When asked about their earliest memories of SGH, nearly all the doctors in this series of Bicentenary interviews mention their student days. They recall attending lectures at the College of Medicine Building and going on ward rounds with senior doctors at Bowyer Block. Professor Koh Tian Hai, however, is the only one to admit, with more than a hint of boyish mischief, that he and his friends enjoyed hanging out at Ah Leng’s Canteen and that they sometimes tried to skip classes. The distinguished cardiologist says that his childhood ambition was to be a pilot.
I thought it was glamourous,’ Prof Koh admits sheepishly. ‘My parents talked sense into me and I went into Medicine. No regrets. Working as a doctor has been very enjoyable and fulfilling.’
He joined SGH as a young Registrar in Cardiology in 1984. The department had moved over to SGH from Tan Tock Seng Hospital (TTSH) just three years prior to that: ‘When I first came over from TTSH, I was thinking at that time that we could only be diagnosticians. But in the decade after that, we cardiologists could actually treat patients by doing balloon angioplasty next to implanting stents. And subsequent to that, even more impressive gains have been made, like burning off the extra “nerve-like” tracks in the heart to treat heart rhythm problems, without resorting to open heart surgery.’
To witness the evolution of cardiology has been ‘quite amazing’, he adds: ‘To have seen the transition from the old days when there was almost no treatment available for patients to what we have today, it’s been quite a fulfilling life for me as a d octor and cardiologist.’
The new technologies of angioplasties and stenting not only resulted in greater job satisfaction for him and his colleagues, they also brought vast improvements to the lives of patients. As someone who has been in the thick of it all, Prof Koh offers a rare historical perspective: ‘In the 70s, heart attack patients had to stay in hospital for around six weeks because, apart for some pain-relieving angina medications, there really wasn’t very much we could do for them. But over the years, cardiology and cardiac surgery have really evolved quite significantly.
Nowadays, we take for granted that if you have a heart attack, you can just come in and we’ll balloon and stent you, and then you’ll be ready to g o home in only three to four days.’
Over 45 years of service, Prof Koh has treated a great number of patients, so when he is asked to share memorable examples, unsurprisingly, he says there are simply too many. In the end, he talks about a case that has left a deep imprint on him for a number of reasons:‘The patient was a European lady who had just given birth, and soon after developed a massive heart attack. Luckily, she rushed to Emergency Department of SGH, where she underwent emergency angioplasty and stent implantations in NHCS (National Heart Centre Singapore) However, her heart muscles were severely damaged and despite being put on Extracorporeal Membrane Oxygenation (ECMO), a temporary heart support device, her heart could not adequately recover its pumping function. She was then implanted with a Ventricular Assist Device (VAD) by our cardiac surgical colleagues.
This device took over the function of her heart and about a month later, she was able to return to her country. A couple of years later, she actually visited NHCS with her daughter, the newborn at that time. It’s pretty amazing that the VAD was still working inside her, enabling her to travel by air to Singapore!’
Because of such experiences—where he has seen with his own eyes how advances in cardiac medicine can save lives, alleviate suffering andspare families from heartache—the soft-spoken professor becomes visibly excited when the subject of research and Academic Medicine comes up:‘We run a very big clinical trials unit where new medicines and devices can be quickly tested at our Heart Centre. When these trials deliver positive results, we can confidently prescribe these new medications to our patients. In the past, we had to rely solely on trials done in Europe and their results weren’t as useful due to genetic differences between Asians and Europeans.
The unit has also contributed to our international research profile. After conducting tests and trials, we publish the findings. This is what we’ve been doing for the past 10 to 20 years. We collaborate with many international industry partners and cardiac centres.’
The sharing of knowledge and expertise with cardiologists around the world, and in the Southeast Asia region in particular, is something that’s very close to his heart.
The NHCS organises the annual SingLIVE conference, which celebrated its 30th anniversary in January this year. It attracted a virtual audience of over 1,500 from more than 30 countries.
‘SingLIVE is one of the few courses that has persisted since the early years of angioplasty,’ Prof Koh says. The man who started it all, Professor Arthur Tan, was a visionary.
The word ‘visionary’ isn’t a term anyone uses lightly; Prof Koh says it twice when describing his former boss: ‘Prof Arthur Tan was the founder of the forerunner to the NHCS—the Singapore Heart Centre. When he pushed for the SingLIVE conference, we had just started to do cases with those balloon angioplasty procedures for maybe four or five years, so the idea of showing them live to an international audience was quite astounding to me. I asked him, “Are you sure you want to proceed?’
‘He said, “We should try, don’t worry about it, I think we will be successful.”
So yes, we held the first SingLIVE conference at the College of Medicine Building and we were broadcasting live from our cath lab catheterisation laboratory]. We did around six cases.’
For the inaugural SingLIVE conference, the Singapore Heart Centre featured local as well as international cardiologists like world renowned Professor Gary Roubin. Prof Arthur Tan performed the first heart stent in Asia during the second SingLIVE conference, under Prof Roubin’s guidance.
Prof Koh emanates optimism and compassion, virtues for all who work in healthcare but perhaps even more so for those in cardiac medicine. The heart is a metaphor for love, and the heart is also a fist-sized organ, pumping away to keep us alive. When the ongoing pandemic is mentioned, Prof Koh’s voice is grave for the one and only time during the interview.
He perks up immediately when he speaks about the new building of the NHCS where this interview is taking place.
It was the fruition of a long and hard campaign, dating from before 2000: ‘[The new building] was quite a major challenge. We had to get approvals, canvas for support and funding. Before this new centre was built, we were in Mistri Wing [the former Paediatrics building built in 1956]. It had only four floors. We had to have six clinics crammed on each of two levels. The whole place was extremely crowded. It took a long time but I’m very happy that we managed to move into this new building in 2014. I’m also happy we had the support of our then Chairman, Mr Peter Seah, and others like Professor Tan Ser Kiat, the then Group Chief Executive Officer, SingHealth and the then Minister for Health, Mr Khaw Boon Wan.’
The interview setting moves to the outdoor terrace for photographs to be taken for this story.
A wide rectangular space that is accessed through a cosy staff lounge and pantry, the terrace is vacant except for a few shrubs and young trees. As the photographer snaps away, Prof Koh gazes steadfastly at the camera and responds to a q uestion about the surroundings: ‘You see how this area is like a garden now. It’s actually for us to have some space for expansion in future, if needed. I think it should be able to see us through the next 50 years.’
This forward-looking posterity mindset has come up before in the interview, not in relation to the ‘hardware’ of the building, but the ‘software’ of the people who work in it: ‘Sometimes, in other hospitals, the doctors tend to choose alternative pathways and after a couple of years in the hospital, they go into private practice. I’m proud that our senior team has basically stayed intact over the last 10 to 15 years. The young guys who come to Cardiology in NHCS are able to learn from our senior doctors.’
This is a mindset that is steeped in gratitude for the mentors of the past. No wonder Prof Koh pronounces the names of his mentors with respect and affection, mourning gently the ones who have passed on: Professor Chia Boon Lock; Dr Wan Shong How; Dr B.A. Johan; Professor Gordon Ransome; Professor Seah Cheng Siang.
Prof Koh Tian Hai is an Emeritus Consultant in the Department of Cardiology, National Heart Centre Singapore. He obtained his MBBS in 1976, and Master of Medicine (Internal Medicine) in 1982 from the National University of Singapore. From 1995 to 2001, he was Head of Cardiology in SGH and then Deputy Director, and Medical Director of NHCS from 2003 to 2014.
His sub-specialty interest is in interventional cardiology. Since 2003, Prof Koh has been the course director for the SingLIVE Course, an annual international cardiology conference showcasing the latest interventional techniques in cardiac and peripheral procedures. It attracts a large number of medical professionals from Singapore and around the world each year. Prof Koh also regularly delivers lectures and performs live angioplasty demonstrations in Asia.
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