Post-SARS, capacity development remained a key priority, especially with ongoing threats such as the H1N1 epidemic in 2009. However, it was the Covid-19 pandemic in early 2020 that brought on unprecedented onslaughts, not just for SGH, but for healthcare globally. SGH swiftly established a COVID19 Taskforce to direct hospital and nation-wide attempts to contain the infection, beefing up its laboratories, frontline staff and emergency services. In early April, the crisis ratcheted up a notch when foreign worker dormitories were found to be virus hotspots, and medical teams were galvanised to work with other agencies to devise stringent protocols for testing, isolation and recovery. This was a major logistical and medical undertaking to deal with sheer volumes stemming from the more than 1 million foreign workers. Healthcare staff were also isolated from their loved ones for long periods. The Circuit Breaker period of 8 April – 19 June 2020 when the entire Singapore was placed under a stay-at-home order was an intense and prolonged testing of the mettle and resolve of SGH staff. Healthcare teams went beyond the physical confines of SGH campus, to be on duty at 4 Halls of Singapore EXPO, with a combined number of more than 50,000 infected foreign cases, forming mobile swab teams to test all migrant workers and elderly at nursing homes. At its peak, there were record tests of 1,600 done each day. By this time, complementing the services of doctors and nurses, were also volunteers, robots and in the recovery wards, SIA crew.
Crisis is the instigator of innovation, and better tests, as well as methods of testing had to be in place fast to ensure safety of the healthcare workers themselves. A team of SGH anaesthesiologists swiftly develop a foldable swab screen system that can help double the number of tests performed without putting healthcare workers at risk. They did so within a week in March, naming their system “Swab Assurance For Everyone” or SG SAFE in short. They also used industrial grade chemical resistant materials. The systems are now being used at SGH’s emergency department and extended facilities to assess patients for COVID-19.
Wearing just an N95 mask, the healthcare worker steps into the U-shaped transparent booth and sticks his hands into a pair of biosafety level 3 gloves built into the panel to take swabs from the patient who is standing or seated on the other side. The booth is then disinfected, and ready for the next patient. The entire process takes about two-and-a-half minutes.
In wards and clinics where SG SAFE is not available or cannot be placed due to space constraints, healthcare workers can bring in the SG SHIELD. As the name implies, it is a shield which blocks healthcare workers from droplet deposition that patients may cough out during throat swabs.
Conceptualised by a multidisciplinary team of doctors from SGH Departments of Otolaryngology – Head & Neck Surgery, and Urology, as well as clinical innovation engineers from Medical Technology Office (MTO), SingHealth, they drew inspiration for the design by observing a throat swab procedure simulation.
The mobile swab station (MSS) integrates a booth system developed by SGH called SG Safe, into a Singapore Armed Forces cross country ambulance. The joint project by the Singapore Army, Defence Science and Technology Agency (DSTA), and ST Engineering will help in the testing of all 323,000 foreign workers in dorms. The MSS was deployed on Monday (May 11) to do swabbing operations at places outside of purpose-built dorms.SG SafeR
Drawing inspiration from the innovation SG Safe, SGH’s Department of Diagnostic Radiology designed a mobile x-ray unit, SG SafeR that can be deployed off-site with lowered exposure risk for radiographers performing the x-ray. As a result of the protective isolation elements included in the design, the mobile x-ray unit can be operated by one, instead of the usual two radiographers, who wears just an N95 mask instead of full personal protective equipment.
In 2003 when SARS hit, SGH constructed two wards of 40 single-room cabins to nurse patients with fever of unknown cause. It was located at the site of the current National Heart Centre Singapore. In 2020, in the midst of the fight against Covid-19, SGH constructed an isolation facility occupying a total space of 3200 sqm, comprising 50 purpose-built isolation units and the necessary requisites needed in a ward. Each isolation unit is a negative pressure single room with en suite toilet and shower facilities to house patients with infectious diseases. This new facility is located in the car park adjacent to Bowyer Block and is aptly named Ward@Bowyer. By leveraging technology and developing tools as well as systems allows SGH to take better care of our patients, many of which are introduced in this new facility.
Since January 2020, the Isolation Ward nurses had been caring for suspect and confirmed COVID-19 patients, while the Molecular Laboratory staff processed up to 500 samples a day after the outbreak. In a short span of 4 months, the Lab has processed more than 10,000 samples, the workload of the preceding year.
The frontline teams of the Emergency Department (ED) and the Fever Screening Area (FSA) also organised Mobile Swab Teams to test migrant worker dormitories and elderly care homes. Compared to the 100 swabs they conducted a day during the initial phase of the outbreak, they had swabbed around 1600 tests a day for the virus, both at SGH as well as its many off site tents at Singapore Expo and foreign worker dormitories.
Logistical challenges of supporting unprecedented inflows of infected patients, meant endless daily challenges of ensuring testing safety protocols for staff, creating new beds and ad hoc isolation wards and all supporting. SGH had expanded beyond its physical structure. New wards were temporarily opened in the the newly completed Outram Community Hospital to house patients with non-COVID conditions.
The Japanese occupation forces took over the General Hospital for use by their troops in Southeast Asia.
However, the disruption from the war brought about a paradigm shift in the local medical community. With the expatriate doctors interned by the Japanese during the war, local doctors and staff assumed full responsibility in running the hospitals that continued to serve the locals. They proved themselves capable and became aware of the imperative need to unify the medical service with equal treatment of local and colonial doctors posted from Britain and India.
Just five years after gaining independence, Singapore was actively exploring avenues of economic development to ensure its sustainability. Initiatives were underway to make Singapore a liveable city, and healthcare systems and services had to keep pace with modern advances across the globe.
As the country was gripped by events like Konfrontasi, the Maria Hertogh riots, the Pulau Senang prison riot and the Hock Lee Bus protests, SGH continued to treat their respective victims.
SGH has undergone numerous transformations since its establishment nearly 200 years ago to keep up with the needs of Singaporeans. The iconic Bowyer Block, a National Monument in recognition of its national significance and rich history, is a standing reminder of how far we have come in advancing patient care.