The interview with Associate Professor Tay Kiang Hiong and Ms Aw Lian Ping takes place as Singapore continues to battle the COVID-19 pandemic. When they are asked how the work in their respective departments has beenaffected, both A/Prof Tay and Ms Aw draw comparisons with the situation caused by the Severe Acute Respiratory Syndrome (SARS) in 2003.
‘After SARS, we re-examined our infection control measures to beef them up. The Hospital formed a disease outbreak taskforce to tackle global healthcare crises like COVID-19. I am a member of the team,’ says Ms Aw.
One of the big differences for Ms Aw and her colleagues in the Department of Radiography between their work now and in 2003 is the provision of a lead-lined X-ray room in the fever screening area: ‘During SARS, we had to use a makeshift X-ray room with mobile lead screens in the fever screening area. This time, we are more prepared and we can respond faster. We only need to push a portable X-ray machine into the lead-lined X-ray room and we are ready to provide the imaging service.’
In cases where CT scans are needed, there are stringent control guidelines in their CT scan rooms. These procedures have been put into practice beforehand in ‘ tabletop exercises’, hospital-wide dry run rehearsals that took place regularly. Ms Aw credits the preparedness of her department to years of careful emergency planning and practice:
‘When the pandemic happened, all these things were pulled out, to review and to see what are the areas we need to do better in. In January and February 2020, when the first cases started to come in, we were ready because we had done preliminary work, our infection control guidelines are in place and we are familiar with the use of PPE.’
A/Prof Tay has a jovial personality but when the subject of COVID-19 and SARS comes up, his manner turns serious. There had been a cluster at SGH Diagnostic Radiology during SARS: ‘A SARS patient unknowingly came to our department and as a result, several patients, visitors and a few of our staff including one health attendant became infected. The health attendant passed away from the disease.’
SARS provided costly and painful lessons. The difference between SGH now and how it had coped with an infectious disease outbreak two decades ago is evident: ‘Because of that past experience, now we segregate our inpatients from outpatients. We are also used to the concept of split teams; very early on, we implemented this. We are conscious of the implications of a quarantine. If large numbers of us get quarantined, the work cannot get done and patient care will suffer.’
The pandemic has resulted in a bumper crop of international peer-reviewed publications for him and his team, a reflection of global thought leadership. He shares that since 2020, he has published over 10 articles on crisis leadership, pandemic preparedness, infection prevention control and safety measures as well as protocols in reputable journals: ‘The fact that we have been able to share our expertise with countries like the US, Australia, New Zealand and Europe, is a big honour.’
Before 2020 and 2021, SGH Interventional Radiology (IR) already enjoyed high standing in the world, thanks to the contributions of the pioneers of the department. He highlights his predecessor and mentor Professor Tan Bien Soo’s achievement in being awarded Distinguished Fellow by Cardiovascular and Interventional Radiology Society of Europe (CIRSE). Prof Tan was the third Asian to receive this accolade, ahead of many senior interventional radiologists in the bigger Asian countries.
About a decade ago, IR was restructured to better cater to the care of patients coming for IR procedures and the SGH IR Centre, the first in the country, was formed. In 2017, SGH IR led the way again by being the first in the region to form a separate Department of Vascular and Interventional Radiology to further enhance the level of clinical care, education and research in IR.
A/Prof Tay says, with a laugh, that this is his first and last job. On hindsight, choosing IR was a fortuitous decision: ‘Before I graduated in 1990, I had wanted to be a surgeon, but when I went through the surgical rotation, I saw that it was very competitive. Seeing how, in the early days, there were so many other areas of need also got me thinking.’
He was posted to SGH Diagnostic Radiology for a month during his National Service (NS). Whilst he was there, he saw doctors using IR to treat patients.
It made a positive impression on him, so much so that after completing his NS, he requested to return to the same department as a Medical Officer.
‘IR was such a new specialty at that time,’ he says, joking that IR is often mistaken for Integrated Resorts these days before he continues: ‘The Consultants at that time were very happy for people to join them, they needed people to grow this new specialty. Because of that, I got a lot of opportunities. I was sent to Canada, one of the top centres for IR, for further training and I was supervised by Professor Lindsay Machan who is very famous in the field. I got a lot more opportunities in terms of research and lecturing because of him.’
A/Prof Tay’s self-deprecating sense of humour comes across in his throwaway remark about benefitting by ‘some osmosis’ from his ‘big shot’ supervisor’s reputation and network. Another remark about how he came to head his department is similarly self-effacing: ‘Because it’s a small team, I became chief of IR and from there, I b ecame chief of the whole department.’
No doubt his successful career has been the result of hard work and dedication. He mentions how deeply satisfying and fulfilling his work has been several times during this interview. At the end, he reveals that his daughter, a Diagnostic Radiology Resident, plans to specialise in IR too. He adds, with a laugh, that it will be ‘quite awkward’ although it is obvious that he is filled with pride and delight.
Ms Aw’s description of how she came to become a radiographer also strikes one as being fortuitous. After completing her ‘A’ Levels, she temped as a clerk in Singapore Airlines. Travel perks were an enticement, she admits with a quiet chuckle, and her plan was to apply for a permanent position. But one day, a church friend mentioned that she was trying for a position as radiation therapist. Ms Aw accompanied her friend to the interview: ‘It was at MOH. That was where I realised there are two fields in this radiation work. One is the diagnostic radiographer, one is radiation therapist. I chose to join the school to train as a diagnostic radiographer. The course took two years. When I finished it in 1987, I joined SGH as a radiographer.’
She was thankful for the job as she came from a family with modest means. To be offered a job that provided training and an allowance struck her as a good deal. When she recalls her first impression, the awe she felt back then, almost thirty years ago, seems to show in her voice: ‘It was one of the bigger departments at that time. There were a lot of X-ray rooms. We had very good training and exposure because the patients we saw had a wide range of diseases, so you could learn a lot.’
Her boss, Mr Tay Ngiang Soon, sent her for training in Japan. She was elated to be chosen as she was still a junior radiographer back then. Not only did she get to travel overseas, but she was also based in Japan for four months and her training involved learning how to use the Computed Radiography (CR) machine.
Ms Aw remembers that experience well because she cherishes being given that rare opportunity to train overseas: ‘This training programme was sponsored by the Japan International Medical Technology Foundation and Japan Association of Radiological Technologists as Singapore was considered a Third World country back then. There were radiographers from the region and also representatives from all the major Japanese companies.
Whilst I was there, I met the Fuji representative. He told me that SGH had bought the CR machine. That would be our first CR machine. Before that, we were on analogue systems using X-ray films. After I returned from the training, I was able to make use of what I had learnt and operate the new machine. That was the beginning of our Digital Radiography journey.’
What does the future hold for SGH? Ms Aw and A/Prof Tay’s responses are unanimously positive. Their optimism speaks volumes about their sure-footed confidence in SGH. Ms Aw shares that for staff safety, her department came up with the innovation of using a booth to performchest X-rays for patients without them coming into contact with radiographers. The patient is given instructions to position themselves and the radiographer takes the X-ray from a safe distance. She is confident that robotics will herald more breakthroughs in her field.
For A/Prof Tay, the embrace of Academic Medicine has resulted in the most remarkable changes at SGH. Although research and education have always been pursued at the Hospital, clinical service always came first until the recent years’ push for Academic Medicine: ‘Whether it’s on the research side or the education side, I can see that the framework is getting stronger and stronger. For the younger people coming up, it’s no longer the way it was in my time, when we had to find time after office hours and during weekends to do research and teach.
Now, education itself is a specialty and there are opportunities to obtain a Masters or even PhD in Education. In research also, we are doing higher level research. It’s no longer just case reports. We conduct clinical trials, we do device development.’
When A/Prof Tay talks about research, his eyes light up. He shares that IR procedures have very high success rates, so whenever cases fail, they are taken very seriously and thorough reviews are carried out. Failure is the impetus for improvement, and research is what makes improvement possible: ‘There are certain procedures where we have found that the results are not so good. They become the focus of our research: how can we make it better?
We conduct a lot of clinical trials. Sometimes, there are many treatments for the same thing. How can we tell which would be best for the patient in terms of durability, cost, effectiveness, sustainability?’
He gives the example of comparing different types of balloons in treating the narrowing of blood vessels in kidney failure patients on haemodialysis. The results of the trial led not only to more informed decision-making for patients, but also to the publication of a research paper in one of the world’s top IR journals in 2014 where it was voted the best paper of that year.
Their shared optimism about the future of SGH and Medicine in Singapore is the bright note on which this interview ends. The optimism comes from a grounded sense of what is possible, from having gone back to basics to address problems at root cause and putting in place the necessary changes and reinforcements. Whether it’s preparedness for this pandemic or the next, whether it’s research and education for higher clinical standards and raising healthcare in Singapore to the next level, there is much to cherish and good cause for hope.
Aw Lian Ping is a Diagnostic Radiographer experienced in general radiography, mammography, computed tomography (CT) and magnetic resonance imaging (MRI). She is currently Head of the newly formed Department of Radiography. She graduated from the School of Radiography at the Ministryof Health and holds a BSc in Medical Imaging from Curtin University, Western Australia.
A/Prof Tay Kiang Hiong is currently the Head of the Department of Vascular and Interventional Radiology and immediate past Head of the Department of Diagnostic Radiology. After his medical and radiology training in Singapore, he completed a 12-month Clinical Fellowship in Vascular & Interventional Radiology followed by a six-month Research Fellowship at the University of British Columbia under Dr Lindsay Machanfrom 2000 to 2001. A/Prof Tay has authored and co-authored more than 110 publications and 380 scientific abstracts and has two patents to his name. A regular speaker at national and international conferences, he was conferred Fellow of the Society of Interventional Radiologists (FSIR) in 2010 and Fellow of the Cardiovascular and Interventional Radiology Society of Europe (FCIRSE) in 2018. He is the Secretary General of the Asia Pacific Society of Cardiovascular and Interventional Radiology (APSCVIR) and President of the College of Radiologists Singapore (2019–2021).
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