TESS TEO LIN & KENNEDY NG YAO YI

There is a crispness in this room in Academia and it’s not coming from the air-con. As Singapore continues to battle the COVID-19 pandemic one and a half years after the discovery of the first case here, stories about the strains caused by this prolonged situation of the ‘new normal’ have become commonplace. The healthcare sector, from the doctors, nurses and service personnel at polyclinics and family clinics to the staff at hospitals, is facing its biggest challenge to date in the new millennium. Yet, the two doctors who are seated on the other side of the room are bright-eyed above their face coverings and say hello with exuberance.

It is 8 o’clock in the morning. Over the next hour, the room will be filled with the animated voices of Dr Tess Teo Lin and Dr Kennedy Ng Yao Yi, freshly-minted doctors of Emergency Medicine and Medical Oncology at Singapore’s oldest hospital. They speak about their sense of responsibility towards patients, colleagues and the wider community. There is a striking humility about them, an impression that is all the more remarkable given that both, in his and her own unique ways, seem endowed with great resources of willpower and ability.

In 2020, Dr Teo became an Associate Consultant in A&E (rebranded as the Department of Emergency Medicine in 1997). She doesn’t like routines and she cites this as one of the reasons she chose to specialise in Emergency Medicine. Her inclination for unpredictability does seem to have equipped her with equanimity for meeting all manner of pressing medical situations head-on.

No doubt her training must have played some part in this, although there is also more than a hint of another trait that is useful for problem-solving: the initiatives she spearheaded in her department to safeguard her colleagues’ mental health during the pandemic suggests her ability to take stock of the big picture and act quickly and decisively to set up pre-emptive policies and procedures.

She feels strongly that transparency and open communication is the best way to keep fears and anxieties in check: ‘From staff feedback, we learnt that there was a lot of stress coming from their families. Taking care of staff goes beyond looking after the individual.

I came up with an information sheet with FAQs to reassure family members who were worried about their husbands and Dr Teo is her department’s wellness representative. Reading about the COVID-19 situation in the news and hearing also from her peers in Emergency Medicine in other countries about the looming crisis, she arranged for the Medical Officers (MOs) in her department to have huddles with SGH Medical Social Workers (MSWs). She anticipated that they, being junior doctors, would need the most support. These huddles or check-ins took place days before the Orange status of the Disease Outbreak Response System Condition (DORSCON) was declared in Singapore, after which time MSWs weren’t allowed to be physically present in her department.

‘It was a good thing we arranged for the check-ins just before DORSCON Orange,’ Dr Teo says with palpable relief. ‘Some people in the MSW department knew us from previous projects so it was easy to get them to come in and help with the huddles.

They helped our MOs to be mentally prepared by telling them: “Things are going to happen, you may have reactions to them, you may get frustrated, irritable, and these are normal reactions. Don’t worry, you will have support.” They also came up with slides about managing stress.’

wives coming to work and being in contact with COVID-19 patients and potential cases. We sent these out via email so that our staff could share them with their families. We also put them up at the SGH intranet so that other departments could use them if they wanted to.’

Taking care of the wider community is also a theme in Dr Kennedy Ng’s sharing about working at SGH during the current pandemic. He highlights Project WireUp, a programme of TriGen, a volunteering organisation made up of SingHealth staff. 

Dr Ng is a co-founder. Project WireUp involves SGH and SingHealth staff going to the rental flats near SGH to distribute mobile phones to elderly residents and teaching them how to use the phones for essential services and get in touch with their families.

The public-spirited aspect of SGH is something that Dr Ng values greatly. ‘When there is a common purpose, a common enemy, people really step up to go above and beyond,’ he says before going on to share examples from his experience of serving in the COVID-19 Isolation Ward when it was first set up.

On the third day of the Lunar New Year in 2020, a few days after the news about the first case in Singapore broke, Dr Ng and other Senior Residents in the Division of Medicine were called back for the setting up of an outbreak ward. At that point in time, Dr Ng was scheduled to rotate to Medicine from Medical Oncology. He decided to put his hand up to serve in Ward 68, the Isolation Ward: ‘We were joking that when SARS happened, most of us were in primary school or secondary school, and the only memories we had of SARS was e-learning and we were very happy that school stopped and you could chill at home. Now, as the generation which grew up after SARS, we’re finally given an opportunity to do something.’

Personal factors made it a difficult decision for him: ‘My wife was pregnant then and we had just moved into our new place. I had to ask her if she was okay with me putting myself forward to do it. She’s a paediatrician working at KKH. At that point in time, we didn’t know how fatal getting COVID-19 could be.

If you go by MERS, there was 70, 80 per cent chance of death; SARS was 30 per cent. One careless mistake, you get it, that’s it. Now we know that COVID-19 is less than one per cent, but we didn’t know this at that time.

With my wife’s and her family’s blessing, I joined my friends in Ward 68 where we saw the first COVID-19 patients. I lived in our home by myself whilst my wife went to stay at her parents’ place.’

During those five weeks in Ward 68, Dr Ng grew to appreciate the team spirit of SGH even more. It was distressing to see colleagues becoming sick and having to be tested and isolated, to see colleagues from Emergency Medicine coming to the Isolation Ward. Nonetheless, people mustered their courage and pressed on. He speaks about the significant challenges when he and his team had to intubate their first patient who was a suspected case: ‘Having to intubate patients [putting a plastic tube down their throat to help them breathe] or do procedures in full Personal Protective Equipment (PPE) really brought things to a whole new level. You’re wearing a mask, a hood, a space suit and you’re treating very sick patients with COVID-19. We don’t usually do procedures, especially high-risk procedures in cumbersome outfits.’

Dr Teo chips in: ‘The hood is made of plastic, and after repeated wiping with disinfectants, the thing deteriorates. I don’t know how it was for you, Kennedy, when you started out, how clear your hood was.’

Dr Ng nods and continues: ‘The hood was from the time of SARS, so it’s definitely not new. Apart from the scratches on the plastic, when you’re wearing it, your breath condenses and it fogs up. You can’t wipe it with your hands since they’re outside and they’re dirty. You’re sweating inside from the gown and the hood and from adrenalin and nerves. Most of the time, when you finally take everything off, you’re drenched.’

There were other factors that raised the stakes. Each medical team had to be leaner than usual because of restrictions on the number of people who were allowed to be inside the negative pressure room of the Isolation Ward. It was a heightened security space with double doors, which added another layer of complexity, as Dr Ng shares: ‘We huddled outside and did a few rounds of checks to make sure we had all the equipment we needed. Because of the double doors, you don’t have the luxury to forget something and go out of the room to get it. The first door takes 10 seconds to open and close before the other one starts, also taking 10 seconds to open and close. If you forget anything and you have to go out and come back in, you’ll be wasting precious time.’

He pauses. Perhaps the scene is flashing across his mind. When he resumes his recollection of the time he spent in the Isolation Ward, there is a softness in his voice: ‘There are so many instances of colleagues going out of their way to make things better. The nursing colleagues liaised with immigration officers and got hold of necessary documents. They also took time to help the elderly patients, sometimes using their own mobile phones to set up video calls for patients and their families.’

Working in teams kept us safe and we became very close-knit,’ says Dr Teo. She is referring to her department’s swift implementation of an outbreak roster from the time the first case was reported. Emergency Medicine was divided into five teams and each team only came into contact with two other teams, the

one they took over from and the one they handed over to. Each shift was 12-hours long.

Dr Teo’s voice is as lively as ever even though she is saying that it was very tiring: ‘From the very beginning, we were the first hospital that went into the most hardcore response. People I didn’t know so well before have become people I rely on now because of the split team system. We bonded over bubble tea,’ she says, erupting into hearty laughter.

This is the last interview that is being conducted for this book. Dr Teo and Dr Ng are the youngest members of staff. They are also the only ones who say ‘friends’ rather than ‘colleagues’ when they refer to fellow doctors, whether these are people at SGH, other hospitals in Singapore or overseas. Perhaps this is also why they are on the same page when they share their key realisations from the pandemic.

For both of them, the lessons from the pandemic resonate beyond Medicine. When Dr Teo speaks, there are times when she sounds almost breathless in her excitement to get her point across: ‘The most important thing for me is not so much what we’re doing in terms of the clinical medicine. That will evolve and change over time; that component will always be there. The important thing is the people practising it, and the team on the ground.

If the team is not strong, you cannot practice good medicine. You cannot do good emergency treatment and resuscitation.

In five years’ time, I hope SGH does a bit more for staff wellness.’ She thumps the table in mock seriousness and chuckles.

Dr Ng says affectionately: ‘ Must record this down. In 10 years’ time, we’ll ask her.’

Meanwhile, Dr Teo has returned to her earnest mode: ‘It can be as simple as a communication sheet.’

And Dr Ng, too, has stopped laughing and concurs: ‘I echo what she says.’

Dr Teo continues: ‘Even though I’ve always felt strongly about staff welfare, through the pandemic this has further solidified for me. If the team is not rested, everything you do for the patient will be sub-par because you’re not at your best. The morale has to be maintained. Even when the pandemic is over, this principle still stands. It’s so important that staff are taken care of so that we can take care of the patients.’

All the while as Dr Teo speaks, Dr Ng is making small assenting sounds. When she finishes, he picks up her train of thought and expands upon it with similar gusto. The principles that have made SGH great need to be preserved and this can only happen if the staff are valued, he says: ‘We started off with people coming together to make a difference and that’s how we will carry on. This can only happen if we value our people. Everyone who walks through SGH needs to feel proud of being part of SGH. They should feel that the organisation values you and the work that you do. The pandemic has showcased how jobs that we don’t prioritise in society provide essential services, like cleaning, for instance.

I spoke to one of our housekeepers who was later featured in the TODAY newspaper. She’s worked here for last 20 or 30 years. She’s seen four or five pandemics—SARS, H1N1, MERS. She has cleaned all the wards of infected patients. She’s a Malaysian who is serving our patients and she can’t go back to see her family. I really hope that SGH will continue to be an organisation that prioritises the well-being of everyone: from housekeepers to porters to nurses to doctors to pharmacists...’

Dr Teo quips: ‘And the security.’

Dr Ng continues: ‘Yes, the security who have to work overtime now because we swab everyone. They come back on weekends.’

The pandemic has brought home to him the importance of getting the simple things right: ‘As a doctor, you start off thinking of high-tech Medicine. In cancer care, there’s a lot of emphasis on tertiary care and the latest high-tech treatment you can give patients. But COVID-19 has reminded us that simple things like vaccination, hygiene, good social network to help seniors at home, good primary network can make a large difference during a public health crisis.’

The second paradigm shift for him has to do with being adaptable to present  ircumstances: ‘There will be many more volatile situations to come in the future. We

have to pivot, as we have done in the case of COVID-19, to telemedicine, otherwise we risk being left behind and becoming irrelevant.’ 

Leveraging on telemedicine has helped Oncology maintain its presence as a regional centre: ‘People used to fly over from China for clinical trials, for access to the best treatment. Because they can’t fly over, we get them to do their CT scans there and then we see them on Zoom and mail the medication to them.

This crisis has caused people to be a little more open to new ideas. We really should ride on that wave. Fundamentally, it has changed a lot of things that we do and if we don’t sustain some of these changes, we would have wasted everything we’ve learnt during this time.’

Dr Ng didn’t get into medical school on his first attempt. He had to go to the army first and then he re-applied. That experience gave him exposure to people from other walks of life, as well as time for reflection and introspection.

He says that he came out of it with a greater understanding of something he’s heard before, a verse that goes: ‘From those to whom much has been given, much will be expected’: ‘I do think that all of us, healthcare professionals, and SGH in itself have been given much. We have a lot and we are where we are because many people have invested in us and in this institution.

We must never become complacent. We must remember that there is this obligation, there is this expectation, there is this moral responsibility to do our best and to chart the direction of healthcare for Singapore, to give the best possible care to our patients.

Someone said that if we, as the oldest institution, cannot find a cure to this disease, we must take it on ourselves to find it. We must have that conviction. These are my aspirations for SGH.’

The interview ends and there is a flurry of well wishes all round. The doctors make their way back to their departments, schedules and patients, putting into action all that has been said and more.

Dr Tess Teo Lin is an Associate Consultant at the Department of Emergency Medicine with an interest in Geriatric Emergency Medicine, Sports Medicine and Acupuncture. A former Chief Resident, Tess is passionate about the SingHealth Residency Program and does her best to give back where she can, particularly in the areas of education, medical humanities and wellness. She cares deeply about looking after the welfare of her juniors and colleagues and has been involved in improving peer support for doctors, leading the SingHealth PGY1 BLUES Peer Supporter Programme with the PGY1 Team.

Dr Kennedy Ng is a Medical Oncology Senior Resident at the National Cancer Centre Singapore. He graduated in 2016 from the Yong Loo Lin School of Medicine as the class Valedictorian. He is the co-founder of TriGen, a charity that aims to deepen intergenerational relationships and provide holistic care for unprivileged seniors. He is passionate about health policymaking, leadership development and medical education.