MARCH – MAY 2020 • MCI (P) 052/10/2019

Constantly out of breath 7 things to note when caring for a person with dementia at the end of life CARING FOR PATIENTS WITH SERIOUS ILLNESSES

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THE HOSPICE LINK • MARCH – MAY 2020 CHIEF EXECUTIVE’S NOTE Members’ Contacts Contents Caring for patients Assisi Hospice St Luke’s Hospital 832 Thomson Road, S(574627) 2 Bukit Batok Street 11, S(659674) T: 6832 2650 F: 6253 5312 T: 6563 2281 F: 6561 8205 with serious illnesses www.assisihospice.org.sg www.slh.org.sg [email protected] [email protected] merican actor Michael J Fox said: lifestyle to enjoy quality of life by adopting good Bright Vision Hospital Tsao Foundation “Family is not only an important thing. care tips, a balanced diet and caring regime. 5 Lorong Napiri, S(547530) 298 Tiong Bahru Road It’s everything.” The multidisciplinary and care support group T: 6248 5755 F: 6881 3872 Central Plaza, #15-01/06, A I am sure all of us concur but often will be there to: www.bvh.org.sg S(168730) [email protected] T: 6593 9500 F:6593 9505 ask: then how could care be better extended? • Reduce unwanted variations in care and tsaofoundation.org The care quality of patients with serious illnesses improve the patient experience Buddhist Compassion Relief [email protected] can be enhanced through using a systematic • Improve efficiencies and outcomes at a potential Tzu Chi Foundation (Singapore) approach. Most individuals, when faced with the lower cost 9 Elias Road, S(519937) 16 loss of independence or control to their health, will • Align communication and collaboration among T: 6582 9958 F: 6582 9952 2 Simei Street 3, S(529889) tend to have mixed feelings of denial about the all healthcare disciplines www.tzuchi.org.sg/en T: 6788 8833 F: 6788 0933 2 Members’ Contacts situation or extreme concern about the future and • Enable one to effectively face new challenges www.cgh.com.sg Dover Park Hospice worry about their loved ones. Learning more about your or your loved one’s 10 Jalan Tan Tock Seng, S(308436) 3 Chief Executive’s Note Indeed, depression and anxiety can be common disease and condition can help ease concerns and T: 6500 7272 F: 6258 9007 90 Yishun Central, S(768828) issues for people dealing with illness, and anxieties. Hence, it is important to educate yourself www.doverpark.org.sg T: 6555 8000 F: 6602 3700 4 7 things to note when sometimes, even for their caregivers. Often, a person from the best sources of information so as to be [email protected] www.ktph.com.sg caring for a person dealing with chronic illness may grieve or feel a able to mitigate issues relating to you or your loved sense of loss. If you or someone you are caring for one’s condition. HCA Hospice Care KK Women’s and with dementia at the are not coping well, talk to the people who care 705 Serangoon Road, Block A #03-01 Children’s Hospital end of life @Kwong Wai Shiu Hospital, S(328127) 100 Bukit Timah Road, S(229899) about you. T: 6251 2561 F: 6291 1076 T: 6225 5554 F: 6293 7933 With appropriate support, especially from the Ms Evelyn Leong www.hca.org.sg www.kkh.com.sg 6 Constantly out of breath multidisciplinary team and caregivers, patients with Chief Executive [email protected] chronic illness can learn to adjust and realign their Singapore Hospice Council Ng Teng Fong General Hospital Metta Hospice Care 1 Jurong East Street 21, S(609606) 8 Losing muscle control of 32 Simei Street 1, T: 6716 2000 F: 6716 5500 the body Metta Building, S(529950) www.ntfgh.com.sg The phases and layers of care T: 6580 4695 F: 6787 7542 [email protected] www.metta.org.sg 10 Holistic cancer care [email protected] National Cancer Palliative Care ... introduction to palliative Centre Singapore 12 Not just on the surface approach MWS Home Hospice 11 Hospital Drive, S(169610) Living with a life-limiting 2 Kallang Avenue, T: 6436 8000 F: 6225 6283 illness with any prognosis Ongoing medical treatments CT Hub #08-14, S(339407) www.nccs.com.sg 14 Singapore Palliative Care as appropriate Symptom management T: 6435 0270 F: 6435 0274 Conference 2020 Hospice care/home supports www.mws.sg Psychosocial support of Condition is non-curative [email protected] 11 Jalan Tan Tock Seng, S(308433) patient/family Maximizing quality of life T: 6256 6011 16 An unexpected journey Symptom management Singapore Cancer Society www.ttsh.com.sg End-of-life Care Terminal Care 15 Enggor Street, #04-01, Palliative chemotherapy/ Spiritual care radiotherapy Weeks to months to live Realty Centre, S(079716) Woodlands Health Campus 18 Where are you now? Days to hours of life T: 1800 727 3333 9 Maxwell Road, Symptom management www.singaporecancersociety.org.sg MND Complex Annex A, Psychosocial support 20 Prevent cancer Palliative surgery Spiritual healthcare [email protected] #03-01A, S(069112) T: 6681 5999 caregiver burnout Maximizing community supports St Andrew’s Community Hospital www.whc.sg Psychosocial support 8 Simei Street 3, S(529895) 22 Improving nutrition and T: 6586 1000 Lien Centre for Palliative Care www.sach.org.sg Duke-NUS the mealtime experience [email protected] Medical School Singapore 8 College Road 24 Upcoming Events & St Joseph’s Home Level 4, S(169857) 36 Jurong West St 24, S(648141) T: 6601 2034 / 6601 7424 [Education] Lend Your Voice to T: 6268 0482 F: 6268 4787 T: 6601 5113 [Research] Palliative Care The way to get started is to quit www.stjh.org.sg www.duke-nus.edu.sg/lcpc [email protected] “ talking and begin doing.” WALT DISNEY 2 3

THE HOSPICE LINK • MARCH – MAY 2020 THE HOSPICE LINK • MARCH – MAY 2020 DEMENTIA CARE TIP TIP #3 #6 things to note when RECOGNISE THE PERSON WITHIN LEARN TO MANAGE AND Throughout the illness trajectory of persons CONTROL SYMPTOMS with dementia, their personhood remains. The Hospice team will be working with It is no different at the end of life. They are you to manage the symptoms that may be caring for a person still the same person with the same likes troubling your loved one. and dislikes, personalities and values. We Prevention is best, but picking up the can still help them recall pleasant past symptoms early is as important. Problems with dementia at memories that trigger positive responses. such as constipation are notorious for We can also stimulate their senses with their causing abdominal cramps, and can be favourite tastes, sounds and fragrances. easily resolved through laxatives and the end of life good bowel clearance. Skin care is a must, through applying moisturising agents and regular turning to prevent skin breakdown Caring for a person with dementia, especially at the end of life, can be very TIP and pressure sores. Mouth care is another important area. Your loved one may be on 7challenging and tiring for the caregiver. The Principal Resident Physician #4 tube feeding, or may have very poor oral of Assisi Hospice, Dr Rina Nga, who is from the Assisi Dementia Palliative intake. Dry mouths can lead to cracks in the oral cavity and painful mouth ulcers. Work Group, shares the following tips which can make the entire journey a HAVE AN ADVANCE CARE Your loved one may experience little less bewildering for the caregiver. PLAN DISCUSSION WITH YOUR other unpleasant symptoms like HEALTHCARE PROFESSIONAL pain, breathlessness, nausea If not already done, do ask your or vomiting. In addition to the healthcare professional for an Advance medications that your healthcare Care Plan (ACP) discussion. You may have workers prescribe, do also create a TIP to stand in as proxy decision-maker for comforting reassuring environment #1 your loved one. It is important to keep through dim lighting and calm in mind that decisions should be made sounds. Aromatherapy and gentle based on what your loved one would massage may also help. RECOGNISE WHEN YOUR LOVED have wanted for him/herself, not what ONE IS AT THE END OF LIFE you would want for him/her. According to research, it has been found Nevertheless, the final decision will that persons with dementia who are in also take into consideration the practical TIP their last year of life generally experience aspects of whether the preferences stated more frequent admissions to hospital for can indeed be honoured. #7

complications like pneumonia and urinary ASSISI HOSPICE tract infections*; and another life-limiting illness such as advanced cancer or end- HONOURING THE PERSON WITHIN Dr Rina Nga stage organ failure. interacting with Don’t get caught up in tasks for your loved As the entire a patient at TIP one. Set time aside to also reminisce with the Dementia dementia illness Palliative ward in the rest of your family and appreciate the DR RINA NGA PHOTO DR RINA NGA PHOTO trajectory is TIP Assisi Hospice #5 life of your loved one. You may want to set usually very long aside items and memorabilia that highlight and protracted, #2 RECOGNISE SIGNS OF the significant moments of his/her life. These family caregivers DISCOMFORT OR PAIN may include pictures, favourite soundtracks, often find it FOCUS ON WHAT IS POSSIBLE, Towards the end of life, pain, breathlessness, craftwork and other items. difficult to come to NOT THE IMPOSSIBLE nausea and vomiting may be experienced One suggestion is also to start envisioning a point of realisation Although we would all hope that our loved more. Healthcare workers may use different the type of funeral you may want to have, to that the journey may ones would remain with us forever, we know non-verbal pain assessment tools such as honour the life of your loved one. be coming to an end. deep inside that this is not possible. PAINAD to help them assess the level of During this time, good palliative care However, what is important and possible discomfort your loved one has. If you know support is available both for the person to achieve in this phase of a person’s life is of any particular sign that your loved one These tips are not exhaustive. There are many resources with dementia as well as the family to provide comfort and maintain as best a exhibits which indicates some discomfort available from organisations like Agency for Integrated Care, caregivers. Do speak with your loved ones’ quality of life as possible. If we can focus on (e.g. tightly shutting the eyes, shouting, Alzheimer’s Disease Association, Health Promotion Board, primary doctor to discuss a referral to and work towards these goals, caring for a tapping the bed, becoming very quiet, Monfort Care, Yishun Health and Tsao Foundation. either a Hospice Home Care, Day Care or person with dementia at the end of life can frowning etc.), do inform the healthcare

Inpatient service. indeed be a positive and fulfilling experience. GROUP WORK DR RINA NGA, ASSISI DEMENTIA PALLIATIVE workers who are attending to him/her. *Source: Schonwetter, R. S., Han, B., Small, B. J., Martin, B., Tope, K., & Haley, W. E., 2003: “Predictors of six-month survival among patients with dementia: An evaluation of hospice Medicare guidelines” in American Journal of Hospice and Palliative Medicine WORDS WORDS

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THE HOSPICE LINK • MARCH – MAY 2020 THE HOSPICE LINK • MARCH – MAY 2020 PACING YOURSELF Constantly out

2 DRESSING of breath • consider wearing loose clothing • sit on a chair to put on your pants Tan Tock Seng Hospital senior occupational therapist Stella • use long-handled reacher to reach for clothing Liew gives her perspective on how to manage breathlessness so as to allow continued participation in valued tasks.

r X has been living with chronic are useful skills. These skills, once mastered, 3 obstructive lung disease for coupled with compliance to a medication TOILETING M the past five years and he is regimen, allow them to continue to engage in • use urinal or commode if you have difficulty now at the last stage of this valued tasks and manage daily activities. in walking to toilet at night chronic illness. He is constantly bothered During the initial assessment of each patient, • pace your breathing when defecating by breathlessness. Everyday activities like I conduct an interview to understand their showering and wearing his pants can take a daily routine, the activities they like to do but toll on him. Therefore, he prefers to stay at have difficulty engaging in, and those they are home, instead of going out to have coffee with currently doing but are having difficulty with friends. An occupational therapist was referred due to breathlessness. I will also check on their to him during a visit by a community nurse to emotional well-being, cognitive ability and 4 coach him on breathlessness management so physical ability regularly. With the information COOKING he can continue to participate in the activities obtained, collaborative goals will be set with the • sit down to prepare the ingredients e.g. washing of he values. patient. Therapy sessions will focus on energy vegetables, cutting of ingredients conservation and activity pacing. Practical • take a break during cooking by placing chair nearby WORKING WITH PATIENTS WITH END-STAGE application of the skills taught will follow to • serve food in small portions instead of carrying pots and LUNG DISEASE allow knowledge assimilation. For patients with pans loaded with cooked food As an occupational therapist in Tan Tock Seng difficulty in community mobility, they will be • push or slide objects across tabletop Hospital for the past six years, I have developed introduced to powered mobility aids such as a strong interest in working with patients with motorised wheelchairs or motorised scooters. I end-stage lung disease. Many whom I know are will conduct assessment and practice sessions plagued by breathlessness and started to stay for them to achieve basic skills needed to drive home, which eventually led to social isolation. the device safely. Home visits will be conducted Most of these patients lack the knowledge about to ensure they are able to utilise the device in energy conservation and activity pacing which their familiar environment. 5 GROCERY SHOPPING • plan a shopping list to buy only what you need • use a shopping trolley • take a few breaks if distance to travel is long TIPS FOR PATIENTS WITH BREATHLESSNESS ISSUE

1 SHOWERING 6 MOPPING • sit down to shower • use a spin mop or a mop with a handle to drain water • use warm water (avoid water that is too hot or too cold) • take a break after cleaning each room • shower when weather is not cold • use long-handled sponge to wash back and legs • ensure toilet is well-ventilated; for example, open toilet SENG HOSPITAL TOCK TAN THERAPIST, HUI, SENIOR OCCUPATIONAL STELLA LIEW CHUAN 7 SWEEPING window, leave gap at door • use dry wiper sheet or vacuum cleaner instead of broom • break down steps to shower: wash upper body, take a • use the momentum of the body while cleaning the floor break, then wash lower body • take a break after cleaning each room WORDS AND PHOTOS WORDS

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THE HOSPICE LINK • MARCH – MAY 2020 THE HOSPICE LINK • MARCH – MAY 2020 LOSS OF MOVEMENT

There are many care routines to go through exercises and activities (e.g. getting patients to on a periodic basis, especially for patients with grasp a ball with his/her hands). SMA. These include insertion of feeding and Losing muscle control tracheostomy tubes, stoma care and passive As the condition advances, what physical and exercise (may also apply to patients with DMD). psychological changes should patients and Emotional guilt is common as well, especially their loved ones expect? of the body for the mothers of patients with DMD, as the There are ups and downs while caring for condition can be passed on from the mother, who patients with SMA and DMD. Patients and their Spinal Muscular Atrophy (SMA) and Duchenne Muscular Dystrophy (DMD) is a carrier of the genetic trait. The diagnosis often loved ones may experience low moods at the affects the entire family, as the female siblings start, but grow to accept reality over time, and are two neuromuscular conditions commonly encountered by the HCA could also be carriers, which might impact family- even embrace the new norm and focus on the Hospice Care Star PALS team. Palliative care nurses Serene Wong and Ren planning decisions. remaining abilities. In addition, financial difficulties may arise, given As patients with SMA and DMD gradually Hui elaborate on challenges and care tips for these conditions. the chronic nature of SMA and DMD and need for lose all their physical functions and become specialised medical equipment to support ongoing completely bedridden, risks of mucus blockage care. For patients with milder forms of SMA and and aspiration pneumonia can occur. DMD, they might be able to attend school and go Some parents might experience anticipatory or the parents of HCA Star PALS outdoors, but transportation options are often grief as their child’s condition deteriorates, (Paediatric Advanced Life Support) limited and expensive. but the child’s positivity and acceptance often F patients, the journey of caring for brings them much comfort. their children is often fraught with What are some tips to strengthen muscle and varying challenges and mixed emotions. Patients joint function? How does the HCA Star PALS team prepare

often experience great challenges with activities Maintenance is key to slowing the deterioration patients and their loved ones for the Opposite page: of daily life. of SMA and DMD, and improving quality of life eventuality of death? Patients with SMA often require through passive exercise, supplements and The HCA Star PALS team builds rapport with numerous medical What are some common physical symptoms sun exposure. Passive exercise can minimise patients and their loved ones over time and equipment to assist in basic physical of SMA and DMD and their accompanying contractures and facilitate secretion movement. encourages open discussions of what is functions, such challenges? For patients with DMD, supplements to boost important to the patients’ lives, and to live life as breathing and eating; Below: Patients afflicted with SMA are often dependent muscle function can be given. Using the cough fully. If the family does not want to broach the HCA volunteer Kay on machines to maintain their bodily functions assist machine, incentive spirometer and subject of Advance Care Planning (ACP), the Thomson assists with lung exercises for a (such as breathing, eating and removing peak flow meter can also help to maintain team will respect that. Maintaining normalcy Star PALS patient, secretions). This reliance increases as the lung function. in the family’s routines, such as playing who has SMA. This helps to dislodge the condition progresses and patients gradually Most importantly, caregivers should try games and having meals together, can also be secretions that build lose muscle control of the body. As a result, to maintain existing functions through play, beneficial to all. up in the lungs they become completely dependent on their caregivers for all activities of daily living (ADL). For patients with DMD, the condition is often detected in early childhood, as they experience muscle weakness and falls more often than their peers. Scoliosis, contractures and poor heart function are common in DMD patients. Similarly, as the condition advances, they gradually lose their physical functions and require assistance for ADL.

What are some of the challenges that caregivers Maintenance is of patients with SMA and DMD might face? Caregiving is a round-the-clock responsibility, key to slowing the which can be both emotionally and physically draining. In the advanced stages of both SMA and DMD, patients who are bedridden will need to deterioration of be turned very frequently, in order to minimise the risk of bedsores. Patients with DMD often SMA and DMD, lose a lot of weight in the advanced stages of CARE HCA HOSPICE the condition, which makes it difficult for them to find a comfortable resting position. As they and improving steadily lose fat and muscle mass, caregivers have to be especially careful during transferring,

quality of life. to prevent fractures and dislocations. AND PHOTOS WORDS

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THE HOSPICE LINK • MARCH – MAY 2020 THE HOSPICE LINK • MARCH – MAY 2020 CANCER-SPECIFIC TIPS

Holistic cancer care Hip-knee flexion Cancer is a chronic disease and can be disabling, physically Consult your healthcare professional or and emotionally, for a long time. Here are some tips that can physiotherapist, and do not attempt these stretches without a caregiver. help patients and those caring for a loved one with cancer. 1. Hip-knee flexion Patient lies flat, face up, in bed. Caregiver supports patient’s heel and back of knee. adam Lee (not her real name) Bend the hip and knee toward the chest and was diagnosed with cancer and Caring for cancer straighten the leg out. Repeat 10 times. M underwent surgery to remove the tumour in her brain. After 2. Inner thigh stretch surgery, she was admitted to St Luke’s Hospital. requires strong medical Patient lies flat in bed. Caregiver supports She had difficulty performing daily activities the patient’s heel and back of knee. Move like walking. She also experienced hearing and and social support. Your the leg away to the side. Hold the stretch for vision loss. Besides her physical impairments, 10 seconds when you feel slight resistance. Madam Lee struggled emotionally and mentally. Return the leg to neutral. Repeat 10 times. She grieved over her condition and loss of quiet acts of service and independence, and frequently broke down Inner thigh stretch 3. Calf stretch during her rehabilitation sessions. journeying alongside will Patient lies flat in bed. Keeping the patient’s After two months of rehabilitation at knee straight, toes facing upwards, caregiver St Luke’s Hospital, Madam Lee was able to walk bends patient’s ankle towards the head. Hold with a walking frame with minimal assistance. be of great comfort. the stretch for 30 seconds. Repeat five times. The journey was not easy but she persevered despite many setbacks. Madam Lee was also How can I help my loved one feel more cared for by a multidisciplinary team of doctors, comfortable? nurses, therapists, dieticians, social workers Coping with cancer requires strong medical and counsellors. that includes medication time, shower time, and social support. Your quiet acts of service meal times, and time for recreational activities and journeying alongside will be of great What are some common physical symptoms a and exercise. Spread out the higher and lower comfort. For example, accompany patients for person with cancer may face and what are some energy activities. Scheduling can help patients appointments, get their favourite food, and ways to help them cope? better pace themselves and make the daily share good books and music. Fatigue activities more achievable. Patients may experience fatigue that may not Are caregivers expected to put up a strong be proportionate to their activity. For example, Memory loss front all the time? taking a bath can be very tiring. A simple Some patients may face memory loss such Caregiver stress is real. Take time to pause helpful strategy is to design a daily timetable as forgetting tasks, where they place things and reflect. Do acknowledge your feelings and important appointments and events. This regularly. You are allowed to feel sad or can be upsetting and frustrating. Use a to- Calf stretch inadequate. You are not expected to know do list. Put personal items at the same place everything. You are definitely allowed to rest. instead of scattering them so that it is easier Cancer rehabilitation at to look for them. Set calendar reminders for How can I approach end-of-life topics with my important events. This would allow patients loved one? St Luke’s Hospital to feel that they still have control over certain Listen actively and observe if there are St Luke’s Hospital provides services to meet the aspects of their daily lives; it will be a great underlying fears, anxiety and worries. It is needs of cancer patients. The cancer rehabilitation encouragement to them. important to address these emotions and issues earlier, for instance, to complete team provides care during pre-rehabilitation stage Joint stiffness and muscle tightness unfinished business, encourage reconciliation (before cancer surgery / treatment), treatment Due to pain and fatigue, patients may wish or forgiveness in relationships. stage (during chemotherapy / radiation therapy) to lie in bed more often. To help reduce joint If the patient wishes, you may ask for and post-treatment stage (post-operation). The stiffness and muscle tightness, and to promote Advance Care Planning, which is a platform for JOLYN KHOO, PHYSIOTHERAPIST, ST LUKE’S HOSPITAL ST LUKE’S PHYSIOTHERAPIST, KHOO, JOLYN team includes therapists trained in lymphoedema blood circulation, here are some stretches that individuals to make plans about their future management for chronic swelling in the lower limbs. can be done safely on the bed daily, together healthcare and record their preferences if they For more information, email [email protected] with a caregiver. Helping with these exercises lack the mental capacity to make decisions also promotes therapeutic touch, and is a in the future. For more information, visit practical way to show you care. livingmatters.sg WORDS AND PHOTOS WORDS

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THE HOSPICE LINK • MARCH – MAY 2020 THE HOSPICE LINK • MARCH – MAY 2020 WOUND CARE

Wound care nurses will need to do their homework well so that they are able to communicate and care for their patients.

Her vast experience has also taught her from the wound,” shared Sister Liew. that wound care is an area that requires She once had a patient with a tumor on lots of teamwork involving nurses, doctors, his neck and was unable to turn his head. dietitians and even therapists to ensure Due to its size, the nurses decided to use patients are well taken care of. Networking baby diapers and a scarf to cover it so that with other healthcare institutions is also the patient will still be able to enjoy his life very important. outside the ward. In addition, therapists will advise their To reduce the odour, Sister Liew and her Touch Therapy is an important patients on the suitable positions to be team placed an antibiotic powder in between aspect of palliative caregiving as it creates feelings of closeness when they are resting or moving around. the gauze. They even placed green tea leaves between caregiver and patient under his bed.

WOUND CARE FOR PALLIATIVE PATIENTS “We have to be innovative and think out Palliative patients will need support of the box when attending to such wounds,” physically and psychologically for their she said. quality of life. For this, Sister Liew works with the BVH A JOURNEY IN WOUND CARE rehabilitation team to provide for patients’ Sister Liew started caring for chronically ill social well-being with activities like playing patients on a part-time basis in 2005 before Opposite page: Bright Vision mahjong with other patients or going for venturing into rehab and sub-acute wards Hospital’s wound refreshing trips outside of the hospital. and eventually specialising in wound care at care nurse Sister Not just Liew Lee Fong To ensure that patients receive the best BVH in 2012. tends to wounds comfort during these activities, Sister Liew During her many years of work, Sister directly and through nutrition and the rehab team do what they can so that Liew encountered numerous patients who patients can be active and enjoy themselves. suffered from pressure injury wounds. Those on the surface “The challenge comes when patients experiences built up her skills and interest in have tumors on obvious areas such wound care. From using diapers and scarves to cover the neck, to placing tea leaves under as the cheek, face or neck. They can be “I get to know my patients first even before a patient’s bed to mask the smells, Bright Vision Hospital’s wound nurse embarrassed because of how they look they are being transferred to BVH,” she said. and the unpleasant odour that exudes Essentially, wound care nurses will need Sister Liew Lee Fong teaches us a thing or two about caring from the heart. to do their homework well so that they are able to communicate and care for their patients – understanding the patient and their urses at Bright Vision Hospital (BVH) loved ones on how to clean and dress a wound, care, being constantly updated on the latest look after both the body and soul of as well as what to look out for in order to prevent Tips on wound care wound care products, attending conferences N patients who receive an extended any complications. 1. Ensure that you have sufficient knowledge about the wound. to keep abreast of the latest news, as well period of stay after their transfer “Most of our patients are elderly, who tend to 2. Nutrition is very important when it comes to wound care. as having a good network of healthcare from a general hospital or nursing home. have low immune systems, and red blood cell Approach dietitians to ask how to improve the colleagues. With more than 15 years of nursing experience, levels that are dynamically unstable. Some of nutrition hydration. Although the healing process for her BRIGHT VISION HOSPITAL BRIGHT VISION HOSPITAL Sister Liew Lee Fong takes a special interest in her them also suffer from low blood pressure or are 3. Be mindful of blood glucose and diet. patients may be extensive – some as long as patients’ wounds. As the only wound care nurse sometimes anaemic,” explained Sister Liew. “This 4. Reduce or avoid smoking. six years – it does not stop Sister Liew from in BVH, she helps to assess, treat and care for is why wound nurses need to work with other 5. Have emergency contacts ready at all times. loving her job. patients with simple or complex wounds. healthcare professionals such as dietitians to “You can see the progress of the wound 6. Visit the doctor on time and regularly as a follow up. Because wounds need frequent attention, Sister make sure the patient has enough nutrients so healing, which can be fulfilling!” shared

Liew will also help to educate patients and their that the wound does not deteriorate.” AND PHOTOS WORDS Sister Liew.

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THE HOSPICE LINK • MARCH – MAY 2020 THE HOSPICE LINK • MARCH – MAY 2020 SPCC 2020 Singapore Palliative Care Conference 2020 – Embrace ∙ Engage ∙ Envision

The Singapore Hospice Council marks its 25th anniversary this year with a conference that will engage professionals beyond the palliative care community.

his year marks the 25th anniversary of T the founding of the Singapore Hospice Council. It is therefore timely, that the 7th Singapore Palliative Care Conference (SPCC 2020) held from 8 to 11 July 2020 at the Sands Expo & Convention Centre invites everyone to embrace our rich history and discover for ourselves the core values of compassion, strength and resilience that lie deep within our roots. It is pertinent that we reach out beyond our traditional boundaries to engage professionals outside the fraternity, as well as community services and industrial partners in relevant fields. diverse range of topics, that music therapy. The workshops offer It is only through bridging the divide include management of pain and opportunities for speakers to engage a amongst specialities, services and breathlessness, serious illness smaller group of participants and also interest groups that we may extend conversations, end-of-life care ethics allow participants to meet and connect holistic and comprehensive care to as well as holistic care for paediatric with others of similar interests. patients and their families. As we patients. As we continue to improve Our pre-conference symposium on celebrate who we are and what we access to palliative care beyond Dignified and Compassionate End-of- have achieved together, we continue to cancer patients, we are discovering Life Care is one of the highlights of reach out with open hearts and minds, an increasing awareness of the SPCC 2020. This one-day international fixing our eyes on the future. Thus, the palliative care needs of non-cancer symposium brings together four world- theme of the conference: “Embrace • patients of healthcare professionals. renowned scholars and clinicians in COUNCIL SINGAPORE HOSPICE Engage • Envision”. This resulted in increasing the fields of thanatology, palliative,

This four-day conference will interdisciplinary collaborations hospice and bereavement care to share PHOTO feature plenaries by esteemed local in the last few years. Many of our their knowledge in rendering holistic, and international speakers, pertinent speakers at SPCC 2020 are involved dignified and compassionate care to updates on clinical practice, as well in these collaborations across better support patients and families as presentations on recent scientific different settings and we are facing death, dying and bereavement. developments. Building on the excited to be able to learn from All in all, SPCC 2020 promises great community’s shared knowledge, their experience. opportunities for learning, rediscovering skills and insight, SPCC 2020 aspires SPCC 2020 starts with eight our inspiration for holistic clinical to provide our participants with an pre-conference workshops and a practice, and reconnecting with old inspirational vision into the future of pre-conference symposium over friends as well as making new ones hospice and palliative care. two days, covering a breadth in the ever-widening palliative care Thirteen overseas and more than of topics, from management of community. On behalf of the Organising

50 local eminent palliative care breathlessness, neuropalliative Committee, we welcome you to SPCC DR HO SHIRLYNN, COMMITTEE; ORGANISING 2020 CHAIR OF SPCC HAN YEE, DR NEO professionals have been invited care, to psychosocial interventions, 2020. We are certain it will be a rich VICE-CHAIR OF SPCC 2020 ORGANISING COMMITTEE COMMITTEE ORGANISING 2020 OF SPCC VICE-CHAIR to share their expertise across a serious illness conversations and learning and networking experience! WORDS

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THE HOSPICE LINK • MARCH – MAY 2020 *In view of the COVID-19 situation, please refer to https://singaporepalliativecare.comTHE HOSPICE for LINK the • latestMARCH updates. – MAY 2020 KIDNEY DISEASE

Opposite and this page: KTPH renal coordinator Sri Fairuz Baizuri counsels the patient An unexpected journey and his caregiver A patient suffering from renal failure at Khoo Teck Puat Hospital shares his journey thus far. When I was first introduced to the Disease Specific Advance Care Plan (DSACP), I thought it was a good he usual reaction idea as I will be able to express people will have when my thoughts and preferences in T they are first diagnosed case anything unexpected happens with kidney failure is to me and I am unable to choose shock and denial. However, I was my preferred medical treatment. I not surprised as I was expecting feel ACP really benefits my family the news. Having had diabetes as they do not have to carry the for more than 20 years, I knew it burden or guilt in making medical was a matter of time before my decisions for me in the event that I kidneys fail. To make matters worse, am unable to speak for myself. ACP despite having hypertension and also helps to prevent conflict among diabetes, I did not adhere to my my four children. dietary restrictions. I ate a lot of Two years after I first saw my is wasted away even though my Some of the scenarios asked salty and junk food too. I thought nephrologist, I finally initiated dialysis schedule is in the morning. during the ACP discussion were to myself, I was lucky to avoid other hemodialysis via vascular access. I rely on a wheelchair to get around. about my decision in the event I am complications from diabetes such My first session took two hours. I cook my own low-salt meals. faced with low chance of survival, as blindness and amputation but I I remembered feeling mentally and I no longer consume sweetened loss of ability to move around or was not able to avoid kidney failure. emotionally down as I was still drinks. Despite my nephrologist communicate, or mental incapacity. I told my wife and children about unable to accept my condition. I telling me my fluid restriction is I prefer a good quality of life and do the news. They too accepted it. Like was worried about the expense 800ml, I limit myself to 500ml per not want to be cared for 24 hours a me, they did not want to worry and complications of dialysis, and day. I no longer eat my favourite day as I do not want to be a burden too much. I have friends who are the unexpected. My family visited food – nasi briyani. to my family. It is very important to on dialysis but they seem to look me every day and I was discharged On 26 December, I had my me that I do not become a burden to normal and are still active in the on 2 October. Advance Care Plan (ACP) done. them physically and financially. community. Thus, we decided to My life has definitely changed take each day at a time and try to after starting dialysis. Physically, I adhere to the dietary restriction am free of the breathlessness and that we were told. swollen legs. My leg wound is also Prior to the dialysis initiation, recovering well. I am able to sleep Patient’s perspective Caregiver’s perspective I had multiple hospitalisations and lie flat on my bed now. Don’t give up hope. If you Ever since my father started dialysis, due to my leg wound and leg However, I still feel less than decide on hemodialysis, we have become more attentive swelling. Despite having multiple perfect. To me, hemodialysis is prepare your vascular access to his needs and always plan and doctors telling me that my leg just a way to survive. My freedom early to avoid the need for a discuss my father’s transportation swelling was due to my worsening Eventually, during one of the is restricted as I have to adjust to dialysis catheter. A friend of to and from the dialysis centre. We renal function, I still hesitated to consultations with my nephrologist, the strict thrice-a-week dialysis mine, who is also undergoing even make time, despite our busy create the vascular access. During I was given the ultimatum to initiate Once I start dialysis, there is no schedule. I can no longer go for hemodialysis, did not manage schedule, to accompany him for the pre-dialysis counseling, the haemodialysis either via vascular turning back as I would need long holidays nor meet my friends to have his vascular access his medical check-up. It is normal renal coordinator had mentioned access, or a temporary dialysis it for life. Also, I’m retired and I outside like I used to, as I will feel created on time and went to develop emotional stress from to create the vascular access catheter while waiting for the worry about the financial impact very tired and weak after dialysis. instead of wasting money and vascular access. I finally agreed to on my family just to support Due to my heart condition, my through at least three dialysis caring for the patient. Thus, it is creating pain for myself with the create the vascular access. me on dialysis. I wanted to try physical activities are limited and catheter insertions and multiple also important to have good social catheter insertion. My children On 10 September 2019, I was alternative treatment overseas I experience occasional chest pain. hospitalisations until he started support from family members, close were convinced and persuaded admitted for fluid overload. Prior to which was recommended by my I can only hope my chest pain using his vascular access for friends, and colleagues. I shared with me to create the vascular access admission, I had difficulty sleeping friend. My son was against that HOSPITAL PUAT KHOO TECK BAIZURI, RENAL COORDINATOR, SRI FAIRUZ does not occur before or during dialysis. Lastly, always give due my colleagues and they understand but despite having accepted my as I was unable to lie flat on my bed. as he was worried that something my dialysis as I will be asked to consideration to your doctor’s when I need to take leave. Do not condition, I wasn’t ready to create I was feeling very breathless and unexpected might happen. seek treatment at A&E. I am unable advice, over and above your over-think your problems and always one. I thought my kidney condition my legs were badly swollen, with Furthermore, it will be difficult to walk long distances and have friends and family. heed your doctor’s advice. was not too serious. I wouldn’t need blisters. Many doctors advised me to for my family to oversee the difficulty with steps and kerbs.

dialysis so soon. initiate hemodialysis but I refused. treatment as they are here. AND PHOTOS WORDS On dialysis days, my whole day

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THE HOSPICE LINK • MARCH – MAY 2020 THE HOSPICE LINK • MARCH – MAY 2020 MEMORY SHIFTS

Opposite page: Pastoral care volunteer Martina Ho having Where are you now? a conversation with a St Joseph’s Home resident; Right: Pastoral care volunteer, Martina Ho, at St Joseph’s Home talks about the joys of caring Residents with dementia live in for dementia patients, and the importance of meeting them on their own terms. the now

lease lah, please lah. Most touching of all, they care very real and rich to them. To be prayed and asked God to send one Give me two dollars.” about me. I recall an encounter compassionate caregivers, we need Japanese soldier to take care of my “P Mary looked at me with another resident named Rita. to meet them where they are. father and bring him back.” Then, earnestly. She had “I see that you’re here every day,” hunching low, she clasped her hands attempted to ask for money from Rita commented. Then, in hushed MEETING THEM WHERE THEY ARE and squeezed her eyes tight to show the nurses, but without success. She tones, she asked, “Do you get paid?” Jasmine is a gentle and soft-spoken how fervently she prayed. now turned her attention to me. I shook my head, “No, no, I’m a lady. When she is invited to join She continued, “While I was Thinking fast, I asked her in volunteer. They don’t pay me.” in activities, she mostly keeps praying, bullets and bombs flew return, “Why do you need two Almost shocked, Rita quietly to herself. Hoping to get to know past me.” With that, she motioned dollars? Everything here is free.” pushed her plate full of food her better, I introduced myself. her hands around her head, “Oh, good.” She considered, gave a towards me. “Come, eat this.” She Eventually, she opened up with mimicking the imaginary bullets slight nod and relaxed into the chair. insisted. “The food here is free. Eat a story from her childhood. It was and bombs zipping by. As she considered that, things Less than five minutes later, Mary before you leave.” during the Japanese occupation. The busy environment fell away fell into place. She brightened and prodded my arm. She whipped My friends often ask how I She was only 11 years old. The around us. In that moment, she was replied, “You’re right!” have learnt in my years volunteering an empty lipstick case from her manage to converse with residents radio broadcaster had announced living in the memory of herself at 11 at St Joseph’s Home is that the handbag. “Come, I sell you this with dementia. To my friends, they that all males are to be whisked years old. That was her present and LET THE PAIN OF GOODBYE GUIDE window of time we have with them is lipstick case. It’s three dollars.” are either repeating stories of old or away in a truck and killed. She was that was where I needed to be to YOUR MINISTRY OF NOW all that matters now. Caring for residents with dementia making impossible demands. distraught and especially worried share in her life. The pain of caring for a loved I would like to share a final story is such a joy. I laugh at their witty While residents with dementia for her father. one with dementia is that we will about Rita. I hope it quells the panic replies and reminiscence at their can appear to go back and forth on She looked me straight in the ALLOW THE ORDINARY TO BE witness parts of them disappear you have when your loved ones dwell childhood stories. their timelines, the present remains eyes and emphasised, “I prayed and EXTRAORDINARY before the death occurs. Their in the past or when they talk about On another visit to the home, I personalities change. Their memory dying. found Mary feeling dejected. She seems distorted. Every day, we fear I found her enjoying the windy was grumbling that she no longer that we might have lost another part morning after her daily Mass on one gets to play mahjong. Staff have of them. of my visits. encouraged her to join other So, we scramble to regain who While waiting for lunch, we casually activities, but she remains adamant. they are. chatted. We somehow “I’m a prisoner here,” she accused. During residents’ birthdays, some got on the topic of death. She Not sure what the anecdote might families would prepare a party. commented, “I come naked and I go be, I drew a chair to sit beside her. I have been to one such birthday naked. When my time has come, I will Then I asked, “Who did you use to celebration. The children would become a bird and fly to heaven.” play with?” encourage their mother to don her I panicked. “Don’t fly!” I anxiously “My friends from the same favourite blouse. Old songs played. replied, “If you fly away, I’d have no

ST JOSEPH’S HOME ST JOSEPH’S neighbourhood. We’re all about Decorations were put up. Family one to talk to.” Hearing that, Rita the same age.” She recalled with members sat around to talk about burst out laughing.

PHOTOS PHOTOS fondness. I could see her face lifting old times. Then, the celebration Catching myself reacting to her into a smile. would end with a group photo. hints about death, I added in a more It seems like an ordinary memory, The truth is, most of the residents serious note, “But Rita, if you feel like but it is special and treasured by with dementia do not remember it is time to fly away, go ahead.” her. Hence, I took care to honour their birthdays. They are simply She nodded at me, a gentle, that memory in my response. living their current moment. What I peaceful smile on her face. I responded, “If they are about your age, then they must have grandchildren too! Remember when you were caring for your To be compassionate grandchildren? You had to go to the market, do the laundry, watch them caregivers, we need to meet MARTINA HO, PASTORAL CARE VOLUNTEER CARE VOLUNTEER PASTORAL HO, MARTINA complete their homework… Imagine how busy your mahjong kakis WORDS WORDS RESIDENTS’ NAMES ARE CHANGED RESIDENTS’ are now!” them where they are.

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THE HOSPICE LINK • MARCH – MAY 2020 THE HOSPICE LINK • MARCH – MAY 2020 CAREGIVER RESPITE Prevent cancer caregiver burnout

Taking on the care of a cancer patient, especially during end-of-life, could see the caregiver’s whole life consumed by this one task. Here are the signs of caregiver fatigue and ways to prevent burnout.

aking care of a cancer the emotional signs and symptoms You may feel a sense of loss at having patient, especially of burnout. You may become to give up your lifestyle, plans or T during end-of-life, can increasingly irritable, often dreams. You may even feel unhappy often be emotionally feel helpless and hopeless, at having to make certain sacrifices. and mentally exhausting. It involves and frequently feel fatiqued Remind yourself of opportunities adopting new responsibilities, and exhausted. on the caregiving journey to make juggling various work- and family- Your emotional state can also affect meaningful memories and build related roles and navigating the your physical state and behaviour, deeper connection with your healthcare system. which could also be indicators of care recipient. breathing space. Give yourself Caregivers very often play a team of social workers at SCS The demands of caregiving can be burnout. For instance, you may find Secondly, having a self-care permission to take breaks away crucial role in supporting the provides casework and counselling relentless, and your life may even yourself falling sick easily, using boundary is important, so that you from your caregiving tasks. This cancer survivors’ cancer journey. services to help caregivers cope seem to revolve around caring for alcohol or stimulants more often, will not feel overwhelmed by your may involve making a commitment Yet, the needs of caregivers are better in their caregiving roles. your loved ones with cancer at home. losing interest in previously enjoyable caregiving tasks. This means knowing to allow yourself to participate in often overlooked. Find out more about our cancer Sometimes you might be so focused activities and isolating yourself from when to say “no”. Know your own activities or hobbies that will re- The Singapore Cancer Society (SCS) caregivers training workshops on your loved ones that you do not social events. limitations so that you do not take energise your spirit. You will build strives to meet the needs of family (conducted periodically) by realise that your own health and Being aware of these signs will on more responsibilities than you up your capacity to handle stress caregivers of cancer patients through emailing us at scs_pss@ well-being are affected. enable you to take active steps to can handle. and be better able to care for your its services and programmes. The singaporecancersociety.org.sg Caregivers have been found to be prevent a major breakdown. By Do not be afraid to ask for help. loved ones. more stressed and depressed and paying attention to your own self- Sometimes you may helpless because It is important to be assertive have lower levels of physical health care, you avoid reaching the stage you think that you lack the money, in communicating your needs to and general subjective well-being of learned helplessness, where you resources or skills to manage your others. Be willing to share your than non-caregivers (Pinquart & believe that you cannot do anything caregiving role. Seek and accept worries and concerns with trusted Tips to help yourself prevent Sörensen, 2003). If left unchecked, to improve your situation. support from trusted family, friends individuals. Advocate for yourself caregiving burnout: prolonged exposure to caregiver How then can you better take care and healthcare professionals. Various by being clear and specific about 1. Caregiving is not a sprint but a marathon. To help yourself manage your stress can lead to burnout. Caregiver of yourself? Firstly, it is important financial assistance schemes are the type of help you need to better caregiving roles for the long haul, pace yourself and be aware of your burnout is a state of emotional, to change your attitude towards available for needy patients as well as cope with your caregiving roles and strengths and limitations. Know when to say “no”. mental and physical exhaustion, your cancer caregiving experience caregiver workshops to increase your responsibilities. where one becomes overpowered and yourself. Let go of thoughts and effectiveness as a caregiver. There When things go wrong, express 2. Seek practical support from others to help you to run errands, collect by caregiver stress over time. Often, feelings that are unhelpful, such as are also respite care services that your feelings honestly to others medications and go for medical appointments. feeling a sense of powerlessness can blaming yourself for your loved ones’ can allow you to take a temporary who are supportive, and find out 3. Seek emotional support from trusted individuals who can provide you with lead to burnout and depression. illness, and feeling bitter and resentful break from your caregiving roles. Do how you can improve on managing a listening ear and encouragement. It is important to be aware of over handling your caregiving tasks. alert your healthcare professional your caregiving tasks. Part of the 4. Continue to participate in activities that you enjoy and give yourself if you need help to cope with your caregiving journey is also learning permission to take breaks when necessary. caregiving roles. to communicate well with friends 5. Seek respite care services that allow you to have a temporary break from Caring for someone who is sick, and family. Sometimes it may be your caregiving duties. By attending to your own needs, taking on new responsibilities, and hard to talk to them about cancer, 6. If you find yourself unable to manage, seek professional help from worrying about the future can be especially when breaking bad professionals such as social workers and counsellors to help you better exhausting. At moments like this, news. It is important to be clear cope with your caregiving roles and responsibilities. you will build up your own capacity do not be too hard on yourself but on how much you and your care affirm yourself and even celebrate recipient are prepared to share, to handle stress and be better able the successes, however big or small. as well as how much information DR JOAN KHNG, SENIOR SOCIAL WORKER, SINGAPORE CANCER SOCIETY SINGAPORE CANCER SOCIETY WORKER, SENIOR SOCIAL KHNG, DR JOAN

Another way of taking care SINGAPORE CANCER SOCIETY your loved one, family and friends Reference: Pinquart, M., & Sörensen, S. (2003). Differences between caregivers and noncaregivers in psychological health and of yourself is to set aside time are comfortable to receive. When in physical health: A meta-analysis. Psychology and Aging, 18(2), 250-267. doi:doi:http://dx.doi.org.eproxy.lib.hku.hk/ PHOTO to care for your loved ones. to recharge and give yourself WORDS doubt, do not hesitate to seek help. 10.1037/0882-7974.18.2.250

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THE HOSPICE LINK • MARCH – MAY 2020 THE HOSPICE LINK • MARCH – MAY 2020 NUTRITION & EATING TIPS

4. SERVE SMALL MEALS OR SNACKS THROUGHOUT THE DAY a. Encourage your loved one to decide when or what they would like to eat. b. He or she may tolerate 5 to 6 small meals a day better than 3 large meals. c. Small servings may look less intimidating. You can always top up with more food if they are still hungry. d. If nausea is present, remember to serve the nausea medication at least 30 minutes before a meal, or as advised by the doctor.

5. MAKE EVERY MOUTHFUL OF FOOD COUNT a. Increase calories and protein content in meals, e.g., add sesame oil, egg, fish or tofu into porridge; add peanut butter or tuna to biscuits; add oral nutritional supplements to milkshakes. b. Provide high calorie, high protein snacks, e.g., red or green bean soup, sesame paste, bubur cha cha, bao, beancurd. c. Provide nourishing fluids, e.g., soya milk; full cream or flavoured milk; oral nutritional (Abstracted from Singapore Hospice Council’s Improving nutrition and supplements; fruit smoothies; yoghurt ‘Nutrition in Advanced Illnesses’ resource booklet. drinks; adding milk, ice cream or honey For more tips and recipes, download the booklet here: the mealtime experience to beverages. https://singaporehospice.org.sg/caregiver/) Tips to maximise your loved ones’ nutrition, comfort and quality of life when faced with advanced illnesses.

1. UNDERSTAND FOOD PREFERENCES b. Create a relaxing environment to allow a. Your loved one may have enjoyed certain types of enjoyment of food, e.g., in the company food in the past, but their preferences can change – of family or friends or play some soft a sambal belacan lover in the past may now background music. prefer plain porridge with simple bland c. Place dishes and cutleries within easy reach. side dishes. d. Encourage your loved one to eat at the b. Be brave and experiment with table, or at least out of bed. different herbs and seasonings to e. A good upright sitting posture on a enhance flavour and aroma. chair or being propped up well on a c. Different temperatures can bed helps to prevent regurgitation. It make the meal more interesting, is good to remain upright at least 30 e.g., hot main meal followed by minutes after each meal or snack to cold ice cream for dessert. prevent gastric reflux. d. Listen to your loved one, observe their responses to food and 3. ASSIST AND PACE AS NECESSARY drinks, and be open to your loved a. Eating can be tiring for your loved one one’s changing feedback. especially if they are breathless or tire easily SINGAPORE HOSPICE COUNCIL SINGAPORE HOSPICE to begin with. Take frequent breaks during 2. MAKE MEALTIMES MORE ENJOYABLE AND the meal. EASIER FOR YOUR LOVED ONE b. Ensure your loved one has swallowed the food a. Have meals in a well-lit environment and help put before feeding the next spoonful. on your loved one’s spectacles if needed to help c. Provide small sips of fluid between mouthfuls of

them appreciate what they are eating. food to help clear the food in the mouth. AND PHOTOS WORDS

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THE HOSPICE LINK • MARCH – MAY 2020 THE HOSPICE LINK • MARCH – MAY 2020 CALENDAR Upcoming Events

8 – 11 JUL 2020, WED – SAT* 7th Singapore Palliative Care Conference (SPCC 2020) SPCC 2020 is a highly anticipated biennial conference organised by Singapore Hospice Council, featuring an excellent programme LYV campaign video was screened of distinguished local and at bus-stop shelters, MRTs, digital billboards at Wilkie Edge & Bugis international speakers. We look Junction and digital TV-screens in forward to welcoming you at HDB lifts from 5 December 2019 to 15 January 2020 SPCC 2020! Venue: Lee Kong Chian School of Medicine, Novena Campus (8 & 9 Jul) & Sands Expo and Convention Lend Your Voice to Palliative Care Centre, Marina Bay Sands (10 & Hot on the heels of our very well-received viral campaign #LendYourInstagram, the 11 Jul) Singapore Hospice Council has launched a sequel initiative, titled ‘Lend Your Voice to Target Audience: Healthcare professionals from all fields Palliative Care’ (LYV), a nationwide social movement urging brands and individuals to Contact: secretariat@ help spread the message of hospice and palliative care, and dying with dignity. singaporepalliativecare.com Many Singaporeans are still unaware of or have little understanding about palliative Registration: care and how it aims to maximise the quality of life of those with life-threatening https://singaporepalliativecare.com illnesses, by caring for the “whole person” physically, emotionally, psychologically, (early bird rate closes on socially and spiritually, and alleviating suffering for both the patients and their loved 30 Apr 2020) ones. Because ultimately, hospice and palliative care empowers these patients to #LiveWellLeaveWell during their final days. *In view of the COVID-19 No matter who you are or where your talents lie, find out how you can help bring situation, please refer to https://singaporepalliativecare.com hospice and palliative care to those who are most in need. Whether it’s offering a service for the latest updates. / product / promotion, donating advertising space or creating beautiful works of art, anybody is welcome to lend a helping hand. Find out how you can help at https://singaporehospice.org.sg/lendyourvoice/

EDITORIAL COMMITTEE

Editor Christina Wee Associate Editor Anne Loh

Assisi Hospice Angela Yeo Bright Vision Hospital Muhammad Azhar bin Abdul Rahim Buddhist Compassion Relief Tzu Chi Editorial Team Tzu Chi Foundation (Singapore) 1 Lorong 2 Toa Payoh #07-00 Changi General Hospital Rasidah bte Alias Braddell House Dover Park Hospice Jenny Goo HCA Hospice Care Toh Wei Shi Singapore 319637 Khoo Teck Puat Hospital Tricia Tan T: 6538 2231 Lien Centre for Palliative Care Jessica Goh Siew Hong E: [email protected] Metta Hospice Care Sandy Lim MWS Home Hospice Nicole Andrea Tan www.singaporehospice.org.sg Singapore Cancer Society Kumudha Panneerchelvam Singapore Hospice Council Sheena Koong St Andrew’s Community Hospital Peh Lay Koon Contents are not to be quoted or reproduced without the prior St Joseph’s Home Shereen Ng written permission of the Singapore Hospice Council. St Luke’s Hospital Chua Hwee Leng Tan Tock Seng Hospital Candice Tan Tsao Foundation Desiree Lim

Design Christian Subrata Printer Yung Shung Printrade Pte Ltd

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THE HOSPICE LINK • MARCH – MAY 2020