27 Nov 2011
BY: Judith Tan
Every child, no matter how tiny or weak, is worth saving.
Going by this motto, Professor Ho Lai Yun, 63, lives and breathes babies, particularly those born pre-term.
The senior consultant at the Department of Neonatal and Developmental Medicine at Singapore General Hospital (SGH) does not walk through the neonatal intensive care unit without pausing at every incubator.
Neonatology, a sub-specialty of paediatrics, focuses primarily on the medical needs of newborn babies, or neonates, still in hospital.
If a baby is born prematurely or with an obvious medical problem, he is taken directly to a neonatology centre for intensive treatments.
“Previously, we focused entirely on the survival of these preemies (premature babies), but today we also pay more attention to their welfare and long-term development to ensure they live and grow up healthy,” he said.
Early last year, Prof Ho, who is also a Justice of the Peace, married a couple not knowing that the bride was one of his former patients.
“I didn’t know the bride was a former patient until her mother whipped out a photo of her in the incubator. I felt a tear knowing that that tiny baby in the picture had grown to be the beautiful bride,” he said.
Prof Ho was instrumental in establishing neonatology here. He also pioneered many important programmes in perinatal care, bringing in a new era of collaboration with obstetricians.
These included birth defect clinics, perinatal counselling services, multi-disciplinary high-risk consultations and neonatal follow-up programmes.
But becoming a paediatrician, let alone a neonatologist, was not Prof Ho’s first choice as a vocation.
“My brother’s a paediatrician and a neonatologist to boot. I didn’t want to be in his shadow,” he said, laughing.
As fate would have it though, after graduating from medical school in 1973 and posted to general surgery, he kept getting assigned to child patients.
“It seemed I had a way with kids,” he said.
When he finally got his paediatric posting, he was sent to “the less popular area of looking after pre-term babies”.
“Neonatology – then and even now – is not popular because it involves long hours and hard work,” Prof Ho said.
To develop his specialty in child medicine, he applied for and received a Commonwealth Scholarship in 1981 to train at the Hospital for Sick Children in Toronto, Canada, one of the foremost neonatal departments in the world.
“We affectionately call it Sick Kids,” he said, adding that the 12 months spent there changed his life. “It was the time of rapid development in neonatology. It was then the first hospital that put premature babies in a ventilator.”
“Prior to this, people actually went into this field without knowing much about the physiology of newborns, especially premature babies,” he said, adding that treatment was by trial and error, according to adult protocol.
“For example, premature babies need oxygen, and it was given to them indiscriminately. As a result, a lot of these babies, because of the high exposure to oxygen, became blind,” he said.
“Because of this, the amount of oxygen was then arbitrarily lowered to not more than 40 per cent. There is no scientific basis for this. Some babies ended up with cerebral palsy.”
At the hospital, Prof Ho said he was shown not only the good of neonatology but also its mistakes.
“I was taken to the floor above the ICU. It was filled with babies who had been ventilated on adult ventilators and suffering from lung damage and disorder,” he recalled.
This is, as Prof Ho sees it, the essence of mentorship – to be exposed to the good and bad.
“You tell doctors they are here to learn. There is the good, but at the same time there is the bad that should not be repeated. Others would rather hide the mistakes,” he said.
And this essence Prof Ho kept with him, when he himself became a mentor to younger doctors. He was such a conscientious and effective mentor that he won the prestigious National Outstanding Clinician Mentor Award 2010, given by the Health Ministry.
He said mentoring involves “a brain to pick, a ear to listen and a push in the right direction”.
When he returned in 1982, Prof Ho not only modified the adult ventilators in SGH, making them suitable for babies and saving smaller and smaller ones, but he also drove home the message of continuing care.
He pioneered many important programmes in perinatal care such as birth defect clinics, perinatal counselling services, multi-disciplinary high-risk consultations, and a neonatal follow-up programme. He also initiated congenital hypothyroidism screening and neonatal hearing screening as early as 1990, both of which are now practised nationwide.
“It is important to keep in touch. By following through, we have the results to justify the continued development and practice of neonatology,” he said, adding that the oldest preemie he looked after is already 25 and happily married.
Having seen what could happen to babies born premature if the right management was not given, Prof Ho also got involved in fostering the area of early child development service in Singapore.
In 1991, nine years after he returned from Canada, he founded the Development Assessment Clinic. Under his leadership, it became an important local and regional referral centre. It identifies early and manages children with developmental problems, to correct developmental dysfunction if possible and minimise the impact of a child’s disability.
But his work with children does not simply stop when his day is done at the hospital, making it hard to tell when his day job ends and when his volunteer work with various children’s organisations begins.
Outside of work, he continues to live and breathe children and their welfare.
He initiated several pioneering research on child abuse and neglect, as well as parenting practices, while volunteering at the Singapore Children’s Society.
His work with children and efforts in the Prevention of Child Abuse and Neglect (CAN) provided him with useful insight to help develop legal and social policies for CAN in Singapore.
Prof Ho said his concerns for child abuse and neglect started as early as the 1970s when, as a houseman on medical rounds, he noticed children who were victims of abuse, neglected in the wards.
“At that time, there was no proper training for hospital staff in caring for such victims. We were not equipped to manage them and it was an unpleasant issue,” he said.
One particular little girl has stayed in his mind till today.
“She was about four then and was born a blue baby. She needed constant care and attention but her parents neglected her. She had three strikes against her – born a girl, born with a defect, and born in the year of the Tiger,” he said.
A blue baby is one born with cyanosis or dark bluish or purplish discoloration of the skin as a result of a congenital defect, causing inadequate oxygenation of the blood.
Prof Ho said all she needed was care and concern, “and she kept by my side while I did my paperwork at night”.
But her life was tragically cut short. “One morning, a ward nurse came and told me (the girl) had died and handed me a little gift she made for me but never had the chance to give to me,” he recalled, with a glint of tears in his eyes.
With her in mind, Prof Ho actively championed the cause – continuing to look after children like her at the hospital and was on the panel to map out national strategies for the prevention of child abuse and neglect.
In recognition of his contributions in this area, he was conferred the C. Henry Kempe Distinguished Career Award by the International Society for Prevention of Child Abuse and Neglect, which is based in the United States, in 2008.
Yet Prof Ho is not one to rest on his laurels. Despite having worked for more than 20 years on these issues, he believes there is still a lot of work to be done.
“Like neonatology, it’s hard work and long hours. All you need is a very understanding wife and family, and I am lucky I have both,” he said.
His wife, a former journalist, is now a housewife and they have three grown sons, two of whom are in the medical field.
His philosophy: Take a step at a time, but make each step count. Eventually you will reach your destination.
Email: juditht@sph.com.sg
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