Tell us more about your background. How did you get into Palliative Care and what made you stay?
Oh! That was quite some time ago. My first contact with palliative care was when I was a Year 4 medical student. Like any medical student, I had the opportunity to do electives. I chose to be attached to HCA home care for a one-month elective. So for [the first] two weeks, I was in their daycare. It’s a very different setting from the hospital – it’s mainly singing karaoke, enjoying yourself, talking to patients… but in that setting, they weren’t like patients, they were just people gathering and trying to have a good time. For [the last] two weeks, I was attached to their home care doctor and nurses.
That was my first contact with palliative care—in the community setting, not quite the hospital setting. Which is good – it opened my eyes that not all medical or healthcare has to be done in a hospital.
After graduation, I did my housemanship for a year. Then, in my medical office year, I think it was my third posting, I had chosen to do palliative medicine as a six-month rotation. That context was in the hospital, and I was with National Cancer Centre Singapore (NCCS), which is the department I’m now with. That was where I met Professor Cynthia Goh and Dr Li Jie Yi, and some of the pioneers doing [palliative care] work.
After six months, I was convinced that this was good work and [necessary] work—but not by me! At that point, for a young daughter, it was pretty draining—not physically, like the kind where you have to stay long hours. But it was emotionally or spiritually quite draining, and I didn’t have the resources to deal with that at that point. So although I saw the value of the work, at that point it was hard to think of it as a career I could sustain.
After that posting, I continued my training in internal medicine, before I had to choose my specialization. Then I sort of circled back [to palliative care] as something I could see myself developing a career in. I guess by that time I had the experience or at least the emotional or spiritual resources to make sure I’m balanced and well enough to contribute to patient care in that role.
You are someone who wears many hats and is deeply involved in the palliative care scene in Singapore. Could you tell us more about some of your most memorable moments?
Palliative care opens doors in many ways. For clinical or patient care, it opens the door not only to the patient but also to their family. A physician’s role is already a very privileged role—people tell you about themselves, about their body, things they don’t tell other people. And in palliative care, there’s an additional dimension that is open for you as a clinician: their life philosophy, how they’ve been living, their legacy, what they would like to leave behind, their regrets—the good parts and the not so good parts. They open their hearts to you. And sometimes in the community, it’s very literal—you go into their homes, with their families, when they’re at their most vulnerable place or time. That opens doors to a different, very privileged relationship.
That’s sort of the highlight in palliative care—the relationship with patients.
Also, my work with APHN opens doors to different countries or different sectors in APHN and allows me to learn about what happens in other countries for this group of patients or this group of healthcare professionals. [Other sectors within the Network] are also very open with us. They don’t just share the good side—the shine and the gleaming department—but they really show you the struggles, the lack of resources, the lack of manpower, and what they need.
For me, the cross-country relationship is also a highlight.
You were also involved in other palliative care programmes outside of Singapore, such as the Train the Trainer programme with Lien Collaborative in Bhutan. Did these experiences change or expand your outlook on palliative care in any way? If so, how?
Well, yes. My outlook in palliative care expands. As I’ve mentioned, different systems, health or healthcare is delivered in different ways, end-of-life care is delivered in different ways. Not only is the medical setting different, the social setting or cultural setting is also different. This has certainly opened my eyes and helped me make new friends and build relationships. I mean, I currently have a Bhutan doctor living with me. She will be here for a year so that she gets trained in palliative care, and when she returns to Bhutan, she can do some of the palliative care work there. [Working outside of Singapore] opens doors and helps me build relationships across countries.
In your opinion, what is the most pressing issue in palliative care today?
I don’t think I can consolidate it to just one issue, but.. I think there are many issues in different settings. We are all struggling in different countries or settings to integrate palliative care into the mainstream healthcare system. It’s not an add on, or at the frills, or good to have – but really an essential component of healthcare. We are finding our ways in different countries – there are some countries where even primary care lacks resources, and there, they’re thinking ‘how do we incorporate palliative care into our healthcare systems?’ In more developed systems like Singapore or the USA, it’s about how we channel our resources, how we make it part of the system, whether it’s in the tertiary or hospital system – so in the community system.
How do you manage the emotionally and mentally challenging aspects of being part of the palliative care field?
Self-awareness and self-understanding. It’s very important to check in with yourself, whether it’s physically, emotionally, or spiritually. We notice the changes – well, I notice the changes with my body and emotions. I find my own rhythm and catch myself. Now, I’m trying to get that balance back after COVID.
Before COVID, I knew I needed a break every quarter. I need to be away, take time off, whether to travel or do something that’s away from work. And I need to do it regularly, or else I’m not quite myself. I cannot function fully or give myself fully to each relationship with my patients, or to the work that I’m doing.
With COVID, you can’t really… you’re sort of stuck. You’re doing slightly different work. You’re trying to find that balance back again—taking care of yourself, so that you are well able to take care of your patients. It’s rest, having time away, spending time with family—basic things that must be ongoing.
A lot of us [palliative care physicians] also see the value and meaning of the work we’re doing. So sometimes when we are stretched and when resources are low, it’s really hard to prioritize. The meaning of what we’re doing pushes us to give more of ourselves; we just have to make sure we take care of ourselves too.
How would you like to see palliative care develop in the Asia Pacific region?
I don’t think there’s a one-size-fits-all model. The Asia Pacific is so varied, and so are their healthcare systems. I’d like to see each region take the core tenet of palliative care and make it work in their setting—whether it’s culturally, spiritually, or according to their healthcare systems. They should deliver the care in that [specific] way, rather than a prescribed way of doing things.
Do you have any words for aspiring palliative care doctors that you would like to share?
Be open to trying new things, things outside the system. We’re all very used to hospital systems or care, so do try outside that system—care in the community, or even try things in other countries, like seeing what it’s like in other countries. You’ll be surprised how you can actually contribute to palliative care.
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Original article source: APHN