We have about 50 Esthers in our network,’ Ms Esther Lim shares. The Esthers she mentions are not called Esther in real life and it is pure serendipity that Ms Lim goes by that name.
The ESTHER Network is a group of volunteer ambassadors whoare either patients or caregivers. Ms Lim, a medical social worker and family therapist, is its lead coordinator. At today’s interview, apart from Ms Lim, Mdm Teo Gek Hoon, the very first Esther of the programme, is also present. Mdm Teo is 77 this year. She has been an Esther since 2016.
‘We launched the ESTHER Network in June 2016,’ says Ms Lim.
‘June 24, 2016,’ Mdm Teo interjects.
‘Very good memory, huh? She even remembers the date,’ Ms Lim says. ‘I remember one day when Mdm Teo called me and said, “Do you know this is our fifth year anniversary?”’
The ESTHER Network embodies a philosophy of personcentred care. ESTHER ambassadors are ordinary people who share their care experience and serve as concrete human reminders of the singular considerations that should be borne in mind when healthcare professionals devise solutions for their care.
The concept originated in Sweden in 1997 to meet the needs of the elderly. The ESTHER Network is made up of patients, caregivers, clinicians and community partners who work together to care for those with complex care needs in Jönköping county.
‘Esther’ is a symbolic 88-year-old person who requires the coordination and integration between different care settings to address her needs. The Network is all about creating the best value for ‘Esther’ by taking responsibility for her total well-being and working closely to make the healthcare system more efficient and sustainable.
Ms Lim shares that SingHealth sent a delegation to Sweden to learn more about the ESTHER Network in 2014 as part of its research into patient-centred care.
As an Esther, Mdm Teo is always on the lookout for someone, another patient or nonhospital staff like her, who may need a word of encouragement.
‘When I am at the Hospital and I notice old people who look a bit sad, I will go over and talk to them. I ask, “How are you?”’ Mdm Teo says the greeting in Hokkien, her voice booming and the smile on her face widening.
Mdm Teo lives in a flat with her husband. They have no children. She is his sole caregiver and has to go for dialysis herself. Her smile is as radiant as ever even when the subject of dialysis comes up. She gives the impression of having many joyous things to share, too many to dwell on anything unhappy.
Mdm Teo took care of her cousin’s children since 1990. ‘ Three kids!’, she says with delight:‘Now they’re in their 20s. They have their own kids. I look forward to cooking for them. I make porridge for the kids, I play with them. I want to stay alive to see what they’re like when they grow up.’
As Mdm Teo speaks, her eyes seem to twinkle. It makes this writer blink a few times. Then, she mentions the fact that she has been hospitalised ten times in a casual, fuss-free fashion, as if she were talking about going to the wet market.
She admits that the first time, when she had to have a pacemaker implanted, she was afraid. ‘But after that, no. The doctors always explain what the risks are and I tell them, I’m already immune,’ she says with a deep-throated chuckle. ‘I’m not scared anymore.’
Ms Lim, who has been sitting close by, adds that the ESTHER Network has younger members, including a married couple. ‘The husband has diabetes and the wife is an executive,’ she says. That said, the demographic that seems to have been impacted most powerfully by ESTHER is the elderly.
We have a group who are in their 70s and 80s and some of them move very slowly with walking aids. When we invite them to share their stories, they always show up. These gatherings are called Esther cafés.
Over time, we observed a change in these elderly Esthers. They become more confident and open with us. In the past, they will say, “Very good, very good” when you ask them about their healthcare experience, but now, they trust us and give more details. This helps us to act on their behalf, nip the problem in the bud.
It takes a lot of courage for patients to share their stories. To tell us honestly and confidently what matters.’
Ms Lim says that when Mdm Teo first started her dialysis treatment, her doctors had advised her to stay at her niece’s home rather than go back home:‘The assessment then was that she would be too weak and that she wouldn’t be able to take care of herself or her husband. That broke her heart.
She wanted to be with her husband. She told the medical social worker, “This isn’t what I want. I want to go home.” So we gave her intensive therapy and Mdm Teo also worked very hard, and eventually she got to go home.’
‘I’m so blessed,’ Mdm Teo says. ‘When people see me, they say, “Wah, you look so good ah, Mdm Teo!” I’m positive! I want to stay alive! I’m very disciplined.’
‘Patients have their own needs and wishes. If they don’t have the confidence to articulate these things, it’s not helpful for anyone,’ Ms Lim says. ‘ESTHER reminds us to ask them what their wishes are. Doctors, nurses and allied health workers may come up with a care plan for the patient that’s based on our own understanding of what is best for the patient. But there is also the patient’s own perspective.
The ESTHER Network is about constantly reminding ourselves: “Does my plan matter to our Esther? If she thinks that what I do doesn’t really help her, then why am I still doing it?” This is what we are trying to i nculcate in all our healthcare staff.’
‘Our motto at SingHealth is “Patients at the Heart of All We Do”. The concept of the ESTHER Network offers a structure, a process, and a human face that makes this tagline clear and simple for staff to remember and apply to people. This way, we can be sure that the care we provide is truly person-centred.
It’s about being compassionate and not making assumptions about our patients; it’s about taking the time and making theeffort to find out what matters most to them. This is where shared decision-making comes in. In some ways, the patient, too, is an expert in her own care. She knows her own circumstances best.’
ABOUT ESTHER LIM LI PING
Ms Esther Lim Li Ping graduated from the National University of Singapore with a degree in Social Work and Masters in Evidence-Based Social Intervention from the University of Oxford. She joined SGH in 1995. In her current role in the Regional Health System for SGH Campus, SingHealth, she oversees the strategic implementation of community integration initiatives and champions the adaptation of ESTHER Network in Singapore to drive person-centredcare within and across the health and social sectors. She also drives staff engagement and leadership development initiatives for Allied Health Professionals (AHP) to maximise the diverse talent within the AHP community.
ABOUT TEO GEK HOON
77-year-old Mdm Teo Gek Hoon is the pioneer Esther in SingHealth’s ESTHER Network. She lives in Telok Blangah with her husband who is 85. She is his sole caregiver. For 30 plus years, she worked as a linen housekeeper at Cockpit Hotel, Ming Court Hotel and Cairnhill Hotel. She enjoys listening to music and singing.
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