The 2018 Asian Games
Every four years, the Asian Games (AG) and Asian Para Games (Asian PG) highlight the commitment and work put in by our national athletes to achieve their best when representing our country. While it might culminate in athletes achieving a podium position, this is often only the beginning of an even longer journey that many hope will subsequently lead to them competing at the highest level – the Olympic or Paralympic Games. Following last year's South East Asian Games (SEAG) and ASEAN Para Games (APG) held in Kuala Lumpur, Malaysia, the 2018 AG was held in Jakarta (Java) and Palembang (Sumatra), Indonesia. Since the success of the home 2015 SEAG and APG, Team Singapore has been aiming higher and higher when competing on the world stage. This year, a total of 265 athletes and 140 officials travelled to the AG, representing the hopes of our nation. At the final ranking, Singapore was ranked 18th out of 37 participating countries.
For the athletes who competed, their work continues with the focus on their next competition. This is despite enduring injuries from the competition and training, daunting schedules and funding concerns. In many ways, the level of commitment to their sport is similar to that seen among medical professionals over the span of their careers; without perseverance and commitment, attaining one's goals or professional fulfilment will be an almost impossible dream. Indeed, there are many lessons about resilience, mental fortitude and dedication that the general public can learn from our athletes.
Medical support
To support the athletes, a team comprising sports physicians, sports physiotherapists, sports scientists and sports trainers from the Singapore Sports Institute, the National Youth Sports Institute, and both the public and private sectors, provided medical services and coverage for the Games. The level of involvement ranged from meal planning and post-event nutritional recovery, to checking of lactate levels during training and preventing or managing acute injuries or illnesses.
With the 2018 AG taking place in Jakarta and Palembang, Team Singapore was essentially split into two teams, and medical and recovery centres were established in the Athletes' Villages in each city; for the former, it was based at Kemayoran, while in Palembang, the team was based at the Jakabaring Sports City. It meant that athletes could be looked after in a centralised manner and resources could be optimally utilised. In addition to the treatment centres, physiotherapists or sports trainers were allocated to specific teams for the duration of the event, enabling better understanding of the sport and the demands that athletes experience, and the ability to treat symptoms immediately.
Medical resources were also allocated based on whether or not the sport was considered high-risk (eg, rugby, combat sports). In such situations, a sports physician and a physiotherapist or sports trainer, trained in immediate care in sport, were allocated to the event to support the team and manage any concerns. Although they were not called upon often, it meant the athletes' care and return to play could be expedited where appropriate, in situations where assistance was needed.
In addition to the medical support provided by Team Singapore, the Indonesian Asian Games 2018 Organizing Committee (INASGOC) set up polyclinics at the Athletes' Village, equipped with 24-hour medical support, a pharmacy for emergency medications, X-ray and/or diagnostic ultrasound services and specialist consultations for dental, orthopaedic and ophthalmological conditions.
Challenges
During the preparatory and delivery phases of the 2018 AG, a number of challenges arose and served as a positive learning experience for the medical team involved. This was particularly pertinent due to the team being split between two islands and the geographical spread of events in Java.
Pre-Games
Prior to travelling to Indonesia, one of the key activities was collating information about the athletes and officials who would form Team Singapore – particularly those who were first-timers to the Games. General health questionnaires and pre-participation screenings were conducted to establish if there were any pre-existing medical conditions, and whether or not medications or supplements that were being used were compliant with the anti-doping rules. For athletes requiring a therapeutic use exemption, steps were duly taken to submit their applications as needed.
Another pre-event consideration was the deployment of medical services due to the length of the games and turnover of athletes; sports teams would arrive a few days before their events and leave for home upon completion of their competitions. This rapid turnover meant that medical personnel were deployed from one team to the next as we needed to ensure that there was sufficient coverage. This required advanced planning of logistics and maximising utilisation of resources of manpower and medical supplies.
Games time
Compared to the 2015 SEAG held in Singapore, where residences and venues were readily accessible, some competition venues in Jakarta were located at a fair distance from the Athletes' Village. When coupled with unpredictable traffic situations and security concerns, it meant that staff at venues and the medical centres needed to be self-sufficient. Fortunately, with the support of host medical services, Team Singapore's medical staff were able to support our athletes with the medical care they required.
Another challenge during the Games was communication. With the many different stakeholders involved at such an event, it was important to establish clear lines of communication so that information was provided on a need- to-know basis. So while there might be multiple conversations taking place within the medical team, with individual teams and athletes or with the Team Singapore Games secretariat, at any one time, the route of communication for all things medical was through the Chief Medical Officer, Dr Teoh Chin Sim, and Lead Physiotherapist, Ms Yeo Hwee Koon. Through their combined efforts, the medical team was able to provide coordinated care and information to the various stakeholders as required.
Finally, with only three sports physicians looking after the entire contingent, 24 hours a day for three weeks, one was challenged to find pockets of time in-between work to recuperate and reflect, as duty and service to others always came first and foremost. However, it is important to always "sharpen one's saw"; one way was to take part in exercise or physical activity when time permitted, while other methods included communicating with family and friends back home or visiting the other medical centres to share experiences with colleagues. All this provided an essential time-out from the clinical environment and by doing so, enabled refocusing on the task at hand.
Sports medicine and the community
At the end of the 2018 AG, members of the sports medicine team returned to their respective institutions having gained invaluable knowledge and experience. This learning can hopefully be applied in routine clinical practice, benefitting the general public in overcoming their injuries or medical complaints.
Indeed, many of the experiences from elite sport have been successfully translated to clinical practice, whether they are techniques to optimise recovery from sports surgery, provide pre-participation screening, or develop alternative treatments for common musculoskeletal conditions. With the paradigm shift in healthcare from simply treating conditions to trying to prevent or limit their impact, experiences at such major games can be particularly useful for clinicians in refining their knowledge of preventative strategies in sport, as well as recognising when early interventions are required.
Elite sporting events are believed to bring out the best in athletes, support staff and even the spectators, inspiring individuals to give their best efforts in support of their nation. With the strong pool of clinicians gaining experience from events over the years, the sporting and active population in Singapore will surely continue to reap the benefits for many years to come.