BATTLING AN UNSEEN

ENEMY

BATTLING AN UNSEEN

ENEMY

Issue 3: COVID-19 & Nurses’ Day special 2020

COVID-19: the basics

FROM IN-AIR SERVICE TO ON-GROUND CARERS

26 4616ACING THE SCREEN TEST

Nurses’ Day Special 2020:

Read more on page

47

Yishun Health’s system-wide effort to contain the COVID-19 pandemic and care for patients

brings out the best in our healthcare heroes

2 |

4 WHAT’S UP Patient experiences &

showing appreciation during the pandemic

14 TIMELINE Our COVID-19 Trajectory

SPOTLIGHT16 Acing the Screen Test20 Collaborations &

Conversions24 Critical Expansions

26 EVERYDAY HEROES From In-air Service to

On-ground Carers Temporarily grounded flight

attendants re-directed their skills to care for our patients

SPOTLIGHT28 Reaching Out to Care32 Allies in Healthcare34 Fundamental Contact

38 5 THINGS ABOUT… Handwashing Why it is important during

the pandemic

08 COVER STORY

Rise Up: Responding as one Yishun HealthHow Yishun Health came together to effectively contain COVID-19

16

CONTENTS

26

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SPOTLIGHT40 Safe & Secure Access42 Food from the Heart44 Lines of Communication

46 DAILY DOSE COVID-19: The Basics

PUBLISHERYishun 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.

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) 088/07/2020

EDITORIAL TEAMHannah Wong

Sabrina NgSharon NgAlbert Foo

ktph.com.sg/aha

aha@ktph.com.sg

PUBLISHING AGENTTHINKFARM PTE LTDwww.thinkfarm.sg

MANAGING DIRECTOR

Christopher Tay

HEAD, E DITORIAL Chua Kim Beng

CONTRIBUTING E DITORSheralyn Tay

E DITORDang Hui Ling

HEAD, CREATIVE Sean Lee

HEAD, CLIE NT RE L ATIONSHIPJessie Kek

CONTRIBUTORSJustin Loh

Lee Lily

EDITORIAL COMMITTEEThe 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 YangBastari Irwan

Chia Kwee LeeFatimah Moideen Kutty

Shirley HengTeresa Foong

CONTRIBUTORSBob Lee

Rachel Tan

T his special issue of aha brings to you stories from inside Yishun Health. Read about how the past six months has seen staff rise above and beyond their call of duty to ensure that

our patients continue receiving quality care during the COVID-19 pandemic.

Recognising the many nurses who have played important roles in the hospital, particularly during this crisis, we celebrate their achievements in a special section that commemorates Nurses’ Day.

BATTLING AN UNSEEN

ENEMY

BATTLING AN UNSEEN

ENEMY

Issue 2: COVID-19 & Nurses’ Day special 2020

COVID-19: the basics

FROM IN-AIR SERVICE TO ON-GROUND CARERS

26 4616ACING THE SCREEN TEST

Nurses’ Day Special 2020:

Read more on page

47

Yishun Health’s system-wide effort to contain the COVID-19 pandemic and care for patients

brings out the best in our healthcare heroes

44

Answering common questions about the pandemic

47 NURSES’ DAY 2020 A special section

to honour our healthcare heroes, who have stepped up their game during this pandemic

* All photos of people without their masks were taken before the Circuit Breaker

4 |

WHAT’S UP

ACTS OF KINDNESS

It is said that no act of kindness is ever wasted. In difficult times,

small gestures by our Yishun Health family have made a big impact on COVID-19 patients. These are heart-warming stories of staff going above and beyond caring for patients — a reflection of Yishun Health’s person-centred mantra.

A birthday to rememberWhen Case 44, a 37-year-old auxiliary police officer from Certis, was diagnosed with COVID-19 on 10 February 2020, he was in disbelief. He had volunteered to serve quarantine orders, and wore a mask and gloves during his duties. Despite these measures, he still contracted the illness.

This led to a two week-long stay in KTPH. Suffering lethargy, diarrhoea and erratic fevers, he was also wracked with anxiety for his wife

and two young children, who were serving their quarantine at home. The isolation, he knew, would be hard. “As an adult, I already couldn’t take it. I knew it must be worse for the children,” he mentioned in an interview with the press.

Since the start of the circuit breaker period, more than 2,100 people have been caught breaching safe distancing rules, while over 500 did not wear a mask outside their homes.

Environment and Water Re-sources Minister Masagos Zulkifli yesterday gave this update on Face-book about those who have flouted

the circuit breaker rules since they kicked in on April 7.

“I am glad that most Singapore-ans and residents have adhered to the measures, and we have seen the number of community cases fall in recent days. However, there’s a minority of people who are not doing their part,” wrote Mr Masagos.

He added that if there is a signifi-cant decline in Singapore’s local transmission numbers, “we may be able to gradually ease some of the measures”.

The National Parks Board also an-nounced yesterday that, in line with the new measures to enhance safe distancing, food and beverage outlets, as well as convenience

stores, in gardens, parks and nature reserves would close from 11.59pm yesterday.

All carparks in gardens, parks and nature reserves will also be closed during this period, the board said. More details on theclosures, which will last until May 4, can be found at www. nparks.gov.sg/noticeboard

The moves come after the Gov-ernment announced several en-hanced measures to curb the spread of the coronavirus, includ-ing a month-long extension of the circuit breaker period to June 1.

In his Facebook post, Mr Masa-gos also touched on the new crowd control measures that apply to four popular wet markets: Geylang Serai Market, Chong Pang Market at Block 104/105 Yishun Ring Road, and the markets at Block 20/21 Mar-siling Lane and Block 505 Jurong West Street 52.

From today, consumers heading

out to buy groceries at these mar-kets will be able to do so only on al-ternate days, depending on the last digit of their identity card or Foreign Identification Card num-ber.

Mr Masagos said: “The above measures will help reduce the crowding and queues at these popu-lar markets, especially on week-ends. Similar access restrictions may be introduced in other wet markets, where crowding is ob-served.”

Jean Iau

Jean Iau

Long queues were spotted at bub-ble tea shops across the island as Singaporeans tried to get their last fix of the sugary beverage before the stores temporarily shut their doors at 11.59pm yesterday.

Last night, the Ministry of Trade and Industry (MTI) announced that all standalone food and bever-age outlets selling mostly drinks and snacks, as well as hairdressing

and barber shops, will have to shut until May 4, for now.

The announcement was part of a further tightening on businesses deemed essential during Singa-pore’s circuit breaker, which has now been extended until June 1.

Long queues were spotted at a LiHo bubble tea outlet at My Vil-lage in Serangoon Garden, Gongcha’s bubble tea shop in Toa Payoh, and the Koi outlet in Jurong East following the announcement.

At a LiHo shop in Yishun Avenue

6, over 40 people, including deliv-ery drivers, were spotted waiting for their drinks. There was also a line of about five cars along the road in front of the shop. A deliv-ery rider, Mr Alif Haikal, 31, said he had been waiting for more than 25 minutes for two orders of bubble tea to deliver to customers. Usually this would take only five minutes.

He said: “Since 5pm, I’ve started to get at least two orders for bub-ble tea from various shops every hour – I didn’t think much about it

until I heard at around 8pm bubble tea shops would be closed tomor-row.”

While delivery business was good yesterday, Mr Alif is worried the move to shut bubble tea stores would affect his income, as half his orders are from drink stalls.

Standalone food and drink out-lets in hawker centres, foodcourts and coffee shops are not affected.

All other establishments that sell meals including hot or cooked snacks or breads may remain open for takeaway and delivery only.

Companies will be allowed to have a minimal number of workers return to their outlets today to pack and organise perishables but the storefronts must stay shut.

jeaniau@sph.com.sg

Cheryl Tan

A total of 50 children and adoles-cents have been infected with the Covid-19 virus here, with around half of them still in hospital.

Among them is a three-year-old Singaporean girl (Case 582), who has been warded for 29 days – the longest stay of all children so far – since she tested positive for the Covid-19 virus on March 24.

She was warded in KK Women’s and Children’s Hospital (KKH) af-ter testing positive, and is linked to Cases 418 and 647, whom The Straits Times understands to be the girl’s parents. Both were imported cases who had returned from the United States, and they were dis-charged on April 9 and April 6 re-spectively.

Of the 50 children and adoles-cents here who have been infected, eight of them are aged one and be-low. Thirteen are aged above one to six, while 22 are aged between seven and 12. Seven are aged 13 to 16.

Five children tested positive for the virus on April 18. Four of them were related and linked to a family member found to have contracted the virus on April 13. The fifth was a one-year-old girl whose family member was infected.

Among the 50 cases to date, a one-year-old boy was the fastest to recover. He tested positive for the virus on Feb 16 and was discharged two days later. The boy was one of the 174 passengers on the second Scoot flight chartered to evacuate Singaporeans and their family members from Wuhan on Feb 9.

Professor Dale Fisher, group di-rector of medicine at the National University Health System and chair-man of the World Health Organisa-tion’s Global Outbreak Alert and Re-sponse Network, had said children appear to be asymptomatic or less likely to be sick from Covid-19 than adults.

With other diseases such as chicken pox and hepatitis A, chil-dren also experience milder or no symptoms compared with adults, which suggests that they may have a different kind of immune system.

He also added that in Singapore’s family clusters, there is no evi-dence that the child was the first person to contract the virus. In-stead, it is usually the other way round – parents infecting the child, though the child remains asympto-matic even when he tests positive for the Covid-19 virus.

Dr Sharon Nachman, head of pae-diatric infectious disease at Stony Brook Children’s Hospital in New York state, told Agence France-Presse: “Children see so many ill-nesses in the first few years of life that their immune systems are tuned up and respond nicely to novel infection.”

In a study published last month in the journal Pediatrics, re-searchers from the paediatric divi-sion of the medical school at Shang-hai Jiao Tong University studied 2,143 infected children in China. They found that 50.9 per cent of children experienced mild symp-toms, 38.8 per cent had moderate symptoms and 4.4 per cent had no symptoms.

The remaining 5.9 per cent were serious cases, which was well be-low the 18.5 per cent of adults who experienced severe symptoms.

However, the study said younger children are more likely to suffer se-vere symptoms than older ones af-ter contracting the coronavirus.

The data revealed that infected children younger than one year old suffered severe to critical symp-toms 10.6 per cent of the time. Chil-dren from ages one to five, on the other hand, experienced critical symptoms 7.3 per cent of the time. Those who were 16 and older expe-rienced these symptoms 3 per cent of the time.

In a Morbidity and Mortality Weekly report released by the US Centres for Disease Control on April 6, it was found that compared with adults, children who are un-der the age of 18 are less likely to ex-perience fever, cough or shortness of breath.

Other studies have also shown that children tend to have longer in-cubation and virus shedding peri-ods compared with adults.

tansuwen@sph.com.sg

Shivraj Rajendran

Two months after being dis-charged from the isolation ward at Khoo Teck Puat Hospital (KTPH), the Certis officer who contracted Covid-19 is back at work, albeit no longer on the front lines.

Asking to be known only as Case 44, the 38-year-old father of two is now working from home and has re-turned to his regular duties of han-dling manpower and deployment arrangements. He has been with Certis since 2005.

Case 44 had been performing these manpower duties until late January, when Certis started look-ing for volunteers within the organi-

sation to help with its quarantine services. Sensing an opportunity to gain valuable work experience, he offered to help.

As a quarantine order agent, he was deployed to serve quarantine orders to individuals during the early days of the Covid-19 outbreak in Singapore.

Equipped with gloves and face masks, Case 44 and a nurse from the Health Promotion Board served quarantine orders to per-sons, assessed their health condi-tion and determined if their homes were suitable to be used for quaran-tine purposes.

Among the individuals to whom he served quarantine orders were a mother and daughter from Wuhan,

China. The pair later came to be known as Case 13 and Case 26 re-spectively, when both tested posi-tive for Covid-19.

On Jan 31, he began experiencing swollen tonsils, although this did not cause him any worry since he has a history of recurring tonsillitis up to three times a year.

He visited a general practitioner on Feb 2 and was given antibiotics to ease the swelling of his tonsils.

The swelling led to a fever and when the fever did not subside af-ter some days, Case 44 walked into KTPH on Feb 6 to get himself checked. He was placed under ob-servation for two nights as his fever worsened.

On the morning of Feb 8, a swab

test for Covid-19 was performed, which returned positive the next af-ternoon, and he was immediately transferred to a dedicated isolation ward.

When the doctors first told him he had tested positive for Covid-19, Case 44 said he was “in disbelief”. While fighting through the lethargy and erratic fevers, he thought of his wife and two children, aged five and seven, who were isolated in their four-room flat in Sembawang.

“As an adult, I already couldn’t take it (the isolation). I knew it must be worse for the children,” he said.

He spent his birthday on Feb 14 in isolation, with his wife and chil-dren video-calling him to sing Happy Birthday to him. The nurses at KTPH surprised him with a cake, knowing that he could not cele-brate with his family.

He was finally discharged on Feb 18, and was ecstatic to be received by his family upon his homecom-ing.

“I tried to be cool in front of my children but the happy tears just came. I am very thankful that my family is safe,” he said.

He is grateful to his homemaker wife for holding the fort during his absence and to his sister and brother-in-law for helping with the groceries when the family was iso-lated.

Case 44 is also the first recipient of a grant from The Courage Fund, through which the Community Chest issues monetary grants to those affected by Covid-19. The grant has helped with the provision of necessities for his family, he said.

In support of those infected with Covid-19, he added: “Believe that the doctors and nurses know what they are doing. You are not alone and please remain strong in the fight.”

shivrajr@sph.com.sg

When he had to spend his birthday in isolation at Khoo Teck Puat Hospital, Case 44 was surprised by the nurses in his ward with a birthday cake. The 38-year-old father of two, who served quarantine orders to individuals in the early days of the outbreak here, said he was ecstatic to see his family after being discharged. PHOTO: COURTESY OF CASE 44

Bubble tea fans lining up outside the LiHo shop @ My Village at 9.15 last night. ST PHOTO: WANG HUI FEN

50 children and adolescents infected by coronavirus here; half of them still in hospital

Coronavirus pandemic

Over 2,100 caught for not observing safe distancing

Rush for bubble tea as non-key businesses asked to shut

3-year-old girl with virus still in hospital after 29 days

I tried to be cool but the happy tears just came: Recovered Certis officer

Children who have come down with Covid-19

InfantsAges 1 and below

Young childrenAges above 1 up to 6 (inclusive)

Primary schoolchildrenAges between 7 and 12 (inclusive)

YouthAges between 13 and 16 (inclusive)

Total number of children

0 5 10 15 20 25

Fifty children and adolescents (aged 16 and below) have been infected with the coronavirus.

Source: MINISTRY OF HEALTH STRAITS TIMES GRAPHICS

8

13

22

7

| WEDNESDAY, APRIL 22, 2020 | THE STRAITS TIMES | � TOPOFTHENEWS A9

“Believe that the doctors and nurses know what they are doing. You are not alone and please remain strong in the fight.”

The cake that KTPH nurses presented to Case 44 on his birthday, which was also Valentine’s Day

Pho

to c

our

tesy

of

Cas

e 44

When KTPH nurses knew that Case 44 would have to spend his birthday — which falls on Valentine’s Day — in isolation, they arranged for a video call with his family for a small celebration.

The nurses even surprised him with a birthday cake. It was an emotional moment for him, and the gesture left him “super touched”. His stint in the hospital also left him grateful and confident in the healthcare system. “Believe that the doctors and nurses know what they are doing. You are not alone and please remain strong in the fight,” he urges.

Scan to read the article

| 5

Cared for like familyFor seven years, Mr JM Jasim has worked in Singapore — one of the many Bangladeshi migrant workers whose hard work builds our nation’s physical infrastructure.

When he was diagnosed with COVID-19 in early May, the 28-year-old felt sad, but was convinced that he would be fine. His experience with Singapore’s COVID-19 response, particularly the care he received at KTPH, validated this confidence. He shares, “Migrant workers were looked after as if they were Singaporeans,” he told The Straits Times.

When Mr Jasim’s ward nurses found out that he could not celebrate his son’s first birthday, they empathised and, hoping to make him feel a little better, relayed their own birthday wishes to his son. “I cried because I was so touched,” he reveals.

Moved, Mr Jasim took to Facebook to pen his gratitude.

“Thanks to each and every one in Singapore who has loved us as their own, especially the healthcare workers, who did not avoid us and took care of us like family.”

Pho

to c

our

tesy

of

JM J

asim

Clement Yong

A record 1,337 Covid-19 patients were discharged yesterday.

This means a total of 19,622 pa-tients have fully recovered fromthe disease, or 58 per cent of the 33,860 Covid-19 patients here.

The new high comes after the Ministry of Health (MOH) an-nounced a change in its discharge criteria for patients on Thursday.

Before the change, patients needed two negative swab tests 24 hours apart before they could bedischarged. Now, those assessed to be clinically well and no longer in-fectious by day 21 of their illness will be sent home without havingto undergo further tests.

It is uncertain if the change in the discharge criteria led to an increase in the number discharged.

Yesterday, there were 611 new coronavirus cases. Among them were nine community cases, two of whom are Singaporeans and the other a permanent resident.

The rest are two work pass hold-ers and four work permit holders.

Five of the work pass and work permit holders tested positive dur-ing the ministry’s proactive surveil-lance and screening, either of mi-grant workers living in shophouses in Balestier Road owing to their proximity to another cluster or those due to start work on plumb-ing or electrical projects in schools.

A Singaporean and a PR are linked to dormitory clusters and

had been placed on quarantine ear-lier. The other Singaporean, a 25-year-old, is currently unlinked to previous cases.

Migrant workers living in dormi-tories made up the remaining 602.

The ministry announced two new clusters: A dormitory at 35 Kaki Bukit Place and a dormitory at 40 Kaki Bukit Industrial Terrace.

The average number of new daily community cases has dipped in re-cent days, from six cases two weeks

ago to five in the past week. Un-linked community cases in the same period stayed stable at two.

The FairPrice supermarket in Taman Jurong Shopping Centre has been added to the list of public places visited by Covid-19 patients while they were still infectious.

The ministry added the spot to the seven places on the list that was first provided on Monday.Others on the list included super-markets in Bukit Panjang and Ju-

rong Point, and two markets in Ju-rong West.

An active case was at FairPrice in Taman Jurong on May 20 from 7pm to 8pm. A case was also there on May 22 from 8.30pm to 9pm.

In an update, MOH said more than 39,000 pre-school staff have been tested as part of its proactive screening, yielding 13 positive cases as of yesterday.

It also said its tests showed 12 of these cases were unlikely to be in-

fectious by the time they were tested in the recent screening.

The 13th case, a non-teaching em-ployee, is a recent infection. She had been asymptomatic and her close contacts have been placed un-der quarantine, the ministry said.

As of yesterday, 461 remain inhospital, including eight in inten-sive care, while a total of 13,745 are in community facilities.

clementy@sph.com.sg

Calvin Yang

Singapore and China will launch a “fast lane” arrangement early next month to facilitate essential travel for business and official purposes be-tween the two countries, as they emerge from the Covid-19 pandemic with control measures in place.

The arrangement would first ap-ply to Singapore and six provinces or municipalities directly under the

Chinese central government – Shanghai, Tianjin, Chongqing, Guangdong, Jiangsu and Zhejiang, said Singapore’s Ministry of For-eign Affairs (MFA) in a statement last night.

This arrangement will be gradu-ally expanded to the other Chinese provinces and municipalities.

The Straits Times understands that this is the first green lane ar-rangement between Singapore and another country.

Both countries agreed to explore the increase of air links between them as part of the arrangement, following a videoconference meet-ing between MFA Permanent Secre-tary Chee Wee Kiong and Chinese Vice-Foreign Minister Luo Zhaohui on Thursday.

The second China-Singapore Joint Meeting on Covid-19 was also attended by education, trade and in-dustry, Customs, immigration, transport and health representa-tives on both sides.

Both countries stressed the im-portance of securing the connectiv-ity of production and supply chains, and agreed to improve the effi-

ciency of freight linkages and Cus-toms clearance, including facilitat-ing the flow of goods such as essen-tial medical supplies and food.

They agreed also to advance coop-eration on the Belt and Road Initia-tive, especially by maintaining progress in the three government-to-government projects.

This includes maximising therole of the China-Singapore (Chongqing) Connectivity Initia-tive-New International Land-Sea Trade Corridor to strengthen trade connectivity between Western China and South-east Asia.

Appreciation was expressed on both sides for the mutual support

and assistance given over the course of the pandemic, including to each side’s nationals staying in the other country. Each side will continue to provide support to these individuals for their medical treatments and during their stays.

The meeting also touched on en-hancing the regional cooperation on Covid-19 prevention and con-trol. The control of the coronavirus, as well as economic and social re-covery, has entered a new phase for both countries.

Singapore will soon relax its cir-cuit breaker measures and gradu-ally resume economic and social ac-tivities. China, too, successfully held sessions of the 13th National People’s Congress and the 13th Na-tional Committee of the Chinese People’s Political Consultative Con-ference, said MFA.

The two countries will soon hold the 16th Joint Council for Bilateral Cooperation Meeting, which is the apex bilateral platform between both countries, to discuss issues in-cluding public health. It will be hosted by Singapore this year.

calyang@sph.com.sg

When he found out he had tested positive for Covid-19, Mr JM Jasim, a migrant worker from Bangladesh, felt sad but did not panic.

“I knew Singapore has good medi-cal facilities and will take care of us,” Mr Jasim told The Straits Times.

He was so moved by the care he re-ceived that he penned a note in Ben-gali with a translation in English on Facebook earlier this week, thank-ing “each and everyone in Singa-pore who has loved us as their own from the bottom of my heart”.

“During this pandemic, Singa-pore hasn’t pushed us far away,” wrote the 28-year-old, who has worked here for about seven years, adding that the Government has spent money to battle the coron-avirus outbreak among workersin dormitories.

He told ST: “They appreciate our hard work in building their country and now, they take care of us when we are sick.”

The construction safety super-visor was diagnosed on May 5, andis recovering.

He believes he contracted the virus at his Cochrane Lodge II dor-mitory, an infection cluster with more than 400 cases.

He said migrant workers were looked after in the same way as if they were Singaporean.

“We have left our families andour own dreams to work in thisforeign land, but we are not alone

in this country,” he said. Mr Jasim began feeling unwell on

May 1, when he developed a fever.The next day, he felt chest pains,

dizziness and headaches. The symptoms persisted, and he

saw a doctor on May 5, and was re-ferred to Khoo Teck Puat Hospital (KTPH), where he had an X-ray and swab tests done.

That night, a nurse told him he had tested positive for Covid-19.

The father of a one-year-old boy broke the news to his parents and 22-year-old wife, who cried.

“But I told them they didn’t have to worry because I would be getting better treatment here, and they calmed down.”

During his stay in hospital, where he was in a ward with seven others, Mr Jasim felt well. His symptoms went away after a few days.

Mr Jasim, who comes from Jes-sore district in south-west Bangla-desh, stayed in touch with his fam-ily through video calls.

The chats mostly revolved around his child. “I miss my son a lot. My son can’t talk much, but he would call me ‘papa, papa’ when he sees me on the screen,” he said.

“I would be so happy that I would forget I was sick.”

However, it was difficult to be so far from home when his son, Tahamidul Hasan, turned one on May 13, his ninth day at KTPH.

“I felt sad that I couldn’t celeb-

rate it with him,” he said. “I shared with the nurses that it

was my son’s birthday, and when they came in, they would ask me to share their wishes with him. I cried because I was so touched.”

On May 19, after two weeks in hos-pital, Mr Jasim was well enough to be transferred to the Singapore Sports Hub, a temporary accommo-dation where he is still at.

Throughout the past few weeks, Singaporeans have stepped up to spur him on, said Mr Jasim, who isa contributor for local Bengali news-paper Banglar Kantha.

“Some would message me to ask how I am, others tell me they are here for us,” he said.

When asked why he wrote the Facebook note, Mr Jasim said he simply wanted to convey his ap-preciation.

In it, he thanked the healthcare workers. “They did not avoid us and took care of us like family,” he said.

Some of the support workers here have received include continued salary payments, free quarantineaccommodation and “top-class” medical treatment, he said.

He also thanked non-governmen-tal organisations for their help.

“I am proud of being a migrant worker here,” said Mr Jasim. “When I recover, I want to work hard and contribute back to Singapore.”

Calvin Yang

Bangladeshi construction safety supervisor JM Jasim with his son Tahamidul Hasan, who turned one on May 13, in a photo taken five months ago. PHOTO: COURTESY OF JM JASIM

Move from June will first involve the Republic and six Chinese provinces or municipalities

TOUCHED BY CONCERN

I felt sad thatI couldn’t celebrateit with him... I shared with the nurses that it was my son’s birthday, and when they came in, they would ask me to share their wishes with him. I cried because I wasso touched.

’’MR JM JASIM, a migrant worker from Bangladesh whose son Tahamidul Hasan marked his first birthday on May 13 –Mr Jasim’s ninth day at Khoo Teck Puat Hospital.

Moved by the care, migrant worker pens grateful Facebook note

New cases: 611Imported: 0In community: 9(3 Singaporeans/PRs, 2 work pass holders, 4 work permit holders)In dormitories: 602

Active cases: 14,206In hospitals: 461 (8 in ICU)In community facilities: 13,745

Deaths: 23

Patients with Covid-19 who died from other causes: 9

Total discharged: 19,622Discharged yesterday: 1,337

TOTAL CASES: 33,860

Update on cases

Coronavirus pandemic

Both countries stressed the importance of securing the connectivity of production and supply chains, and agreed to improve the efficiency of freight linkages and Customs clearance, including facilitating the flow of goods such as essential medical supplies and food.

Sino-Singapore ‘fast lane’ for essential business, official travel

The Jurong West Market and Food Centre (above) is among places listed as having been visited by Covid-19 patients while they were still infectious. Yesterday, the FairPrice supermarket in Taman Jurong Shopping Centre was added to the list of public places visited by such patients. ST PHOTO: KELVIN CHNG

New high of 1,337 patients discharged; 611 new virus cases

| SATURDAY, MAY 30, 2020 | THE STRAITS TIMES | TOPOFTHENEWS A9

Scan to read the article

In his post, which has gone viral, he thanked “each and every one in Singapore who has loved us as their own from the bottom of my heart”. He expressed special appreciation for healthcare workers, saying, “They did not avoid us and took care of us like family.”

6 |

WHAT’S UP

SHOW OF APPRECIATION

While Yishun Health continues to work hard in the fight against COVID-19, our frontliners have

been showered with much appreciation. These acts of kindness and support go a long way to spur our healthcare workers on in this long battle.

As of June 2020, more than 135 members of the public, partners and organisations have sent in over 140 different items, such as edibles, vitamins, fruits and flowers. We thank you for caring for us as we continue to care for our residents and patients!

On Valentine’s Day, Nee Soon GRC and Gardens by the Bay sent Yishun Health lots of love by delivering beautiful flowers

Ms Mavis Khoo, Patron of KTPH, sent yummy Goodwood Park refreshments such as hot meals and pastries

| 7

Alexandra Health Fund donated generously to provide staff with hot and fresh meals prepared by Food Services

Goodie bags and gift cards from Mayflower Primary School and various organisations certainly

brought much joy to our colleagues

One of our partners, Tzu Chi Singapore, sent their well wishes and fresh fruits!

Students from schools, such as Northland Primary School, also came by to present notes of heartfelt thoughts and wishes to our staff

The online space was filled with encouragement from our Facebook

followers, who reminded us that Singapore showed great solidarity

during tough times

DBS Bank provided complimentary drinks from Bettr Barista, one of our vendors nested

in our campus. Staff enjoyed cups of coffee and tea, which were great perk-me-ups

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COVER STORY

8 |

COVER STORY

RISE UP: Responding as one Yishun Health

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It was January 2020, and Chinese New Year was just around the corner. Many Singaporeans were

looking forward to a four-day weekend of visitation, family time, food and relaxation. All around the Yishun Health campus, wards, clinics and public areas were festooned with red ornaments. Amid this festivity was a more worrying undercurrent: news was trickling in that the city of Wuhan, China, was experiencing an unidentified form of pneumonia.

In light of this development, the Ministry of Health began issuing precautionary updates, while Yishun Health’s leadership kept an eye on the evolving situation, recalls Ms Yen Tan, Chief Operating Officer (COO). “In December, a month before Singapore had its first COVID-19 patient, Chief Executive Officer (CEO) Mrs Chew Kwee Tiang emphasised that we should keep tabs on this, and we started discussions on department responsibilities to raise vigilance. In the first week of January, our Infection Control Team sent out its first advisory on precautionary measures and PPE required when handling suspected cases.”

On 30 January, the WHO declared the outbreak a Public Health Emergency of International Concern. That day, work began in earnest to form Yishun Health’s Pandemic Taskforce. Says Mrs Chew, “From the first day, everyone at Yishun Health was very clear of our goals to strike a balance between caring for COVID-19 patients and those with acute conditions, as well as keeping every healthcare worker safe.”

COVID-19 is one of the greatest infectious disease challenges in recent memory. Multilevel efforts have been rolled out to care for the afflicted, contain the contagion, and flatten the curve so that healthcare capacity here is not overwhelmed. Right from the start, the Taskforce stepped in to ensure Yishun Health’s preparedness and enhance staff safety so as to maintain continuity of operations.

TASKFORCE, ASSEMBLEThat morning, Yishun Health’s Chairman of the Medical Board (CMB), A/Prof Pek Wee Yang, and Yen met as Chairman and Co-Chairman of the Taskforce to run through the broad game plan. This was followed by an emergency meeting with her Operations team. Together, they worked late into the night to put together charts, workflows and pandemic plans. It had been almost two decades since SARS, and pandemic plans — while already in place — had to be refreshed.

The next two days of long hours and late nights passed in a blur of activities. There were back-to-back meetings as important updates about upcoming pandemic responses and workflows were cascaded to staff, vendors and stakeholders to ready the campus to hit the ground running.

Even as the evolving COVID-19 posed much uncertainty, CEO Mrs Chew Kwee Tiang continued to lead the organisation through the crisis

RISE UP: Responding as one Yishun Health

“The protection of frontliners was the single most important thing to ensure. The second consideration was how to configure the hospital to manage COVID-19.”

A/PROF PEK WEE YANG CHAIRMAN, MEDICAL BOARD YISHUN HEALTH

On 21 January, Yishun Health’s Taskforce was officially convened to support the Command Centre.

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COVER STORY

This meant that plans had already kicked in before Singapore identified its first COVID-19 case two days later. From workflows and charts to liaising with MOH and vendors nested within Yishun Health, discussions were extensive. “It was fortuitous that preparations had already been proactively made to put together our pandemic plans and workflow,” Yen says. “On the afternoon of 23 January, we met Yishun Health staff for a Townhall, and walked everyone through our plans so that staff would be prepared. By night time, the ‘enemy’ had landed on our shores.” The immense scope of work meant the Taskforce worked through the first few days of Chinese New Year, missing reunion dinners and customary visitations. But the team knew these hectic first days were critical to secure business continuity.

CHARTING A COURSE FOR THE STORM AHEADIn the pandemic’s early days, many unknowns made for a worrying time. No one knew the nature of the virus, how extensive the outbreak would be, or the severity of the symptoms. But the Taskforce focused on preparing as much as it feasibly

could, especially with regards to business continuity.

It was imperative that hospital operations could continue smoothly, and that duty of care could continue, Yen says. It helped that the team had the strong support of Prof Philip Choo, Group CEO, and Prof Chua Hong Choon, Deputy GCEO (Clinical), National Healthcare Group; both gave guidance on various plans made to manage the pandemic.

Safety was one of the priorities for the Taskforce. A/Prof Pek explains, “The protection of frontliners was the single most important thing to ensure. The second consideration was how to configure the hospital to manage COVID-19.”

During SARS, A/Prof Pek had been a respiratory consultant running the Intensive Care Unit (ICU) at Tan Tock Seng Hospital, the epicentre of care. He knew first-hand what it was like at ‘ground zero’. “I personally experienced the chaos and uncertainly,” he shares. It was a particularly traumatic experience for healthcare workers at the frontlines. “We knew we were putting ourselves at risk; we were seeing our colleagues dying from SARS.”

A/Prof Pek looked back on the life-changing SARS experience to

guide the Taskforce on how to best respond and support staff. For one, it was essential that the chain of command was strong and that communication was clear. “Instructions had to be timely and unambiguous so that people had clarity on what to do,” he points out.

Over and above operational issues to maintain business continuity, the Taskforce had another important role: ensuring organisational morale, build trust, and maintain confidence. “Communication was essential to ensure that staff knew they were being supported and cared for, and

At the start of the year, staff from across multiple departments dedicated hours to meetings and extensive preparations for the months ahead

“It was fortuitous that preparations had already been proactively made to put together our pandemic plans and workflow.”

MS YEN TAN CHIEF OPERATING OFFICERYISHUN HEALTH

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that we were doing everything to keep them safe,” emphasises A/Prof Pek. In times like these, many hard decisions needed to be made. “We make it a point to articulate why certain measures are being taken. The how and what is important, but the why is even more so.” This communication has served to further bond the entire organisation to this day, even as safe distancing and telecommuting are now part of our new normal. (Read more about Corporate Communications and Clinical Informatics on page 44)

Apart from gearing up clinical capacities and managing the load, manpower and resource were other areas of focus, Yen recalls. Seeing rising cases in Malaysia and cognisant of the relatively large number of Malaysian staff who commute daily to Yishun Health, her Operations team had foresight and made plans to assure and ensure this would not affect manpower allocation and patient care. (See box story)

FACING OUR GREATEST CHALLENGEThe stability and focus built in the early days, with clear lines of communication and accountability, served to drive Yishun Health along as a united front and aid it in navigating the highly fraught and fluid months ahead.

“As an integrated campus, we had designed and planned for this,” explains A/Prof Pek. “All our wards and clinical areas can be reconfigured according to needs.” Under the leadership of A/Prof Tan Kok Yang and guided by the Taskforce roadmap, the hospital was adapted to meet pandemic needs, such as infrastructure adjustments for infection control and triage, setting aside separate workflows for COVID-19 management, refreshing infection control training and gearing-up capabilities. (Read more about Screening & Testing on page 16 and Ward Conversions on page 20)

SECURING OUR ESSENTIAL BACK-OF-HOUSE TEAMSThe Intelligence team of the Taskforce had, since 2 March, anticipated that Malaysia would close its borders. To mitigate the effects of this, Yen pre-emptively engaged staff from numerous departments — nursing, ancillary, administration, allied health and medical — and even various suppliers, tenants and service partners. “I thanked them for their contributions and began to prepare them for the potential of manpower restrictions and, if it really happened, we were prepared to take care of them,” she shares. By 16 March, Yen had worked with Human Resources and her Operations team, readied their contingency plans, and prepared spaces and rooms for accommodation. A few rental HDB flats were secured, space in the campus was cleared and converted to temporary dormitories, and mattresses and cots were purchased. That day, she met with Malaysian staff to garner their support. “I asked them, ‘Will you stick by us?’ I urged them to begin making childcare arrangements, to pack a suitcase and carry it with them to work every day just in case the borders closed that day.” Though some perceived the team’s preparedness as being paranoid, their proactive thinking was vindicated that very evening when Malaysia announced its COVID-19 Movement Control Order (MCO), which barred citizens from leaving or re-entering the country. It was a moment of relief for those who had planned for this since February. On Tuesday, 17 March 2020, as the 10pm news reported a massive traffic jam on the Causeway leading into Singapore, more than 90 of Yishun Health’s Malaysia-based staff were watching the news unfold in the comfort of a brightly lit temporary room, tucking into a special supper of prawn noodles made by Food Services. (Read more about Food Services on page 42) While some ate, others wept a little, overcome by thoughts of family they would not be able to see for a while. Their dedication and personal sacrifices have been invaluable contributions to the COVID-19 battle, Yen ventures. “Our duty is patient care, and our support staff perform core duties to enable the hospital to run. Departments such as housekeeping and food services are essential to make sure our frontliners can focus on patient care.”

By the time MCO was announced, COO Ms Yen Tan had safely ensconced her Malaysian staff in Yishun Health

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COVER STORY

Ms Fatimah Moideen Kutty, Director, Operations, and Dr Liew Li Lian, Deputy Director, Operations, both took on the role of Commander of the Command Centre. Balancing the outward focus of watching the ground, ensuring all is safe and well, and caring for the Command Centre team were just some of their responsibilities. Since mid-May, their roles have evolved to Commander Mentors, training and supporting senior Operations staff in their roles as they stepped up to be Commanders. “COVID-19 has given us a different perspective of how we can care and work during a pandemic,” reflects Fatimah. Ensuring business continuity was a fine balance between keeping up the level of healthcare services while maintaining safe distancing, and meeting the growing demands of the pandemic all at the same time. “We used this crisis as an opportunity to find new ways of caring for patients and develop new ways of working through IT.”

Dr Liew notes that this time of uncertainty can also be used as a catalyst to boost camaraderie. “The challenge is making everyone see

that we have a future together and are capable of changing ourselves. It is important to keep framing what people are looking forward to, whether it is bubble tea tomorrow, fewer COVID-19 cases next week, or a holiday finally next year. We need to keep everyone facing true north as we keep our eyes and ears to the ground.”

Each day brought a tide of fresh challenges, says Chief Nurse Ms Shirley Heng, whose nursing team was constantly on the move to keep up. One of the most difficult was getting various areas of the hospital — such as the A&E, wards and treatment areas — to keep up with growing needs. Holding areas had to be established, ‘hot’ zones demarcated, and patients segregated based on needs and risks. “Because of changing capacity and containment demands, we have had to also keep adding workflows and adapting spaces, all while dealing with capacity issues,” Ms Shirley explains. It meant the workload not only kept increasing, but was constantly in flux and getting more complex. (Check out our Nurses’ Day Special on page 47)

Despite these pressures, staff across the campus pushed on. The hospital even began to take the extra step to test all patients with pneumonia for COVID-19, a move that increased the workload, but offered greater reassurance and safety.

The preparation, pre-emptive testing, and early treatment throughout the relatively ‘low’ initial period of the outbreak bought the organisation time. “We used it to prepare,” A/Prof Pek says. “By the time patients were slowly moved from the National Centre for Infectious Diseases (NCID) to us, we were already on high alert.” (View our COVID-19 timeline on page 14)

Nevertheless, there was “immense strain” from multiple sources, especially at the beginning of the outbreak in March, says Dr Mathew Yeo, Consultant, A&E, who is also the Clinical Lead for Disaster and Pandemic Response. He works closely with and is mentored by A/Prof Francis Lee, Senior Consultant, A&E, and Pandemic IC. (See page 16 to read more on A/Prof Lee’s work at the A&E) “We were dealing with uncertainty over

(above) From NHG, both Prof Philip Choo, Group CEO, and Prof Chua Hong Choon, Dy GCEO, came to walk the grounds and provide good advice on various developments

(left) In February, CMB A/Prof Pek Wee Yang met up with nursing leaders to prepare them for the long road ahead

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the virus — which patients are most at risk, the risk of staff infections, high workload from patient volume, evolving COVID-19 protocols, as well as manpower shortages,” says Dr Yeo. “During this pandemic, I devised strategies for my department’s response based on current needs and demands, and also what is predicted for the near future, so that we are not always playing catch-up.”

By April, the pressure — already great — mounted. Cases in Singapore surged due to outbreaks in foreign worker dormitories, many of which were located in the north, thus bringing an influx of patients to Yishun Health’s doors. Staff from clinical departments, administrative units, ancillary teams and more all stepped up to the plate in response, greatly expanding screening and isolation facilities as well as acute and critical care bandwidth. (Read more about ICU planning on page 24)

Besides ramping up medical care, a great amount of effort has also been put into tackling the concerns and fears of patients, many of whom are foreign workers. Says Dr Valliammai D/O Nallakaruppan, Consultant, General Medicine, “We are also addressing psychosocial aspects, ensuring that food is catered to their taste, that we have translators to overcome the language barrier, and making sure they have sufficient telecommunications access to connect with their family.” (Read more about foreign worker welfare on page 30) There has also been another aspect of care, notes Dr Shereen Ng, Associate Consultant, General Medicine. “We are also taking the extra measure to seek previously undiagnosed early-stage chronic diseases, and educating patients on how to manage these.” It is all part of ensuring a holistic, person-centred approach that looks beyond acute issues.

THE BATTLE IS FAR FROM OVERNow, some six months from the day Yishun Health admitted its first COVID-19 patient, the campus has screened more than 4,600 suspect cases and treated more than 2,600 patients with COVID-19 infection. We have also screened more than 1,300 in the community, including nursing homes. (Read more about PHCT on page 28)

More than half of Yishun Health has been converted to care for COVID-19 patients according to severity. Working in split teams as part of safe distancing, every member of staff has had to acclimate to working in new ways.

Where some saw their roles and responsibilities amplified, others took up brand-new job scopes, stepping up to carry the growing load. And all through this journey, our multidisciplinary teams have continued to attend to non-COVID-19 ailments and cope with near full occupancy in the general wards

under tightened infection control protocols and manpower limitations.

Many have had to step outside their comfort zones or take on many additional roles, notes Dr Ng Yeuk Fan, Director, Corporate Development. Dr Ng himself became involved in contact tracing, far removed from his typical job scope where he strategises internal plans on a corporate level. “In this crisis, it was the intrinsic resilience of our people that has helped us to weather the storm. We drew upon the strong relationships, trust, and collaborative spirit built in peacetime to get the job done,” he shares. (Read more about Contact Tracing on page 34)

“We are in this for the long haul,” says A/Prof Pek. Without a vaccine or effective cure, COVID-19 will continue to make its mark not only on the healthcare landscape, but our everyday lives. “We must continue to fortify not just operational and clinical responsiveness, but also psychological resilience, and look around the corner for the broad, long-term cascading effects of this pandemic.” (Read more about PALS on page 31)

As Yishun Health and Singapore grapple with the many uncertainties ahead, some things remain clear. “We remain in the thick of the action and must stay united to go the long haul. Our clarity of goals, commitment, care, constant communications, and collective leadership will see us through in the new normal,” says Mrs Chew. This ethos will continue to fuel the whole of Yishun Health in this marathon race. “I am humbled and proud of the strong commitment demonstrated by everyone, ranging from the Taskforce leaders to the most junior staff on the ground. They perform duties outside their peacetime roles, whether in clinical or admin work. I am grateful for all the personal sacrifices they have quietly made to care for our patients and residents.”

“We remain in the thick of the action and must stay united to go the long haul. Our clarity of goals, commitment, care, constant communications, and collective leadership will see us through in the new normal.”

MRS CHEW KWEE TIANGCHIEF EXECUTIVE OFFICERYISHUN HEALTH

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T IMEL I NE

INCREASING OUR CAPACITY• more than 50% of Yishun Health

converted to COVID-related wards• ICU beds ramped up from 22 to 90 • 109: the highest number of patient

transfers to Community Care Facility (CCF) in a day

• 5 holding areas set up in total

31 December The World Health Organization (WHO) is alerted by authorities in China of a string of pneumonia-like cases in Wuhan, a city of 11 million people

23 January • Taskforce meets Yishun Health

staff for a COVID-19 Townhall• Singapore confirms its first

COVID-19 case at night

24 January • An Expanded Screening

Wing (ESW) is set up outside the A&E in 48 hours

• 2 wards are converted into negative-pressure isolation wards

5 February• Travel and contact

history, and symptom screenings begin for patients and visitors in ambulatory care areas

• Only one next-of-kin can accompany outpatients on appointments

7 February • MOH raises DORSCON

level to Orange • All staff begin daily

temperature recording at 8am and 4pm

• ESW officially begins operation

21 January Yishun Health holds its first Taskforce Meeting

22 January • Acute & Emergency

Care Centre (A&E) begins temperature screening

• MOH declares DORSCON Yellow

25 January Yishun Health’s Contact

Tracing Team begins operating

28 January All staff working in

clinical areas mandated to wear mask

31 January Outpatient visitor and patient

screening set up

A timeline of the measures Yishun Health took as the COVID-19 pandemic gripped our nation.

9 February KTPH admits its first

COVID-19 patient

10 FebruaryCross-campus staff

movement is restricted

18 February KTPH discharges its

first COVID-19 patient

19 February Business Continuity Plan

team segregation kicks in

22 February Safe distancing measures take place across campus

Handling The Crisis: In Numbers

• more than 30 temporary staff rostered to run screening stations at main lobby, satellite clinics, and AdMC

• more than 31,600 polymerase chain reaction (PCR) tests done

• more than 2,600 COVID-positive patients swabbed • more than 4,650 COVID-suspected cases swabbed• more than 1,620 CCF transfers

OUR C VID-19 TRAJECTORY

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9 AprilHolding Area (H1) begins operating to manage the cases from dormitories

10 April A&E P3 shifts to Specialist Outpatient Clinic C31

12 April H2 begins its operations

13-17 April YCH patients are decanted to Ang Mo Kio-Thye Hua Kwan Hospital to create beds for Pneumonia Surveillance Negative patients

17 April H3 begins operating

19 April H4 begins operating

3 April Specialist Outpatient Clinics are closed

7 April • Singapore’s Circuit

Breaker takes effect• Cabin Crew join

Yishun Health as Care Ambassadors

• No visitors are allowed

8 April • ESW expands and

doubles in capacity • YCH begins its ward

conversion to house COVID-positive patients

A timeline of the measures Yishun Health took as the COVID-19 pandemic gripped our nation.2 March

Yishun Health starts planning for the scenario

that Malaysia would close its borders

4 March National Stay-Home Notice and Leave of

Absence begins

12 March WHO declares COVID-19

a global pandemic

18 March Malaysia’s Movement

Control Order takes effect

28 March The first case from the

dormitory cluster is diagnosed

End March Yishun Health starts

planning for potential spike of cases from

the dormitories

2 June • Circuit Breaker ends• Healthcare services start

resuming gradually

6 May H5 begins operating

at FutsalArena@Yishun, Nee Soon

Sports Centre

12 May SafeEntry is

implemented for visitors

18 May SafeEntry is

implemented for all staff

TEAMWORK AND COMMITMENT • 21 staff deployed outside Yishun Health• 343 staff cross-deployed within campus• 100 staff on standby as Smart Medical

Response Team• more than 200 staff made the sacrifice to stay

on in Singapore to battle the outbreak

• 35 departments shared in the task of contact tracing

• 96 staff trained in contact tracing• 40 extra doctors underwent ICU

fundamentals to support critical care needs• 120 nurses from different disciplines

mobilised to support ICU expansion

MANAGING A PANDEMIC• 5,642 contacts risk-assessed• 60 minutes: the average

time for a contact- tracing interview with a COVID-19 patient

OUR C VID-19 TRAJECTORY

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At the frontline was Yishun Health’s Acute & Emergency Care Centre

(A&E). On 24 January 2020, just one day after Singapore confirmed its first case, an Expanded Screening Wing (ESW) was already set up outside its doors. This was eventually extended to the YCH lobby when

SPOTL IGHT

Rigorous testing and screening efforts have been key to Singapore’s COVID-19 response. Supported by intensive contact tracing, this leave-no-stone-unturned approach detects and sequesters cases early to reduce the risk of spread and improve patient outcomes.

ACING THE SCREEN TEST

dormitory-based infections rose. To accommodate those awaiting swab test results for discharge or admission, a total of five holding areas (H1-5) were progressively set up.

These holding areas, explains Dr Jerry Goo, Consultant, General Surgery, who was also the lead of H4, played a vital role in managing the

This COVID-19 issue of covers the incredible work that has been done at Yishun Health in response to the pandemic. Every member of Yishun Health has played an invaluable role and stepped up to keep hospital operations going amid fluid and challenging times, thus maintaining Yishun Health’s important mission of care. With so many stories to highlight, we have expanded this section, so expect to read more than one Spotlight feature!

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Retrofitting and converting spaces for these infection control facilities was a logistical feat that took the combined effort of multiple teams from both clinical and ancillary departments, such as Facilities Management, Security, Materials Management, and Operations Support Services. The vast scope of work meant many had to be on standby all the time so as to be able to respond swiftly to developments.

This meant sourcing critical supplies and equipment, relocating staff and patients, and coordinating with contractors and suppliers — all while also working around manpower and time constraints. Mr Donald Wai, Head, Hospital Planning & Infrastructure, whose team works closely with Facilities Management to ensure sufficient hospital capacity with any new change, shares that it was teamwork that saw them through many challenges. “I tell my team that we are in the same boat, and we are in it together to fight the COVID-19 battle. Despite numerous challenges, we have been fortunate that we are still able to come to work to support the hospital and busy ourselves with important facilities-related tasks.”

their families,” adds Dr Goo. “The sacrifices the team has made are exemplary — everybody stepping up and being ready when called upon.”

PARTNERING THE COMMUNITY The partnership with the community was underscored by the setting up of Pre-Community Care Facility Holding Area H5 at Nee Soon Sports Centre. Aaden Lim, Senior Executive, COO Office, who was in charge of this “tough, yet fulfilling project”, shares how the futsal facility was converted into a 336-bed capacity area to accommodate clinically well COVID-positive patients awaiting transfer to Community Care Facilities (CCF). Under a collaboration with Fullerton Health Group (FH), 30 of its medical staff helped to man the site. The partnership also included the FutsalArena@Yishun owner, who graciously provided the space, and Tzu Chi Singapore, which readily offered its Humanistic Youth Centre as a conducive space for FH staff to eat, rest and freshen up. It was heartening that all the MPs in Nee Soon GRC supported this move. A/Prof Kenneth Mak, KTPH’s previous CMB and the current Director of Medical Services in MOH, also came to walk the grounds.

Nee Soon GRC MPs, NHG Group CEO Prof Philip Choo, Yishun Health Senior Management, and partners from Fullerton Health, Tzu Chi Foundation, and FutsalArena@ Yishun at H5

surge of COVID-19 and right-siting care as patients were admitted to specially converted COVID wards at Yishun Health or to Community Isolation Facilities. Undertaking swabbing at the screening areas were doctors as well as allied health professionals redeployed from a wide range of specialties. From physicians and physiotherapists to pharmacists and psychologists, all assisted in basic nursing and vital-sign monitoring.

This freed up hospital resources to care for patients who required urgent medical care in the wards. “Many took on additional roles and responsibilities. A few even made the extreme choice to stay away from home to avoid infecting

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SPOTL IGHTSays Tony Yang, Senior Manager,

Facilities Management, “Although we are a support team, I know we add value to staff at the frontline.” This was true not just for clinical operations, but for every staff at every level. Take the bolstering of safety and security across the Yishun Health campus. To serve the many new facilities, extra auxiliary police officers as well as surveillance cameras were needed. According to Gan Pei Soon, Manager, Security, the job for the ESW security team was made extra challenging due to the need to wear full PPE. “Thanks to the Facilities Management team, fans were brought in to cool patients and staff down,” he recalls. SPACE PLANNING At the same time, additional steps had to be taken to protect patients coming through the A&E. Working quickly, they reorganised workflows and spaces to minimise interactions and infection risks between patients and between staff. Both ‘hot’ and ‘cold’ zones had to be demarcated to keep A&E patients — whose critical and co-existing conditions put them at high risk — safe. “We were dealing with very large numbers of undifferentiated patients with a host of medical issues, coupled with the increasing probability of COVID-19 as another co-morbidity,” shares Dr Sanjay Patel, then Head and Senior Consultant, A&E.

Reprising his role during the 2003 SARS outbreak, A/Prof Francis Lee was appointed the Pandemic IC for COVID-19. Concurrently a Senior Consultant in the A&E, he spent much of his time reviewing daily COVID-19 operations. “I have been doing more clinical shifts so as to be involved in the patient care,” he shares. “It helps me gain awareness of issues faced by staff and patients, and what needs to be done to manage the situation.”

As the A&E is an entry portal

(1–3) From frontliners to support staff, all hands were on deck for the setting up of holding areas

(4) Materials Management staff taking stock of equipment

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for patients, it was important for the department to be reorganised with clear segregation of areas and workflows. The department pre-emptively expanded to adjacent areas outside and commandeered spaces within Yishun Health. This was done in stages, calibrated to the workload and types of patients as the crisis evolved. It was difficult at times to judge what was too much or too little preparation but, according to A/Prof Lee, every individual had stepped forward and assumed the roles and tasks without hesitation. Displaying an all-hands-on-deck attitude, they were quick to learn, fast in action, and dedicated to their work. “It also speaks volumes of the culture that we have nurtured since Yishun Health’s inception.” Apart from this, A/Prof Lee had also been mentoring Dr Mathew Yeo while they were both leading the A&E in all COVID-19 matters. (see the Cover Story, on page 8, for more on Dr Yeo)

Benjamin Ethan, Senior Executive, who works in A&E Operations, remembers how they had to adjust workflows every time screening, holding and treatment facilities were expanded. Many measures were put in place to manage and maintain patient flow through the hospital system, including tapping on community resources to safely discharge patients back home. “There was a heightened sense of tension in the air, knowing that the situation may change very quickly,” he says. Part of the reorganisation included relocating the A&E’s P3 to Specialist Outpatient Clinic (SOC) C31, where various SOC nurses were trained and redeployed to take over its operations.

STRETCHED LABS And while hundreds of patients were being swabbed on the ground floor, the Department of Laboratory Medicine diligently kept pace with the huge volume of tests. One of the

most important players in the COVID-19 pandemic, the laboratory withstood the surge with speed and commitment. One of their first challenges was developing a robust and accurate in-house COVID-19 test by adapting a method from NCID’s National Public Health Laboratory. The Polymerase Chain Methodology (PCR) test, which identifies two specific genes in the COVID-19 genome, had to be optimised for existing PCR equipment. To cope with the exponential increase in workload, the laboratory ramped up manpower by redeploying staff and adjusting shifts in Molecular Diagnostics. Apart from this, eight volunteers from the NUS Faculty of Medicine were trained and onboarded in April 2020 to meet manpower needs. This gave medical technologists who had been working 12-hour shifts since February much-needed reprieve, and grew the headcount at the Molecular Diagnostic section from 1.5 to 11.

From 120 samples per day in the first month, the laboratory now

Support staff helping out with the cleaning and disinfecting of numerous types of surfaces

The Department of Laboratory Medicine diligently kept pace with the huge volume of tests

tests up to 800 samples daily. “Our team has risen to the occasion to learn new roles and take on new challenges without compromising quality,” says A/Prof Wong Moh Sim, Deputy CMB (Clinical Quality and Medical Manpower Development) & Head and Senior Consultant, Laboratory Medicine.

This team spirit and dedication has been matched by resourcefulness, notes Jesse Boyer Godfroy, Manager, Laboratory Medicine. In light of the evolving crisis, the laboratory has had to make adjustments on the fly. For example, the large number of tests meant reagents were being used more rapidly. With flight restrictions and lockdowns affecting supply lines, non-traditional sources had to be identified; stocktaking was done daily. As circumstances evolved, the team worked quickly to implement changes, from work processes and shift changes to stepping in to take on additional responsibilities to cover for colleagues affected by travel restrictions. While it has been challenging and stressful for him and his team, they know they are part of a larger picture. “There’s a reward in knowing you are part of the national response, helping to identify and isolate the cases, allowing the economy to open up safely.”

20 |

A part from expanding screening and holding facilities to cope with the

rising number of patients due to the clusters found across foreign worker dormitories, Yishun Health had to quickly respond to ensure sufficient ward capacity.

This meant turning multiple KTPH and YCH wards into COVID-related and operationally ready ICU wards (turn to page 24 to learn about the ICU conversions). Helming these conversions were A/Prof Phoa Lee Lan, Deputy CMB (Care Integration & Clinical Standards) and Head of General Medicine, and Dr Lee Kok Keng, Medical Director, YCH, working closely with KTPH and YCH Nursing leaders and Inpatient Services. Besides deciding which wards to convert to meet current demands, they had to plan for future needs. “Many factors had to be considered, such as maintaining enough essential wards for non-COVID emergency cases, and obtaining Ministry

SPOTL IGHT

Making the whole Yishun Health COVID-19-ready took not only leadership and speedy planning, but also the united and coordinated efforts of multiple stakeholders across the campus.

COLLABORATIONS & CONVERSIONS

in Tower B will always remain notable to me. They went from a medical ward to a pre-swab ward, then later to a mixed pre- and post-swab ward, and finally to a COVID-positive ward. It was a real life VUCA (Volatility, Uncertainty, Complexity and Ambiguity) experience! The entire inpatient nursing team across Yishun Health stepped up to the challenge.”

Mdm Chua Gek Choo, Director of Nursing, YCH, recalls that YCH conversion plans had already been proactively raised since late

approval for all conversion plans,” shares A/Prof Phoa. Given the evolving situation, they had to work quickly and closely to ensure smooth discharges, transfers and decantments. MULTIPLE CONVERSIONS Over at KTPH, more than 60% of wards were progressively converted. Some wards, shares Nursing Assistant Director Ms Eileen Cheah, went through multiple conversions. “Two wards

| 21

February. “Together with A/Prof Phoa and Dr Lee, we discussed initiating the transfer of Pneumonia Surveillance Negative (PSN) patients to Ward D48, a sub-acute ward in YCH. Our YCH team then planned and transferred patients to other wards to create beds for admission of PSN patients.” When case numbers rose, these surge plans kicked in. Coordinated by Ms Florence Chng, Deputy Director, Administration Office, YCH, the mammoth task of decanting YCH patients to other community

COLLABORATIONS & CONVERSIONS

hospitals was rolled out with the support of MOH and the Agency for Integrated Care (AIC). Beginning on 13 April 2020, with the efficient support of KTPH’s ambulance fleet, patients were seamlessly transferred to Ang Mo Kio-Thye Hua Kwan Hospital; in just two weeks, all beds in YCH were dedicated to COVID-19 patients.

From just two COVID-19 wards initially, more than half of Yishun Health was eventually converted.

EXTRA TRAINING Nursing Deputy Directors Mdm Yiap Pok Ling and Ms Velusamy Poomkothammal add that, physical conversions aside, intense preparation and training was also rolled out to equip nurses with relevant skills for the increased acuity. Many of these nurses were also ready to be deployed, when necessary, to support other needs in the community swab team and Community Isolation Facility. “Despite the many adjustments and changes from the norm, our

(left) A&E doctors and nursing leaders assessing a ward’s suitability to be converted

(opposite) A converted ward in YCH housing patients from foreign worker dormitories

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nurses ploughed on to deliver care to patients,” attests Eileen. (To read more about our nurses, turn to page 47 for the Nurses’ Day Special)

“It was quite a roller coaster journey for all of us,” admits Kelly Tan, Assistant Director, Inpatient Services, who led on the administrative front. “The stress level is, no doubt, high during these trying times, but knowing that we’re doing everything we can for patients and staff makes it all worth it.”

SURVIVAL TRIAD Running one of these COVID-19 wards at YCH is Dr Clement Chia, Consultant, Department of General Surgery, KTPH. With non-urgent elective surgeries postponed, manpower from his department was redeployed to support the national strategy of centralising and prioritising care for COVID-19 patients. The transdisciplinary team ran daily rounds in full PPE. On top of reviewing overnight events, admissions, as well as relevant haematological investigations, his team also monitored vital signs, ran blood tests, and conducted swabs to ensure that all patients in the 34-bed ward maintained their stable conditions. Where appropriate, patients were discharged to either home or community isolation facilities. In his perspective, working in a pandemic situation entailed thinking of a ‘survival triad’: ensuring the survival of as many patients as possible, protecting medical team members and leaders, and self-preservation to enable a safe return to family and loved ones. (Read how we support our healthcare staff on page 31)

This means, apart from timely evidence-based treatment, infection control regimes had to be

Even before Circuit Breaker began, the Inpatient Services team was already dealing with bed surges and forward planning of ward conversions

tightly followed. “We strictly adhere to infection control protocols to prevent cross contamination. In addition, one senior and one junior doctor are paired up as buddies for ward rounds, where we oversee each other and ensure appropriate donning and doffing of PPE.” Strict PPE protocols, Dr Chia admits, has led to some inconvenience, but a strong culture of putting patients and their safety first meant that everyone was able to appreciate the importance of safety in the ward. “We know that our actions do not just affect ourselves, but also impact other healthcare workers in the same environment.”

DIVERTING MORE MANPOWERDoctors aside, nursing and allied healthcare manpower had to also be reorganised to serve these converted wards and provide adequate 24/7 acute care. Stepping up to the plate were registered nurses, enrolled nurses, and even dental assistants who were seconded to support YCH Nursing. Meanwhile, YCH allied healthcare professionals — physiotherapists, occupational therapists, speech therapists, therapy assistants — were deployed to A&E and holding areas

to support nurses in basic nursing duties, vital signs monitoring, and engaging the patients.

On top of the movement of patients, this extensive logistical and planning effort meant the conversion, cleaning and reorganising of numerous spaces. Much of the necessary infrastructure changes were undertaken by the Facilities Management department, while allied health, operations and ancillary departments — including

“The stress level was high but knowing that we’re doing everything we can for patients and staff makes it all worth it.”

KELLY TAN ASSISTANT DIRECTOR INPATIENT SERVICES

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CLEAN AND SAFE DAYS AHEAD

Food Services, Environmental Services, Linen, Portering, Security, Visitor Management and Materials Management teams — all had to adapt their workflows to accommodate the new processes. To say it was a massive effort of collaboration is

Infection Control staff were also involved in conducting PPE and mask-fitting sessions for the Care Ambassadors

The installation of disinfectant mats at COVID-19 wards of KTPH and YCH is an added measure to keep staff safe

an understatement.“We are grateful for every

department’s solidarity,” says Mdm Chua. “From the loan of portable screens, installation of partitions in patient cubicles, and demarcating ‘hot’, ‘warm’ and ‘cool’ zones to the provision

of PPE and scrubs, signage and ward cleaning, we truly appreciate everyone’s contribution.” Concurring, A/Prof Phoa also notes, “Multiple strands make a cord strong. We cannot do much alone, but together, we can achieve so much. And we have.”

In her day-to-day work, Senior Nurse Clinician Foo Meow Ling oversees the prevention of infections and spread of ‘superbugs’ within the hospital. During this pandemic, her responsibilities have grown, as she ensures that rigorous infection controls are implemented at all the new facilities being built for COVID-19. “My role now is to actively evaluate the situation in Singapore and across the world to determine and prepare our crisis management,” she says.

Her team’s particular expertise in infection controls has also been extended to almost all levels of the hospital’s pandemic response. From setting up the Extended Screening Wing, adapting the Extended Diagnostic Treatment Unit into an Acute Respiratory Wing, converting general wards to COVID-19 wards, and sanitising COVID-19 care areas, they make sure that safety is prioritised at all times. Just as important has been the securing of adequate supplies of PPE, and ensuring that everyone undergoes refresher training in the proper way to wear and discard PPE. These trainings have understandably intensified, with the message disseminated not just through live fittings initially, but also via posters and teaching videos as safe distancing began to kick in.

During peacetime, the team puts in effort to pursue, implement and sustain infection control measures. In this pandemic, their expertise and infection control measures have been put to the test. Benjamin Tan, Assistant Nurse Clinician, Infection Control, shares, “Whether it is during peacetime or pandemic, our role as Infection Control nurses does not change — we oversee infection prevention and control measures to ensure our staff, patients and visitors are safe from disease transmission.”

To protect staff working in the converted wards, the Infection Control team had to train everyone on the use of the Powered Air Purifying Respirator (PAPR), a machine used only in high-risk areas, such as the ICU and Isolation Wards. They also coordinated the distribution of this essential equipment across the wards and departments.

Apart from clinical implementations, the team also keeps up to date with the latest developments and knowledge about the ever-evolving COVID-19. For example, after studying various research journals, they implemented tile carpets as disinfectant mats at the wards for staff to remove viruses on the soles of their shoes.

All this work had to be done while also overcoming the challenges of working in split teams and loss of face-to-face meetings. “I am very gratified to see many hands extending help to us,” shares Meow Ling. Having survived the SARS outbreak, she is grateful to see how that experience has helped to improve responses to this current crisis. She takes pride in seeing her Yishun Health family combat the crisis together. “We are all holding up strong despite the many difficulties, stress and discomforts.”

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A focus on early detection and treatment has been the mainstay of Singapore’s

healthcare delivery; the same can be said of its response to the COVID-19 pandemic. However, downstream preparedness for critical cases is nevertheless essential, especially when local statistics indicate that some 5% of cases need intensive care.

Even before case numbers rose, increasing critical care capacity and capabilities was at the forefront of Yishun Health’s outbreak plans. To this end, a multidisciplinary team was formed to develop a Yishun Health ICU surge plan that would help manage the load when the need arose.

Since early April 2020, KTPH’s 22-bed ICU capacity was progressively increased to 90 beds through the conversion of wards and the Post-Anaesthesia Care Unit. To ensure sufficient medical support for the expanded intensive care facilities, clinical departments had to reorganise their work from eight- to 12-hour shifts.

In addition, a total of 120 nurses have been mobilised since March 2020 to support the ICU. Hailing from varying disciplines — such as General

Screening and testing aside, another massive undertaking for Yishun Health was raising its ICU capacity so as to be fully equipped and ready for emergencies.

CRITICAL EXPANSIONS

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A/Prof Edwin Seet (left) and Ms Audrey Saw were part of the key

people in Yishun Health who led the expansion of the ICU

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Ward, Peri-Ops, and Specialist Outpatient Clinic — these nurses were trained by their ICU colleagues and supervisors so that they had the knowledge and skills to take on patient management in a new care setting. “Despite the steep learning curve, these nurses have risen to their call of duty to meet the needs of the hospital,” shares Ms Audrey Saw, Deputy Director, Nursing. About 40 non-ICU-trained doctors also underwent a course on the fundamentals of ICU management, intubation, ventilator-setting, and trouble-shooting.

The hectic, high-pressure environment of the ICU, with its high levels of alertness and code-blue activations, requires not only ICU skill sets, but also fortitude. This moral support has been invaluable to those who have had to take that end-of-life journey with patients. With isolation protocols in place, ICU nurses have found themselves facilitating teleconferences between patients and family members; they were sometimes in the heart-rending

position of being the last pair of hands that patients hold, or the last comforting voice patients hear. “We all play a pivotal role during this current pandemic,” shares Rebecca Oyog, Senior Staff Nurse, ICU 1 (Medical). “Our individual actions, no matter how small they may seem, can affect the entire ward.”

To support many of the medical professionals who have been deployed to this new specialty, senior nurses who went through the SARS episode of 2003 have stepped up to share their experiences and help juniors and peers to process their anxieties and fears.

Training and mental resilience aside, Yishun Health has also adopted a potentially life-saving prone positioning (lying on your front) practice in the ICU, and rolled this out across the hospital, with ICU nurses and physiotherapists jointly leading the effort. This technique optimises pulmonary (heart and lung) function, clears airways, and improves oxygen intake in patients with severe respiratory failure associated with

COVID-19. It also minimises post-ICU-acquired complications.

“Our team has been kept up to date with daily sharing of new knowledge related to COVID-19 from international and global literature. Our practices have consistently incorporated the most current guidelines and recommendations,” explains Sunny Tan, Senior Physiotherapist, Rehab Services.

This is just one of the many ways that the nursing and medical teams have risen to the task, despite the long and arduous hours dressed in PPE. “Everyone is working tirelessly in physically challenging environments, but we are working collectively to face these tasks,” says Dr Kumaresh Venkatesan, Senior Consultant, Anaesthesia, and Chairman, ICU Committee.

(opposite, top & below, right) ICU facilities and equipment are set up and ready to take in patients when the need arises

(below, left) The Post-Anaesthesia Care Unit has dedicated beds for non-COVID-19 patients who also require ICU care

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EVERYDAY HEROES

With a cheerful greeting and warm smile, veteran flight attendant Seyu

Yeong Khang has more than two decades of experience flying the friendly skies, looking after passengers’ comfort and well-being. These days, Yeong Khang is not plying the narrow aisles of an aeroplane, but the airy and light-filled wards at KTPH. As the COVID-19 pandemic has put air travel on hold for now, Yeong Khang is among the cabin crew who have traded their ‘wings’ for wards, and passengers for patients. CARE AMBASSADORS Initiated by KTPH and SIA, SilkAir and Scoot, the Care Ambassador (CA) Programme seconds the cabin crew to public hospitals in a bid to supplement manpower needs brought on by the COVID-19 outbreak. This comes as healthcare institutions experience increasing demands due to the need to care for a rising number of patients; at the same time, cabin crew have been grounded due to the suspension of commercial flights.

It was with this in mind that Siti Musleha Binte Husain decided to

sign up. “I wanted to assist nurses as much as I can so that they can focus on caring for patients,” she says, adding that her work in the geriatric ward has been meaningful and rewarding.

Tristan Yap also applied for the role as a way to contribute towards the battle against COVID-19. Offering not only his service skills, he signed

FROM IN-AIR SERVICE TO

More than 100 temporarily grounded flight attendants from Singapore Airlines, SilkAir, Scoot and Jetstar have applied their mile-high award-winning service on the grounds of KTPH as Care Ambassadors and Service Support Officers.

ON-GROUND CARERS

on with a goal to uphold the Scout’s motto: do a good turn daily. The heart of the job, says Tristan, is actually very similar to what he does in the air, as it involves meeting the needs of people and looking after their safety. “Only my ‘office’ no longer flies,” he jokes.

Stepping into the gap, Yeong Khang, Musleha and Tristan have

Care Ambassadors all ready to learn from one of our Yishun Health nurses

| 27

been working to alleviate the care load, especially for basic care. As CAs, they are trained to carry out essential basic caregiving, nutritional support, as well as patient service management for patients in low-risk wards. As Yeong Khang puts it, their job has evolved from just service recovery to include serving patients in their recovery instead.

CAs undergo a five-day training programme. This includes a primer on basic medical terms, how to monitor vital signs and safely feed patients, as well as how to comfortably and effectively turn and position them in bed, and how to ambulate (transfer) them around the hospital. In addition, CAs are trained in safety and infection control measures, and how to properly use personal protective equipment.

While these duties seem simple, Ward B106 Nurse Manager Yvonne Yap shares, “Our CAs have been a great help in the wards as they bolster our resources for service-related work and basic caregiving.” As staff are diverted to care for COVID-19 patients, this collaboration with SIA helps augment manpower during a very challenging time, adds Ms Shirley Heng, Chief Nurse, Yishun Health.

SERVICE SUPPORT OFFICERS Outside of the wards, 43 staff from Jetstar have also come on board as Service Support Officers (SSO). Deployed to various areas across Yishun Health to alleviate the workload of healthcare staff, they provide assistance across many functions not directly related to patient care. They take on roles such as patient screeners, patient greeters, visitor managers, tele-visit officers, patient service associates, supply chain coordinators, and pharmacy service support staff.

(left) A Service Support Officer ready for duty at the lobby

(right) Our Service Support Officers work hard on the ground, ensuring both traffic and visitor flows run smoothly

One of our CAs working along a different kind of aisle

Having struck up friendships with CAs, our nurses have learnt to style their hair in the iconic Singapore Girl updo!

MORALE BOOSTERSWherever they are deployed, these extra helping hands provide morale-boosting support. Carol Tai, Nurse Manager, shares how some CAs collectively volunteered to take over the 6.30am distribution of pyjamas, towels, bedsheets and blankets to patients so that nurses could get a little extra rest. “I was so touched when I saw the message; I am so thankful,” she gushes.

Melannie Wong, a Chief Stewardess with SIA, has even gone over and above her job description to aid in tasks such as assisting patients with diaper change. The act has reinforced her appreciation for the work that goes on daily within wards, and the effort taken to treat patients like family. “It gives me peace of mind to know that, if my family member was warded, healthcare workers will care for my loved one as if he or she were one of their own.”

It is an experience that Yeong Khang has also found truly eye-opening. “It is a change of environment, a chance to learn something new, challenge myself to do something out of the norm, and contribute to a meaningful cause.”

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Our COVID-19 response went beyond our campus. In response to cases

that arose in nursing homes and dormitories, Yishun Health began actively playing its role to care for these groups of patients in April.

The Population Health and Community Transformation (PHCT) team partnered various departments to send swabbing teams to nursing homes. Led by Dr Wong Sweet Fun, Deputy CMB (Population Health) & Clinical Director, PHCT, and Dr Laurence Tan, Consultant, Geriatric Medicine, the team also developed pictorial guides for community care partners, including the Agency for Integrated Care (AIC). These handy

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REACHINGOUT TO CARE

Throughout the crisis, Yishun Health and our partners have been coming together

to provide not just clinical care for our patients and residents in the

community, but also soothe the anxieties brought about by the pandemic.

KTPH staff (in blue shower caps) with nursing home staff during a swab training session

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aids helped to improve awareness, education and recognition of infection control measures. “This initiative reflects PHCT’s ingrained mission to bring healthcare beyond the hospital, as well as empower and educate those in the community to take care of one another,” says Dr Wong. In all, more than 1,000 swab tests were done across three residential homes. NO EASY TASK Going into the nursing homes to conduct swab tests was no easy feat. Apart from having to wear full PPE for long hours, the team also had to ensure that the swabs were taken carefully and safely, as many residents were senior and frail. The team also

tried to assuage the residents’ fears and anxieties while factoring in their deteriorated cognitive function.

To support these nurses, their colleagues from the admin department were deployed. Whether it was attending to logistical needs or being trained to conduct swabs, teamwork was essential as everyone tried to adapt to new procedures and the need to be mobilised quickly. “What constantly motivated me was ensuring the safety of the vulnerable in the nursing homes,” shares Nicholas Neu, an Administrative Assistant in PHCT. “Working on the frontline made me appreciate our healthcare colleagues more, as I could see them toiling under these conditions.”

To ensure long-term sustainability in the care of these nursing home residents, the team trained the homes’ staff to conduct swabs independently. Today, more than 70 staff from 11 nursing homes have been trained. The swab team also conducted more than 200 swabs and 190 serology tests at Northpoint City when it was identified as a cluster.

This has strengthened the partnership between PHCT and nursing homes in the community. “I am able to work alongside different people of various

positions and backgrounds, witness their team spirit, and better understand the nursing home environment,” affirms Ng Lai Fong, Staff Nurse, PHCT.

Before the Circuit Breaker (CB) kicked in, its Community Nurse Post (CNP) increased its number of sessions from 19 to 37 to help residents manage their long-term conditions. This way, referrals to the nearest Public Health Preparedness Clinic or hospital could be made if the residents were found to have symptoms. This also allowed the nurses to educate these seniors on relevant precautionary measures, such as handwashing and mask wearing. Understanding that senior residents may fear heading to the clinics and hospitals during the pandemic, this helped them to feel at ease and yet still cared for. CONTINUED PATIENT CARE While CNPs closed during CB, PHCT continued sending staff out for home visits, relieving surge demands for hospital beds. Their work ranged from attending to post-discharge needs of residents who have recovered from

The swab team from PHCT

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COVID-19 to aiding seniors in their rehabilitative exercises. Simple educational videos on home exercise and healthy home cooking were also created.

The health of our patients and people in our community goes beyond illness, and value-based care is more than providing timely treatment. In such a time as this, says Dr Wong, “It is even more apparent that emotional, functional and social well-being are being looked after as we continue to give quality care.” Understanding this and delivering

appropriate care have always been Yishun Health’s mantra, she adds. “We continue to look out for one another, and reach out to make these times a little more comforting for everyone — in big ways and small.”

CARING DONORS Beyond community care, many other acts of care have also continued to buoy spirits across the organisation. One of our own patients who had recovered from COVID-19, Mr Winston Tan, donated basic necessities such as T-shirts, towels and biscuits

to the foreign workers who were hospitalised in his ward. One of Mr Tan’s carers, Staff Nurse Lee Yin Yin, recalls, “Many of them were admitted without essentials, and this donation came at the right time.”

Other donations came from our own staff, who brought clothes and other necessities from home. “We were heartened by their generosity and quick response to support our foreign workers,” shares Rebecca Quek, Medical Social Worker (MSW).

Medical Social Service (MSS) had undertaken many acts of holistic care to support the rising needs of COVID-19 patients and provide psychosocial care. For example, Social Work Assistants (SWA) worked closely with ward and logistics team to identify and address practical needs, playing ‘broker’ to link up foreign worker patients with resources. “We’ve supplied patients with SIM cards and handphone chargers to help them keep in touch with their loved ones during this isolating period. We’ve also assisted some patients in obtaining medical devices, such as glucometers, so that they can monitor their diabetes upon discharge,” shares Elizabeth Thomas, SWA. PSYCH SUPPORT Scarlet Lee, Senior MSW, adds, “We created a resource kit to address their psychological stress.” Via teleconference and with the aid of translators, the MSW team worked to alleviate the anxieties due to job insecurity and mental health issues from prolonged isolation. In order to facilitate smoother transition from hospital to community, MSWs started establishing relationships with new community partners, such as HealthServe and Transient Workers

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Wheels on the Bus is an initiative headed by Dr Michael Wong, Medical Officer, General Surgery, and Dr Chloe Ting, Resident Physician, A&E, who went beyond their clinical duties to ensure that foreign worker patients had essential items with them. The initiative serves as a platform for individuals and organisations to contribute, and people in need to receive. “A large majority of COVID-19 patients, though asymptomatic, struggle with the effects of being isolated. Many of these are our foreign workers living in dormitories. We hope that the little we provide can help tide them over their journey through hospitals and isolation facilities, and show them that our community cares. The people who make up our community are the vehicles for change. We are just the wheels that help them move along,” explains Dr Wong

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PALS TO LEAN ONDue to COVID-19, staff have been taking on longer shifts, while others have been taking on more roles. In addition to augmenting manpower to cope with the increased workloads, the well-being and mental health of staff are also a priority. A series of measures to reduce staff burnout, such as counselling services and peer support programmes, have been put in place.

The Peers Around Lending Support (PALS) programme, launched in 2008 and run by clinical psychologists, draws lessons from SARS to provide ongoing support and counselling for staff. “After SARS ended, people realised that healthcare workers were still affected by how difficult it was. For several years after the acute event ended, people were still reporting things like heightened stress levels and sometimes even PTSD-like symptoms,” shares Dr Goh Kah Hong, Head & Senior Consultant, Psychological Medicine. “We realised that there was a great need for more systematic staff support.”

The PALS Pandemic Support and Advocacy Plan plays an important role in assisting staff to transition smoothly between peacetime and pandemic periods. Via varied platforms — group meetings, a helpline, email, outreach to those at high-risk, educational materials — the programme offers a safe, conducive space for staff to receive support.

While meeting the emerging needs of COVID-19 patients, another team of MSS worked with non-COVID-19 patients to ensure safe discharge and continuity of care in the community. They worked with relevant agencies such as AIC to seek alternatives to ensure safety and care for the vulnerable in the community. Other members of the MSS team took on new roles, providing on-site administrative support to the CSC Loyang Swab Isolation Facility, supporting nurses to provide basic patient care in the wards, and working in logistics to coordinate Yishun Health’s COVID-19 response.

Jenny Goh, Deputy Head and Principal MSW, shares, “Being adaptable and agile were two key characteristics seen in our MSS staff. Our team saw the crisis as an opportunity for them to try different ways of responding to needs and delivering service.” Though the tasks were unlike their typical work, core social work skills, such as active listening and providing emotional support, were still deployed daily. “I feel privileged to be part of the healthcare team to support our people during this pandemic, and I believe our team feels the same. There is more gain than loss in this helping journey, seeing how we came together collectively to serve a good cause,” reflects Chua Ee Cheng, Head and Principal MSW.

On top of health checks, CNP nurses also educate residents on relevant precautionary measures, such as handwashing and mask wearing

Count Too, that have experience working with migrant workers. With a clearer picture of the available resources and manpower legislation regarding foreign workers, staff were better equipped to support this group of foreign workers. Says Social Work Executive Jacky Tan,

“My interactions with the foreign workers helped me understand their fears and anxiety in the face of uncertainty. I learnt how important it was to offer assurance and confidence, and tell them, ‘You are safe here; we will take care of you. Let me know how I can help you.’”

Via teleconferencing and with the aid of translators, the MSW team worked to alleviate the anxieties of patients affected by the pandemic

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ur Allied Health Professionals (AHPs) have responded to the

needs of the COVID-19 patients in many settings, such as A&E, Holding Areas, wards, the ICU, and Community Facilities,” shares Teresa Foong, Head & Deputy Director, Allied Health Services & Pharmacy.

Beyond the additional workload for radiographers, intensive care physiotherapists, lab technicians and pharmacists — some of whom were seconded to National Centre for Infectious Diseases (NCID) — many AHPs stepped out of their comfort zones to take on wholly

different job scopes, innovate care, and support their colleagues.

One innovative idea was the implementation of tele-rehab, so patients need not come to the hospital for rehabilitation. Another, tele-therapy, demonstrates relaxation techniques to alleviate anxiety. Physiotherapists, clinical psychologists and more are connecting with patients to ensure their holistic well-being.

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Allied Healthcare Professionals form a critical part of every well-developed care plan, seeing to the varied needs of every individual seeking medical care. It is no surprise that, as we navigate the COVID-19 pandemic, they have filled important gaps in care and supported a wide number of functions and services to ensure the best patient outcomes.

ALLIES IN HEALTHCARE

O“Staff from pharmacy have

also transitioned to delivering medication for patients. For Admiralty Medical Centre patients, these deliveries have increased from 10–15 deliveries per day to 70 per day. The KTPH outpatients are also not excluded: today, these deliveries have tripled to about 150 per day, with an expected increase of up to 300–400 per day.

Siew Yu Yao, Dietitian, Nutrition

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& Dietetics (N&D), who provides administrative support to a Swab Isolation facility, says, “No doubt, it was daunting at first to take on roles and responsibilities different from what I was trained to do and keeping up with protocols that are changing daily. However, in challenging times like these, I am more than proud to be able to contribute in whatever way possible.”

Her N&D colleagues have also contributed by advising the Food Services team how to better plan meals for Muslim patients to ensure that their nutritional needs and cultural practices were supported when they were admitted during the Muslim fasting month of Ramadan.

(opposite) Since mid-April, Physiotherapist Wilson Woo has been caring for COVID-19 patients instead of conducting his usual sessions

(left) Belinda Chua, Pharmacy Technician, making sure patients receive their medication via the home delivery service

Birthed out of a collaboration between Yishun Health and Woodlands Health Campus’ Rehab Services, the Teh Tarik Workout is a simple exercise that was created for patients recovering from COVID-19 and those working from home.

Meanwhile, our Clinical Psychologists and Medical Social Workers have helped out on a national level by manning the CARE Hotline, which has handled more than 6,600 calls nationally since it started operating on 9 April 2020. More than 30 AHPs were also deployed to Command Centre and Contact Tracing Centre to augment the work there. (Read more about our Contact Tracing effort on page 34) “I am very happy and proud that our AHPs came together in a positive spirit to help and work with other colleagues in many different areas in the fight against COVID-19,” says Teresa.

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ESSENTIAL DUTIESRadiographers: Chest X-rays to aid in diagnosis and treatment

Medical technologists: Blood and swab tests

Physiotherapists: Functional recovery through exercise, mobilisation and rehabilitation

Clinical psychologists: Psychological well-being

Medical social workers: Holistic person-centric support and resources

Dietitians: Adequate nutrition geared towards medical, cultural and religious needs

ABOVE AND BEYOND• Bolster NCID manpower

• Take on basic nursing care at SIFs and Holding Areas

• Support Pandemic Taskforce and Command Centre

• Conduct Contact Tracing

• Support the KTPH Transfer Team for patients transferred to Community Facilities

34 |

Contact tracing has been the backbone of Singapore’s COVID-19 response, enabling the speedy and effective containment of the disease.

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FUNDAMENTAL CONTACT

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Amid the COVID-19 outbreak, many staff of Yishun Health have found themselves

in expanded, evolved, or wholly different job roles. One of them is Dr Ng Yeuk Fan.

In his usual work as Head & Director, Corporate Development, Dr Ng is in charge of organisational development and strategic transformation for Yishun Health. But when COVID-19 struck, he became the Lead for Yishun Health’s contact-tracing effort, and was tasked to set up a Contact Tracing Centre (CTC).

While contact tracing was new to him, Dr Ng was able to draw upon his experience of working through both the SARS epidemic and H1N1 pandemic. It also helped that he and his colleague, Dr Chikul Mittal, Assistant Director, had received training in public health. With the rest of the CTC managers, they were able

to direct contact-tracing efforts, guide CTC team members on the management of priority cases, and ensure the surveillance of patient and staff contacts to keep Yishun Health Campus safe. They also received guidance from infectious disease specialists and infection control nurses.

Dr Ng explains that contact tracing is an established public health strategy that aims to isolate anyone who has been exposed. The ability to efficiently quarantine and monitor anyone who may be infected so that you can provide treatment while limiting the spread of the disease dramatically decreases the impact of an epidemic or pandemic. “Contact tracing saves lives, yet the tools we use are very ordinary. The team basically talks to patients and investigates where they went, what they did, whom they met and

The team basically talks to patients and intestigates

where they went, what they did,

whom they met and interacted with

14 days prior to the onset of their

symptoms

DR NG YEUK FAN HEAD & DIRECTOR CORPORATE DEVELOPMENT

“Contact tracing requires a certain level of people skills so that patients are comfortable sharing the minutiae of their lives.”

36 |

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interacted with 14 days prior to the onset of their symptoms.”

GOING INTO DETAILSThis questioning is quite detailed, as getting down to specifics ensures that all potential contacts are accounted for. Once the data is in, contact tracers will analyse if these contacts and interactions are meaningful or not, and make data-driven and risk-assessed recommendations. The work is not complicated, but can be very tedious. It also requires a certain level of people skills so that patients are comfortable sharing the minutiae of their lives. Garnering this information is a powerful and effective method of containment as it helps to prevent further infection and the formation of clusters; nationally, it also helps to mitigate the volume of cases in Singapore.

When the number of foreign worker cases increased dramatically, CTC had to learn on the job how to communicate despite language barriers. With these index cases, questions had to be modified to simple words, such as asking if they experienced “head rounding

and rounding” (dizziness) or “head no good” (fever). “You would imagine the kind of stress, worry and uncertainly that goes through everyone’s minds at that point,” shares Linda Ong, a Volunteer Coordinator in YCH who has been part of the CTC team since February 2020. “For that reason I have to be extra mindful, calm and patient while I walk index cases through every single activity, including where they had been to and whom they met. These conversations can sometimes last up to 90 minutes or longer,

depending on the extent of their movements and activities.”

There were many challenges the team had to face, including keeping up morale even as cases kept rising, updating CTC workflows to keep up with MOH policies, which was changing rapidly as the pandemic progressed, as well as training the large number of volunteer CTC staff. “Staff with little to no patient-fronting experience had to learn to navigate multiple IT systems to piece together the patients’ journey across Yishun Health to pinpoint the locations of potential contacts,” shares Liu Naiying, Senior Manager, who was also deployed from Corporate Development to CTC.

GETTING MORE MANPOWERTo meet the demand for contact tracing, staff from 35 different departments, such as Human Resource, Finance, Population Health & Community Transformation, Allied Health, and Clinical Research Unit, were mobilised. More than 10 colleagues from NHG HQ also chipped in. As everyone was on a rotating roster, juggling their own

Once data comes in, contact tracers

analyse whether contacts and interactions

are meaningful before making

data-driven and risk-assessed

recommendations

TAN JIA LING SENIOR PHYSIOTHERAPIST REHAB SERVICES

“My colleagues and I even started 10-minute workout sessions to break the cycle of prolonged sitting.”

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Contact tracers in the middle of a workout session to mitigate the effects of being desk-bound for prolonged periods during their CTC shift

workload, CTC had to ensure there was enough people in a rostered team. By July 2020, CTC had trained more than 70 staff in order to keep operations running 14 hours a day, seven days a week. At the peak, the team was contact tracing more than 80 cases a day, more than 400 cases a week. To date, CTC has managed more than 1,800 index cases.

TAKING A BREAKTan Jia Ling, Senior Physiotherapist, Rehab Services, who manages a team of five to six contact tracers, shares, “Instead of being up on my feet and working on rehabilitation programmes with my patients, I am now seated at the computer for most of the day.” At the CTC, she juggles between checking for updates, tabulating data, as well as going through activity maps done by her team. Interestingly, while she had to adjust to her new role and

a different working environment, it also gave her a greater understanding of why some of her patients suffer from neck and back aches due to prolonged desk-bound work. “My colleagues and I even started 10-minute workout sessions to break the cycle of prolonged sitting. This definitely lifts the mood and ensures everyone receives some form of workout!”

With new experiences come memorable incidents. Naiying recalls one priority case involving an extensive number of locations that had to be completed urgently to mitigate infection control risks. “We even had to go to our staff’s home and wake him up just to get information fast!” What helps during times like these, shares Naiying, is that everyone is really committed to ensuring that contact tracing is done well and completed in a timely manner.

The CTC also communicates its findings to MOH in order to enable the

larger national-level contact-tracing effort and quarantine operations. “We are accountable for our contact-tracing findings, our risk assessments, and our recommendations on all patient, visitor and staff contacts. Inaccurate findings or inappropriate risk assessments can have repercussions, such as impacting our capacity for patient care,” says Dr Ng. This underscored the need for good contact history collection and rigorous risk assessment for every case.

Looking back on the CTC’s work amid the chaos of the pandemic’s early days, Dr Ng is heartened by the way his colleagues have stepped up. “It shows that we are surrounded by good people with the intrinsic resilience to respond and overcome challenges. When the pandemic broke out, this resilience, as well as the relationships built during peacetime, were the two key factors why we could get the job done.”

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Germs spread in many ways — especially through touch. This is why clean hands are so important in the prevention of COVID-19.

5THINGS ABOUT

HANDWASHING

1 SOAP AND WATER, YOUR BEST DEFENCEHandwashing addresses germs in two ways.

Running water physically moves germs off the skin’s surface, while soap damages their cell membranes, thus disabling them. Soap and water also create a slippery surface that makes it hard for them to adhere to.

5 Things About...

In consultation with Foo Meow Ling, Senior Nurse Clinician, Infection Control

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2 WASH WISELYYes, you can overdo handwashing — and that can lead to dry skin that traps even

more bacteria. Wash your hands based on what you do:• Before and after preparing food• After coughing, sneezing or blowing your nose• After touching an animal or animal food• After using the toilet• After taking out the trash• Before and after being with someone who is ill

3 SING THE ‘ABC’ SONGLather wet hands with soap for at least 20 seconds (sing your ABCs as a way to

keep time). Remember to rub the backs of your hands, between the fingers, and under the nails for maximum coverage.

4 RUB IT INHand sanitiser is a convenient backup if soap and water are not available. Use one

with at least 60% alcohol in order to inactivate microbes. Alcohol-based hand sanitisers can quickly reduce the number of microbes on hands, but they do not eliminate all types of germs.

Apply enough hand sanitiser to thoroughly wet the surfaces of your hands and fingers. Spread the solution around and rub until your hands are dry.

5 HOW ABOUT ANTIBACTERIAL SOAPS?For everyday use, antibacterial soaps are

not more effective than regular soap. While strong antiseptic cleaners are used to reduce microbial activity in specialised settings, such as healthcare, this is not necessary at home.

60%ALCOHOL

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Screenings have been a huge part of the national COVID-19 response, and

not just in the diagnostic sense: they are also part of security and surveillance measures. To this end, Yishun Health’s Operations team has had to respond speedily to set up temperature screening points across the campus.

Joe Leng, Assistant Director, Operations, helms Emergency Planning and oversees Security and Visitor Management (VM). “My role is amplified during this pandemic. It is no longer just scenario planning, but a real pandemic,” he says. Besides attending Taskforce meetings, where key policies and measures are deliberated and decisions made, Joe works closely with colleagues from

amount of time. “We quickly formed a screening team to look into the manpower, logistics, processes and ground management, much of which was very different from our usual practice” notes Nee Ker, whose primary responsibility during peacetime is using new healthcare technology to improve hospital operations, systems and processes.

Supporting him were his Operations colleagues, Bong Ai Wei, Assistant Director, and Joanna Tang, Senior Manager, and a team of Management Associates (MA). The urgency of the situation, fast-changing advisories, and new job scopes meant that team members were constantly on their toes. Extra manpower also had to be pulled from different departments to take on various

SPOTL IGHT

To keep everyone safe and meet national pandemic protocols, a robust Visitor Management System had to be quickly set up to ensure the well-being of hundreds of visitors and patients that flow in and out of the hospital each day.

SAFE & SECURE ACCESS

Operations to ensure visitors to Yishun Health are safe. “There is a need to respond quickly when we receive new MOH directives. We also make sure the information is translated into smooth processes for all our visitors.” With an evolving COVID-19, Joe shares that his team has had to think out of the box, as there was no one-size-fits-all set of procedures early in the pandemic.

OPEN-CONCEPT CHALLENGELing Nee Ker, Assistant Director, Operations, reports that one of the challenges they faced was working around the open-concept grounds to manage access, set up designated entry and exit points, and create centralised screening stations. All these had to be done in a short

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compliance, and explain the necessity of screenings. Compounding the inconvenience was the use of paper forms in the initial days. “It was time consuming and wasteful due to frequent changes in screening criteria,” he recalls. “So, we requested for iPads and created an online form.”

It has been a “tiring but fulfilling” job, but Nee Ker’s team has relished the challenges. “We feel privileged to be given the opportunity to learn and contribute in the fight against COVID-19,” Nee Ker affirms. “My work does not normally require direct interactions with patients and visitors. Through this assignment, I got to roll up my sleeves and meet people, for whom the systems that I am developing will help. It made me more mindful of the patient experience.”

Koh Choon Leong, Executive, Security, echoes Nee Ker’s sentiments. Whenever there was a new guideline, the VM team would be on their feet, ready to review and analyse the processes on the ground. At the peak of COVID-19, visitor policies had tightened and many restrictions were implemented for the safety of both patients and their loved ones. “Additional processes, such as pre-registering nominated next-of-kin and turning away certain visitors, posed a big challenge for our team.” Choon Leong recalls when visitors would become anxious and frustrated at the VM team. “There was a need to assure them by meeting them face-to-face, understanding their concerns, and explaining rationales for the restrictions.”

Apart from managing visitors, the team also set up a tele-visit facility to enable communication between patients and their loved ones when no visitors were allowed. “While most patients are able to contact their loved ones via their own mobile devices, there are some who are less tech-savvy or too ill to do so,” notes Kong Ka Hei, Executive, Operations. “To help them maintain some sort of human touch, we rolled out a tele-visit service.” Ka Hei discloses that COVID-19 has given the team a new perspective on how they can better connect patients using technology. “Hard work pays off when we hear stories of how these efforts made things a little easier for our patients and visitors during this time.”

temporary roles, such as ushers, screeners, lift marshals, and more. “We conducted regular briefings and trainings to ensure our team abided by each new change,” say Nee Ker. There was also a lot of experimenting to find the best processes and layouts. As these could only be done after office hours, the team often worked late into the night.

MAKING THINGS CONVENIENTThe team did not just have to work around logistical and operational difficulties. “Being screened before accessing healthcare service was unfamiliar to patients, so we had to manage the inconvenience to patients and visitors,” Nee Ker adds. MAs were deployed to engage people, foster

(left & right) These screenings ensured that everyone who walked into Yishun Health was healthy

(far left) Ng Jin Lim was one of the many MAs who screened visitors and patients at the KTPH lobby

(middle) Nee Ker conducting one of his regular briefings to ensure all the temporary staff were clear about their roles

(left) Joe giving Ka Hei a fist bump — here’s to good teamwork!

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Even in a crisis, the show must go on, especially when it comes to keeping patients and staff nourished for the battle ahead.

SPOTL IGHT

FOOD FROMTHE HEART

Hundred of kilogrammes of vegetables, rice, meat and other food supplies

come through Yishun Health’s kitchens each week. In the midst of the COVID-19 pandemic, it was imperative to ensure that there was no disruption to food supplies and meals, as well as adapt processes to accommodate pandemic protocols.

As Head and Manager of KTPH Food Services, Ghazali Bin Mohamad shares the initial feelings of uncertainty. “There have been many changes in manpower management, inter-department coordination, preparation, production and supplies.” Staff movements had to be reorganised according to safe distancing guidelines, work schedules rearranged, and more space had to be allocated to create interim storage areas for food supplies. “While internal caterings reduced, we had to increase staff meals for clinical and non-clinical areas,” he explains. In addition, the team had to work with various external caterers to supplement meal provision.

Significantly, many of the Food Services team members from Malaysia had to stay on

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(top) With donations from Alexandra Health Fund, our Food Services team prepared and delivered hot and fresh meals for staff working in the wards

in Singapore to work, unable to go home to their families due to Malaysia’s Movement Control Order (MCO) — a situation that had some shedding tears. “It has been important to ensure that staff morale is not affected. I consistently communicate with my team and colleagues,” he says. More effort was also made to listen to concerns and needs. Greater sensitivity, understanding and compassion have been foundational in building trust and camaraderie.

Over at YCH, the Food Services team moved away from serving modified meals to regular ones, as more wards had been converted to house COVID-19 patients. This meant implementing changes in their stock intake and operations. “The sudden surge in patient load caused an increase of 300 to 400 meals during meal times,” shares Wendy Ng, Manager of Food Services in YCH. “We reshuffled our manpower and workflows so that we could respond quickly to the fluid situation.”

Sharing Ghazali’s heart for the staff under his care, Wendy also made sure that she was there for her colleagues, keeping them updated regularly and helping them in stressful moments.

Ghazali also worked closely with Human Resource to ensure that allowances and accommodation were all provided for during their time working in Singapore. “It was so heartening to see our local team helping our Malaysian colleagues during the early stages, from providing comfortable clothing to wear outside of work to offering laundry ‘services’.” To celebrate Hari Raya, some even cooked special meals of lontong and kueh to provide a sense of home and family. These acts of kindness helped many overcome feelings of homesickness, and bonded the team even more closely. “All of our team members are more appreciative of each other’s roles and responsibilities. Most of all, I am blessed with a team that’s second to none as far as commitment, responsibility and ever-readiness are concerned. Throughout this episode, the team has become family.”

Their work may not be on the frontline, but Ghazali, Wendy and their teams are proud to fight in an important behind-the-scenes role. “In providing meals to both patients and staff, we are helping patients in their healing and ensuring that our colleagues have the energy and motivation to continue working and fighting COVID-19.”

When Yishun Health went into Weekend Mode, the Food Services team were down to take care of staff meals

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W ithin Yishun Health, strong and robust lines of communication

were seen as imperative from the get-go. “Our most urgent and critical task was to roll out fast and accurate information related to COVID-19 to four different groups of people: general public, patients, their next-of-kins, and our internal staff,” explains Albert Foo, Deputy Director, Corporate Communications.

“As communications professionals, we needed to quickly digest the barrage of information coming to us, assess which part of that information each of our four groups of stakeholders needs, simplify it into accessible language, and disseminate it promptly so that people can take appropriate actions as the situation evolves rapidly.”

He shares that, on a daily basis, various domain experts will approach his department for assistance to develop communication materials, from posters and scripts to FAQs and advisories to videos. “However, they do not always have the time to explain what they need in great detail,” Albert says. “They may not even have all the answers to our clarifications, as the situation is in a state of flux.” He adds that his team’s biggest challenge was therefore to quickly comprehend

Visitor advisories by the Corporate Communications team help to ensure that both patients and visitors are kept informed and safe

SPOTL IGHT

The biggest difference between this COVID-19 pandemic and the SARS outbreak of 2002 is neither their scope nor nature, but the way information about them has spread. In this era of instant messaging and social media, news — including fake news — travels incredibly fast and can cause more damage than the spread of the disease. This underscores the need for clear, accurate and speedy communication.

LINES OF COMMUNICATION

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the background, technicalities and sensitivities, then develop accurate, concise and useful materials under very tight deadlines.

Beyond developing collaterals, another important role the department plays is to tell stories of the great work from various teams and share situational updates with everyone on the campus. “Regular staff communication is critical in a crisis because it helps to keep everyone informed of the bigger picture, beyond their own areas of work. More importantly, it helps build trust, a sense of ‘we are in this together’, confidence in the system, and strengthens the culture of the organisation,” Albert explains.

“Despite the challenges of COVID-19, the pandemic has also brought about more opportunities for us to educate and engage the public on the work of our healthcare workers and, in the process, build a stronger Yishun Health brand,” Albert adds. Throughout these many weeks, the team has regularly pushed out engaging Facebook posts that allowed Yishun Health to build an online community of more than 10,000 followers, up from around 6,000 before the crisis started. The numbers are still growing.

HARNESSING TECHNOLOGYMuch of this communication has leveraged technology. According to A/Prof Terence Tang, Deputy CMB (Clinical Informatics, Innovation & Patient Engagement), this crisis has been an opportunity to meaningfully and creatively apply even more information technology into clinical care. As Chief Clinical Informatics Officer, A/Prof Tang leads a team of informaticians who design electronic medical record (EMR) systems and identify ways to optimise

clinical workflows, efficiency, safety and compliance. “As segregation and isolation due to COVID-19 arise, communication becomes a vital aspect of care,” he says. Creative use of technology thus enables care providers to reach vulnerable patients. “Many still need care but we don’t want them to risk infection by travelling to the hospital.” To connect with these patients, the team trialled consultations via video conferencing. Technology also helped with internal communications as split teams and telecommuting became a way of life.

Technology was also used to match the EMR design to change workflows caused by infection control measures. With new wards, care areas, processes, tests and drugs, IT had to be used to anticipate and meet needs. “At the same time, a lot of data is being generated by this flurry of activities,” A/Prof Tang adds. “These are valuable for analysis and generating insights for guiding care.” In order to achieve this, a lot of time was spent listening and participating in management and meetings; content from these meetings are then shared with the team for discussion, deliberation, design and deployment.

Yishun Health staff got the opportunity to share real stories of fear and courage through videos and on other communication platforms

Tele-consultations provide outpatients with access to care in the safety and convenience of their own homes

A/Prof Tang is pleased to see technology, data and predictive models impacting numerous changes that improve the delivery of care to patients. He hopes that more good can emerge from this outbreak. “As Churchill once said, ‘Never let a good crisis go to waste’,” he quips. “The experience of managing these thousands of COVID-19 cases must be captured in the form of data and put to good use. Analysis gives us clarity and insight on what we are dealing with and how to do better. At the end of the day, what you know makes you less fearful.”

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WHAT IS COVID-19?Coronavirus Disease 19 (COVID-19) is caused by a new coronavirus strain identified in Wuhan, China, in late 2019. It causes respiratory illness and can lead to severe lung infection. Coronaviruses are a large family of viruses that can cause illnesses, ranging from the common cold to pneumonia.

WHAT ARE SOME OF THE SYMPTOMS?The symptoms of a COVID-19 infection are similar to that of regular pneumonia. Typical signs include fever, cough and shortness of breath.

WHAT IS THE INCUBATION PERIOD?This is the time between exposure to an infection and the appearance of the first symptoms. Current data suggests that the incubation period for COVID-19 is around 14 days.

ARE THERE ANY TREATMENTS?As COVID-19 is a novel strain of virus, there are no proven specific treatment or anti-viral drugs currently available.

Instead, supportive treatment is provided based on the severity of a patient’s condition.

HOW IS COVID-19 TRANSMITTED?Current evidence suggests the virus spreads mostly via respiratory droplets and direct contact. The virus is carried within droplets emitted from an infected person over a short distance (such as when the person coughs or sneezes). You can become infected if you inhale infected droplets; or your hands come into contact with infected objects or materials, then transfer the virus by touching your eyes, nose or mouth. This is why masks, basic hygiene, and safe distancing are important.

HOW SEVERE IS THE ILLNESS?Most people with COVID-19 have mild symptoms. However, severe disease and death can occur in 2–3% of those infected, especially among the elderly and those people with underlying health problems or compromised immune systems.

DAILY DOSE

Apart from masking up, practising good hygiene, and safe distancing, another important thing we can do is arm ourselves with accurate knowledge about the disease.

WHAT DO I DO IF I HAVE COLD-LIKE SYMPTOMS?Make an appointment with a General Practitioner (GP) clinic or polyclinic that has been designated as a Public Health Preparedness Clinic (PHPC). PHPCs provide investigation and subsidised treatment for those with respiratory symptoms, such as fever, cough, sore throat, and runny nose. To date, there are more than 950 PHPCs.

Remember to bring along your NRIC or birth certificate, along with your PG/MG/PA and CHAS card (where applicable). Go to flugowhere.gov.sg to find the PHPC closest to you.

Source: moh.gov.sg/covid-19/faqs

COVID-19: the basics

Read abouT our nursing family who have stayed committed to their calling in the midst of the COVID-19 pandemic

Nurses’ Day special 2020

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NURSES’ DAY 2020

CONNECT. COMMIT. CONSTRUCT:MS SHIRLEY HENG

CHIEF NURSE YISHUN HEALTH We are in the midst of an unprecedented time. Around the

world, healthcare systems and healthcare professionals are under

enormous pressures to tackle the onslaught of a dangerous pandemic. In Singapore, we are facing one of our greatest trials as a nation. The COVID-19 outbreak is more than a healthcare issue; it impacts our social and economic foundations.

As nurses, we find ourselves at the frontline of this crisis. And it is within this most demanding of situations that we ask ourselves: “Why do we do what we do?”

It brings me to the theme of this year’s Nurses’ Day: ‘Connect. Commit. Construct.’ These three words not only define the mindset needed to work in the nursing profession, they implore us to be more than a nurse.

Indeed, each day, I see so many of you live up to this immense task of going beyond your call of duty. I see you facing daily — even hourly — challenges with instinct, diligence and teamwork. I see you connecting to your sense of purpose, to patients’ needs, and to the widening responsibilities in response to our COVID-19 control measures.

It is heartening that, even as we physically distance ourselves safely, this sense of connection to each other

and our greater mission of care remains a shining beacon that guides us in our work. It strongly showcases one of the most important traits that we need to nurture: mental resilience. It is this fortitude that will see us through this pandemic — and keep us primed to face an unknown or new future.

The pandemic has changed the way we live, work and play, and it will continue to do so for the foreseeable days ahead. The hard truth is that ‘business as usual’ may be a thing of the past. We are in an era of profound change.

This underscores the need to revisit our commitment to our calling. Strength comes from conviction in the ‘rightness’ of what we do. This pandemic is a crucible in which we test and forge our true sense of vocation.

As we embrace a new normal, we have to continue to bolster our mental strength and build mental models to raise our resilience for the long road ahead. This strength does not come easily, nor is it innate in all of us. It is a mindset that we construct for ourselves with time and intentionality. We have to be prepared to adapt, pivot and move quickly. We must also be ready to make hard decisions and difficult choices.

The months ahead will not be easy — and this is exactly where our training and aptitude will come to the fore. Professional duty aside, it is also where we extend our humanity to truly be more than a nurse towards others — to heal, advocate, comfort, care and protect our patients and the communities that we serve.

MS LOW BENG HOIDIRECTOR, NURSING POPULATION HEALTH & COMMUNITY TRANSFORMATION

When COVID-19 hit our shores, I can honestly say we were not 100% ready.

Thankfully, our PHCT team had its foundations in place, so half the battle was in our favour. The other half was fought with resilience. Without ifs, ands or buts, every nurse rose to the situation and voluntarily re-organised, re-aligned and re-prioritised to respond to institution and community needs.

Change was the only constant for us, and our approach was simply to stay united, prepared and ready. It was heartening and encouraging to work hand in hand

with Operations under the strong leadership of Dr Wong Sweet Fun. While the past few months have been far from normal, everyone displayed fortitude, optimism and adaptability — this mindset helped us rise to the occasion and respond to the many unexpected challenges.

I find it meaningful that the theme of this year’s Nurses’ Day speaks of being more than a nurse. In normal times, we are already like an octopus — we wear many hats, undertake many tasks, play many roles. Multitasking has only intensified during this pandemic, and the road ahead is likely to be long-drawn and unpredictable. Our journey going forward will require us all to continue to make sacrifices that go beyond self for the greater good.

It means further displaying the characteristics that we are highlighting in this year’s theme — ‘Connect. Commit.

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MORE THAN A NURSEMDM CHUA GEK CHOO

DIRECTOR, NURSINGYISHUN COMMUNITY HOSPITAL The current COVID-19 pandemic has affected more than 200 countries,

infected well over seven million people, and led to more than 400,000

deaths. To flatten the curve, many countries, including Singapore, implemented movement restrictions, closed workplaces, and curtailed social gatherings. Beyond just a healthcare crisis, the pandemic also presents economic and socio-political challenges, affecting jobs, livelihoods and the way we work, learn and socialise.

The pandemic has underlined the importance of infection control, being prepared, and being socially responsible, thus validating the Yishun Health integrated care model, which has enabled us to swiftly and seamlessly combat the crisis.

YCH’s primary role is to provide right-sited care and support to KTPH by freeing acute beds. When COVID-19 hit, we stepped up to continue alleviating the load. From decanting patients to other community hospitals, and converting our wards to acute and sub-acute COVID-19 wards, we deployed manpower where it was needed without institutional territorialism. We were able to achieve speedy ward conversions — less than a week — mainly due to excellent team spirit. We benefited from the labour support and knowledge

sharing of colleagues across Yishun Health.The COVID-19 crisis has shown how much we

as nurses are more than the specific functions of our specialties. Our training has equipped us to be versatile and resilient enough to assume diverse roles in different situations.

The pandemic has required personal sacrifices, with nurses forgoing seeing loved ones in Malaysia, Philippines and India for months. Others have postponed weddings, missed important prayer ceremonies, and given up time with family. They have, instead, responded promptly to the urgent need to contain the pandemic. This just-do-it attitude clearly goes beyond just being a nurse.

This Nurses’ Day is unlike any other. We will not be able to gather in our usual way, but we make up for it with a deeper connection to our purpose. In the midst of our greatest crisis yet, we commit to the things that matter: our calling, our colleagues, and our community. In spite of the restrictions and limitations that challenge our norms, we creatively construct new solutions, going above and beyond our duty, to be more than a nurse.

I would like to take this opportunity to wish our nurses a healthy and happy Nurses’ Day. Thank you for your compassion, dedication and sacrifice. You have done Nursing proud. Together, we can achieve and overcome the COVID-19 pandemic, and be stronger for it. Once again, thank you!

Construct.’ — and how we can creatively find ways to achieve our goals and roles even amid many new restrictions.

One of the biggest missions for us at PHCT is creating connections with our residents in the community. Our Community Nurse Posts (CNP) at HDB blocks are strategically positioned to enable greater access so that residents can drop by for health assessments, informal meetings, conversations, exercise, and communal activities. All these have had to temporarily cease in light of infection-control and safe-distancing measures. However, we continued to carry out our commitments as best as we could, with essential home visits and urgent medical home services. We are also constructing new solutions for changing times so that we can fulfil our roles. For instance, the team has begun

tele-consultations to keep in touch with residents and patients with long-term chronic conditions. We will find new and safe ways of continuing our mission of care.

Through the lens of this pandemic, we as nurses — whether at PHCT or across the spectrum of nursing settings — are gaining a greater awareness of our roles and functions, strengths, responsibilities, and abilities. Even more so at this time, we are reminded that nursing is the heartbeat of healthcare. And by stepping up, we enable each other to do our work better, care for patients more effectively, and support not just the hospital, but our community and the nation at large.

To every nurse in every setting, in every ward, and every team — whether at the frontline or not — I am grateful for your important and meaningful contributions.

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NURSES’ DAY 2020

Flowers blooming in adversityMore than 2,100 stalks of

paper roses were delivered to the nurses of Yishun

Health on Nurses’ Day. It all started when the Nurses’ Day Organising Committee 2020 wanted to show appreciation for every nurse for their work over the years, especially during this COVID-19 crisis. It was also a chance for non-nursing colleagues across the campus to connect with nurses with a handwritten note.

Each bloom was a story of determination and heart. The paper roses were all handmade by colleagues, who had toiled for more than a month to assemble them. Across the campus, Yishun Health staff turned up at the makeshift ‘floral factory’ to learn how to twirl paper delicately around wire stems. Some even brought the materials home to concentrate on the crafting process.

In all, 123 volunteers across nine departments participated in this effort to showcase the deep gratitude we hold for our nursing family. (above, left) Penning thank-you notes; (above, right) Twirling paper to make a bloom

Chairman of the 2020 Nurses’ Day Committee A/Prof Tan Kok Yang presenting the nursing leaders with the handmade blooms

Yishun Health nursing leaders with flowers ready to be given out to the rest of the nursing family

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As Yishun Health enters a new decade of nursing, it is a good time to reflect and take stock as a community of healthcare

professionals. Our nurses are striving onward with the conviction of their calling — underscored by this year’s theme.• Connecting minds and hearts to our purpose so

that we can all serve patients better and work together with greater joy.

• Commiting to this job that is our purpose, and taking on all its responsibility and even sacrifices to own our work and our duties.

• Constructing ways to improve and rise up to every new challenge, from new ways of working, new relationships and partnerships to new models of care and new mindsets, nurses take into their hands the power to make a critical impact.Let us all not just turn the page to a new chapter,

but write a new volume in this journey of nursing, and translate these words into actions to transform healthcare in Yishun Health and soar higher and higher, together!

MARKING A NEW DECADE

I Can Connect, Commit, Construct by A/Prof Tan Kok Yang

Sometimes I feel the pressures of time, policies and emotions, Physical and invisible barriers of interactions, difficult commotions. Yet I feel lifted when I catch my patient smile with such pure gratitude, I can thus connect, in heart, in mind, I can care with purposeful attitude.I may be challenged by many distractions, competing for my attention,Balancing my needs with some demands that go beyond my comprehension. Yet I feel strength from my fellow nurses who bring me much encouragement, And together, hand in hand, we can own this noble job with much commitment!Workflows and processes may bring much hassle to our dear patients, And it pains me to see how difficult it can be, truly testing one’s patience. Yet I am inspired by little improvements that sprout out right before my eyes, I want to play my part to help construct meaningful models that bring surprise!

And as we celebrate a decade of caring with science, love and wisdom, I can hear a music in my heart that moves with such melodious rhythm, I take pride in the work that I do, the care that I give, my passion erupt! With this passion, I can connect, I can commit, I can construct!

A/Prof Tan Kok Yang Chairman Nurses’ Day Committee 2020 Yishun Health

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NURSES’ DAY 2020

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Nurses’ Merit award 2020

HOU LUYIN ASSISTANT NURSE CLINICIAN

WARD B86 KHOO TECK PUAT HOSPITAL

Get to know the seven Yishun Health nurses who received this year’s MOH Nurses’ Merit Award through their pearls of wisdom — wisdom that has been gained through the expenditure of much blood, sweat, tears, and a large dose of empathy.

In my 14 years as a nurse, there have been many moments that have touched me and kept me going. I had one patient who, although she was suffering, had faith that she would recover. She placed a lot of trust in us, and we tried our best to care for and encourage her.

When she was finally well enough to be discharged, I was on leave, so she left me a gift. I teared up when my colleague passed it to me, because it had my name stitched beautifully onto it. In that moment, I realised that nurses, with our passion and knowledge, make a difference in patients’ lives and are remembered by them forever.

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All of the hard work that nurses put forth on a daily basis is made completely worthwhile when we see patients who once needed constant care regain their independence. I love being a Nurse Clinician, as the role requires me to keep my knowledge and skills up to date. Nursing has gotten more challenging and complex over the years, but our motivations remain the same — to care for and make a difference in the lives of our patients.

CHAN ZHI QIANG NURSE CLINICIAN WARD B75 KHOO TECK PUAT HOSPITAL

I started my nursing journey in 1995, and was part of the pioneer

batch of nurses who graduated from Nanyang Polytechnic. Those

in healthcare then were used to nurses who attended the School

of Nursing, and met my batch with scepticism. That was a

time of transition for nursing in Singapore. Through the decades

and in various care settings, my patients have been my greatest

teachers and mentors. Their health journeys have

enriched my nursing knowledge and shaped my perspective on life.

ONG WEI WEI ASSISTANT NURSE CLINICIAN

AGEING-IN-PLACE COMMUNITY CARE TEAM (AIP-CCT)

POPULATION HEALTH & COMMUNITY TRANSFORMATION

NURSES’ DAY 2020

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Taking care of patients and earning their trust has always been very important to me. These 10 years of nursing have taught me to always consider different perspectives and care for people with sincerity. In my time as a ward supervisor, I have learnt to treat all members of my team equally and be a leader whom my staff can rely on.

One of the best pieces of advice I received was when my preceptor said to me, “Patients who most need our close attention are non-communicative and have no next-of-kin to advocate for them.” And an incident I encountered with one such patient as a new nurse taught me to always give my best and speak up, especially when the well-being of my patients and co-workers is in question.

SHARIFAH MARYAM ALHABSHEE BINTE ZEN NURSE MANAGER WARD A62 KHOO TECK PUAT HOSPITAL

FAITH TAN YEN HOONG ASSISTANT NURSE CLINICIAN WARD D78 KHOO TECK PUAT HOSPITAL

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In my 12 years as a nurse, one of the most memorable milestones is the day

I plucked up the courage and agreed to be transferred from a general ward

to an isolation ward. That was the beginning of my journey in learning

how to care for patients with infectious diseases. Observing first-hand the

difficulties some patients experienced when coping with illness is a reminder

for me to stay kind and caring. I hope that nurses will continue to embody the

spirit of compassion and camaraderie in all that we do for a better future.

CHNG HSING YUN, PRISCILLA

ASSISTANT NURSE CLINICIAN NURSING ADMINISTRATION

YISHUN COMMUNITY HOSPITAL

Taking up nursing was incidental for me. I was

waiting for the opportunity to do something else, but

a young patient I cared for changed my perspective. I

am glad that I did not give up Nursing as it has turned out

to be my calling. 2020 marks my 26th year as a nurse. Once

a nurse, always a nurse.

FAN SEE WAI NURSE MANAGER

GENERAL MEDICINE CLINIC KHOO TECK PUAT HOSPITAL

CONNECT. Linking purpose to practice.

KIMI HENGSTAFF NURSE, EAR, NOSE & THROAT CLINIC, KTPH

DESPITE THE DEMANDS OF BEING A NEW MOTHER, KIMI VOLUNTEERED TO WORK IN THE A&E TO CARE FOR PNEUMONIA-POSITIVE PATIENTS.

“Early this year, I requested to move from the inpatient ward to the Specialist Outpatient Clinic because I became a mum. But when COVID-19 hit, I decided to be part of A&E to care for patients with pneumonia, even though this meant going back to shift hours. The work is harder, faster paced, and less predictable. There’s a lot of extra precautions — we have to wear a mask and protective suit, and shower before going home.

My new work scope includes coordinating patient flow within the A&E, doing various tests and treatments for patients coming in, and working closely with colleagues across many disciplines. To be honest, the irregular hours have taken a toll — I had to cease breastfeeding earlier than expected. But the changes, redeployment, rescheduling, coordinating and collaborating are all part of what we do as nurses. Seeing my colleagues step up uncomplainingly to take on extra duties inspires me.

What also keeps me going is the tremendous support from my team, from my wonderful family and friends, as well as the outpouring of appreciation from the public. This is a once-in-a-lifetime experience that I am glad to play my part as a nurse.”

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NURSES’ DAY 2020

While COVID-19 has tested our limits, our team of nurses — the backbone of Yishun Health — has stood firm. Many of them have, as these stories attest, stepped up to be deployed for COVID-19 duties, or had to adapt their current roles during this crisis, making many personal sacrifices in the process.

a reminder of their CALLING

ERNIE YANTY BORHANUDINSENIOR STAFF NURSE, PHCT

AS A NURSING LEAD FOR THE MEDICAL HOME PROGRAMME, ERNIE HAS BEEN WORKING HARD TO SUPPORT THE DIFFERENT NEEDS OF RESIDENTS BASED ON THEIR CONDITION. DESPITE THE PANDEMIC, IT WAS IMPORTANT TO CONTINUE CARING FOR PATIENTS IN THE COMMUNITY AND HELP THEM STAY CONNECTED TO THEIR DOCTORS, HEALTH SERVICES, AND OTHER CARE NEEDS. THIS SERVICE HAS ALSO BEEN EXTENDED TO INPATIENT WARDS AND SPECIALIST OUTPATIENT CLINICS TO HELP EASE BED OCCUPANCY RATE THROUGH PROVIDING HOME-BASED CARE BY MULTIDISCIPLINARY TEAMS.

“During this pandemic, we have seen a surge of referrals to Medical Home, requiring us to increase manpower, even during weekends. This has meant cross-training within our Community Nursing department.

Our work ensures that patients recuperate well in

their homes, caregivers are adequately trained to take care of them, and they are linked up with other community partners, if necessary.

To cope with the increased load while ensuring the same level of access, we began tele-consultations to reduce the risk of cross-infections. To keep residents, their families, and our nurses safe, we implemented mandatory pre-visit phone calls to ascertain the residents’ condition and potential exposure to COVID-19. Interactions were also limited whenever possible. These home services have helped us ensure that many residents received timely care and avoided hospitalisation.

Although this period has meant a lot more work, fewer visits to see my family, and many uncertainties, I am proud to know that I am serving people in a time of hardship, and this privilege to fulfil my life’s purpose gives me a lot of intangible satisfaction.”

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BENJAMIN TANASSISTANT NURSE CLINICIAN, INFECTION CONTROL, YCH

INFECTION CONTROL, ALWAYS A PRIORITY IN HEALTHCARE, BECOMES MORE STRINGENT DURING A PANDEMIC. IN LIGHT OF WORKFLOW CHANGES AND EXPANDED COVID-19 CAPACITY, IT WAS NO WONDER BENJAMIN SAW HIS ROLE EXPANDING. BUT HE WAS DETERMINED TO STAY ATOP OF THINGS IN ORDER TO KEEP COLLEAGUES AND PATIENTS SAFE SO THEY CAN RETURN TO THEIR FAMILIES.

“To handle the influx of patients with COVID-19, my team increased the frequency of trainings for N95 mask fitting and PPE donning and doffing, from once a month to as many as twice a day. The PPE protocols were also modified to meet the requirements of dealing with this virus, so these were more intensive and complex compared to pre-pandemic PPE training sessions.

In addition to this, we trained nurses being deployed in wards that were converted to admit COVID-19 patients on the use of Powered Air Purifying Respirators, machines

that are usually used only in high-risk areas, such as the ICUs, Isolation Ward, and the A&E.

The scale of the outbreak and the changing circumstances meant that we were continuously looking for ways to improve workflow and safety while also keeping pace with hectic timelines and many unexpected situations. It was a challenge to manage expectations and accept new norms. In this long journey, we have also had to review many of our initial measures — set up with safety in mind — to make them more efficient.

We have learned, adapted, and learned some more. For example, when we read that COVID-19 can be carried on the soles of shoes, we rolled out disinfectant mats that have decreased the risk and reduced the workload of our housekeeping team.

It has been encouraging to put my unique work scope as an Infection Control Nurse to the test and see our expertise dovetail with our overall mission of care.”

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NURSES’ DAY 2020

SIA HWEE WANNURSE CLINICIAN, OPERATING THEATRE, KTPH

DURING THE SARS CRISIS, HWEE WAN WORKED WITH PATIENTS SUSPECTED OF HAVING THE ILLNESS. TODAY, SHE PUTS THAT EXPERIENCE TO GOOD USE, GUIDING NURSES IN KTPH’S OPERATING THEATRES. HER PASSION FOR HEALTHCARE HAS FUELLED HER THROUGH BOTH PROFESSIONAL CHALLENGES AND PERSONAL TRAGEDIES.

“In my day-to-day work, I support the smooth running of the operating theatres. With COVID-19, this work has had to go on, but under much greater pressures, even tighter infection controls, and many changes to our shift and manpower numbers.

It has been challenging and even scary, so stress levels have been extremely high. Having experienced SARS, I see this as an opportunity for my nursing sisters and me to sharpen our leadership skills, enhance our management of nurses across disciplines and departments, cascade skill sets to differing levels of knowledge and competencies, and, importantly, drive effective communication to ensure team coherence and efficiency.

It has been a time to not just do our jobs, but cement our reasons for doing it. When we understand our purpose, know our objectives, and reflect on our core values, we can be guided to do our best for our profession and our patients. It helps us focus and find solutions for the many problems we face. It is also what lights our inner fire. One thing this pandemic has demonstrated is the can-do spirit of our team — and that has inspired me so much.

This period has been hard. I suffered a great loss when my father became critically ill and passed away in Johor Bahru. Due to the lockdown in both countries, I could not visit or attend his funeral. It has been an exceptionally difficult time and an emotional roller coaster ride.

In all this pain, there is also some comfort in the knowledge that I am doing work that is meaningful. In this global crisis, we have to put individuality aside and come together. I have never been prouder of myself and my fellow nurses, to be contributing to the cause in a time like this.”

MANJIT KAURSENIOR NURSE MANAGER, WARD B55, KTPH

MANJIT STILL LOOKS BACK ON SARS AS A SAD AND SCARY TIME, BUT SHE HAS CHANNELED THAT EXPERIENCE TO GIVE HER STRENGTH IN THIS FIGHT AGAINST A NEW VIRAL ENEMY. IN FACT, THE VALUABLE LESSONS SHE LEARNT THEN HAS HELPED HER TO SUPPORT NOT JUST PATIENTS, BUT HER COLLEAGUES AS WELL.

“With SARS, the fear of the unknown was extremely worrying. I remember that we had to quickly equip ourselves as nursing leaders with as much knowledge as possible to share with and educate our team of nurses so as to alleviate their intense worry. What I learnt from that experience was just how important teamwork and team spirit were in raising us all up to do our work well.

Right now, I am working in a COVID ward. It was an existing ward that we converted into a new 84-bed ward within a couple of days. It was a great challenge not just logistically; manpower had to be pulled from outside the inpatient wards. This meant organising new routines, team building, and rolling out education to ensure everyone was trained to handle working in the ward.

We are all working long hours under stressful conditions. I realise that my role as a nurse is now especially important — not just in caring for patients, but in supporting and encouraging my fellow nursing and medical colleagues. We have to boost each other up in spirit so that we can do what we were trained to do. This support has come from everywhere — from Human Resources, our Peers Around Lending Support (PALS) team, and even each other — but, most importantly, from inside ourselves.

Knowing I can contribute to my nation validates my career choice, my passion, and my purpose here. I am proud to be a nurse and an essential worker in this time, and have zero regrets about joining the nursing workforce.”

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NURSES’ DAY 2020

COMMIT. Stepping up with dedication.

CARILLO KRISTINE ANGELIE SALVADORSTAFF NURSE, WARD D98, YCH

IN HER LINE OF WORK, KRISTINE IS USED TO PUTTING OTHERS FIRST. AMID A PANDEMIC, HER SACRIFICES HAVE BEEN EVEN MORE PRONOUNCED. NOT ONLY DOES SHE ACCEPT THE RIGOUR, INCONVENIENCE AND DISCOMFORT OF ENHANCED INFECTION PROTOCOLS, SHE HAS ALSO HAD TO POSTPONE HER NUPTIALS. BUT THESE TRIALS HAVE ONLY SHARPENED HER COMMITMENT TO HER CALLING.

“My role as a staff nurse hasn’t changed, but in accordance with pandemic guidelines and to keep our patients and colleagues safe, we have adjusted our usual routines. Every shift starts with checking-in and hand hygiene, followed by changing into the scrub suit. Before I enter the ward, I don my mask and PPE. Unlike a usual workday, when we can move about freely, I have to be more careful and follow a specific path to enter and exit, and be mindful of cool, warm and hot zones.

We also have to work around increased physical distance from patients. The work can get very hot and uncomfortable in full PPE, but I know it’s something I need to bear for my own safety and the welfare of my patients, colleagues, housemates and the community. I also make sure I shower and change before I go home to prevent transmission of germs and viruses to others. As a nurse, I believe we must be flexible to changes and have a united team spirit.

I feel that working in healthcare in a time like this is an honour and a privilege. It reminds me of the moment I realised I made the right move to be a nurse. Initially, it was my mother’s decision; but as a young nurse, seeing patients recover made me realise how fulfilling the work is. It was then that I found my passion.

And it has been such a satisfying career, even though there are so many challenges and even personal sacrifices. For me, it has meant postponing my wedding on 9 May, which also happens to be my fiancé’s birthday. It was heartbreaking at first, but I know that safety is more important. And in times like these, we have to put other considerations above ourselves. I do not have regrets at all. When that time comes, I do believe that it will be worth the wait!”

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KNG HAN NEE, SENIOR STAFF NURSE, PHCT

WORKING SIX DAYS A WEEK DUE TO INCREASING DEMANDS FOR HOME-BASED NURSING, HAN NEE CARES FOR PATIENTS IN THE COMFORT OF THEIR HOMES. IRONICALLY, FOR MORE THAN SIX MONTHS NOW, SHE HAS HAD TO FORGO VISITS TO HER FAMILY HOME IN MALAYSIA. DESPITE THIS, HER COMMITMENT TO HER CALLING IS UNWAVERING.

“Every time I step into a patient’s home, I feel privileged to have their trust. As part of the PHCT team, I support — through home visits and phone follow-ups — patients and their families after they have been discharged. I also guide and train patients and caregivers on self-monitoring and management.

It can take time to connect with patients; when it happens, it feels so rewarding. One of them is elderly, lives alone, has mental health issues, and is hard of hearing. He was initially resistant to my visits but I have gained his trust over time. He now takes his medication regularly, and has even learnt how to use a hearing aid and mobile phone.

Amid this pandemic, the fact that I can contribute my skills in these simple but meaningful connections with patients is fulfilling and impactful. It is rewarding to see patients improve after our interventions or whenever we can provide comfort, care and compassion to caregivers. On a broader level, we help to support the greater healthcare landscape and grow the reach of the nursing profession. This is especially so as we work to extend our Home Medical Services to more patients so we can ease bed occupancy rates and ensure continuity of care.

On a personal level, I miss my parents greatly. I used to travel home weekly to visit them, but can no longer do so due to the travel ban. We keep in touch over the phone. The thought of my parents supporting me pushes me to do my best for patients here. It hasn’t been easy, but I do not regret becoming a nurse. Instead, I am truly proud to be able to help my patients in these trying times.”

ROBLES FRANCIS JR BULACLACSTAFF NURSE, WARD B96, KTPH

MANY PERSONAL COMMITMENTS HAVE TAKEN A BACKSEAT DURING THIS PANDEMIC. FOR FRANCIS, IT HAS MEANT POSTPONING HIS WEDDING. PUSHING HIS DISAPPOINTMENT ASIDE, HE HAS DOUBLED DOWN ON HIS JOB, KEEPING RENAL PATIENTS IN HIS WARD SAFE AND CARED FOR, AND ENSURING THAT THEIR ESSENTIAL TREATMENTS CONTINUE.

“One of the hardest sacrifices in this pandemic was seeing my wedding plans in the Philippines — and months of coordinating, preparing and travelling back and forth — come to nothing in the blink of an eye. It was especially hard to muster the courage and inform our families and friends about this; they had been looking forward to this day as much as we have.

Despite this blow to my personal life, I am even more committed to my professional one. In the middle of this pandemic, I know I help provide a safe environment for my patients, many of whom I have gotten to know and built a rapport with over the four years I have worked here. It is always heart-warming and rewarding when they remember me — and when they show their trust in me by seeking my advice on how to get better.

Even though our ward does not handle COVID-19 patients, the effects of the pandemic still impact our work. Due to the fluid nature of the pandemic, we are constantly on our toes, adapting to changes in policy and protocol. We also have to ensure these updates, especially on visitation, are communicated clearly to patients and visitors. We are more vigilant in screening our patients, and have to expand our scope of work so we can alleviate the load for our colleagues in other wards. For example, our ward now takes on the management of surgical cases, which allows us to learn and hone different skill sets.

Despite the many challenges, I remind myself to count the good things that have happened. I am grateful that I am part of the healthcare team, able to contribute my experience, skill and time, and share the heavy workload in this difficult time. It has affirmed my career choice: I want to be and always will be a nurse.”

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NURSES’ DAY 2020

LIM YI XIANSENIOR STAFF NURSE, WARD B106, KTPH

YI XIAN TAKES HER RESPONSIBILITIES SERIOUSLY, AND CAN BE COUNTED ON TO LOOK OUT FOR HER COLLEAGUES. PATIENT CARE ASIDE, SHE MAKES A CONSCIOUS EFFORT TO ENSURE HER TEAM GETS ADEQUATE PHYSICAL REST BY ROSTERING AND MANAGING STAFF ASSIGNMENTS SO THEY DO NOT BURN OUT AMID THE INTENSITY OF COVID-19 WORK.

“Being a healthcare professional during this time is a great honour and responsibility. Living and working through a pandemic has been a great learning opportunity. Maintaining positivity and keeping calm under pressure are ways that I employ in order to help reassure myself, my patients and colleagues at this time.

This pandemic has particularly highlighted the importance of nurses as healthcare professionals who are present at the bedside 24/7. Every action we take makes an impact, from our clinical role in delivering patient care to being a patient advocate. Beyond our clinical roles, even something as simple as setting up teleconferencing for an elderly patient can be meaningful. I’ve seen a 90-plus year-old patient shed tears of joy after she was able to virtually meet her daughter through a tablet screen. That moment greatly moved me.

The work of my colleagues uplifts me as well. They inspire me greatly with their often silent but selfless dedication. We adapt quickly to new measures, such as the donning of designated PPE, learning new competencies such as swabbing, while also managing a high volume of admissions and transfers due to the conversion of my department to a pre-swab ward.

Work may have been busy and challenging these few months, but my nursing family show up every single day without fail to deliver their best care. Some of them have been deployed to other areas, such as A&E and ICU, to be upskilled and/or to support operations there. Others also have volunteered unflinchingly to directly care for COVID-positive patients.

Living through a pandemic has moulded me into being a better nurse. We all have had to hone our communication and critical-thinking skills quicker than we would have had to during peacetime, yet we always strive to not lose sight of what is inherently important: our patients.”

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CONSTRUCT. Lighting the way with positivity.

SITI ZAHIDAH BINTE MOHD YAZIDSTAFF NURSE, PHCT (BELOW)

IN HER WORK WITH THE COMMUNITY, ZAHIDAH ENSURES THAT PATIENTS’ NEEDS ARE SEEN TO. WHEN MANPOWER WAS NEEDED FOR THE RISING NUMBER OF COVID-19 PATIENTS, SHE VOLUNTEERED TO CARE FOR THEM IN AN INPATIENT SETTING.

“I had fears, especially in the beginning, when we didn’t know much about the virus. But with the number of cases increasing, I knew my nursing sisters in the inpatient wards would be under a lot of strain, so I volunteered to be an extra pair of helping hands — because it’s my calling.

In the COVID-19 ward, I saw how worried patients were and how it affected their family members. Many of them cried during their video calls. It was sometimes hard to communicate, but I was able to converse in simple English, and would always end by reassuring them. It was always wonderful when doctors broke the news that patients were COVID-free. Even with their masks on, I can ‘see’ their wide smiles. When patients make video calls to inform their families of the good news, some let me talk to their family — I feel so touched, and happy for them, too.

I am buoyed by my cheerleading squad. My nursing friends and I have a Happy Vibes chat group that we use to organise gatherings and share positivity, jokes and laughter. The message I regularly share with them I also share with Singapore: let us stay safe, stay positive, and keep those spirits up — we will get through this together.”

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NURSES’ DAY 2020

FARHANA BTE SALIM NURSE CLINICIAN, WARD B105, KTPH (ABOVE)

RUNNING A BUSINESS-AS-USUAL (BAU) WARD, FARHANA AND HER TEAM HAVE NOT BEEN SPARED HAVING TO FACE UNPREDICTABLE FACTORS ARISING FROM COVID-19. THOUGH SADDLED WITH MORE RESPONSIBILITIES, SHE REMAINS COMMITTED TO CARE FOR HER PATIENTS IN THE WARD, WHICH COMPRISES GENERAL MEDICINE, DIABETIC FOOT UNIT, AND ACUTE STROKE UNIT.

“We went through numerous changes in administrative process, workflow and clinical protocol as we learnt more about the disease and raised levels of patient safety and infection control. We now care for more patient types. These changes require new clinical competencies and greater monitoring, and has meant stepping out of our comfort zone to learn new skills. We have also stepped up patient and family education. Clinical work aside, we do a lot more reassurance and explanation to alleviate the anxiety of patients and their next-of-kin, especially because visits are restricted.

I am heartbroken not to be able to hug my three young children when I return home after a long day until I’ve had my shower. But I feel it’s important to remain calm and positive. These trying times are a learning experience, and give me a sense of fulfilment being part of a team fighting this pandemic. This experience has allowed me to stretch my capabilities, challenge my clinical knowledge, and solidify my commitment to the nursing profession.”

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TOKONG ANNETH CANOYSENIOR STAFF NURSE, WARD B76, KTPH

KEEPING UP WITH DEVELOPMENTS DURING A PANDEMIC HAS BEEN A BIG CHALLENGE — NOT JUST IN THE WORK ITSELF, BUT ALSO IN BUILDING RESILIENCE. THROUGH IT ALL, ANNETH HAS REMAINED POSITIVE, GUIDING AND SUPPORTING HER TEAM THROUGH MULTIPLE CONVERSIONS OF HER WARD AS THE SITUATION EVOLVED.

“A nurse’s job has its doubts and fears — and burnout is real, especially now. But we can shape our environment, attitude and perceptions so that, while we face many difficulties, we can still have fun, take time to care for ourselves, enjoy our work, and boost the spirits of our team.

As nurses, we carry on a legacy. Throughout history, nurses have always played an integral role during pandemics; knowing this inspires us to serve, care and comfort. With this attitude, happiness can be found.

I know COVID-19 has been a worrying time for all, but we have to conquer our fear of uncertainties. By learning and understanding more about the disease, we can overcome these anxieties and feel more confident. This confidence builds each time we see a patient get well. I remember when our very first patient was discharged — we felt victorious! We jumped and danced like kids, knowing he could be with his loved ones again.

Of course, not all days are like this — there are bad days. But it is our choice to move past getting upset and find strength in words of inspiration from our colleagues. Today, we put our heads down and battle on. One day, this fight will be a memory and part of history; then we can look back, hold our heads up high, and say, ‘We won!’”

YVONNE TAN SIOW LIN NURSE MANAGER, WARD D97, YCH

YVONNE HAS SEEN NURSING CARE DELIVERY BECOME EVEN MORE CHALLENGING — RISING WORKLOADS, RESTRICTED INTERACTIONS, AND ADDITIONAL INFECTION CONTROL MEASURES HAVE PUT PRESSURE ON HER. BUT SHE LEADS WITH EMPATHY FOR PATIENTS AND HER TEAM.

“While my ward manager responsibilities are largely unchanged, I pay more attention to compliance of infection control measures and PPE use. Patients are restricted to their cubicles and cannot receive visitors. Our interactions with patients must be done in full PPE, and sometimes from a distance and in shorter duration. We can no longer socialise with colleagues like we used to. But these challenges do not mean we cannot connect and care for each other — we just have to do it in new ways.

I couldn’t be prouder to be a nurse — there’s been an increase in the public’s appreciation of us. This crisis has also shone a spotlight on the central role that nurses play in the healthcare sector. There are so many different ways that we as nurses can adapt and contribute.”

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NORINE GOH NURSE MANAGER, WARD B26, KTPH

WORKING IN THE ICU HAS TAUGHT NORINE MUCH ABOUT WORKING UNDER PRESSURE. SHE BRINGS MORE THAN SKILLS AND EXPERIENCE TO THE TABLE; HER RESILIENCE, COLLABORATIVE

NATURE, AND CHEERY DISPOSITION BUOYS HER AND HER COLLEAGUES IN TOUGH TIMES.

“During this pandemic, we increased ICU capacity in anticipation of a surge in COVID-19 patients requiring intensive care. This has led to general ward nurses as well as nurses from other specialties taking an ICU crash course to support this ramp-up. It took a tremendous amount of coordination while firefighting unprecedented issues, sometimes with unfamiliar resolution methods.

It has been a fearful time, a stressful time, and a busy time. We have had to contend with anxiety and work reshuffles. There is also the emotional strain of caring for patients under visitor restriction and witnessing their isolation. We all try to facilitate video calls; it’s always bittersweet for us in these moments. Our work is a daily challenge, with constantly changing situations, guidelines and protocols. All these not only take place under safe-distancing and infection-control workflows, but in hot and sweaty PPE.

At this time, being of the mindset that ‘tough times don’t last, tough teams do’ has been helpful. It helps me to look beyond the current challenges to see the outcomes we can achieve as a team. I learn from colleagues who have been through the SARS epidemic, and the guidance and support from my family, bosses, colleagues, and friends at work. These bring comfort and reassurance that we will get through this.

The whole experience reminds me, more than ever, that I hold a big responsibility as an advocate for my patients and, in my current position, my nurses. Although it has been a challenge to maintain normalcy among the chaos, it has been an enriching experience as I get to work even closer with my fellow nurses and colleagues from across Yishun Health.”

Rawaida (right) with her colleagues

from the A&E

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RAWAIDA BTE MOHAMED ARONSENIOR STAFF NURSE, A&E, KTPH

RAWAIDA’S OPTIMISTIC ATTITUDE SEES HER THROUGH THE TOUGHEST OF DAYS. IN THIS CURRENT CRISIS, THIS PERSPECTIVE CARRIES HER THROUGH THE MANY WORK CHALLENGES AND PERSONAL SACRIFICES SHE HAS HAD TO MAKE IN THE PURSUIT OF HER ROLES AS A NURSE, MOTHER, WIFE, DAUGHTER AND COLLEAGUE.

“Every day is a challenge and a constant adventure. I feel privileged that I am in a position to help and to be at the forefront of the pandemic. While there is a sense of being on high alert all the time at work and at home, I try to stay positive.

I am fortunate to have a family that appreciates the work I do. Being able to work with team members who always thank each other for the hard work at the end of the day has also helped me get through this difficult

time. When I am having a bad day, I tell myself that, after all, it is just a bad day and not a bad life.

It is rewarding to take all that I have been given in my work and life, and turn them into something good. My job, for all its many hardships, definitely instils a sense of accomplishment in me. Sometimes it calls for working past my shifts to do training; most days, I get home exhausted. But I gather my reserves to spend time with my toddler son and guide him in his home-based learning.

With all things in life, I just try my utmost, and I actually do enjoy the challenge of pushing myself; at the end of the day, it makes me feel satisfied. In a crisis such as this, it is good to have the end goal in mind. Things happen for a reason. We can push on and push through by focusing on our mission and doing the best we can.”

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