A Healing Space - Creating Biodiversity at Khoo Teck Puat Hospital

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Khoo Teck Puat Hospital was officially opened on 15 November 2010. This 550-bed acute care hospital is Singapore’s first public hospital to open in the last decade. It serves more than 700,000 residents in the northern region of Singapore.

Situated in a neighbourhood known as Yishun, the site located next to the existing Yishun Pond was selected for the hospital. Easy access by public transportation, proximity to the community and the potential to transform the adjacent stormwater pond into a scenic, health-promoting park were the major factors in deciding on this location.

The development of KTPH as a “hospital in a garden, and a garden in a hospital” meant that several environmental priorities were kept in mind throughout the design and planning stages.

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• Provide a healing environment for patients and take the “coldness” out of a typical hospital setting • Become a model for environmental conservation and reduce the hospital’s carbon footprint • Create community involvement through volunteerism and placemaking

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Introducing Khoo Teck Puat Hospital 1 2 3 4 5

Yishun residential town Yishun Pond KTPH Tower C: Specialist Outpatient Clinics KTPH Tower A: A&E, Private Wards KTPH Tower B: Subsidised Wards

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Contents Foreword Preface Creating a Healing Environment Mitigating Biodiversity Loss Landscape Design and Planting Principles A Garden for Flora and Fauna to Thrive Urban Farming: The Possible Dream Placemaking: Creating Community Spaces A Built Environment can Co-Exist with Nature Acknowledgements

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Foreword When we first started building the hospital, we assured then Member of Parliament for Nee Soon GRC, Mr Ong Ah Heng, that the hospital would not take anything away from Yishun Town. Instead, it would enrich the neighbourhood by bringing back familiar community elements and be a welcoming, health-promoting space for residents.

Our intention was to create a healing environment through gardens that would engage the senses of sight, sound, scent and touch. The purpose was threefold: It would help our patients recover more quickly.

Patients’ families would have conducive spaces for discussion and respite. The community, through our placemaking efforts, would find spaces in and around the hospital to pursue their interests, conduct their activities and enjoy social interaction.

We are most fortunate to have had many partners help us make this dream a reality.

Passionate and skilled volunteers have invested countless hours and dug into their own resources to transform KTPH into a Shangri-La oasis. In fact, the idea for this book was raised during a volunteers’ gathering at the home of our Chief Gardener, Mrs Rosalind Tan. Mr Lee Chiu San, Dr Tan Hwa Luck, Dr Ho Hua Chew, Mr Tan Wee Lee and others then began writing various chapters and contributed personal photographs for this book. We are extremely grateful to them.

Our gardens and the rejuvenated Yishun Pond have become natural extensions of the nearby Yishun Park. We are glad to see indigenous and South East Asian species of plants, jungle trees, butterflies, birds and fish being restored to the area. With the help of dedicated volunteer advisors and partner organisations, we will strive to do more to make this “hospital in a garden” a vibrant environment for humans, flora and fauna to thrive.

I hope you enjoy this book and our gardens.

Liak Teng Lit Chief Executive Officer Alexandra Health System

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Preface The development of Khoo Teck Puat Hospital as a “hospital in a garden, and a garden in a hospital” began more than a decade ago when Alexandra Health was still managing Alexandra Hospital.

A former British military hospital, Alexandra Hospital was built on 32 acres of rolling land. It was only from the year 2000 when the hospital was handed over to the new management that 20 acres or approximately 70 per cent of the hospital’s total land area were converted into 25 gardens. Staff from across the hospital invested innumerable personal hours planting the gardens and tending the grounds.

The gardens thrived, hosting 500 plant species and over 100 butterfly species. They quickly became the hospital’s hallmark, attracting both nature-lovers seeking out shy butterflies and birds for observation and photography, as well as patients wanting a soothing alternative to typical cold hospital spaces.

The success of Alexandra Hospital’s gardens made it only natural for Alexandra Health to replicate the green environment in the new hospital. Care was also taken to incorporate sustainable environmental practices throughout the design and planning of the hospital and its gardens.

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KTPH’s compact size meant that the gardens had to rise vertically and complement the new building’s modern façade and sleek lines. This book captures the thought process that went into designing this green space and documents some of the species of birds, butterflies, fish and other creatures that have made KTPH their home. From nature enthusiasts to patients and residents seeking a tranquil, calming environment, KTPH’s rich biodiversity and dense foliage provide a pleasant environment for discovery and relaxation.

The gardens of Alexandra Hospital became the inspiration for the new Khoo Teck Puat Hospital

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Homalomena (Homalomena rubescens) and West Indian Holly (Turnera ulmifolia)

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Creating a Healing Environment The belief that plants and gardens are beneficial for the sick is more than 1,000 years old.

However, Singapore’s rapid development and scarce land resources resulted in urban cityscapes where many people had less interaction with nature.

Hospitals became cold, institutional places that focused on efficient care and infection control.

Naturally, hospitals place heavy emphasis on investing resources to increase hospital beds and high-tech machines to enable healthcare to be more efficient. However, the tide is changing and more hospitals are now paying greater attention to greening their premises.

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Level 4 rooftop garden of Khoo Teck Puat Hospital

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A growing body of research shows that stress and psychosocial factors can affect patient health outcomes. In turn, there is considerable evidence to show that just a few minutes of viewing plants and nature scenes can result in positive psychological changes.

Good feelings such as calmness and pleasantness are enhanced, while negative emotions such as fear, anger and sadness are diminished. In terms of physiology, viewing nature scenes has been shown to lower blood pressure and decrease muscle tension, among other effects.

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Garden at Level 1 of the hospital

Gardens also provide a pleasant environment for social support and privacy. Ambulant patients can spend time with their loved ones outside the confines of the ward, while bereaved families can gather to comfort one another in a serene setting. In the wards, views of greenery help with healing. The therapeutic effects of foliage and the power of patients’ minds – which are influenced by their surroundings – help their bodies to cope with the stress and trauma of being ill. Patients recover faster from their physical ailments and enjoy better mental health.

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Kind to the Environment A hospital is a resource-intensive institution that runs 24 hours a day, 7 days a week. Hospital administrators have to contend with issues such as infection control, medical waste disposal and intensive water, chemical and energy needs. A hospital therefore presents a unique opportunity to implement sustainable design principles.

In line with the concepts of urban sustainable development, the KTPH building features floorto-ceiling windows that allow natural sunlight to filter into the wards. Combined with artificial lighting and a 900 sqm bank of solar panels, this enables the hospital to enjoy energy savings.

Natural sunlight also has a positive impact on productivity, health and well-being.

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Airy main lobby with high ceiling and use of solar panels

Vertical greening helps cool the hospital and improves rainwater management

The hospital’s façade system features “fins” to channel wind into the building while multiple rooftop gardens act as a shade for the roof, improving insulation and reducing energy demand for air-conditioning. This in turn reduces greenhouse gas emissions. The gardens improve storm water management, as rain is stored in the soil, where it is taken up by plants and returned to the atmosphere through evapotranspiration.

Run-off is also delayed, which helps to reduce sewage overflow. The quality of the run-off itself is improved as it is filtered through the plants and soil.

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The rejuvenated Yishun Pond with flower trails, marshlands, a wooded area and a promenade

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Yishun Pond was once a bare stormwater collection pond. It was adopted by Alexandra Health in 2005 under the Public Utilities Board’s Our Waters Programme. In partnership with the Housing and Development Board, National Parks Board and PUB, Yishun Pond has now been transformed into a lush, health-promoting, inter-generational garden that is a natural extension of the hospital.

Water from the pond is filtered and cleaned before being used to fill water features and to water plants in the hospital’s gardens.

Rain sensors regulate this water source to prevent wastage. This recycling process, complemented by the use of water saving thimbles throughout the building, has significantly reduced the hospital’s water consumption.

This comprehensive approach towards ensuring environmental sustainability earned KTPH the Building and Construction Authority (BCA) Green Mark Platinum Award in April 2009 for its green and energy efficient design.

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Mitigating Biodiversity Loss Before being built up as a residential neighbourhood, the Yishun area consisted of farmland interspersed with patches of secondary jungle. Rubber plantations, pineapple plantations and animal farms were integral to Yishun’s heritage. There was a wide variety of wildlife.

Construction projects involve the inevitable loss of biodiversity, whether through the actual construction process or the disruption of resources that adversely affect biodiversity.

A large-scale project like KTPH impacts local biodiversity in several ways. Clearing the land results in habitat destruction and displacement of resident populations, causing animals and birds to move to other areas. The noise and light generated by construction work may affect feeding and breeding behaviour and force wildlife to relocate.

In addition, the fragmentation of native habitats may change the size and distribution of resident populations, as well as migration rates. Creatures with large home ranges such as birds are the most severely affected.

The timing of construction also matters – construction during the nesting season, for instance, can endanger nests and chicks.

Runoff from the construction site could enter watercourses. Soil, waste concrete, toxins and other pollutants could affect the aquatic habitat and endanger resident populations of plants, invertebrates and fish.

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The site adjacent to Y ishun Pond before the construction of KTPH

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Khoo Teck Puat Hospital during construction

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A Belief That Man Should Not Destroy What Nature Has Provided Understanding the impact of construction on the ecosystem, KTPH’s management determined that biodiversity replacement would be a key strategy in planning the hospital’s gardens.

When a survey of the site was conducted prior to construction, only three species of butterflies were sighted. Although KTPH occupies only a small area in Yishun, the grounds are sufficiently large to support self-sustaining populations of Singaporean and other Asian species. Therefore, a conscious effort was made to restore as much as possible of the earlier biodiversity by reintroducing some of the native species formerly found here.

“If exotic, non-native species were to be brought in, these would be unknowns. Coming from different environments with different conditions, it would be difficult to predict whether they would aggressively out-compete and over-run the locals or need to be mollycoddled to prevent them from dying out.

“It would be nothing more than guesswork to predict whether or not the aliens would be able to fit harmoniously into a local ecosystem.”

Dr Ho Hua Chew, Vice-Chairman of the Conservation Committee of the Nature Society of Singapore, said, “By trying to reintroduce nature to the hospital, we work with what is known. Local animals and plants evolved over millennia to suit conditions here. They have their own niches in an ecosystem that has found its own balance over a long period of time.

Dr Ho Hua Chew looking out for his flighty friends

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Pink Powderpuff (Calliandra surinamensis)

Dwarf Water Lily (Nymphaea cultivar)

Cantana (Cantana camara)

Ixora

Aristolochia tagala – Host plant for the Common Birdwing Butterfly

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Papaya

Establishing Local Species Quickly It was necessary to quickly establish the local species in the hospital grounds. Nature abhors a vacuum. If the ecological space available had been left empty, exotic weeds and other undesirable plants could have taken root and become problematic to eradicate.

The flow of nature is two-way. Remnants of native species hanging on for survival in the surrounding urbanised neighbourhoods also use the hospital as a refuge to rejuvenate themselves. This enhances their chances of escaping local extinction.

With the local species put into place, there are now sufficient greenery and habitat niches within the hospital grounds to let this area serve as a core for native species to multiply. The progeny of plants, birds and butterflies conceived here can spread to colonise the larger park across the road and into the waters of the adjacent pond.

The conscious effort to make KTPH an ecologically friendly area is important for the preservation of local biodiversity in the Yishun area.

Staff gardening day

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Kock’s bauhinia (Bauhinia Kockiana)

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Landscape Design and Planting Principles KTPH was conceptualised as a “hospital in a garden, a garden in a hospital”. Landscape design company Peridian Asia Pte Ltd drew inspiration from images of Shangri-La Hotel. The new hospital’s ultra-modern design, however, posed a challenge. With modern design elements such as clean lines and plenty of glass and steel, the landscape architects had to find a way to integrate the gardens harmoniously with a modern façade.

Plant density within each plot was also maximised.

The new hospital had limited green areas to work with. Without the luxury of sprawling grounds, vertical green concepts amidst the three hospital towers were therefore the way to go.

“The aim was to make the gardens look like they were already here and the hospital was built around them. The plants that were chosen had to feel like they naturally belonged there, leaning over planter boxes and covering the curbs to soften the feel of a built environment,” said Mr K Rajendran, General Manager, Tropical Environment Pte Ltd.

“We didn’t have much area to work with, so we maximised the visual cues so that you feel that you’re surrounded by greenery when you look at the hospital from different angles,” said Mr Glenn Bontigao, Associate, Peridian Asia.

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“When we plant, we tend to put plants further apart than what occurs in nature. In KTPH, we mimicked nature and put high concentrations of plants within a small area. By selecting the right mix of plants, the gardens were able to adapt and thrive with minimal human intervention and pruning,” said Mr R P Jickky, Director, Tropical Environment Pte Ltd.

View of Khoo Teck Puat Hospital from Yishun Pond

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The ‘Rainforest’ at basement one

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Bauhinia vines along the perimeter of the podium block

Creating Canopies Apart from planting in and around the hospital entrance, the basement courtyard garden has been planted to offer different views from the basement and on Level 1. The entire perimeter of the podium block has also been planted with trailing Bauhinia (Bauhinia kockiana) vines for added colour and to soften the building’s horizontal lines. On Level 1, a lush garden with shallow ponds opens onto an expansive vista with the rejuvenated Yishun Pond as the centrepiece.

“The plant palette has been chosen so that you feel like you are walking into a rainforest in Basement 1.

But at ground level, you see green canopies.

This softens the perimeter of the courtyard and is supplemented by the Bauhinia vines draping along the corridors above. Visitors often tell me they don’t feel like they are walking into a hospital at all,” Mr Bontigao said.

The plant palette was curated to include fastgrowing plants that have been tried and tested in Singapore’s climate, in order to achieve the look of a mature jungle in a short period of time. The selection minimised the need for regular pruning and trimming. The maintenance of the garden consists mainly of clearing dead leaves periodically.

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Ornate coraltail damselfly (Ceriagrion cerinorubellum)

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A Tropical Garden for Flora and Fauna to Thrive Alexandra Health System Chief Executive Officer Mr Liak Teng Lit’s mandate was that KTPH should eventually host 100 species each of birds, butterflies, fish, edible plants, fruit trees, flowering plants and medicinal plants as these add sight, scent and sound elements to the gardens. And not just any species – the various species should preferably be native to Singapore and Southeast Asia. While landscaping has helped to partially meet the target for flora, fauna poses a different challenge especially for migratory creatures such as birds and butterflies.

Butterflies Butterflies are picky creatures that require specific conditions to breed and call a particular location home. The ideal butterfly garden has full sunlight, which is important for the butterflies to warm up after cooler overnight temperatures. The area also needs to be sheltered from wind.

To attract butterflies, a garden must have host plants for breeding, and nectar plants for food. “If there are no host plants, butterflies will not stay in a garden; they will just pass through,” said nature enthusiast and retired architect Mr Tan Wee Lee.

Mr Tan Wee Lee waiting for a magic moment to capture a butterfly photo

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Attracting Delicate and Discerning Habitants Each species of butterfly has its own preferred host plant. For instance, the Plain Tiger butterfly prefers milkweed or Asclepias while the Common Tiger butterfly looks for creeper weed (Raphistemma pulchellum). Female butterflies search for host plants on which they lay their eggs. They “taste” the leaves through the sensors on their feet to determine if they have found the right plant.

Judicious planting and careful cultivation have seen the resident butterfly population in KTPH grow from just three species when the hospital first opened, to over 35 species today. Staff go the extra mile to ensure survival by taking caterpillars home and hand-feeding them thrice a day until they metamorphose.

The Common Birdwing Butterfly, which has yet to make KTPH its home

Nevertheless, the butterfly breeding programme has not been without its challenges. Despite planting the requisite host and nectar plants, the gardening team has been unable to get the Common Birdwing to settle in. One of the largest butterflies in Singapore, the striking Birdwing has yet to call KTPH its home.

“It would be an achievement to get the Birdwing to settle here. But we are breeding butterflies in an open concept environment. It’s very democratic – they go when they go, come when they come. We leave it to nature,” explained chief gardener Mrs Rosalind Tan.

Mrs Rosalind Tan inspecting a caterpillar

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Tree Yellow

Tawny Coster

Autumn Leaf

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Painted Jezebel

Birds Conditions have also been put in place to welcome birds from the neighbouring parks and woodlands to the hospital. So far, 12 species have been recorded within the hospital walls, all of them resident to Singapore, foraging for insects, nectar, berries or resting in transit to other habitats.

The ubiquitous presence of the Eurasian Tree Sparrow (Passer montanus), Olive-backed Sunbird (Nectarinia jugularis), Common Tailorbird (Orthotomus sutorius) and the Yellow-vented Bulbul (Pycnonotus goiavier) with their spritely activities and cheery calls and songs can be heard at all levels of the compound. They lend a soothing upsurge of life to the hospital ambience. These species are breeding within the compound while Spotted Doves (Streptopelia chinensis) have become regular foragers.

The Little Spiderhunter (Arachnothera longirostris) is an uncommon woodland species in Singapore. It probably comes from the nearby woodland at Yishun Park to forage for food in the lush greenery, or perhaps, it is attracted to the banana fronds, one of its preferred nesting site, at the roof-top garden. What this shows is that the Yishun Park woodland will play an increasingly significant role as a source for the birdlife within the hospital area as the greenery becomes more mature. This will help to provide diversity by luring woodland species, such as the Golden-backed Woodpecker (Dinopium javenense), Crimson Sunbird (Aethopyga siparaja) and Pied Triller (Lalage nigra), amongst others.

At Yishun Pond, nine wetland species have been recorded, among which are the Purple Heron (Ardea purpurea) and the Blackcrowned Night Heron (Nycticorax nycticorax), both nationally threatened and listed in The Singapore Red Data Book (2008).

Olive-backed Sunbirds

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Little Spiderhunter

Olive-backed Sunbird with blue chest

Black-crowned Night Heron

Collared Kingfisher

Little Egret

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Common Sandpiper

Purple Heron

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Fish In the early collections of the Raffles Museum of Biodiversity Research, over 100 species of freshwater fish were recorded as being native to Singapore. By the time another survey was carried out in the 1960s by Eric Alfred, then curator of the same museum, less than 40 native species could be found. At KTPH, ecological freshwater niches have been created. To populate these niches, native species were introduced. Though many species are now extinct locally, fortunately, quite a number of them still exist in the rest of Asia. Stock was therefore sourced from neighbouring countries to re-create the bustling freshwater populations that were here when Sir Stamford Raffles arrived in 1819.

The hospital has four distinct freshwater environments. Fish were selected to suit each of these.

Creating the Right Water Environment for Native Swimmers At the main lobby is a shaded pond that resembles a clear, still jungle lake. This has been stocked with Cyprinids (carp-like fishes) both large and small. Local barbs were the first to breed in this pond.

In front of KTPH’s cafeteria is a large and relatively shallow body of water where conditions are like those found on river flood plains.

Sunlight is strong, reeds grow out of the water, and the fringes are overhung with vegetation. Much of the Bukit Timah area must have been like that before the canal was built.

The shaded pond at the hospital’s main entrance

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Besides Cyprinids, many species of air-breathing Anabantids are stocked here. Anabantid fish such as gouramis, climbing perches, bettas and their relatives are able to survive in still and muddy waters. They colonise padi fields and swamps where they withstand the high temperatures and murky water.

Though the water outside the cafeteria is not allowed to become murky, it does in some ways resemble conditions found in padi fields. Hence the Anabantids feel right at home. Archer fish have been added to provide topics for conversation when they display their insect-shooting skills. Though they come from tidal swamps where seawater intrudes, archer fish are also known to live long in pure fresh water.

The shallow pond outside the cafeteria

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The “Shangri-La�inspired waterfall

In the first basement is a waterfall, cascading into a deep pond, with turbulent and fast flowing water like that found in unpolluted Asian rivers.

Here is where KTPH houses its river giants. Though still young, they are growing rapidly. Sultan fish (Leptobarbus hoevenii), Mekong Catfish (Pangasiodon sanitwongse) and Black Sharks (Labeo chrysophekadion) vie for attention with Giant Gouramis (Osphronemus goramy) and Tinfoil Barbs (Puntius schwanenfeldi).

The overflow from the waterfall pond is channeled into a stream that flows the length of the basement before the water enters the filtration system. Conditions in this stream, with dappled sunlight, good aeration and lots of little nooks and corners, are like those in the jungle streams. Ornamental aquarium fish thrive in this environment.

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In stocking and furnishing all the water bodies, several factors were taken into account.

In the choice of fish, each body of water was considered as four niches: surface, open water, side crevices, and bottom. Fish with different habitat and feeding requirements were selected to inhabit each niche. In this way, populations were established in which the individual species complemented, but did not directly compete with each other.

And in the case of fish sourced from farms, a number of captive-bred colour varieties were also included. These are of the same species and genetically identical to their wild brethren.

But having been bred for ornamental purposes, they are much more easily visible, making for an attractive display to kindle the interest of casual visitors.

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The Young and Shy Need their Crevices To ensure that populations could be selfsustaining, it was also very important to make sure that eggs and baby fish could survive. To do this, the growth of plants with long roots that trail in the water was encouraged. These provided hiding places for the fish that were shy, and also allowed fish fry to take cover among the tangles.

Big mounds of rounded pebbles were stacked in strategic places. As breeding fish scattered eggs, the currents carried these eggs into the crevices between the pebbles, out of reach of other hungry fish.

The crevices also provided hideouts for baby fish until they could grow big enough to avoid being eaten.

Three Spot Gouramy

Harlequin Rasbora

Apollo Shark Minnow

Spanner Barb

Common Frill Fin Goby

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Croaking Gouramy

Tin Foil Barb

Other Creatures Big and Small “Nature is messy,� said Dr Tan Hwa Luck, a veterinarian who leads the volunteers in managing the fish population. Dr Tan strongly promotes the adoption of ecologically sustainable procedures both in his home and in premises where he conducts his veterinary practice.

Knowing this, KTPH was prepared that there would be operational challenges to be faced in promoting nature conservation and ecologically friendly practices.

Grasshopper

However, no compromises to the hospital’s primary mission of providing quality health care are permitted. When faced with a choice between correct medical practices and environmental issues, medicine wins every time.

As an example, compost, which may attract insects, is not used anywhere near the operating theatres.

Plants are also kept a distance away from areas that have to be maintained in a medically sterile condition.

Common Parasol Dragonfly

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Green Bottle Fly

Common Green Shield Bug Nymph

Caterpillar of the Yellow Tiger Moth

Hello to Harmless Crawlies Many members of the public have the impression that gardens should consist of palms, flowers, carpet grass and nothing else. They are shocked to see caterpillars munching holes in leaves, millipedes and worms crawling over the soil after rain, and bees buzzing through the foliage.

Millipede

Some people have over-reacted to the presence of manylegged, creeping things and demanded that these creatures be removed. Management has to take pains to explain why total extermination is not desirable. Signs had to be put up and the staff had to be briefed to explain to the public that these creatures are harmless to humans, and are welcome in the hospital because they add to the biodiversity.

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Keeping Undesirable Species at Bay However, another problem arose in explaining to staff and the public why the introduction of species had to be done in an organised manner.

When it was announced that the hospital would add native fish to the water bodies, staff and members of the public reacted enthusiastically.

Some were ready to rush home and bring the contents of their aquaria for release in the hospital. The volunteers in charge had to explain patiently, time and time again, the reasons behind allowing only certain species to maintain the fragile balance of the ecosystem.

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Even then, some well-meaning staff and public did not understand the differentiation. Before he could be stopped, one of the hospital’s tenants released a large quantity of fish. And a contractor did not comprehend the reason for rejecting his offer to bring a delegation from his temple to carry out a mass release of fish, birds and insects on Vesak Day. To him a fish was a fish, regardless of type.

Despite vigilance by the security staff and prominent signage to discourage the public from making unauthorised releases, some exotic species have found their way into the water bodies at KTPH.

There are many American and African cichlids, goldfish and livebearers. Initially, attempts were made to net and remove the aliens. However, these frequent forays damaged the foliage in and around the ponds.

The constant splashing of heavy-footed workers also made all the fish extremely skittish, to the extent that they would hide whenever a human shadow fell over the water.

It was pointless having a display of fish that refused to be seen. The regular netting sessions were stopped. It was decided then that undesirable fish could be removed as and when the water bodies were scheduled for major maintenance.

In the meantime, the introduction of native species continues, but with an emphasis on robust ones capable of competing effectively with the unwanted aliens. So far, the big cyprinids, gouramis and loaches appear to be more than holding their own.

Staff trying to catch tadpoles to prevent the overpopulation of toads

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The fish have become tame again, and readily approach visitors for food. This tameness led to another problem – pilferage. Attractive specimens were lost. Children openly arrive with nets. Our security staff increased their vigilance to ensure fish were not pilfered.

Signs of Distress Success in establishing a good environment for nature created problems of its own. Some native species proliferated to the extent of becoming pests. With water for breeding, a large population of toads built up. The volume of their croaking reached levels that irritated patients.

Fears that the hospital would be overrun by toads proved unfounded, however, when nature adjusted itself.

Mr Lee Chiu San inspecting the condition of the fish

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Dr Tan Hwa Luck with the fish he rears in his home

Crickets also bred in large numbers. While harmless, their presence upset the public too.

These had to be removed and released elsewhere.

The steady growth of the fish, a number of which can reach large sizes, and the increase in population through successful propagation will eventually cause the water bodies to reach the maximum of their biological carrying capacity.

During the early days of the hospital, fish were released by the hundreds. Today, the situation is being closely monitored by experienced volunteers who add new species in smaller numbers.

An ongoing challenge will be the management of environmental change. “A garden, fish pond and all within them change,” said Dr Tan Hwa Luck, a veterinarian who is a volunteer advisor at KTPH. “We can start by covering the ground with fast-growing, sun-loving species. Then, as our larger trees grow and provide more shade, we have to introduce other species that can do better with less sunlight.”

Nature will eventually strike its own balance, but until then it is necessary to observe the waxing and waning of the different species, and to sometimes intervene.

Such an initiative is conducive to both the community and the environment.

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Chief gardener Mrs Rosalind Tan and volunteer gardener Mr Robert Lo tend the rooftop farm

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Rooftop organic fruit and vegetable farm at Tower C

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Urban Farming: The Possible Dream Singapore imports more than 90 per cent of its food. With soaring food prices and rapid urbanisation, urban agriculture is a logical alternative to food importation. It offers numerous economic, social and environmental benefits.

Urban agriculture involves growing crops or rearing livestock on vacant lots, gardens or rooftops. It can take many forms, from community gardens to larger operations that benefit a residential community. The community farm is often tended by local residents and uses resources such as organic waste for compost and wastewater for irrigation. Produce is distributed among the farmers for home consumption, or funds are channelled back to help with the maintenance of the garden.

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Economically, urban farming makes sense for Singapore. Of the country’s land area of 70,000 hectares, only 1,465 hectares have been allocated for farming under six agrotechnology parks. However, farming can also be done on a smaller scale in unused areas such as the rooftops of Housing and Development Board flats. Doing so will alleviate the country’s heavy reliance on food imports and put more food within reach of Singaporeans. Political events such as food riots, as well as environmental factors such as climate change and natural disasters have resulted in instabilities in food supply, making it imperative for Singapore to find alternative sources of food.

Urban farming also improves the quality of urban diets by increasing the diversity and quality of food consumed. This encourages people to eat healthier, home-cooked meals, thereby reducing the prevalence of diet-related diseases such as hypertension and diabetes.

The Dreams of Former Farmers Yishun was formerly an agricultural town, producing fruits and vegetables as well as pigs and poultry. Many of Yishun’s residents have farming in their blood, and long for the chance to be able to cultivate crops again.

The idea for a rooftop farm at KTPH was planted when we heard about a group of community farmers who were about to be displaced from their small community farm in Yishun. We offered the farmers the use of the rooftop of the hospital’s specialist outpatient clinic tower.

The farmers gladly accepted and the hospital’s landscaping consultants and engineers set about creating the conditions necessary for an organic rooftop farm.

Staff and volunteers enjoying the ambience of the rooftop farm

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The Social Benefits of Community Gardening Many people are surprised to learn that the hospital’s rooftop farm is run almost entirely by a team of dedicated volunteers, who come to the hospital every morning to tend their crops.

Socially, community gardens bring people together from a wide variety of social backgrounds to work for a common good. They foster a sense of community ownership and the development of a community identity and spirit. Such spaces also create recreational and therapeutic opportunities, promote environmental awareness and provide opportunities to educate the population on sustainability.

The garden also encourages active ageing, which is receiving increased emphasis in Singapore. Active ageing encourages seniors to pursue a satisfying lifestyle through social, intellectual, physical, vocational, emotional and spiritual engagement.

“Most of our volunteers are housewives. We welcome anyone who is keen, and provide support to enable them to enjoy the farming process,” said Mrs Rosalind Tan, KTPH’s chief gardener.

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Madam Lim (in red) is one of KTPH’s most dedicated volunteer gardeners, visiting the farm 5-7 times a week

Thriving Organic Farm The hospital’s rooftop farm is flourishing, producing kai lan (Chinese kale), bayam (Chinese spinach), corn, okra and cabbage, among other vegetables. The farm also features fruit trees such as custard apple, water apple (jambu air), papaya and banana. Harvests are distributed among the volunteer farmers, with a portion going to the hospital’s kitchens to be served in inpatient meals.

The farm is fully organic and runs on sustainable agriculture principles. To mimic natural ecological processes, the farmers encourage soil enrichment by rotating the crops after each harvest.

“We plant something and wait six weeks before harvesting. After the harvest, the soil must be tilled and fertilised before it can be planted again. We also ensure that crops are rotated with each harvest because we cannot plant the same crop all the time or the soil will be depleted,” said Mrs Tan.

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Sweet corn

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Cherry tomatoes

Radish

Local bananas

While the gardeners are not formally trained in agricultural practices, much of their knowledge comes from trial and error and past experience. “We do not use a scientific formula. We rotate crops based on our own experience – if we have planted corn, we do not plant corn again. We choose something else, such as bok choy or kai lan,” Mrs Tan said.

Instead of chemicals, organic pesticides such as neem oil are applied to control crop-destroying pests. The farmers also practise vermiculture. Earthworms are cultivated and used to turn waste from the hospital’s kitchen and the farm itself into rich fertilisers.

This is then used to improve crop quality and soil composition while enhancing the water-holding capabilities of the soil.

Composting is also practised, using organic waste produced from the farming process itself, as well as food scraps from the hospital’s kitchen.

A Rare Showcase of Sustainable Rooftop Farming The rooftop farm is a rare showcase of sustainable planting, according to Mr Bontigao. “A rooftop garden is a concept that usually gets axed when value engineering comes in. It is difficult to maintain not only because of the manpower it requires, but because of the logistics issues related to its location. You have to bring in soil, material, tools and people. It is difficult to do if the garden is not accessible,” he noted. The hospital’s rooftop is accessible both by stairs and lifts, making it easy to transport materials to and from the farm. Mr Bontigao added, “Other hospitals have tried before, but without the success that KTPH has enjoyed.”

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Replicating KTPH’s Efforts in the Community The green efforts at KTPH can easily be replicated elsewhere. “For a start,” said Dr Tan Hwa Luck, “people living in landed property can do much of this on a smaller scale.”

An HDB community garden, or other common space, can also be used to start a neighbourhood ecological project.

Emphasis should be on plant species that are native, and preferably edible. The native species are already well adapted to the local environment. Plants that are edible give the gardener an added incentive to tend the plot more diligently. Herbs are easy to grow, and so are some vegetables. If space permits, a pond can be devoted to the raising of food fish or edible frogs.

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The KTPH rooftop farm showcases methods of farming in small spaces using recycled plastic containers and styrofoam boxes

Volunteer gardener Mr Ronnie Chew tending to KTPH’s first rice harvest

Dr Tan advised neighbourhood farmers to plant a variety of crops, practise rotation and avoid monoculture. The repeated replanting of the same thing time and time again creates problems. It depletes the soil of the elements most preferred by that plant. And it allows a population of pests that specifically live off this plant to become established and multiply.

At the same time, Singaporeans have to learn to be more forgiving, and excuse the birds, caterpillars and squirrels for taking an occasional bite out of a fruit or vegetable.

The aim of each plot should be for a zero exit policy – to, as far as possible, recycle whatever comes out of the land. Leaves, cuttings and other organic material can easily be composted.

As compost is mulched into the soil, that itself changes for the better – improving in texture to be able to support a wider variety of plants.

These practices can be carried out in many places. If they are, the entire Singapore environment will change – for the better.

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Placemaking: Creating Community Spaces The concept of placemaking is consciously practised in KTPH. The team from the US-based Project for Public Spaces (PPS) was invited to visit KTPH to share their expertise and recommendations on placemaking techniques. PPS is a nonprofit planning, design and educational organisation dedicated to helping people create and sustain public spaces that build stronger communities. Its founder and president, Mr Fred Kent, is widely recognised as an expert on placemaking.

Placemaking refers to observing how people live, work and play and creating spaces for them to fulfil their needs and aspirations. When done well, good public spaces that promote people’s health and enhance their wellbeing emerge.

Students studying in a restful environment

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PPS showed that the factors that determine successful placemaking include safety, comfort, shade, proximity to food and opportunities for social interaction. KTPH is sited in the midst of a residential neighbourhood and well connected to the community. The open concept of the hospital purposefully removed barriers to residents and visitors moving through the grounds.

The hospital has been attracting people from the neighbourhood to drop in. Benches, shaded areas, cosy corners and gazebos were incorporated throughout the grounds to create spaces where people can gather for reflection or interaction.

“Water cycling” at the Promenade

Visitors and patients at KTPH do not just spend their time in the wards. Patients and their families gather by the pools in the gardens, where quiet niches have been created to allow groups to have peace and privacy.

Gazebo

Dr Ho Hua Chew commented: “Experiments have shown that patients recover faster in environments with greenery. I’m quite sure that, if nothing else, the depression caused by being hospitalised will be lifted if the patients can see flowers and butterflies and hear birds singing.”

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“It’s an accepted truism that a lush, green environment makes people feel better,” said Dr Ho. “I have never seen people feel so welcome in a hospital environment.”

Retirees practise tai chi on the level platform beside the Yishun Pond. The one-kilometre path around the pond is a popular jogging and brisk walking track because of its flower trails, pebble shores and mini wooded area. The hospital’s caféteria is deliberately situated next to the pond so that cyclists and athletes can grab refreshments while diners enjoy the changing hues of sunrise and sunset. Students have set up their own study corners in various parts of the gardens. The lobby has welcomed performances from school groups and retirees. In wet weather, it also hosts exercise and dance sessions for staff.

More than a place where illness is treated, KTPH aims to promote health and wellbeing to help the population lead long, healthy lives.

Patients and their families enjoying the calming effects of the water features

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Families get to bond while feeding the fish

Performances by schools and music groups at the main lobby

KTPH health ambassadors jogging and brisk walking around the pond

Teaching little ones about “old-school� farming

Enjoying the Shangri-La inspired waterfall

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Fern Tree (Schizolobium parahybum)

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A Built Environment can Co-exist with Nature It is not difficult to create a green oasis within a built environment. But the commitment must exist, and it has to come from the top, said Dr Tan Hwa Luck. While their demands are not mutually exclusive, there will be times when there will be conflicts between the needs of nature, public perception and operational convenience.

Decisions will have to be taken on which gets priority. To protect nature, the decisions will have to over-ride irrelevant and perceived threats. While noxious and venomous species will not be encouraged, weight cannot be given to arguments such as, “People don’t feel comfortable with worms and caterpillars crawling around.”

KTPH staff assembling a “dragonfly pot” to attract dragonflies to the premises

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A person in authority has to hold back the simple solution of applying a broad-spectrum insecticide and allow the caterpillars to stay. The staff have to be persuaded into explaining to the public that the caterpillars have to be tolerated to continue growing the population of butterflies.

Water is vital to creating a green environment.

Dr Tan said, “Collection of water and creation of a pond, even a small one, has to be the first step.

“Water creates a local micro-climate around which plants and insects will gather. It attracts dragonflies.

That immediately increases biodiversity.”

A “de-stress� corner surrounded by water and foliage

Water is also perceived to allow the breeding of mosquito larvae. It attracts frequent and stringent inspection visits from the National Environment Agency. Maintenance staff generally prefer not to have to deal with water, and those in charge have to ensure that pools do not pose health risks.

Dr Tan stressed that it was important to manage the water cycle, from the collection of rain runoff to the disposal of excess or polluted water.

A decision has to be made, even at the planning stage before construction begins, to incorporate good water management facilities.

The placement of other physical structures such as walls and roofs, and whether to tile a surface or leave the soil open, can affect the micro-climate. The one in charge has to have the commitment to ensure that the placement is to nature’s advantage.

With these conditions in mind, what was achieved at KTPH can be replicated anywhere else in the tropics.

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Epilogue It is Alexandra Health’s hope that KTPH’s gardens will inspire various schools, workplaces and residents to create similar green spaces in their premises and neighbourhoods. With some creativity and planning, lush oases can exist amidst the concrete jungle. Vertical and urban greening creates a soothing and aesthetically pleasing environment for work, play or rest.

It also has a positive effect on the environment.

Equally important, it will increase and restore biodiversity to various pockets of Singapore that have been lost due to rapid urbanisation.

This may encourage children and youth to gain an appreciation for the outdoors and discover the joys of botany or birdwatching. Seniors may feel comforted by the nostalgia of being surrounded by familiar “kampong” flora and fauna. Communal spaces will encourage social interaction and active lifestyles, contributing to the overall health and wellbeing of the population.

The outcome is worth the challenges.

KTPH at nightfall

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Acknowledgements Alexandra Health gratefully acknowledges the contributions, support and advice from the following individuals and organisations in the production of this book: Mr Lee Chiu San Thank you for your labour of love: conducting interviews, writing multiple chapters and contributing personal photos to this project.

Volunteer Advisors Dr Ho Hua Chew Dr Tan Hwa Luck Mr Tan Wee Lee Mr Ronnie Chew Nature Society of Singapore Additional Photography by Mr Richard Ong Mr Andrew Wong Mr David Tan Mr Jimmy Chew Mr Nick Baker Mr Peter Ng Valuable Input from Mr R P Jickky, Director, Tropical Environment Pte Ltd Mr K Rajendran, General Manager, Tropical Environment Pte Ltd Mr Glenn Bontiago, Peridian Asia Mr Richard Ong Mrs Rosalind Tan Staff Project Team Ms Cecilia Pang (Advisor) Ms Jean Margaret Angus Ms Desiree Low A publication of the Corporate Communications Department, Alexandra Health System

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90 Yishun Central Singapore 768828 www.ktph.com.sg