‘It was around this time 20 years ago,’ Dr Chumpon Chantharakulpongsa is speaking about a groundbreaking procedure that involved more than 100 SGH staff and took close to 100 hours to complete: the separation of the Nepalese twins, Ganga and Jamuna, in April 2001. The operation was a success, making headline news around the world.
Dr Chumpon was one of the lead neurosurgeons. He compares the personnel from different departments who were involved in that surgery to a team of mountaineers scaling Mt Everest. Apart from bringing their skills, knowledge and experience to the table, they also supported one another emotionally. The connection between people is something he stresses throughout the interview, whether he’s talking about patients or colleagues.
‘When I teach, I don’t just talk about Medicine which can be very dry. I talk about human behaviour and principles that are drawn from everyday life. Medicinal behaviour is human behaviour. How we behave as doctors comes from how we are in our daily lives, the way we relate to other people.’ He uses the word ‘ frequency’ to convey the importance of c ommunication, or rather, the quality of attention that is required for people to properly understand one another.
Being on the same frequency was vital to the success of the separation of the twins. ‘We were a multi-disciplinary team with kampong spirit,’ Dr Chumpon says with a genial smile, ‘This is why SGH is the best place to work.’ His son, Dr Chan Shu Kiat Sukit, recently became a Resident in Neurosurgery.
He traces the start of the multi-disciplinary culture to the setting up of specialty centres in the 1990s. Neurosurgery plugged into the eco-system and worked with other departments and national centres. There were constructive conversations about the different sub-specialties that different departments were going into, which prevented duplication.
Dr Chumpon’s son, Dr Chan Shu Kiat Sukit, has followed in his footsteps. He is a Resident in Neurosurgery.
Another key factor in the success of any operation is the training and determination of all involved. Dr Chumpon recalls that he’d been in another surgery that was very challenging prior to the separation of the twins: ‘In 1990, I operated for 29 hours on a patient who had AVM.’ (AVM is arteriovenous malformation which disrupts normal blood flow and oxygen circulation due to an abnormal tangling of blood vessels.) ‘Looking back, it seems that I was being trained unknowingly for the toughest operation that came after that involving the twins.’
‘In surgery, every small thing can amplify the effect of the damage. It is very important to be meticulous.’ His eyes light up when he recalls the senior surgeons whom he’d observed closely as a junior doctor:
‘In 1981, I went to Neurosurgery at Tan Tock Seng Hospital (TTSH). I had the two best mentors, Tham Cheok Fai and Gopal Baratham, two very different characters. Mr Tham had started the unit. He was very meticulous. If you dropped one piece of paper on the floor, he would chase you to pick it up. He was very particular about cleanliness. He already had the mindset of infection control, long before people understood it.’
Dr Chumpon’s voice betrays his affection for his mentor: ‘ The hospital couldn’t afford to buy the instruments he considered the best. He liked German technology, so he bought them himself.’
His voice is softer now. He is remembering his other mentor: ‘Gopal Baratham was a writer, a thinker. He liked to talk to the patients, and because of his frankness, his warm and sincere personality, they trusted him even more which is s o crucial in surgery.’ Dr Chumpon’s medical education was in TTSH and SGH. He was born in Thailand and grew up in Penang. In 1971, he came to Singapore on the ASEAN scholarship and stayed at the King Edward VII Hall.
‘Where Duke-NUS is now,’ he adds. His Year 1 and Year 2 were spent in the College of Medicine Building. For clinical training, he went across the road to Bowyer Block. He graduated in 1977 and joined Paediatrics in SGH before he went over to the Accident & Emergency Department a year or two later.
‘Each person teaches you something which you’re able to pick up, make sense of and make into a part of you. I learnt not from what they said but from their actions. There is no end to learning.’
He rattles off the names of doctors who were his role models, the first one being Professor Wong Hock Boon: ‘My first posting was to Paediatrics at SGH in 1977. Prof Wong inspired a lot of paediatricians. A lot, a lot! In fact, I was almost one of them. He inspired me to be detailed in my thinking process. You know how he taught us Medicine? He read everything, he went to t he library every day.’ In Prof Wong’s treatment of his patients, Dr Chumpon saw the basis of Medicine: ‘It is not in technology. Doing tests and interpreting them is part of a bigger process; they are not everything.’
‘We want to cure the patient, to get the person back to his original state and put him back into the community so that he can carry on his own life. To get there, first, we have to understand the patient. You need to speak to the patient, try to get them to open up to you. You must ask intelligent questions.
After taking the history, you examine the patient. The patient may have remembered wrongly, or they may provide inaccurate details, so the notes from the clinical examination must be compared with those from history taking. The two are linked: one is subjective, one is objective. After that comes Part 3, the tests. Tests are useful but they don’t tell us how a disease will progress, or how it affects the patient as a person.
In both history taking and clinical examination, the human behaviour of the doctor is indispensable.’
Dr Chumpon has spent almost 90 per cent of his working life in SGH. He is a living and walking chronicler of SGH history from the 1980s to the 2000s, a period of time when the strengths of the present-day SGH took shape, not only in terms of infrastructure but more importantly, in the calibre of its medical and nursing staff.
When he helped set up the Department of Neurosurgery at SGH in 1989 (the department was officially opened in 1990), he was one of its first two consultants and he worked long hours. The pamphlet about the Department that was published at its inauguration contains this sentence: ‘The team holds the philosophy that personal attention, combined with knowledge, skill and technology is the key to healing.’
Medicine as ethical practice, tapping on the best human traits and competencies to help people, is what comes across in Dr Chumpon’s sharing. To learn a bout how a person is ailing in order to treat them, first, there is the necessity of learning about them as a person. He gives the example of a 92-year-old patient whose history taking began with a seemingly unrelated conversation about the patient’s childhood in Choa Chu Kang and the durian trees in his kampong.
‘After that he opened up!’ Dr Chumpon grins. Just as attention and patience are critical to harmonious and productive relationships at home and outside the home, these qualities help the doctor achieve better outcomes for patients. What is perhaps most striking about this surgeon, someone whose talent for surgery was first noticed in the dexterity of his hands, is his emphasis on the unmechanical aspects in Medicine.
For Dr Chumpon, whose philosophy is to strike a balance between the art and science of healing, non-verbal communication is as critical to the practice of Medicine as the verbal; the human touch is as vital as technique and technology.
Dr Chumpon Chantharakulpongsa is a Senior Consultant in the Department of Neurosurgery of the National Neuroscience Institute (NNI) at SGH Campus. He graduated from the University of Singapore in 1977, where he studied on an ASEAN Scholarship, followed by postgraduate surgical training at the National University of Singapore on a Singapore Government Scholarship. He was NNI’s Deputy Director from 2004 to 2010 and Head of Neurosurgery from 2002 to 2004. In 2001, Dr Chumpon was the senior lead neurosurgeon of a team of 16 specialists in the 97-hour operation to separate the Nepalese craniopagus twins, Ganga and Jamuna Shrestha. He has subspecialty interests in complex skull base surgery, neuro-oncology, neurotrauma and general neurosurgery. In recognition of his outstanding contributions to the training and professional development of clinicians and clinician-scientists in Singapore, ASEAN, and the rest of Asia, Dr Chumpon was awarded the National Medical Excellence Award for Outstanding Clinician Mentor in 2017.
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