Chapter Four: Pioneers of Tomorrow
Another incident through which Alexandra Hospital’s patient care stood out and dominated headlines involved the explosion of an oil tanker called Spyros at Jurong Shipyard on 12 October 1978, just after lunch hour. One by one, ambulances and lorries ferrying patients covered in thick soot, arrived at AH’s A&E.
The explosion had sent flames and hot oil shooting through its engine room and a blast of 3,000 degree celsius air through its lower decks. As the sole general hospital in western Singapore, AH saw 55 severely burnt casualties that day.
AH’s deft handling of the situation cemented an image of dependability into the public eye. Dr. Ng, who was the then head of surgery, said it boiled down to good luck. The hospital happened to be at full strength when the victims were rushed down at about 2 p.m.
A handover of shifts had been underway, which meant that employees for both the morning and afternoon sessions were around. Doctors were also returning from lunch. AH admitted about a third of the injured patients that day. The rest were given pain relievers and antibiotics before they were transferred to SGH’s burns unit.
Dr. Ng said AH, which was fully-equipped and fully staffed by 1978, had succeeded in fulfilling its role in providing immediate A&E care. “We made sure they were as comfortable as they could be and that their wounds were covered up properly before sending them for continued and specialised care.” Over the years, AH attended to more of such industrial and shipyard accidents.
Part Three
Nailing Victim Care: The Spyros Incident
Casualties of the Spyros incident being conveyed to Alexandra Hospital.
A Learning Organisation
AH started to attract student doctors from as early as 1971, following Dr. Frederick Tan’s pioneering efforts to better understand diabetes. Recognising AH’s potential as a learning organisation and eager to promulgate medical knowledge, Dr. Tan went on to initiate a monthly hospital conference the following year.
By 1983, AH had made a name for itself among postgraduate students of medicine, who flocked there for their traineeships. The hospital gained a reputation for the highest examination pass rates among medical students in Singapore.
AH also attracted established doctors. To cater to this crowd, the hospital launched a continuing education programme in 1986, offering private clinic practitioners the chance to maintain and upgrade their skills, and the opportunity to keep learning.
It was thus unsurprising when plans were made for AH to do more in this area. In 1995, AH was selected to officially function as an extension of the NUS Faculty of Medicine’s learning grounds. It was a mutually beneficial arrangement. Students could work with various demographics to learn to tackle a wider range of illnesses and diseases, while patients could enjoy NUS’s standard of care, medical expertise, and resources.
A view of the main corridor of the hospital, facing eastwards.
Paving the Way for the Silver Wave: Singapore’s First Geriatric Centre
The numbers said it all—Singapore was starting to grey. From 1986 to 1996, residents aged 60 and above rose from 208,300 to 305,200—an annual average growth rate of 3.9 percent versus the general population’s 1.9 percent.
The MOH thus started looking more actively into geriatric practice. Its efforts were multifold: it invited illustrious geriatricians from the United Kingdom and Hong Kong, and simultaneously dispatched local doctors for overseas training. AH was among the healthcare institutions that MOH roped in to tackle the grey wave. “We were starting early in preparation for the silver tsunami to come,” said Dr. Chan Kin Ming, who was the founder of Singapore’s first-ever geriatric day hospital at AH in 1994. Before he moved to AH, he worked with the Department of Geriatric Medicine at Tan Tock Seng Hospital (TTSH).
“At that time, the MOH plan was to divide Singapore into three sectors—west, central and east. TTSH will helm central, while AH will helm the west and CGH [Changi General Hospital] the east,” he said. “We sort of decided among ourselves who was going where to set up geriatric departments. So Dr. Philip Choo and Dr. Pang Weng Sun will remain in TTSH, I will go to AH.”
Dr. Chan Kin Ming, a pioneer in his own right, founded the Geriatric Centre.
Dr. Chan found himself parked under the AH’s Department of Medicine as a geriatrician, with only one medical officer attached to him. Not only did he have to establish a new geriatric department and the aforementioned geriatric day hospital, but he was also responsible for seeing all the geriatric patients in the Department of Medicine.
Under Dr. Chan’s leadership, AH established three geriatric facilities under its roof: the day hospital, the community services block, and a geriatric ward. The day hospital was the first of its kind in Singapore and often attracted visits from members of foreign medical institutions in the Southeast Asian region, as well as Japan. The community services block housed the Tsao Foundation then. They were a home nursing foundation that ran the Hua Mei Mobile Clinic and an Independent Living Centre.
The community services block was housed at the former sergeants’ mess, in the two-storeyed building.
The Independent Living Centre was designed for members of the public to view and purchase relevant medical, nursing, and rehabilitation equipment from vendors. The centre featured a mock-up of a typical Housing Development Board two-room flat where elders were presented options to better equip their homes to serve their changing needs.
Dr. Chan said: “The idea was to help them retain their independence and continue to live at home. We had someone stationed onsite to walk elderly visitors through the available equipment at their disposal as per their disabilities. We had different types of grab bars, ramps, wheelchairs, and mobility aids on display.
The Geriatric Centre, located at the eastern wing of the hospital. Its original buildings were constructed after WWII, back in 1948.
To boost AH’s geriatric offerings, a continence clinic and a memory clinic were set up in consultation with a urologist and NUH’s psychiatric department.
AH’s geriatric care facilities were underused in its early years, shared Dr. Chan. Apart from a smaller greying population at the time, the field was relatively new, which caused some confusion when it came to referrals. Dr. Chan said: “The healthcare sector was specialty-oriented. If someone had a joint problem, the hospital would send you off to see the orthopaedic.
Geriatrics operated differently. Our philosophy was to be a one-stop centre for the elderly so that they do not need to see multiple specialists and risk taking too much medicine. It took the other departments some getting used to.” To address this issue, the team instructed the hospital’s A&E department to adopt an age-based approach in their patient admissions policy.
Elderly with medical problems who are 65 and above would be admitted into the geriatric ward. “This helped us get things going,” said Dr. Chan.
Tan Tock Seng Hospital (TTSH), in the meantime, was appointed to serve as Singapore’s geriatric headquarters. The New Changi General Hospital (present-day Changi General Hospital) had its own geriatric medicine department as well. AH’s geriatric day hospital model went on to influence the design, function, and establishment of Senior Citizens’ Health Care Centres in Toa Payoh, Ang Mo Kio, and Tampines.
Community hospitals and nursing homes started sprouting up quickly, working in unison to develop the nation’s geriatric capabilities.
This form of care became popular as it injected warmth into the healthcare experience, recalled Dr. Chan. “The hospital system used to be rather cold. If you were well enough, you’d be sent home to free up a bed. You were expected to fend for yourself. But geriatrics changed that by shoring up the importance of caregiving and familial support. It also put emphasis on the functional ability of the person through early inpatient and outpatient rehabilitation, catering to patients at a more leisurely pace.”
He added: “It was a community-based approach. We encouraged the involvement of family members and told patients to furnish us with details about their caregivers and home situations. Patients noticed this difference. Our day hospital also celebrated patients’ birthdays and local festivals such as Christmas and Chinese New Year. It was a different concept … more holistic, more human. Patients and their family members appreciated this form of care.”
A patient undergoing rehabilitation at the Geriatric Centre.
AH’s geriatric facilities included Singapore’s first self-dependency dialysis centre, founded in partnership with the National Kidney Foundation (NKF).
Its opening ceremony on 6 September 1975 was officiated by President Benjamin Sheares, who served at Alexandra Hospital earlier in his medical career.
He is pictured here with NKF founder and chairman Professor Khoo Oon Teik (on the right), whose foray into this area of care for kidney patients started in the 1960s in an attic at SGH.
Tackling a Silent Killer: The War on Diabetes
AH also stood out for its diabetes treatment and care.
This aspect of its history began with Dr. Frederick Tan Bock Yam, the then head of AH’s department for medicine. He identified the disease as a silent killer worth looking into from as far back as the 1970s.
Prior to joining the hospital, Dr. Tan was based at SGH, where he tended to diabetic patients. His interest in better understanding the disease was ignited during his postgraduate studies in the United Kingdom, where he was exposed to the British Diabetic Association’s various programmes.
During AH’s early days, when patient intake was still low, Dr. Tan and his team expended their energy educating diabetic patients and their caregivers about “disease management.” They also “offered specialised treatment and pioneered cutting-edge practices.” Diabetes soon developed as a general medicine subspecialty at AH, and the hospital became the go-to place for diabetic treatment. As a result of his forward-thinking initiative, AH attracted throngs of young doctors eager to work with him and his team on the little-known disease.
Dr. Tan was also behind the formation of the Diabetic Society of Singapore, now known as Diabetes Singapore. Set up in 1971, it continues to play a key role in diabetes management and, among other things, organises public forums six to seven times a year. As its founder, Dr. Tan held educational meetings and self-care courses at AH’s conference room until 1974.
A/Prof Sum Chee Fang, who set up Alexandra Hospital’s diabetes centre, stands outside its former home at Block 28.
Dr. Tan was later succeeded at AH by Professor William Chew, who worked on the issue of insulin resistance in the country. To move the field forward, he focused on nurturing doctors.
By the early 2000s, the nationwide spike in diabetes cases—a result of affluence and the availability of high fat and high sugar foods—spurred AH to dedicate more resources towards upgrading care standards.
Dr. Chew served as a mentor to Associate Professor Sum Chee Fang, who was later invited to join AH by then chief executive officer Mr. Liak Teng Lit and then chairman, medical board (CMB), Professor C. Rajasoorya. Trained in endocrinology, diabetes, and metabolism at SGH, Dr. Sum was responsible for setting up a dedicated diabetes centre for AH in 2001.
Recounting his time at AH, Dr. Sum said he had been on the lookout for an opportunity to roll out and spearhead such an initiative. The advocate for holistic diabetes care explained that the chronic condition required a multidisciplinary approach as the disease could impact patients’ everyday lives and cause severe complications like kidney failure and stroke. “A solo practitioner tends to have more difficulty coordinating the patient education and the multifaceted patient care, especially for the patient with complex medical problems,” he added.
The multidisciplinary team often gathered to share expertise and knowledge, pulling out complex patient case studies to discuss, exchange notes, and problem-solve. When a body of knowledge was lacking, they conducted their own research. “This set the foundations for multi- and interdisciplinary learning,” said Dr. Sum, adding that caring for patients and constant learning underpinned the centre’s approach.
Recognising the importance of upskilling nurses, Dr. Sum, together with like-minded colleagues, helped formulate training for diabetes education via his collaboration with Nanyang Polytechnic, which led to the launch of a specialist nursing diploma in diabetes management and education in 2002/3. In addition, he also initiated the Advanced Practice Nurse Programme at the centre.
In 2010, AH’s diabetes centre moved to Khoo Teck Puat Hospital, where it continued to focus on patient engagement and research.