There was a time when Professor Ivy Ng Swee Lian spent many after-school hours wandering the corridors of SGH. Her father had been hospitalised after collapsing at home from a gastrointestinal haemorrhage. He lay on the bedroom floor, vomiting and passing out blood. Seeing her father in that state, Prof Ng, or Prof Ivy as she is called affectionately by her staff, thought he was going to die. After one month, he was well enough to go home.
‘I saw with my own eyes how healthcare workers can give hope when there doesn’t seem to be any,’ Prof Ivy says in her account of the incident that led her to pursue Medicine. Years later, her office would be in Bowyer Block where her father’s ward had been.
Through the years, Prof Ivy’s belief in the transformative power of Medicine has never wavered; her choices demonstrate this.
She chose to do research in Genetics because during her time in SGH Paediatrics, she saw that the majority of her patients had hereditary ailments. She was tasked to run the thalassaemia clinic as a junior doctor. Thalassaemia is a blood disorder and patients require monthly blood transfusions from the age of one.
Prof Ivy got to know her patients well as a result of their regular monthly visits. From 1987 to 1989, she witnessed their struggles, an experience which motivated her to go into research about the illness:‘Thalassaemia is our commonest genetic disease. The kids who had it would come to the Paediatrics department every month. They would need to be seen, they would need to have their blood drawn, we would have to arrange for a transfusion. It was a huge burden on the patients and their families, and it was for life.
There were other challenges. A lot of iron accumulated in the patient’s body due to the transfusions. The iron goes into the heart and liver, causing illnesses that will kill them in their teens. They are ordinary young people in all other aspects, but they die in their teens. For me, that left a huge impression.’
Mutations in thalassaemia was her research topic during her fellowship to the US from 1989 to 1991. One of her mentors was the head of Clinical Genetics at Mount Sinai Hospital in New York. Back at SGH, her mentor in Paediatrics, Professor Tan Cheng Lim supported her research by arranging for patients’ blood samples to be sent to her in America.
When she returned to Singapore, she set up the National Thalassaemia Registry and the DNA Diagnostic and Research Laboratory at SGH.
‘Nowadays, we articulate our aspiration to excel in Academic Medicine, but decades earlier, a lot of research groundwork was already blossoming in SGH.
There have been generations of academic clinicians who pushed for advances in care. Prof Tan was one of them. He was always encouraging us to delve in areas where we could provide better care for patients. He was a wonderful teacher, a master clinician. After my subspecialty training, I had offers to join other hospitals but I chose Paediatrics at SGH because of the mentorship of Prof Tan and the SGH culture.’
Prof Ivy’s work on thalassaemia has had wide-ranging benefits, both in improving the care that is available to patients and in preventing the incidence of the illness through population screening and prenatal counselling. She credits the then senior management at SGH for their openness to new ideas, for hearing her out when she was a relatively junior clinician, and giving her permission and support to bring her ideas into fruition:‘I was a young Associate Consultant when I presented the idea of a DNA diagnostic and research laboratory to the SGH Medical Board. I was grilled by then Chairman of the Medical Board, Professor Charles Ng and Chairman of the Division of Medicine, Dr Lim Cheng Hong and Medical Board member, Professor Balachandran. I was heartened when the proposal was approved.’
Openness to new ideas and rigorous analyses are critical in research. Since 1992, when SGH first embarked on DNA investigations in the laboratory, the field of Genetics has grown into a major strategic area of biomedical research in Singapore. Prof Ivy brims with pride when she reflects on the journey:‘A year and a half ago [in 2019], we launched the SingHealth-Duke NUS Genome Medicine Centre. This [development] actually started way back with the Diagnostics and Research Laboratory in SGH Block 6, level 6.
Together with the whole Paediatrics community, we had to move in 1997 to form the KK Women’s and Children’s Hospital, but the start of this work was in SGH. That’s the magic of SGH.’ Prof Ivy is a picture of optimism and vigour throughout her Zoom interview.
When she speaks about how she has seen patients and their families benefitting from new medical breakthroughs, her face lights up:‘Academic Medicine is about pushing boundaries in care. These days, a patient with the condition my dad had wouldn’t stay a month in hospital; they would stay a week or less. Maybe 30 years from now, they wouldn’t even need to be hospitalised. Over two decades, I have seen an evolution in the treatment of thalassaemia patients.
From their monthly blood transfusions, there is the side-effect of iron accumulating in their organs. In the 80s and 90s, they could have iron chelators subcutaneously infused every night for eight hours to excrete the iron, but this was expensive and draining.
Thanks to research and advances in care, the chelators are now administered as an oral medication taken three times a day and more recently, an effervescent tablet that is dissolved and drunk once a day.
The patients I’d cared for since those early days are in their 20s and 30s now. Some of them run marathons; a couple of them have their own babies. One of them is a 38-year-old patient, whose brother also had thalassaemia major. She’s much younger than him so she benefitted from the improvements in treatment. Her parents saw their son die in his teens but their daughter with the same condition has done well—she is married with a beautiful two-year-old son and has a good career. It’s amazing!
I’m sharing the story of this family with you because it shows how improvements from the research that we do, the new knowledge that we gain, totally impacts the lives of our patients and their families.
This is why even though in my own career, I have morphed from clinician, researcher, educator to leader, I continue to be deeply passionate about Academic Medicine. I’ve seen how it changes lives.’
Professor Ivy Ng at Bowyer Block. Source: National University of Singapore
For Prof Ivy, the future of SGH as an acute care hospital is to extend beyond the hospital towards the community and population, educating and empowering them to take ownership of their health:‘My dream for SGH is that SGH, with all of its positive attributes and depth of expertise and talent, needs to think upstream: How do we prevent disease? How do we diagnose conditions earlier? How do we engage with the community to d o better?
I go back to the example of my dad. In the scenario of SGH in the future, not only will we be able to treat him before he becomes severely ill, but we will also give him enoughknowledge so that he knows how to prevent an ulcer. Even if he does have an ulcer, he will have the knowledge that empowers him to ensure that he gets diagnosed earlier so that he can prevent the crisis of the massive bleeding from the ulcer.
SGH has a tradition of providing excellent care within the boundaries of the hospital.
Now, it needs to move out into the community. My dream is that we won’t need hospital buildings because people can live healthy fulfilled lives—at home, at their places of work, in the community. If they get sick, care is given to them in their homes as much as possible.
Don’t we all love being in our homes? No hospital, no matter how beautiful, no matter how comfortable, can be better than your home where you are with your family. Of course, those who are very sick will still have to be in the hospital, but can we dream of a day when this becomes a very small number compared to today?’
The interview with Prof Ivy is taking place online as Singapore has gone from Phase 3 to Phase 2 after the emergence of clusters in the community, including one in Tan Tock Seng Hospital. Certain aspects of the paradigm shift that Prof Ivy speaks of had already been introduced prior to the pandemic, but as Prof Ivy explains, the challenges posed by COVID-19 have accelerated the pace of change:‘The Chinese characters for crisis are weiji (危机) which translates into danger and opportunity at such times. We have seen many opportunities in this past year: from the number of innovations that have come out spontaneously and rapidly throughout SGH and SingHealth, to the ways in which people have banded together and moved out of their comfort zone to provide healthcare where it is needed. That whole spirit of resilience and tenacity couldn’t have been shown as clearly except during a time like this.
We’re fortunate to have talent with not just great depth and expertise but also strength and tenacity. We constantly talk about the new normal but the new normal will keep changing. The key element to not just surviving but thriving is being adaptable and relevant to the challenges as they come. We must hold fast to our dreams and aspirations.
We had the same aspiration of delivering care to the home, of having patients out of hospital even before the pandemic. We were already using technology to stay in touch with our patients. We have a mobile phone app called Health Buddy which allows patients to upload their health information so that doctors can access their data and symptoms before they meet using video conferencing. A good 50 to 60 per cent of stable patients can be looked after in this way.
If the patient needs to come in for blood tests and x-rays, he or she may not have to come all the way to SGH. They could go to the polyclinic nearest to their home and once the tests are done, they can do a teleconsult with their doctor in SGH.
Because of the past year, these activities took off in a way that they couldn’t before. Even though most patients like to see their doctors in person and most doctors also prefer to treat their patients face-to-face, people have embraced new ways of doing things. The number of teleconsults grew by multiples when before it was just going up slowly.
Taking care of patients has always been central to healthcare workers. As part of the SingHealth cluster, SGH can influence healthcare much wider and much earlier than it did in the past. Together with all its sister institutions in the cluster, SGH is part of a network that wraps care around the patient. It’s SGH Plus, an extension of the Hospital so that care can be provided at home or closer to home and earlier.
At 200 and beyond, SGH Plus has the determination to do better. Which is not just about delivering the best care today, about not letting standards drop; it’s also about learning from every patient so that we can do better the next time.
What are the gaps in knowledge? Where are the gaps in the care that we give? How do we address them? And even after that, there will always be another step to take, for us to go further together in this journey of learning, discovering, caring and healing.’
Professor Ivy Ng is Group Chief Executive Officer of SingHealth. Prior to her appointment as SingHealth’s Chief, she was the Chief Executive Officer of KK Women’s & Children’s Hospital (KKH) and Deputy Group Chief Executive Officer of SingHealth. She was previously also KKH’s Chair of the Medical Board and Head of the Hospital’s Department of Paediatric Medicine. She holds a Bachelor of Medicine, Bachelor of Surgery (MBBS) and Master of Medicine (Paediatrics) from the National University of Singapore. She is a Fellow of the Royal College of Physicians (FRCP, Edinburgh), Royal College of Paediatrics and Child Health (FRCPCH, London) and Academy of Medicine, Singapore (FAMS). She is Clinical Professor, Duke-NUS Medical School and Yong Loo Lin School of Medicine, National University of Singapore.
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