.

“We could not simply go in twice a year and pull out teeth.”

It was humbling to realise that their good intentions had unintended consequences. The episodic care meant the community became overly reliant on them instead of building their own strengths.

With this in mind, the project was recalibrated to take a more preventive and asset-building stance to empower the community in a long-term, sustainable way.

Project Sa’bai volunteers hard at work giving vital dental care

| 23

veryday Heroes

Project Sa’bai 2017 team photo

Project Sa’bai has since partnered local schools to educate and involve the teachers on dental hygiene, and care and maintenance regimens. A dental curriculum was introduced, comprising schoolbased programmes for daily tooth brushing and dental education.

With a prepared set of educational materials, teachers also take the role of dental ambassadors, and are equipped to perform dental checks to detect dental diseases for early intervention.

On top of this, Project Sa’bai examines and records every child’s Decayed, Missing, and Filled Teeth (DMFT) index regularly to monitor

disease progression during each trip, painstakingly applying topical fluoride for each child bi-annually to arrest and prevent further teeth decay. This, says Dr Wong, shifts the focus towards restoring and preserving teeth while also preventing unnecessary and undesired competition with local dentists.

“Working with communities downstream, we aim for each school to run the programmes on their own in three years,” Dr Wong explains.

This school-based capacitybuilding approach allows Project Sa’bai to reach out to more children. This way, the Project does less in terms of extractions

For her volunteer work in these communities, Dr Wong received the Healthcare Humanity Award in 2020

and fillings, but more in terms of outreach — and this has a wider and longer-lasting impact. From just working with two schools over two weeks doing extractions and fillings, the team develops community self-management and now reaches a total of 11 schools and more than 3,000 students — not only in Cambodia, but in Timor Leste as well.

Going forward, the team is making plans to take the curriculum digital, and looking at developing videos and resources that can be uploaded online. This will be useful in their newer venture into Timor Leste, which has only 10 dentists for the entire population of 1.3 million. The goal is to partner local Non-Governmental Organisations to see how Project Sa’bai can fit into existing programmes.

Dr Wong credits much of the success of Project Sa’bai to the commitment of the locals. “Our part is actually very small,” she points out.

“We are there for only two weeks a year; the rest of the hard work is done by those on the ground.”

OFFERING HEALTHCARE SERVICE WITH A SMILE Dr Wong emphasises that this work benefits her both personally and professionally. For one, it has truly underscored the privilege of caring for patients. “The trust that patients put in us is something we have to honour,” she shares. The work also helps to keep things in perspective.

“You don’t just treat teeth; you actually make an impact,” she reflects. Though it is easy to get lost in the day-to-day grind, the experiences with Project Sa’bai help her to keep her focus on what really matters.

“You remember that patients are not merely cases,” she says.

“Taking the time to listen to them is just as important as doing the dental procedure.”

24 |

ive Well

RECOVERY, SECOND CHANCES &

THE WHEELS TO GO ON The loss of his leg due to unhealthy lifestyle habits was a turning point for Zhar. He has since made the most of his life and found ways to live well with his disability by giving back to the community.

T

hough he lost a leg to amputation in 2016, Zhar has gained so much more since then — a healthier lifestyle, greater self-confidence, renewed family relationships, and a network of support from adapted athletes. These days, he also volunteers with Yishun Community Hospital’s (YCH) PlayKaki programme, an adapted sports initiative for patients who are undergoing rehabilitation or therapy for disabilities and amputation, or who have limited mobility.

The programme is aimed at

physical activities after their illness or surgery. Zhar is among some of the volunteers who act as buddies to these patients. During the sessions, he shows them how to play bowling with modifications and other adaptive techniques.

However, his adapted sport of choice, which he picked up in 2018, is wheelchair rugby — an activity that also acted as a literal pick-me-up when he was at one of the lowest points of his life.

providing opportunities for them to explore, engage with, and enjoy

Today, at 53, Zhar is a picture of health. With his cheerful smile

RESURFACING FROM A LOW PLACE | 25

ive Well

and sturdy build, he keeps strong and active through his training as a member of the wheelchair rugby team. This is a far cry from 2016, when he was in a dark place

play in competitions and meet other athletes,” he reveals.

physically and mentally, and had turned to abusing drugs. Eventually, his lifestyle caught up with him, and he found himself in hospital with his leg amputated due to his drug use.

“I brought this upon myself,” he shares candidly. The loss of his leg was one of the lowest moments of his life, but it was also the wake-up call he needed to turn over a new leaf. “I am lucky; my family has been very supportive this whole time,” he says. Their unconditional love and encouragement during this recovery from both his addiction and amputation gave him the strength and motivation to make the most of this second chance at life.

This journey of breaking his addiction and recovery from mistakes was a long one. In the initial months of his amputation, he isolated himself from the world. “I was down. I stayed home for around three months,” he recalls. But he knew he could not carry on like this — he had been given another opportunity to live well, and he willed himself to make the most of it.

Bored at home, he surfed the Internet to look for activities to take part in, and discovered a wealth of adapted sports that was available for people with disabilities like himself.

The very first sport Zhar tried was lawn bowls. But this low-impact game of precision and patience did not quite fit the bill. Next, he tried wheelchair rugby. “It was more action-packed!” he enthuses. The physicality and teamwork suited his preference for a more energetic sport, so much so that he has made it to the national team! “Wheelchair rugby keeps me occupied, and I have had the chance to travel to

It was through this team sport that Zhar learnt about YCH’s PlayKaki programme. His teammate recommended it to him in 2019.

Since then, he has been a regular volunteer at YCH. “I live pretty nearby, so it’s convenient for me, and also very rewarding.”

When he first joined, Zhar spent much of the time observing participants and the moreexperienced volunteers. Through this approach of listening and openness, he began to befriend the various patients in the wards. He also learnt ways of communicating with them and coaching them in the PlayKaki activities. “At first, I was not sure what to say or do, but I slowly learnt.” The goal of being a volunteer in PlayKaki for him is not so much about the bowling, but building connections with others so as to encourage them. “I can understand how they feel right after their surgery,” he explains. “We have experienced the same roller coaster of emotions.” Beyond a listening ear and encouraging words, he also enjoys sharing practical advice about the resources and subsidies that they can apply for. In one instance, he brought a walking Quad stick from his home for a patient who was in need of it. “I like seeing people feel

26 |

SUPPORT THROUGH SPORT

happy afterwards; when I see their smile, I feel happy, too!” he shares.

Helping others and being a pillar of support has not only given Zhar a new and meaningful way to give back; by being connected to a community that cares and supports him even as he does the same, it has helped him feel whole again.

WHEELCHAIR RUGBY Wheelchair Rugby is a Paralympic contact sport that combines elements of rugby, basketball, and handball.

It is played on a hardwood court, with a goal line at each end. Each team consists of 12 players, of which four are allowed on the court at any given time during play.

The goal of the game is to score by carrying the ball across the oppositions’ goal, with the two wheels of the scorer’s wheelchair touching the ground. To pass the ball, players may throw, roll, bat or bounce the ball. Kicking is not permitted.

Players who practise wheelchair rugby often have impairments in their arms and legs, and are classified using a points system that measures physical ability. Specially designed manual wheelchairs are used for the sport.

Man down! Zhar (Jersey No. 16) receiving a helping hand from an opposing team member during a wheelchair rugby match

PLAYKAKI:

PROMOTING SPORTS FOR ALL Adapted sports provide physical, cognitive and emotional benefits, just like any other sport. They act as a common ground, building an inclusive community to optimise every person’s ability beyond their illness.

PlayKaki was conceptualised in 2019 by Yishun Health’s Rehabilitation Services and Volunteer Management Team to better engage patients in adapted sports and create a safe space for people of different abilities to interact and experience inclusivity through sports. In July 2019, PlayKaki began as a volunteer-led programme and introduced adapted bowling.

The programme empowers passionate community volunteers to facilitate adapted sports through specific training, and constructs an environment outside of therapy for patients to look past their disability and discover the best versions of their abilities. PlayKaki volunteers are diverse and include persons with disabilities, which gives a deeper meaning and significance to the programme’s inclusivity.

Interested to become a volunteer with Yishun Health?

Contact Linda Ong at volunteers@yishunhospital.com.sg to register your interest or find out more!

Volunteers and participants enjoying themselves during PlayKaki sessions

| 27

Things About...

5SARCOPENIA Things About...

As we grow older, our bodies naturally change in many ways. One of these is a progressive loss of muscle mass, which may impact our strength and functional abilities, such as balance and gait. This sometimes goes beyond normal age-related processes, but can be managed with nutrition and exercise. Can we prevent sarcopenia from affecting our quality of life?

In consultation with Dr Su Su, Consultant, Geriatric Medicine, KTPH

28 |

1

WHAT IS SARCOPENIA?

Sarcopenia is the progressive loss of skeletal muscle that comes with ageing. Most people begin to lose modest amounts of muscle mass after the age of 30, approximately 3–8% per decade. This rate of decline gets even higher after the age of 60.

Furthermore, the resulting loss of strength increases exponentially with age. With sarcopenia, the normal age-related process of muscle loss is accelerated and becomes a health concern. Sarcopenia is thought to play a major role in the increased frailty and functional impairment that comes with age.

2

WHO IS AT RISK?

• • • • •

The natural process of ageing is the leading cause of sarcopenia, but it can also be caused by other factors, including: Lack of exercise, immobility and prolonged bed rest Age-related chronic diseases Insufficient calorie or protein intake Inflammatory conditions such as rheumatoid arthritis or inflammatory bowel diseases Hormone-related diseases such as diabetes, or a lack of sex or growth hormones, etc

3

WHY IS SARCOPENIA A CONCERN?

About one third of people above 60 years old have sarcopenia.

It is a significant risk factor for frailty, and increases the likelihood of falls and fractures in older adults. It is also correlated with functional decline, loss of independence, poor quality of life, and even death.

4

WHAT ARE THE SYMPTOMS OF SARCOPENIA?

People with sarcopenia often experience weakness and lose stamina. This can affect their ability to carry out physical activities. This limitation in activity subsequently leads to further muscle loss.

5

HOW CAN WE MANAGE SARCOPENIA?

Diet and exercise are important areas in managing sarcopenia. Diet plays a large role in preventing sarcopenia, with a higher protein intake being crucial to maintain muscle mass. In fact, older adults need sufficient protein and calories throughout the day.

Eating more protein gives the body more ‘fuel’ to build muscles, while consuming a balanced diet can also make exercise and physical therapy more effective in combating the loss of muscle mass.

Resistance exercises are particularly useful in slowing down the natural loss of muscle mass and strength.

They help to build and maintain muscle mass, and also play a role in strengthening bones as well as lowering the risk of fractures.

| 29

aily Dose

NURTURING & GROWING

RESILIENCE Life is not always smooth sailing, which is why it is important to build psychological resilience — not only to help us weather storms, but to grow stronger with each one we live through.

In consultation with Jocelyn Liao, Clinical Psychologist, Psychology Service, KTPH

WHAT IS RESILIENCE, REALLY? We may think of resilience as strength, independence, psychological stamina, or mental toughness. It is all of these and more. Resilience is a set of thoughts, actions, behaviours and skills that enables us to push through difficulties and thrive against the odds. Resilience is the act of bouncing back better, stronger. More than just mental toughness, building resilience also involves embracing self-acceptance and self-compassion, and a dedication towards self-care.

RESILIENCE CAN BE DEVELOPED OVER TIME It is not something we are born with, but it is an attitude and mindset that we can develop over time. Building resilience starts with understanding that it is a journey 30 |

of many steps and many rest stops. When we meet challenges, we take time to reflect and work through these difficulties, while at the same time allowing ourselves to regroup and recover so that we can continue on the journey reinvigorated.

BEING RESILIENT IS NOT BEING IMMUNE TO NEGATIVE EMOTIONS Even the most resilient people experience stress, emotional upheaval, and suffering. The difference is that they have the ability to cope with hardship and not be overwhelmed. They are able to accept bad news, make tough decisions, and overcome crises by focusing on what needs to be done moving forward, and less so on what negativity has happened.

SELF-AWARENESS AND EMOTIONAL REGULATION PLAY IMPORTANT ROLES

mechanisms. Resilient people tap into their strengths and support systems to overcome challenges and work through problems.

Resilience is important because it gives people the strength needed to process feelings and thoughts about setbacks, and determine adaptive ways of tackling problems. Those lacking resilience get discouraged easily, and may turn to unhealthy coping

SEEK HELP WHEN YOU NEED IT Resilient people know where to get help when they need it. This can be support from loved ones and friends, or from a trained mental health professional.

LEARN CONTINUOUSLY

Improving a skill or picking up a new one is good for personal development.

TAKE CHARGE

Take responsibility for your life; you are your own key to happiness and success.

BE COMPASSIONATE TO YOURSELF

Say and think kind words about yourself. Accept your own imperfections and practise self-forgiveness.

STAY IN TOUCH WITH YOUR SURROUNDINGS

Being more mindful and appreciative of your environment helps clear the mind and stretch the body.

ENGAGE IN MEANINGFUL RECOVERY

Schedule breaks during the day and create work-free zones in order to give yourself space.

Practise good sleep habits.

DEEPEN YOUR PURPOSE

Identify what drives you.

This purpose acts as an inner compass and guides the decisions you make.

COMMIT TO SELF-CAR E

REFLECT

Reflection — on success or hardship — builds self-awareness and helps you deepen experiences by giving you a fresh point of view.

EMBRACE ACCEPTANCE

Understand and accept your strengths and weaknesses.

Don’t dwell on the past and what cannot be changed, but focus on what you can do now and in the future.

DEVELOP POSITIVE RELATIONSHIPS

Grow and deepen professional and personal relationships. Invest in and connect with people who matter. Set boundaries for people who exhaust rather than energise you.

Take time for yourself.

A break, treat or favourite activity helps reinvigorate the body and mind.

| 31

akan Time

32 | 32

cut & keep

BROWN RICE NOODLE LAKSA Rich, creamy and fragrant, laksa is among Singapore’s top hawker favourites. Make this higher-in-fibre, lower-in-fat version at home to wow the taste buds of your family and guests!

Recipe provided by Chef Pay Jun Loong, Food Services, KTPH, in consultation with Nutrition & Dietetics, KTPH

INGREDIENTS SERVES 4 • 400g brown rice laksa noodles • 100g bean sprouts • 300g medium-sized prawns, with shell • 25g dried shrimp • 125g laksa rempah • 100g reduced-fat coconut milk • 1 tsp lower sodium salt • 1 tbsp sugar

LAKSA Rempah (spice paste) • • • • • •

100g unsalted dried chilli paste 25g curry powder 20g garlic 10g lemongrass 10g ginger 10g galangal (blue ginger)

Optional toppings • Hardboiled eggs • Fishcake slices • Laksa leaves

METHOD 1. Prepare the rempah by blending the ingredients together. Add a little water if needed.

2. Blanch laksa noodles and bean sprouts. Set aside.

3. Boil the prawns till cooked. Set aside.

4. In a heated pot, saute the rempah and dried shrimp. Stir on low heat till fragrant.

5. Add 400ml of water, and bring gravy to a boil.

6. Add coconut milk, salt and sugar, 7. Assemble the noodles, prawns and bean sprouts in a bowl.

8. Pour hot laksa gravy over the noodles and serve hot.

NUTRITIONAL INFORMATION (PER SERVING) Energy

392kcal

Carbohydrates

50g

Protein

27g

Fat

9g

• Saturated

4.0g

• Polyunsaturated

0.6g

• Monounsaturated

1.0g

Cholesterol

151mg

Dietary Fibre

16.2g

Sodium

652mg

Potassium

> 523mg

Phosphate

> 191mg | 33

it & Fab

WHEELING

GOOD TIMES Cycling is enjoying a resurgence in popularity as a fun and convenient hobby — and an excellent way to engage in cardiovascular exercise.

But as with all sports and activities, take care to keep yourself safe and injury-free.

In consultation with Dr Dinesh Sirisena, Consultant, Sports & Exercise Medicine Centre, KTPH

34 | 34 |

T

here is just something about cycling — the wind in your face, the swift and silent speed, the sense of freedom, and the knowledge that all this comes from the simple exertion of your own steam.

As a form of sport, cycling is a great way to work the cardiovascular system without too much stress on the joints. Like many exercises, it is also good for one’s psychological well-being, and plays a role in alleviating mild to moderate levels of depression and anxiety — all while you’re enjoying the benefits of being outdoors, in the fresh air.

SAFETY COMES FIRST

To maximise the health and physical benefits of cycling, safety is important. Here are some basic precautions to take whenever you go cycling:

CYCLISTS, BE AWARE!

Falls are a common cause of injury in cycling, and are sometimes seen as a rite of passage, especially if you are a regular cyclist. Having said this, many injuries can be avoided by being more conscientious of road rules and mindful of other road users.

This includes being alert for vehicles at all times, and watching out for pedestrian movements, especially when changing lanes.

CYCLE WHERE?

Ride in areas that are on par with your cycling ability and fitness. Beginners should ideally cycle along Park Connectors, where there is less vehicular traffic.

Experienced cyclists may prefer on- or offroad cycling individually or in a group.

CYCLE WEAR

Make sure you wear the appropriate safety gear, such as helmets, guards, lights and high-visibility clothing. Your bicycle should also be chosen based on your type of cycling preference, whether it is for leisure, races or long distances.

It is also important to keep in mind that, while cycling is relatively low-impact, poor posture can lead to repetitive or overuse injuries. Some signs include tingling or numbness in the hands, and pain in the elbows, shoulders, knees or lower back.

SO, THE NEXT TIME YOU GO CYCLING...

• Make sure the bicycle is the correct size for you • Ensure that it is set up according to your physical measurements • Engage your core muscles and do core training to help maintain your posture while riding • If you find yourself unusually sore after cycling, or experience any tingling and numbness, it is worth consulting a clinician experienced in cycling and cycling-related injuries. They can help identify the problem and advise how best to address it. | 35

Community Nurse Post

Wellness Kampung

Wellness Kampung is an initiative comprising three wellness and care centres for residents in the North. They provide a suite of health and social programmes, creating a support network for residents to inspire each other to adopt healthier lifestyles in a close-knit 'kampung' setting.

Opening hours: Mondays to Fridays, 8.30am to 5.30pm (closed on Saturdays, Sundays and all Public Holidays)*

115 Chong Pang

260 Nee Soon East

765 Nee Soon Central

Blk 115 Yishun Ring Road #01-495, Singapore 760115

Blk 260 Yishun Street 22 #01-87, Singapore 760260

Blk 765 Yishun Street 72 #01-366, Singapore 760765

6257 4702

6257 4802

6257 4842

*In light of COVID-19 safe management measures, please check the KTPH website for the centre schedule and call in advance to see if there are vacancies for group activities.

Admiralty Medical Centre (AdMC) AdMC is a one-stop medical centre for specialist outpatient consultation, day surgery, rehabilitation and diagnostic services, as well as community health outreach activities.

Khoo Teck Puat Hospital (KTPH)

KTPH is a 795-bed general and acute care hospital serving more than 800,000 people living in the north of Singapore.

It combines medical expertise with high standards of personalised care in a healing environment, to provide care good enough for our own loved ones.

Yishun Community Hospital (YCH)

YCH provides intermediate care for recuperating patients who do not require the intensive services of an acute care hospital. Situated beside KTPH, the two hospitals provide an integrated care experience for patients.

676 Woodlands Drive 71, #03-01 Kampung Admiralty, Singapore 730676

90 Yishun Central Singapore 768828

2 Yishun Central 2 Singapore 768024

6807 8000

6555 8000

6807 8800

www.admiraltymedicalcentre.com.sg

www.ktph.com.sg

www.yishuncommunityhospital.com.sg

www.fb.com/admiraltymedicalcentre

www.fb.com/khooteckpuathospital

www.fb.com/yishuncommunityhospital