SEPTEMBER – NOVEMBER 2020 • MCI (P) 052/10/2019

Refuelling our hearts’ tank

Know what your heart beats for PLUS Gifts from Supporting the the heart Palliative Care Team

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THE HOSPICE LINK • SEPTEMBER – NOVEMBER 2020 CHIEF EXECUTIVE’S NOTE Members’ Contacts Contents Support works both ways Ng Teng Fong General Hospital 379 Alexandra Road, S(159964) 1 Jurong East Street 21, S(609606) T: 6472 2000 F: 6379 4339 T: 6716 2000 F: 6716 5500 upport is important, the appropriate range of services • mitigating carers’ emotional and www.ah.com.sg www.ntfgh.com.sg and always works to assist caregivers and patients physical health needs, including [email protected] [email protected] S both ways. A caregiver in making informed decisions. during bereavement; Assisi Hospice Palliative Care Centre for Excellence will often ask: “What Volunteers can also offer practical • MDT to address patients’ needs 832 Thomson Road, S(574627) in Research and Education (PalC) is palliative care and how can my and emotional support, and may for greater pain relief and families T: 6832 2650 F: 6253 5312 PalC c/o Dover Park Hospice www.assisihospice.org.sg 10 Jalan Tan Tock Seng, S(308436) family members benefit from it?”. sometimes form an important part in financial subsistence; and [email protected] T: 6500 7269 For individuals living with serious of the MDT. • patients and caregivers to feel www.palc.org.sg illness, and for their caregiving Knowing what to expect and what relieved and supported. Buddhist Compassion Relief [email protected] Tzu Chi Foundation (Singapore) family and friends, palliative care to do allows: This October, and in celebration 9 Elias Road, S(519937) Sengkang General Hospital offers pain- and symptom-relieving • MDT to effectively execute Advance of the World Hospice and Palliative T: 6582 9958 F: 6582 9952 110 Sengkang East Way, S(544886) treatment to improve their quality Care Planning to prepare for Care Day, we would like to honour www.tzuchi.org.sg/en T: 6930 6000 www.skh.com.sg 17 of life. Healthcare professionals quality end-of-life care; and show our deepest appreciation embrace patients’ desires, values • improved access to timely support to all our palliative care health 2 Simei Street 3, S(529889) Cancer Society 2 Members’ Contacts and plans when considering disease (including services, use of professionals for their dedication T: 6788 8833 F: 6788 0933 15 Enggor Street, #04-01, www.cgh.com.sg Realty Centre, S(079716) management and burden relief appropriate equipment, provision and passionate service to our T: 1800 727 3333 3 Chief Executive’s Note from pain, anxiety, fear, and of relevant information, education community in Singapore. Dover Park Hospice www.singaporecancersociety.org.sg other symptoms. and resources); 10 Jalan Tan Tock Seng, S(308436) [email protected] T: 6500 7272 F: 6258 9007 4 Caring from the heart Similarly, for the multidisciplinary • expanded access to planned and Ms Evelyn Leong www.doverpark.org.sg Singapore General Hospital team (MDT) providing good palliative emergency respite care services Chief Executive [email protected] Outram Road, S(169608) care, the aim is to provide holistic to support caregivers; Singapore Hospice Council T: 6222 3322 6 Shooting stars in HCA Hospice Care www.sgh.com.sg care to allow patients to live 705 Serangoon Road, Block A #03-01 sghfeedback.com.sg the dark well despite their illness, support @Kwong Wai Shiu Hospital, S(328127) caregivers to manage their duties T: 6251 2561 F: 6291 1076 SingHealth Community Hospitals www.hca.org.sg (Bright Vision Hospital, 8 Refuelling our and have appropriate respite care. [email protected] Outram Community Hospital, hearts’ tank Patients and caregivers, on the Sengkang Community Hospital) other hand, need to cooperate with Hospital 10 Hospital Boulevard, S(547530) 90 Yishun Central, S(768828) T: 6970 3000 the palliative care team often made Alone“ we can do so little, T: 6555 8000 F: 6602 3700 www..com.sg/SCH 10 Have I done enough? up of medical, nursing and allied www.ktph.com.sg health professionals by sharing with St. Andrew’s Community Hospital together we can do so much.” KK Women’s and 8 Simei Street 3, S(529895) 12 Know what your heart the team their needs and plans. The Children’s Hospital T: 6586 1000 beats for care team will then be able to offer HELLEN KELLER 100 Bukit Timah Road, S(229899) www.sach.org.sg T: 6225 5554 F: 6293 7933 [email protected] www.kkh.com.sg 14 St Joseph’s Home A true friend at the end Lien Centre for Palliative Care 36 Jurong West St 24, S(648141) Duke-NUS T: 6268 0482 F: 6268 4787 Medical School Singapore www.stjh.org.sg 17 The healing in dying 8 College Road [email protected] Level 4, S(169857) T: 6601 2034 / 6601 7424 [Education] St Luke’s Hospital 21 Gifts from the heart T: 6601 5113 [Research] 2 Bukit Batok Street 11, S(659674) www.duke-nus.edu.sg/lcpc T: 6563 2281 F: 6561 8205 www.slh.org.sg 24 Events calendar & Metta Hospice Care [email protected] A warm welcome to 32 Simei Street 1, Metta Building, S(529950) new members T: 6580 4695 F: 6787 7542 11 Jalan Tan Tock Seng, S(308433) www.metta.org.sg T: 6256 6011 [email protected] www.ttsh.com.sg

MWS Home Care & Home Hospice Tsao Foundation 2 Kallang Avenue, 298 Tiong Bahru Road CT Hub #08-14, S(339407) Central Plaza, #15-01/06, S(168730) T: 6435 0270 F: 6435 0274 T: 6593 9500 F:6593 9505 www.mws.sg/centre-location/ www.tsaofoundation.org mws-home-care-home-hospice [email protected] [email protected] Woodlands Health Campus National Cancer 9 Maxwell Road, HTTPS://BPR.BERKELEY.EDU/ ORGANIZATION, HEALTH WORLD Centre Singapore MND Complex Annex A, 11 Hospital Drive, S(169610) #03-01A, S(069112) T: 6436 8000 F: 6225 6283 T: 6681 5999 www.nccs.com.sg www.whc.sg INFOGRAPHIC WP-CONTENT/UPLOADS/2016/04/INFOGRAPHIC_PALLIATIVE_CARE_EN.JPG

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THE HOSPICE LINK • SEPTEMBER – NOVEMBER 2020 THE HOSPICE LINK • SEPTEMBER – NOVEMBER 2020 SWOOPING IN TO SERVE

feel if I were a patient. We reach out to touch Working in a palliative ward and having a patients’ lives and make a difference.” more personal encounter with life and death As she enters the ward each day, Jacinta takes have given Jacinta much food for thought. Caring from the heart the time to greet the patients, and says goodbye She reflected, “Life is fragile. It is not when her shift ends. She believes it is a simple complicated. I have learnt not to take people From service at 35,000 ft to palliative care, Alexandra way of building a connection with the patients for granted. To express appreciation more and assuring them that the care team is here often to our loved ones. How we live matters, Hospital Care Ambassador Jacinta Chan proves all it takes is for them. and how we leave matters as well. I am a heart in the right place, backed by training and guidance. Her journey as a Care Ambassador has not been thankful to the many people in the palliative without challenges. There have been instances ward who have generously taught us this.” where patients have been more challenging with their needs and care. When this happens, Alexandra Hospital’s 20-bed palliative ward Clockwise from left: she tries to put herself in the patients’ shoes and started services on 1 July 2019. Dr Yong Woon Care Ambassador Jacinta Chan; a handmade card and hairband understand that they may be frustrated with Chai, Senior Consultant, heads the palliative for a patient before discharge; their situation or condition. “I have learnt to be care programme with a multidisciplinary Nutella tarts and honeyed cornflakes baked with patients more patient and understanding,” said Jacinta. team of doctors, nurses, occupational “On a flight, passengers are with us only for a therapists, physiotherapists, speech therapists, fixed number of hours. In the palliative ward, the pharmacists and dietitians. patient could be with us for much longer, for days or weeks. The ward is like their second home.” Care Ambassadors like Jacinta truly care for patients from their heart. When the hospital had to tighten the visitation policy, some patients were unable to see their loved ones. Together with the other Care Ambassadors, Eyra Fazira, Winnie Leong and Joseph Teo, Jacinta took the initiative to Left: Bouquets bought decorate the ward for Hari Raya and worked with by the CAs to cheer the nurses and therapists to organise a cookie- up the patients; Below: (from left) Care baking session to cheer up the patients. They even Ambassadors Eyra went the extra mile of personally buying flower Fazira, Winnie Leong, Joseph Teo and bouquets for the patients. Jacinta Chan

mid the COVID-19 outbreak, cabin crew members from the Singapore A Airlines Group have taken on the role of Care Ambassadors (CA) at various hospitals across the country as part of the effort to help Singapore overcome this difficult period. As Care Ambassadors, they are from nurses in the AH palliative ward, she trained to assist nurses to provide basic and soon learnt how to care for patients’ personal nutritional care for patients. hygiene, needs and wellbeing. As a CA in One Care Ambassador, Ms Jacinta Chan, 37, the palliative ward, Jacinta’s duties include has been with Singapore Airlines (SIA) for 12 assisting patients during bath times, taking years. As an experienced flight attendant, she them out for fresh air, serving meals, and has travelled to no less than 30 cities, serving doing craft work with patients to take their hundreds of passengers. When the opportunity minds off their illnesses. arose to extend her services in a hospital setting Jacinta felt that her training at SIA had as a CA, Jacinta did not shy away. She applied to prepared her for this role. “At Singapore be a CA and was assigned to the palliative ward Airlines, we were taught ‘service from the at Alexandra Hospital (AH) in May 2020. heart’,” said Jacinta. “Passengers are our own Prior to this placement, Jacinta had never home guests. We provide good hospitality heard of palliative care. She was initially and leave them with a memorable and lasting JACINTA CHAN, JOSEPH TEO, EYRA FAZIRA, YEO TAN TAN, ALEXANDRA HOSPITAL TAN, TAN YEO EYRA FAZIRA, TEO, CHAN, JOSEPH JACINTA concerned about caring for patients with life- impression. Similarly, as a CA, our care has to ALEXANDRA HOSPITAL SENIOR CARE MANAGER, TAN, TAN YEO limiting illnesses as she did not know what to come from our hearts. I would put myself in PHOTOS PHOTOS expect. However, with the training and guidance the patient’s shoes and imagine how I would WORDS

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THE HOSPICE LINK • SEPTEMBER – NOVEMBER 2020 THE HOSPICE LINK • SEPTEMBER – NOVEMBER 2020 TRUE CALLING

STEPPING INTO THE COMMUNITY Today, Ya Nee is a valuable member of the As an ICU nurse, Ya Nee often wondered about HCA Star PALS team. Community care has how her patients were coping after being not been without its challenges, but they are Shooting discharged from the hospital. “In my role as also accompanied by enriching rewards. a nurse in the hospital, I could only see a part “The Star PALS team is small, so the area of their lives,” she explains. “I could only serve of care is also expanded, but we also have them when they were ill and hospitalised. more autonomy and flexibility to reach out stars in “I felt fragmented and restricted.” to different resources to help our patients When the HCA Star PALS team put out a and their families,” Ya Nee explained. “It is call to hospitals for volunteers for the annual also a privilege for me to be able to witness Star PALS Family Camp in 2015, Ya Nee grew intimate moments in their lives.” the dark curious about the idea of caring for paediatric For Ya Nee, what began as a soft spot for palliative patients in the community. children has sparked a meaningful journey, The first encounter with Star PALS set the from volunteering to embracing nursing as For former marketing professional wheels in motion. In 2016, Ya Nee decided to a career. Poh Ya Nee, it was a chance sign up for the HCA Medi Minder programme. The HCA Medi Minders are a special group of Below: HCA Star encounter with a little girl that trained volunteers, who provide care for the PALS palliative nurse child so that their caregivers can have some Poh Ya Nee (second prompted her to embark on the from left) and a Star respite from the daily grind of caregiving. PALS patient and her journey of nursing. The experience provided Ya Nee with family at the Star PALS Family Camp in 2019; valuable insights into the daily routines and Opposite page: Poh responsibilities of HCA Star PALS nurses. “I got Ya Nee examines a Star PALS patient on a to see the nurses in action and patients within home visit the familiar comforts of home,” Ya Nee shared. “It really inspired me to want to support this group of patients.”

oh Ya Nee, a HCA Star PALS programme. “I had cold feet when I first got the Beneath Ya Nee’s Palliative Care Nurse, is not just acceptance letter,” she says. “But after the camp, P a nurse, but also a trusted friend I thought, ‘I can do this too’. bubbly disposition is a and supporter to her patients “I felt that as a nurse, I would be able to take and their loved ones. Beneath Ya Nee’s bubbly better care of children.” disposition is a soft spot for children, which has soft spot for children, motivated her to volunteer at an organisation THE TURNING POINT that has been serving chronically ill children At the age of 26, Ya Nee took up the accelerated and their families for over 10 years while Diploma in Nursing at Nanyang Polytechnic. It which has motivated working as a marketing professional. was a major turning point in her career and life. After four years in the marketing industry, Ya “It was tough adjusting to the culture initially,” her to volunteer at Nee had begun contemplating a career switch Ya Nee shared. to nursing. “In the course of my volunteering, But her background and skills in marketing I met an eight-year-old girl who had been proved useful. “The ability to engage and talk to an organisation that battling cancer for more than half her life,” Ya strangers helped me as a nurse,” she said. “I like Nee shared. “She had been in and out of the looking after people as well and it gives me a lot has been serving hospital countless times.” of satisfaction.” The little girl expressed a wish to attend Witnessing the toll that illness takes on

a children’s camp, a simple yearning for the children and their loved ones is never easy. CARE HCA HOSPICE chronically ill children usual activities her peers enjoyed freely. Ya Nee Prior to joining HCA, Ya Nee was a nurse in the accompanied the girl to the camp, taking care Intensive Care Unit (ICU). “It might be a sad and their families for of her daily needs. The experience gave Ya Nee place, but there are bright lights everywhere — the courage and confidence to overcome her the children’s resilience and their parents’ love,” initial reservations to proceed with the nursing she said. & PHOTOS WORDS over 10 years.

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THE HOSPICE LINK • SEPTEMBER – NOVEMBER 2020 THE HOSPICE LINK • SEPTEMBER – NOVEMBER 2020 SELF-CARE ROUNDS

Left: A self-care round has its light moments; Below: A modality for Psychosocial Rounds; Opposite page: Refuelling our Snippet from a poem hearts’ tank penned by the team

“Wow, you’ll be flying with angels!” That was the expression from a fellow colleague just before we joined the palliative care team. We really like this analogy. But we often wonder as well — how do these angels keep their hearts’ tank full for the many goodbyes to those they care for?

appreciation of music, and use of us. The themes covered range art-making and group sharing. Many often easy to forget that we can concepts to foster connection and from managing anger exhibited by of the team members were amazed keep giving only if our personal collective reflection as a team. These patients and handling challenging by how this experiential activity tanks are filled. The Psychosocial open up opportunities to explore behaviours to understanding could unearth deep emotions of loss Rounds and Angel Rounds have our own losses, expectations, individuals with borderline and grief over their roles as palliative been mental and psychological assumptions and emotions. personality, distilling ethical care clinicians, and the loss of other safe spaces for the team to be The exchange among the team conundrums, and holding space freedoms taken for granted previously. attentive to our own emotional encourages healthy sharing and for the moral distress experienced. A pocket-sized self-care booklet and spiritual needs, as well as provides a place of safety to carry By allowing members of the team was also specially crafted by our our individual and collective us through the weight we bear. to share, personal challenges and social workers during this time — a grief. As a team, we would want Conducted mainly in a group setting, struggles are validated openly, pandemic edition of Psychosocial to continue serving our patients facilitated discussions allow the thereby allowing growth as a team Rounds — which included encouraging out of the overflowing sincerity of team to process and make sense from these delicate situations. notes and thoughtful reflective our hearts, and strongly believe of their shared experiences, and exercises for personal contemplations in the importance of refuelling to form a connection of mutual CARING FOR THE TEAM UNDER and emotional recalibration. “The our hearts’ tank in order to soldier support and understanding for COVID-19 PANDEMIC Psychosocial Rounds booklet guided on in what we do. It is our hope one another, in turn building team As with many others, the recent me to pause and reflect on the many that such self-care initiatives will strength and cohesiveness. COVID-19 pandemic has impacted things that had happened over the past continue to remain relevant in alliative care vicarious trauma, compassion “Our work is so hectic that our palliative care team in few months,” shared Dr Chau Mo Yee, supporting each other through subscribes to the fatigue, existential questions and sometimes we go from day to day unprecedented ways. We saw one of our clinicians. personal and team growth, P theory of personhood, possibly burnout. In order to refuel without reflecting what a particular care pathways being rearranged “These self-care sessions are really enabling us all to be empathic which states that each our hearts’ tank, the palliative care patient or his death meant to us. and members of the team being meaningful and help to bind the team ‘angels’ who are ready to stand in individual is a whole, unique and team in Tan Tock Seng Hospital I appreciate that Psychosocial deployed to provide care at in its shared experience of dealing the place of love and pain with our holistic being. Wearing this lens, (TTSH) dedicates regular time to run Rounds help us to take a step back screening centres, intensive care with human suffering, allowing us patients and their families. palliative care challenges one to self-care sessions facilitated by our and make meaning of events that units and wards in the National to vent our emotions, encourage not only treat physical ailments team’s medical social workers, art happen at work,” said Ms Wendy Centre for Infectious Diseases (NCID). healthy introspection and shore the that the patient presents with, but therapist or psychiatrist. We have Ong, Palliative Care Nurse Clinician. We had segregation measures for team against the vicissitudes that to also dive deep into the intricate named these “Psychosocial Rounds” “I was able to reflect on my own department learning, and these come with caring. Whatever and extensive process of caring and “Angel Rounds”. life journey, mortality and to start group activities have mostly been name you call them — Balint for the person who has emotional, Psychosocial Rounds, led by thinking about the legacy that I wish moved to online platforms. groups, Angel Rounds or social, psychological and spiritual our medical social workers or art to leave behind.” In the midst of a pandemic, we Psychosocial Rounds — they needs. Adding to this is the fast- therapist, are sessions set aside Angel Rounds have a unique believe it is ever more vital for our have been instrumental in fostering paced environment where we have to allow reflective and cathartic focus on debriefing complex, team to support one another and mutual trust and communication, as to navigate demanding ethical expressions through various challenging cases. Our psychiatrist to continue our self-care sessions well as the growth of the team over considerations, be in the presence experiential activities. We adopt facilitates sharing and reflection through creative means. Our the years, which has been living of intense emotions and face death, a range of approaches, including around the table, and weighs in art therapist conducted a group and breathing as a family,” said dying and grief on a daily basis. narrative techniques (storytelling, on pertinent perspectives through art therapy session via a video Palliative Care Consultant With the hopes of alleviating poetry writing, imagery), psychological lenses and theoretical conferencing platform, where Dr Raymond Ng. TAN TOCK SENG HOSPITAL TOCK TAN physical and emotional suffering, mindfulness practices (relaxation, frameworks. This helps the team to WORKER) LEE QING HUI (MEDICAL SOCIAL WORKER), EILEEN HO (SENIOR MEDICAL SOCIAL she helped the team express their Palliative care places us the work we do could often bring centredness, grounding), tactile glean clinical insights and process thoughts and emotions towards the at the heart of many intense PHOTOS to the surface experiences of stress, modalities, artwork creation, the psychological impact left on WORDS experiences of the pandemic through conversations and emotions, and it is

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THE HOSPICE LINK • SEPTEMBER – NOVEMBER 2020 THE HOSPICE LINK • SEPTEMBER – NOVEMBER 2020 A SHIFT UPWARD

It is possible that some time later, when the residents pass on, the heartache of losing them would make us question whether we should have done things differently then. But because the future is not guaranteed, our care needs to be inspired by “I have learnt to count the present. ONE HEART It might also come as a surprise that managing face- my blessings. I have to-face visitations can also bring up the question: Have I done enough? learnt that there are Since the onset of COVID-19, staff have had to take on new roles — roles that we did not initially sign up for: gym trainers gamely took up the role of some things we can delivery men, administrative staff seconded to be safe distance ambassadors and our front desk staff count that would bring doubled as comforters. A team of nurses, pastoral staff and administrative staff has been set up to manage face-to-face visitations in nursing homes. joy. I chose those.” Managing visitation schedules while keeping to the strict precautionary measures can be challenging, and conflicts may arise when expectations are not met. During this trying period, staff have learnt to For Lyn, our pastoral care staff, her one-degree overcome their differences and work as a team.

A one-degree shift is to spend five minutes longer than she originally Borrowing the wise words of Rose, a pastoral care could be just spending would by the bedside of bed-bound residents. staff who has been with the Home for decades, “I five minutes more at the bedside of With residents who are silent, it might be easier learnt to count my blessings. Instead of counting my bed-bound patients; to simply stop by for a few seconds. Lyn commits working hours, my pay and how many times my Opposite page: Staff take on new herself to do it differently. While on her afternoon colleagues might have made a mistake, I have learnt roles to manage rounds, she greets every bed-bound resident. She that there are some things we can count that would visitation schedules pays attention to wipe away any stain around bring joy. I chose those.” their faces. This one-degree is not easily noticeable. It is also not often thanked, but it is these one-degree shifts that collectively transform the culture of care. Have I done enough? ONE MOMENT Working in a nursing home and hospice, All it takes is a one-degree upward shift in commitment on appreciating and maximising the present is a habit that our colleagues have picked up. Since we everyone’s part to transform the culture of care. cannot rewind the past or assume a future, our time with the residents is in the here and now. Dolores, one of our nurses caring for residents very day, our staff in the healthcare the parameters down to the exact degree. with dementia, shared about Andrew. Andrew is sector make countless decisions. This way, after one, five or even 10 hours on a loving father and grandfather who spends the E While not every one of them is life the plane, you would actually get to where morning going for a walk around the garden and and death, every decision is made you want. Should the parameters be off listens to music in the lull of the afternoon. He to ensure that we deliver a care that continues to by even one degree, you would be thrown also has advanced dementia. Throughout the day, satisfy and inspire. completely off course. you can find his hands clenched into fists as if he Yet, standing at the bedside of a dying resident, In healthcare, the one-degree shift in was safeguarding something. To ease his anxiety we are challenged with the question: Have I attitude is what makes the difference and draw him to participate in group activities, done enough? in delivering care. If we want to protect Dolores would open her pockets and encourage Sometimes, we ask that of ourselves. Other residents’ dignity, we do not start with him to drop whatever he was “holding” into her ST JOSEPH’S HOME ST JOSEPH’S times, families in their grief ask that of radical changes in infrastructure or pockets. Andrew would accede to it. healthcare workers. The struggle to find an healthcare policies. We start with daily On other occasions, he would be prodding the acceptable answer to that question requires commitments to make that one-degree PHOTOS table and murmuring incoherently. The nurses honesty and can bring healing. shift — for example, to smile more, to ask caring for him would draw a chair and patiently for permission before whisking residents tend to him. They would ask if he was counting

ONE-DEGREE SHIFT away for a haircut, or to wait until they have & COMMUNICATIONS, PARTNERSHIPS COMMUNITY SHEREEN NG, something, and even count with him. Meeting Imagine a plane that takes off from Singapore. To swallowed their food before giving them him where he is in the moment helps him to ST JOSEPH’S HOME ST JOSEPH’S get to your final destination, the pilot needs to set another spoonful. WORDS relax and gives us an opportunity to connect.

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THE HOSPICE LINK • SEPTEMBER – NOVEMBER 2020 THE HOSPICE LINK • SEPTEMBER – NOVEMBER 2020 YOUTH IN SERVICE

Know what your Chelsea Cheang and their families, assisting with practical families may go through a lot of struggles, (right) interacting with patient and solutions or being that listening ear to and palliative care gave “hope in a caregiver support patients and families faced with dark place”. heart beats for financial challenges, emotional turmoil and She said, “But I was also unsure if I was other family issues. She discovered that adequate. Do I have enough maturity in age was in fact not an obstacle to forming life to journey with someone through this a connection with her patients and their pain? Am I too emotional for this?” families; what was important was being When she was contemplating a change genuine and willing to listen. The first in direction after working with children patient that she journeyed with was a big, for two years, the calling to be part of the sturdy man in his 40s, with tattoos covering palliative care team nudged her again. She his entire body. spoke to other medical social workers in She said, “Initially, I did feel intimidated palliative care to understand more about by his appearance. But as I got to know the work, and eventually joined Assisi him, I realised he was a very gentle-hearted Hospice in September last year. man who wanted to share his experience as She added, “I feel that it is a privilege an ex-drug offender, to encourage others on to be able to journey with patients and to the correct path. He encouraged me not families at this difficult stage in their to let others look down on me just because lives. Every patient is someone I can learn I am young.” from, and they are the masters of their Chelsea has worked with people across own stories.” different age groups, including families and One of the most valuable things she children, at a Family Service Centre during has learned is that every day is a gift and her internship and at an early intervention should be filled with thankfulness. She centre for children after graduation. She said, “Instead of counting our days, we has had to face sudden deaths of children should make our days count.” she was journeying with, and helped For young people considering joining families cope with the loss of a parent. She palliative care, she shared, “Speak to had visited Assisi Hospice twice previously, people in the field to find out more. Do both as an undergraduate and social not be afraid of not being equipped worker, and was touched by the sharing of enough, you can learn along the way. Most the medical social workers. She understood importantly, know what your heart beats that patients at end-of-life and their for and go for it.”

Assisi Hospice’s young medical social worker Chelsea Cheang celebrates her second World Hospice and Palliative Care Day in October this year. She shares her experience and advice for young people considering a career in palliative care. “I feel that it is a privilege to be able to helsea Cheang has been with But there were also patients and their Assisi Hospice for a year now and families who treated her as their daughter or journey with patients and families at this C admitted that it was discouraging granddaughter, and were more willing to open when her youthful looks resulted their hearts. She said, “There was a patient’s in people not taking her seriously. At 26 years husband who gave me a flower to encourage difficult stage in their lives. Every patient is ASSISI HOSPICE ASSISI HOSPICE old, many may consider her young for a social me. He told me he felt worried for me, that it worker in a palliative care setting. “There were was not easy for someone so young to face someone I can learn from, and they are the patients’ families who asked if they could death every day.” speak to a senior social worker after they saw As a medical social worker, she provides

me,” she shared. psychosocial and emotional support to patients & PHOTO WORDS masters of their own stories.”

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THE HOSPICE LINK • SEPTEMBER – NOVEMBER 2020 THE HOSPICE LINK • SEPTEMBER – NOVEMBER 2020 BEFRIENDING OUTREACH

A true friend at the end We find out more about Project Happy Apples, Singapore “I still have a keen interest Hospice Council’s long-time community partner, from Dr Mervyn Lim and Dr Shawn Lin who founded the group in advocating for early when they were in medical school. end-of-life (EOL)

How did you get to know about the How has SHC’s advocacy work in helping Singapore Hospice Council? people to “Live Well. Leave Well.” aligned conversations with We co-founded Project Happy Apples (PHA) with PHA’s purpose? in 2012 by raising funds for palliative Since PHA’s humble beginnings, our project care patients while we were in medical has grown to set our sights on enabling loved ones and early school. We subsequently started a medical- change on a national scale — we hope student befriending service and raised to raise awareness on the importance EOL planning in awareness for palliative care by sharing of early planning for end-of-life (EOL) Below: PHA alumni and stories of palliative care through public care and prepare society for nation-wide mentors, Sep 2018; exhibitions. Since the inception of PHA, we ‘Die-Logues’ by sharing the stories of Opposite page the community.” from top: had connected with the Singapore Hospice palliative care and the patients that we Dr Mervyn Lim’s Council (SHC), which supported our project have befriended through our project. The speech at the 2018 Endgame through the years. We collaborated with advocacy work in helping people to “Live Exhibition; Drs as well as medical students and palliative How has your volunteering experience in SHC for fundraising, befriending services to Well. Leave Well.” resonates with the work Mervyn Lim patients (via our befriending efforts). PHA given you a head-start in your career? (left) and Shawn hospices, and through the bi-annual Voices that PHA aims to achieve in all three of Lin when they One of our befriending groups bought Mervyn: While I am not currently training for Hospices exhibition as well as the annual our target audiences: the general public first started the their 12-year-old patient with Duchenne’s in palliative medicine, my experience project as medical PHA exhibitions. (through our annual public exhibitions), students muscular dystrophy a pack of Monopoly with PHA has certainly allowed me to cards for his birthday last year. He was learn more about EOL care and to be typically rather glum and lethargic, but more sensitive about discussions with my the card game seemed to liven him up — patients (and more commonly, with their they’d never seen him brimming with such families). This is important as mortality immense joy before. It turned out to be his can be very real and very sudden in last birthday as he passed on shortly after, neurosurgery. As a healthcare worker, I but we later learnt it remained one of his think such skills are important regardless happiest memories till death. All he wanted of the discipline that we are in, and was some semblance of normality — friends, allow us to provide more holistic care game nights, candid banter — and we for our patients. In addition, I still have a were able to give him that for a few hours. keen interest in advocating for early EOL Following this bittersweet experience, most conversations with loved ones and early of our team realised the true value of our EOL planning in the community, and have volunteerism, and of maximising both life continued to conduct research on these and death. “Live Well. Leave Well.” seemed to topics in Singapore. sum up precisely what we felt. Shawn: The skills of a palliative physician transcend disciplines. Even in my daily life in internal medicine, the communication skills I have built up from my experiences in palliative medicine allow me to empathise with my patients and communicate that empathy in a genuine, sincere way. It has opened my eyes to the realisation that medicine is more than just surgery or drugs, and not just about

SINGAPORE HOSPICE COUNCIL SINGAPORE HOSPICE healing the physical body, but equally

PROJECT HAPPY APPLES, DR MERVYN LIM, DR SHAWN LIN LIM, DR SHAWN DR MERVYN APPLES, HAPPY PROJECT important is the bringing of relief and comfort to the patient’s soul. INTERVIEW INTERVIEW PHOTOS

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PHA president Flora Xu (3rd from left) with current project leaders 2020

A focus group discussion last year revealed How would you encourage the younger generation that people perceived palliative care as an and even your peers to consider volunteering to The healing unsuitable profession for young people and impact and transform more lives? how they were brave to choose such a career It isn’t every day that you get the chance to learn path. What’s your view? more about palliative medicine and EOL care. We do not think that palliative medicine is Through interactions with the people whom you in dying an unsuitable profession for young people. meet and befriend, you not only get a deeper It is a privilege, and requires patience and understanding of what it means to live well and dedication to accompany patients and their leave well, but you will also be given a special families during the last years of their lives. opportunity to play a significant role in the lives of Few associate palliative care with the softer approach that Like any other speciality, it is a meaningful others. Cherish and learn from these opportunities and rewarding profession. Perhaps it is not whenever you get them, and they will make you a takes care of patients’ mental and spiritual well-being but at age, but maturity of thought that would more holistic person and doctor in the future. the end, this could be the most important of all. be the prerequisite for training in such a speciality.

In your opinion, what can be done to he essence of palliative care is medical treatment (70%) but only 15% linked Top: Reaching Message from Flora Xu out to palliative change the public mindset so that more about providing quality of life palliative care to psychological wellness. patients can do will be interested to serve in the palliative PRESIDENT OF PROJECT HAPPY APPLES for patients with life-threatening In reality, faced with dying, the need to wonders for their T state of mind care sector? illnesses, as well as for their find meaning in suffering, to restore peace I’m currently a third-year medical student at the National We feel that raising awareness on the need caregivers. It may involve pain management, and gain mental strength become even University of Singapore. Before entering medical school, I for the palliative care sector and increasing medical and nursing care, therapy, counselling greater and stronger. access for members of the public to serve in volunteered with rehabilitation teams under Singapore National and case management for the patients, and A US research study2 conducted among meaningful and real ways would play a big Stroke Association for a number of years and was keen to learn caregiver training and bereavement for their 248 ethnically diverse patients found that role. For Flora Xu, the current PHA president, about a different aspect of care for these patients. I wanted to loved ones. Much less talked about though is patients wanted help most in overcoming it was only after hearing about PHA and follow them through on their final journey, and see what end- the area of psychosocial and spiritual wellness. fears (51%), finding hope (42%) and meaning joining it that she began to find out more of-life care was like from both the patient and provider’s points in life (40%). about the various avenues to serve in the of view. PHA has given me the chance to meet and hear the LISTENING TO THE TERMINALLY ILL Dr Gary Pasternak, a US-based palliative palliative care sector. This is because serving stories of people in their final months of life, and it has been In 2014, a survey commissioned by Lien care physician and medical director puts in palliative care is not something that we Foundation1 to examine death attitudes and it aptly, “To be a hospice or palliative care

spectacular and sobering in equal measure. I believe PHA’s SERVICES METHODIST WELFARE would routinely encounter in our everyday befriending project gives medical students the rare chance to preferences in Singapore found that only 50% physician is to be a steward of stories. It is lives unless we had a personal encounter learn about what it takes to care for the terminally ill, and help of Singaporeans had any understanding or to understand the fears and desires of other with it or are learning about it. Through awareness of palliative care. human beings, guiding narratives to their patients leave with dignity — both are invaluable things you education and sharing the experiences of Among those who claimed to be aware, most comforting conclusions. [Palliative care] has cannot glean from textbooks and lectures alone. those who have undergone palliative care, we understood it to be about caring for the dying to do with narrative, and with story, the

feel that we can get more people interested. AND PHOTOS WORDS (42%), providing pain relief (66%) and offering nuts and bolts of a life.”

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LEAVING A LEGACY SPIKES PROTOCOL FOR PRESENTING DISTRESSING Tackling the emotional, psychological and INFORMATION IN PALLIATIVE CARE spiritual wellness of patients, listening to their stories is as critical as managing physical pain and symptoms. MWS Home Care & Home Hospice (MWS) Medical Social Worker Zann Wong shared a poignant story of how a patient had talked about her passion in cooking during a home visit. “I offered to document and compile her favourite Hakka recipes so that she can pass it on as a legacy to her children. When her family received the recipe book, they realised it was a tangible reminder of their mother’s love and pride.”

CULTURAL DIFFERENCES In conversations with patients from different cultures, researchers found that values and attitudes affected their feelings, concerns and decision making about end of life. The survey by Lien Foundation found that Singaporeans’ top priorities focused around their families. These included not being a financial burden to family members (87%) and having loved ones close by (78%). Conversely, a US study3 with the family members of hospice patients revealed that the patients’ wishes were more individual- However this changed when she received a Top: Warmth and improvement six months after they empathy go a long centred. These included fulfilling the birthday card from her granddaughter. The way to assuring received intervention from the MWS team. desire to travel (79%) and accomplishing a card moved her so deeply that she decided to patients they are This means that these caregivers feel less not alone personal goal (78%). write cards to those who mattered to her. These stressed because the perceived care burden important last words were both healing for her is no longer as severe. RECONCILIATION AND RESTORATION and her loved ones. Where family members find it hard to show FINAL WORDS ON SPIRITUAL CARE “Through songs, prayer their appreciation and love, and reconcile NAVIGATING DIFFICULT CONVERSATIONS How does spiritual care help terminally past differences, the intervention of USING THE SPIKES PROTOCOL ill patients? palliative care professionals is essential. Managing difficult dialogues and touchy issues MWS Assistant Chaplain Chua Chiew support and recounting the Wei Leng, the niece of one of MWS’ former is a key aspect of palliative care. MWS adopts Poh weighed in. “Some patients may patients, experienced this first-hand. During the SPIKES protocol in presenting distressing be declining physically but we see blessings in their lives, patients a bedside meeting which was to be the last information to patients and their families in a improvements in them spiritually and with her aunt, the family mended their systematic manner. Staff are trained to deliver emotionally. Others suffered from incurable differences, expressed love for one another the bad news clearly, honestly and sensitively degenerative illness yet became more sometimes rediscover new and asked for mutual forgiveness. “As an so that patients feel understood and supported. resilient. Through songs, prayer support Asian family, we aren’t used to expressing and recounting the blessings in their our love,” said Wei Leng. “The bedside EVALUATING PSYCHOLOGICAL HEALTH lives, patients sometimes rediscover new meaning upon reflection.” closure benefitted my family tremendously OF PATIENTS meaning upon reflection. Spiritual care and and I hope more families will experience The MWS team conducts a holistic assessment love make palliative care complete.” this too, because it was really, really special of patients that includes asking about their Spiritual intervention should not be to us.” care preferences and the support system at presumptuous to give a dying patient a

Authentic dialogue on life and death home. In addition, staff also track the patient’s sense of hope. The role of the palliative care 1 Lien Foundation. (2014). Survey on Death Attitudes. Retrieved from is another way to evoke empathy and medical history, mental state, social history team is to encourage spiritual stirring, and http://lienfoundation.org/sites/default/files/Gen%20Pop%20Findings%20 compassion between patients and their and preparation for death, as well as measure not administer it. Report%20-%20Full%20REPORT%20%28Website%29_0.pdf 2 Moadel, A., Morgan, C., Fatone, A., Grennan, J., Carter, J., Laruffa, G., caregivers. This helps restore the person’s the severity of pain, anxiety and overall well- As Zann summarised, “We often get the Skummy, A., Dutcher, J. (1999). Seeking meaning and hope: self-reported psychosocial well-being with family being. Other tests are used to assess depression patient to talk about what the illness means spiritual and existential needs among an ethnically-diverse cancer patient and friends. tendencies in clients and caregivers’ burden. to him or her, and to understand this from population. Psycho-Oncology, 8(5), 378–385. https://doi.org/10.1002/ (sici)1099-1611(199909/10)8:5%3c378::aid-pon406%3e3.0.co;2-a Melissa Fong, MWS Senior Staff Nurse, Recent results revealed that among a spiritual point of view. For most patients, 3 Periyakoil, V. S., Neri, E., & Kraemer, H. (2018). Common Items on a recalled an elderly patient who seemed caregivers who felt moderate to severe the opportunity to share these is therapy Bucket List. Journal of palliative medicine, 21(5), 652–658. https://doi. indifferent about her impending death. burden, 68.5% of them experienced marked in itself.” org/10.1089/jpm.2017.0512

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oping with change is never easy, Gifts from C especially during a nation-wide pandemic. As healthcare is an essential service, our palliative the heart and hospice care member organisations continue to work To show support, love and gratitude to our tirelessly and selflessly to care frontliners during this difficult and stressful for their patients during this period. To express our deepest period in their fight against the COVID-19 appreciation and gratitude, virus, Singapore Hospice Council (SHC) a series of Love Gifts were delivered to frontline healthcare showered them with Love Gifts. professionals and staff.

3 – 5 MARCH 2020

We purchased, packed and delivered Love Gifts to the following member organisations.

RECIPIENTS Assisi Hospice, , Buddhist Compassion Relief Tzu Chi Foundation (Singapore), Dover Park Hospice, HCA Hospice Care, MWS Home Care & Home Hospice,

Metta Hospice Care, Singapore Cancer Society, St. Andrew’s 3 Community Hospital, St Joseph’s Home, St Luke’s Hospital and Tsao Foundation.

APPRECIATION TO SPONSORS Kaiser Pharmaceutical (S) Pte Ltd: mosquito patch Pua Loong Trading Co: Dragon Balm

1 Buddhist Compassion Relief Tzu Chi Foundation (Singapore) 2 Singapore Cancer Society 3 Love Gift #1: 4 Dragon Balm, Milo, mosquito patch, Oreo cookies, white coffee 4 Assisi Hospice 1 5 HCA Hospice Care SINGAPORE HOSPICE COUNCIL COUNCIL SINGAPORE HOSPICE

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WORDS AND PHOTOS AND PHOTOS WORDS 2

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JUNE – AUGUST 2020

From 1 March to 30 April, we launched a fundraising campaign on giving.sg. With the generous donations and amount raised, we delivered goodie bags and bento sets to the palliative care staff of our member organisations. 1 RECIPIENTS Bento sets – Assisi Hospice, HCA Hospice Care, National Cancer Centre Singapore, SingHealth 7 1 Community Hospitals, St. Andrew’s Community Hospital and Tan Tock Seng Hospital.

Goodie bags – Buddhist Compassion Relief Tzu Chi 2 Foundation (Singapore), Changi General Hospital, Dover Park Hospice, , KK Women’s and Children’s Hospital, Metta Hospice Care, MWS Home Care & Home Hospice, Singapore Cancer Society, St. Andrew’s Community Hospital, St Joseph’s Home, St Luke’s Hospital, Tsao Foundation and Woodlands Health Campus.

APPRECIATION TO SPONSORS National Institute of Education (NIE), Singapore 8 2 and Temasek Trust oscar@sg fund: bento sets and goodie bags 3 3 – 9 APRIL 2020 Kaiser Pharmaceutical (S) Pte Ltd: mosquito patch Hisamitsu Pharmaceutical Co., Inc: medicated fever patch We participated in packing and delivering Love Gifts to Probuild Solutions Pte Ltd: surgical masks three locations (before tighter safe distancing measures Ms Zoey Chen: delivery and partial purchase of items were introduced), to the following member organisations and community partners. APPRECIATION TO CONTRIBUTORS Student volunteers from MINDS Lee Kong Chian RECIPIENTS Gardens School: packing Member Organisations - Buddhist Compassion Relief Tzu Chi Foundation (Singapore), Dover Park Hospice,

Metta Hospice Care, MWS Home Care & Home Hospice, 4 National Cancer Centre Singapore, Singapore Cancer Society, St. Andrew’s Community Hospital, St Luke’s 1 Love Gift #3 goodie 6 bags: Metta Café cookies, Hospital and Tsao Foundation. Foreword Coffee, Dragon Balm, medicated fever patch, mosquito patch, 9 Community Partners - MINDS Lee Kong Chian surgical masks or 2 Bento sets with a fruit and packet Gardens School, National University Health System drink 3 Dover Park Hospice (NUHS), Singapore Association of the Visually 4 Metta Hospice Care 5 MWS Home Care Handicapped (SAVH) and St. Andrew’s Autism Centre. & Home Hospice 6 St Luke’s Hospital 7 SingHealth Community APPRECIATION TO SPONSOR Hospitals 8 St. Andrew’s Community Hospital INOUT Enterprise Pte Ltd: surgical masks 9 St Joseph’s Home 10 Tsao Foundation

1 MINDS Lee Kong Chian Gardens School 2 Singapore Association of the Visually 5 Handicapped (SAVH) 10

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A warm welcome to new members

Palliative Care Centre Sengkang Singapore Alexandra Hospital for Excellence in General Hospital General Hospital Alexandra Hospital Research and Education Sengkang General Singapore General is the first Integrated The Palliative Care Hospital (SKH) forms a Hospital (SGH), a member General Hospital in Centre for Excellence vital part of Singapore’s of Singapore Health Singapore providing in Research and master plan to provide Services, is the public holistic and seamless Education is a tripartite quality, accessible care sector’s flagship hospital. care from acute, sub- collaboration between to better serve the Established in 1821, SGH acute to rehabilitative Dover Park Hospice, Lee healthcare needs in is Singapore’s largest settings, reducing the Kong Chian School of North-eastern Singapore. acute tertiary hospital need for transferring Medicine at Nanyang Offering a wide spectrum with 1,700 beds and patients. Champions Technological University of specialist clinics and national referral centre for compassionate Singapore and the co-located with Sengkang offering a comprehensive care and quality of National Healthcare Community Hospital, range of 39 clinical life, the Palliative Care Group, initiated in SKH is part of the newest specialities on its Programme, one of October 2017. PalC aims integrated hospital campus. As an academic Alexandra Hospital’s to upskill the healthcare campus delivering healthcare institution five core clinical community in the multidisciplinary and and the bedrock of programmes, enables translation of palliative patient-centric care medical education, SGH and empowers patients care knowledge to covering all major is also committed to and their loved ones to optimal bedside care healthcare disciplines. innovative translational receive personalised and for patients living with Patients who need longer- and clinical research in holistic support from life-limiting illnesses, term rehabilitative care her continuous drive the multidisciplinary and the support can transfer from general to provide the best care team, helping them of their caregivers hospital to community care and outcomes for to cope better and live on this journey. hospital for recovery. her patients. well before leaving well.

EDITORIAL COMMITTEE CALENDAR

Editor Christina Wee 19–27 SEP 2020, SAT-SUN Associate Editor Anne Loh Singtel-Singapore Cancer Society Race Against Cancer 2020 The annual Singtel-Singapore Cancer Society Run Against Cancer Alexandra Hospital Yvonne Lee aims to raise funds for cancer treatment subsidies, welfare Assisi Hospice Angela Yeo assistance, cancer rehabilitation, hospice care, cancer screenings, Buddhist Compassion Relief Tzu Chi Editorial Team research, public education and cancer support group initiatives. Tzu Chi Foundation (Singapore) Sign up by 18 Sep 2020. Changi General Hospital Rasidah bte Alias Registration: http://raceagainstcancer.org.sg/ Dover Park Hospice Jenny Goo 29 SEP 2020, TUE HCA Hospice Care Toh Wei Shi SHC Multidisciplinary Palliative Care Forum“10 was the limit” — Khoo Teck Puat Hospital Tricia Tan Circuit Breaker, Funeral Practices and Disenfranchised Grief Lien Centre for Palliative Care Elaine Wong Speakers: Ms Ang Jolie & Mr Iskandar Dzulkhairi Bin Abdul Aziz Kajai Metta Hospice Care Cecilia Soh Co-Organisers: SingHealth & Association of Funeral Directors MWS Home Care & Home Hospice Nicolette Yeo Time: 1:00pm - 2:00pm Palliative Care Centre for Excellence Tan Li Kuan Venue: Zoom Webinar in Research and Education Registration: [email protected] / 6538 2231 Sengkang General Hospital Farah Rahman *In view of the COVID-19 situation, please check our website Singapore Cancer Society Kumudha Panneerchelvam www.singaporehospice.org.sg for updates. Singapore General Hospital Mavis Law Singapore Hospice Council Sheena Koong SingHealth Community Hospitals Muhammad Azhar bin Abdul Rahim St Andrew’s Community Hospital Peh Lay Koon St Joseph’s Home Shereen Ng St Luke’s Hospital Chua Hwee Leng 1 Lorong 2 Toa Payoh #07-00, Braddell House, S (319637) Tan Tock Seng Hospital Candice Tan T: 6538 2231 • E: [email protected] Tsao Foundation Desiree Lim www.singaporehospice.org.sg

Design Christian Subrata Contents are not to be quoted or reproduced without the prior Printer Yung Shung Printrade Pte Ltd written permission of the Singapore Hospice Council. 24

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