Healthcare beyond Borders
Singaporean health professionals are heading overseas to lend their medical expertise and empower communities in need.
BY SASHA GONZALES
n 2017, there were a reported 13,386 doctors in Singapore, according to statistics shared by the country’s Ministry of Health. Out of this figure, a small but growing number of medical professionals are pursuing humanitarian work overseas. They volunteer their services with organisations such as the Singapore Red Cross Society, which sends an increasing number of local doctors overseas.
“Due to the overwhelming increase in crises around the world, whether man-made or natural, we have started deploying doctors on a more regular basis. This year alone, the number of doctors we are sending on humanitarian missions has tripled from last year,” shares Charis Chan, head of International Services at the Singapore Red Cross Society. But apart from delivering urgent medical aid in war-torn and disaster-stricken zones, Singaporean doctors also travel overseas to help build healthcare capacity in less-developed nations. More often than not, they are plunged into environments that are often unpredictable and far removed from the sterile hospitals at home.
So what is it that inspires them to leave the familiarity of home to help others?
In the case of Dr Tam Wai Jia – who has embarked on more than 20 humanitarian trips around the world – witnessing locals give up their well-paying jobs to help the poor on a three-week mission to Mozambique encouraged her to volunteer overseas.
“[The experience] shook me and made me ask myself: What do I stand for? Am I going out of my comfort zone? Am I willing to give more?” she shared in an earlier interview.
Apart from the Singapore Red Cross Society, Singaporean doctors also volunteer their medical expertise with other organisations. These include international NGO Medecins Sans Frontieres and the Singapore International Foundation (SIF). The latter, for instance, runs various long-term team-based volunteer programmes that equip overseas communities with medical skills and knowledge to build organisational capacity. These projects involve skilled volunteers, many of whom are doctors.
Take, for instance, its two-year project helping to enhance child and adolescent psychiatric services in East Java, which came to a successful completion this year. Driven by a need to improve mental healthcare services in a region experiencing a rise in young people with emotional and behavioural disorders, the project was led by Dr Cheryl Loh, senior consultant at Changi General Hospital’s Psychological Medicine department, supported by specialists from the same hospital as well as the Institute of Mental Health in Singapore.
As a result of the programme, close to 200 Indonesian trainees – from psychologists to occupational therapists – working at hospitals in East Java were trained to assess, treat, and manage child and adolescent patients with conditions such as autism and psychosis.
“Among other things, we learnt how to deal with challenging behaviours in our child and adolescent patients, as well as how to create effective yet fun nursing-care plans for those with special needs,” explains Dr Yuniar Sunarko, a psychiatrist at Dr Radjiman Wediodiningrat Mental Hospital. Another successfully completed SIF project was the two-year Emergency Medical Care and Management Project in Phnom Penh, which trained healthcare professionals to assess and manage time-critical emergencies, such as cardiac arrest, trauma and stroke.
The multidisciplinary project also featured the development of integrated treatment and rehabilitation plans, including critical-care nursing and physiotherapy, to improve the likelihood and speed of recovery in patients. Working closely with their local counterparts, volunteer doctors, nurses, physiotherapists and pharmacists from Singapore General Hospital (SGH) trained over 900 healthcare professionals from five healthcare institutions in the Cambodian capital.
“ People had great ideas to share, with enthusiasm and rigour, just not over a bland, typed interface. Itʼs up to us to ﬁnd out what ticks in a different culture. ”
Dr Tam Wai Jia, International Volunteer
NO BARRIER TOO BIG
While their efforts have clearly led to improvements in healthcare systems overseas, Singaporean doctors on humanitarian missions do face obstacles.
At the beginning of SIF’s programme in Java, both the Singaporean and Indonesian teams experienced communication problems due to differences in language. Working together on a professional capacity also meant that the teams had to overcome their differences in culture and socio-economic background. “We had to keep in mind that while many of the Indonesian doctors were taught similar material to us, but cultural norms and resource availability had moulded their practices over the years,” says Dr Loh.
Differences aside, the teams were able to find common ground in their struggles to balance both clinical and administrative duties. Dr Loh was also touched by the warmth, hospitality and thoughtfulness of her hosts. In addition, she shared that the teams from both countries bonded over their love of food.
Over in Phnom Penh, the Singapore medical team had to deal with its own set of obstacles. For instance, developing solutions for a community faced with a lack of resources was a challenge. Thus, the volunteers worked towards broadening the scope of their counterparts’ practices, such as through an Advance Cardiac Life Support course. This allowed the Cambodian hospital staff to perform various duties efficiently despite manpower deficiencies.
“Emergency nurses are now trained to read the ECGs they’ve performed so that they can recognise cardiac emergencies, like heart attacks. Enhancing their capabilities also helps them to attain more career satisfaction,” explains Dr Mark Leong, SIF’s specialist team leader and senior consultant at SGH’s Department of Emergency Medicine.
Despite differences in culture and language, he said the Singapore and Cambodian teams connected through a common desire to improve patient care and outcomes.
“Knowing that we were contributing to the health and well-being of Cambodian communities left us humbled. It also made us see that regardless of where or who we are, the people of Southeast Asia all share the same desire: to better our lives and the lives of others,” he shares.
While the programme may be over, its positive outcomes have been sustainable. Through pedagogy workshops, management training and professional sharing sessions, participants have been taught how to share their newfound knowledge and expertise with their peers within the industry. “Our team continues to build on the knowledge, skills and techniques they have acquired,” says Dr Nareth Chhor, head of the emergency department at Calmette Hospital.
Beyond the advancement of his country’s healthcare system, Dr Chhor shares that the collaboration was a good platform to help strengthen relations between the two countries. For example, the Singapore team has invited the Cambodian medical team to participate in workshops in Singapore, outside the scope of the project. On a personal level, both teams have continued to stay in touch.
While the ability to uplift the lives of others is one of the main motivators for Singaporean doctors pursuing humanitarian work, what helps them to attain success in a foreign environment is, perhaps, a willingness to embrace a new culture. Recounting her experiences developing a training curriculum for healthcare workers at an HIV centre in Uganda, Dr Tam admits to being frustrated by her slow progress with the workers. While she initially attributed this to unreturned emails and slow replies, she later realised she had made the mistake of applying her familiar work ethic from an email-centric culture into one that valued face-to-face interactions.
“Once I let go of my obsession with email replies, and started dropping into people’s offices to say “Oli otya?” [How are you], work progressed at a much faster rate. People had great ideas to share with enthusiasm and rigour, just not over a bland, typed interface. It’s up to us to find out what ticks in a different culture,” she says.
Similarly, it was an eye-opening experience for the Singapore International Volunteers on SIF’s project in East Java. “Our team was impressed by how the Indonesian mental-health practitioners placed great emphasis on case discussion. This helped to better facilitate the sharing of medical skills,” shares Dr Loh.
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