As doctors, we are privileged to have the skillset to treat and comfort patients seeking medical care. However, the community at large is often in need of service and aid beyond medicine, and many doctors have realised and stepped up to fill these gaps. In this edition, we feature three senior doctors who have dedicated and volunteered their time and energy to serve different populations and communities outside of the healthcare setting. We hope that their sharing will also encourage colleagues to step up and offer your time and expertise in areas of need.
Gordon Tan
It was at 2 pm on 7 March 2024 when a Singaporean doctor looked up from his couch into the eyes of Mr Oliver Warren (Fellow of the Royal Colleges of Surgeons), the doctor on call at the Lister Hospital, London, UK. Mr Warren held films of a CT scan in his hands and spoke in a measured tone, "You need emergency surgery. Now." The patient asked, "What are you going to do?" Mr Warren replied, "I am going to try and save your leg."
That Singaporean doctor was none other than me.
I was in septicaemic shock from an invasive group A streptococcus infection of the left adductor compartment in my left leg. Following aggressive debridement surgery, I spent five nights in the Lister Hospital's intensive care ward with high doses of IV Augmentin running into my veins and Psalm 23 running through my head (a Psalm which I learnt on my first day of primary school in the Anglo-Chinese School and which was my strength through another episode of shock, this time hypovolaemic from blood loss many years ago, but that is another story for another day).
This experience of being ill in a far and distant land away from the comforts and support of home made me feel deeply for the plight of foreign workers who come to work in Singapore, a distant land away from their home. These workers play a big role in developing our infrastructure as well as carrying out domestic chores in our homes. Hence, when one of my patients' pre-medical school daughter approached me to seek my help with the platform which she and some pre-university friends were setting up, I leapt at the opportunity.
We soon organised a virtual question and answer session via Zoom, set at an appointed time where migrant domestic workers could easily dial in, and I provided help and advice for the workers directly. More often than not, it is such sessions of health education and reassurances that are required and not heroic surgery.
My phone number is also made available to these workers, and in this age of communication, patients can dial up or message in with any query or concern they have. This brings me to the point of availability. As trained and qualified doctors, we all have this calling which goes far beyond monetary rewards and a good night's sleep, as many of you would have realised. It is a calling to be always available to the sick and needy, and to be there to comfort, reassure and give hope. Even more so to those who are far away from home, essentially alone and without the financial resources to pay for such aid.
To me, a warm smile and a "thank you" from those I have helped is more than enough reward.
Ho Lai Yun
As a paediatrician, I received special training in preventing, diagnosing and treating diseases and injuries in children. It did not take me long to discover that increasingly, many children are at risk for health problems that are precipitated or exacerbated by social, community and environmental factors. Paediatricians cannot sufficiently address these health conditions without expanding their roles beyond providing health care to individual patients. Thus, to improve child health, we must work within the communities to identify the needs of the population being served and take appropriate action to influence the policies that address these needs. Volunteering thus became a natural calling for me.
Initiatives to protect our children
In 1986, I was a member of the review committee on Child Abuse and Neglect (CAN) in Singapore, initiated by the then Singapore Council of Social Service. The Government accepted the comprehensive report and recommended that a voluntary welfare organisation spearhead and drive the advocacy role of CAN prevention. That began my 38 years of uninterrupted voluntary service with the Singapore Children's Society (SCS). Our work is research-based, reaching out to at-risk children and their families. Over the years, we have improved the awareness and public attitudes on CAN in the community and influenced parenting practices in Singapore. We also initiated bully-free campaigns in schools and pioneered after-school care in the neighbourhoods. Sunbeam Place, a residential care home, has been transformed from a convalescent home for children with malnutrition and tuberculosis to one caring for children who must be separated from their abusive or negligent parents.
Since 2007, the annual SCS Lectures have become an important child advocacy series for our social work professionals and policymakers. SCS has been a member of the delegations presenting periodic reports on Singapore's achievements to the United Nations Convention on the Rights of the Child since 2001 as well. The SCS is also making significant contributions to our children and youths' social and emotional well-being, including preventing cyber- bullying and ensuring that their voices are heard. Our works are well recognised both regionally and internationally.
Continuing to make a difference
In 1991, as part of Singapore's Next Lap vision (under the recommendations of the Advisory Council on Disabled 1988), I was tasked to set up a Child Development Programme under the Ministry of Health (MOH) for the early detection and management of children with developmental problems. Recognising the limits of medicine, I started to venture out of my comfort zone and strove to build an inclusive, community-based, family-centred and child-focused early childhood developmental intervention ecosystem in Singapore, integrating medical, educational and social support, while establishing strong partnerships with the families in the community over the last 30-odd years.
As of 2023 year-end, we have 23 Early Intervention Programme for Infants and Children (EIPIC) centres operated by ten social service agencies and 29 EIPIC-private centres across Singapore, operating in continuum with a Developmental Support-Learning Support Programme. As a board member of SPD (formerly known as Society for the Physically Disabled) from 2012 to 2024, I witnessed its expansion to a more comprehensive service including early childhood intervention activities and life-course programmes for persons with disabilities. With a new vision of becoming an inclusive society and a new definition of meritocracy, our educational system has become more flexible, diverse and broad-based, recognising learners with different strengths and talents. Through years of advocacy to include persons with special needs in our nation- building story, special education is now compulsory. Since the inauguration of the National Institute of Early Childhood Development in 2019, I have served on it as a board member, playing a role in ensuring that we produce the best early childhood educators appropriate for our nation's needs.
I have also served on the Services Committee of the National Council of Social Service from 2004 to 2022, with six years as its board member, chairing the Voluntary Welfare Organisations Fund Committee in building their governance, service and research capabilities. I have been a volunteer with the Ministry of Social and Family Development since the days when it was known as the Ministry of Community Development, contributing to the Inter-Ministry Child Abuse and Neglect Management Networks in setting the national standards for child protection, Enabling Masterplans, and the Standing Committee on Disability.
Volunteerism has enriched my professional career and made my life more colourful and meaningful. It has given me a great sense of fulfilment and pride, and I am thankful for all the opportunities in my life journey.
T Thirumoorthy
Early in my medical career as a student and young doctor in Malaysia, I was informed and instructed that in the natural course of professional develop¬ment that one becomes a member of the national doctors' association. When I arrived in Singapore in 1979 to take the post of registrar in the Middle Road Hospital, I naturally joined the SMA and the Dermatological Society of Singapore.
Some well-meaning friends volunteered me to serve on the SMA Complaints Committee around the year 1988. These meetings went long into the night and there was often more heat than light emitted on the issues discussed. It was soon clear to the leaders in SMA that instead of being reactive and engaged in putting out fires, a proactive strategy of fire prevention was necessary.
The birth of SMA CMEP
The premise was that many of the complaints against doctors originated from deficits of medical education in the domains of professionalism, medical ethics, health law and communication science. Our strategy was to build educational resources and courses to provide the skills and knowledge so as to reduce the number of complaints and build up the patients' and public's trust in the medical profession. The SMA Centre for Medical Ethics and Professionalism (SMA CMEP) was inaugurated on 10 June 2000, and I had the privilege of being appointed its founding director.1
SMA CMEP opened a new avenue for the spirit of volunteerism to express creative, collective and collaborative work in developing and delivering educational programmes. This collaborative and innovative energy is clearly shown in the signature programmes of SMA CMEP.2
Volunteerism and collaborative work
The Advanced Specialist Training Professionalism and Ethics Course works in collaboration with MOH and the Joint Committee on Specialist Training to create and deliver a curriculum on medical ethics, professionalism and health law.
In the Medical Expert Witness Training course, SMA CMEP collaborates with the Academy of Law, Academy of Medicine, Singapore (AMS), Law Society Singapore and the State Courts of Singapore to equip medical practitioners with the legal knowledge and skills needed to prepare medical expert reports and give oral expert evidence.
In the Caring for Persons with Diminished Capacity programme, SMA CMEP collaborates with the Office of the Public Guardian and the College of Psychiatrists, AMS to train doctors to be competent Lasting Power of Attorney issuers and to care for the vulnerable. And for the Annual National Medico- Legal Seminar, our collaborative partner is the Medico-Legal Society of Singapore.
Challenges in volunteerism
Volunteerism is not without its challenges and heart-wrenching episodes, which are best used as stepping stones and not viewed as stumbling blocks to improving ourselves and the way we work. My experience has been that when we engage in altruistic work with a positive mindset, many helping hands will appear out of the ether and woodwork. In the journey of volunteerism, one will meet with many naysayers – listen to their wisdom, but do not pay credence to negative thinking.
Benefits of volunteerism
One benefit of collaborative volunteerism is that we meet many good people who inspire us and develop meaningful friendships to cherish for years to come. The work demanded of me to complete the Master in Ethics and Law, and Master in Counselling opened my mind to new avenues of knowledge and skills. Volunteerism in medical professional associations cannot but improve our own clinical practice and growth as a professional and healer.
Conclusion
When invited to volunteer, it is natural to ask, "What is in it for me?" or "What benefits will I get from volunteering?" My reply is that in my 25-year journey serving in SMA, the benefits I have reaped are tremendous and far more valuable than just money. Volunteerism, for me, contributed to a meaningful, purposeful and fulfilled professional life. The greater joy is in seeing our younger colleagues, enthusiastically contributing to the work started and bringing them to higher heights. We are able to walk out in the sunset in humble confidence, with a peaceful mind and a heart filled with gratitude.