Singapore Sling - Pausing Healthcare
Chris Pearce was born in Hong Kong and describes himself as always being a bit of an Asia boy. His family moved to the UK, where he went to school and University. He trained as a Orthopaedic Surgeon in London.
After doing two Foot and Ankle Fellowships, one with James Calder in London and the other Hans Split in Dresden he got a Consultant job in the NHS in the UK.
An opportunity presented itself to him to move with his young family to Singapore, where he is now the Head of Foot and Ankle in the National University Health System, NUHS.
Ros
Why did you move to Singapore?
Chris
My best friend used to live here as well and he was kind of hassling me to come out, but unfortunately died just before I came, which is a bit weird, and I almost didn't come.
At the time people were leaving London to get out of the rat race and moving to Cornwall. Everyone was working too hard, and their wives were threatening to leave them. I thought if I came to Singapore, I could have my cake and eat it. I could work and do some research. There's lots of funding for research here which is good. Hopefully I could stay married which I have done so far, and I have a very happy work-life balance.
Ros
You are now a ‘Mid-career Medic, pre COVID, and how would you describe your work-life balance?
Chris
The work-life balance here is much better than the UK. That’s the main reason why I moved here. It only takes me 10 minutes to get to work on my Ducati and 10 minutes home again. Much better than London which was often an hour each way.
My job is, is good, like everybody else as you move further up that sort of ladder you do more and more managerial work.
The clinical load is less in Singapore than the UK, which is a downside. But the research opportunities are very good. I've got nice colleagues and you know and it's a nice place to work.
Ros
Did you have a five-year plan?
Chris
As you know, Ros, I had a bit of a wobble about a couple of years ago where I wanted to go back to London. Possibly to go to work with James (Calder) again and do some work with professional athletes. But my wife, who had never lived abroad before we came here and initially not wanting to move anywhere, said there's no way she would move back to the UK. There would be nail marks on the tarmac at Changi Airport if I tried to take her home, so I had a bit of a bit of a tough time with that.
Just when I was thinking that my career here wasn't working as well as it could have done a few good things happen. I ran that Singapore orthopaedic Association Conference, in Foot and Ankle which you came to and spoke brilliantly at. I managed to get a lot of people from around the world to come. It was a great meeting and soon after that I was promoted to Associate Professor and the hospitals merged.
I became the first Head of any Section of Orthopaedics and in most medical specialties to be the Head of Section across all three of them. I've finally gotten my Foot and Ankle Empire. I've got seven consultants’ colleagues now. There is a big opportunity to really get things started with research front and I am now making a name for Foot and Ankle surgery in Singapore.
But COVID came just as I was putting all those things together. So it's now been put on hold a little bit.
But there's some great young consultants in the unit I think there's some good things that can be done anyway.
Ros
We’ve chatted about this before; Foot and Ankle for me was very much a specialty that was evolving and is probably the most exciting specialty in orthopaedics. The combination of multiple pathologies and the technology we use, makes it very exciting.
There seems to have been a big explosion in in Asia with Foot and Ankle and all the research that they're doing. That seems to be to be very much more recent than the States for example. has been doing. Is it the opportunities that you now have open to your that's really reignited your passion?
Chris
I'm lucky really, the only other Foot and Ankle guy that was around my level was Dr Tan Ken Jin who is a nice bloke. He used to work at the University Hospital, but he went Private so then I was you know, it was quite easy for me to then become the Head over here.
Yes, Foot and Ankle around the region has really picked up you know, China and, and Thailand and Korea obviously is already always been very strong in foot and ankle and here there's some there's some great Foot and Ankle surgeons mostly in the Private sector, actually, unfortunately, but we do have an interesting debate, usually on WhatsApp over cases and things like that.
If it hadn't been for COVID, I would have been away at least six or seven times this year already for various conferences, most of them around Asia actually.
Ros
The experience in Singapore of COVID is very different to what we've had in the UK. I remember phoning you, as COVID was literally about to hit the UK and asking what we needed to do? Asia had been through all of this with SARS in Singapore.
How did you get ready for COVID? What impact did it have on your surgical practice?
Chris
Singapore was hit very hard by SARS as was Hong Kong. One of the things about SARS was that quite a lot of healthcare professionals died in Singapore.
One of the three hospitals that I work in now is called Ng Ten Fong Hospital in Jurong. It was built about four years ago. It was actually purpose built for something like. There is a whole isolation wing, all the doors are non-touch. There are positive pressure rooms and negative pressure rooms and all these sorts of things. It is set up specifically for this kind of thing.
Singapore has had an experience of a of a pandemic which, which was quite bad, so they were very quick to, to put things in place to prevent the spread. The first wave here was dealt with extremely quickly. And that time in early January we have our first case and it did spread in the community, but they managed to shut that down very quickly with contact tracing.
As the situation got a lot worse, especially in the US in the UK, and other parts of Europe, and borders, were starting to be shut down. They brought most of the Singaporeans, especially students who are studying in the UK, or the US, they all came back to the UK and a lot of those patients tested positive.
That was the second wave. The Singapore government were amazing. They basically hired out hotels. All those people that came back, spent two weeks in a five-star hotel so the government could keep them isolated. They really did a great job.
But the border with Malaysia was a big problem. Many thousands of people a day travel across that border when it's open. And so we did get a second wave.
Now we have what you might call it the third wave, which is what we're really dealing with now. It is affecting the foreign workers. Here, construction workers, mostly from the Indian subcontinent are called foreign workers. Mainly from India or Bangladesh, some from Thailand and China and other places. A lot of them live in dormitories, where they're fairly closely packed and sometimes 12 to 20 men in a single room with bunk beds. So of course, one when one or two of these patients or workers get COVID it spreads very quickly.
As of today, I think we've got about 33,500 confirmed COVID cases that in Singapore and 99% of those are in the dormitories.
Ros
Practically, what have you actually been doing? What has your day to day routine been?
Chris
A couple of months ago, we basically stopped almost all elective work. Initially were going down to help out in the emergency department. They built three tents that were built in three stages. These ‘fever tents’ were outside to deal with huge numbers of cases.
We started doing that. More recently, we've been actually going into the dormitories. I go to the dormitories about three times a week. My own team services two dormitories that have about 5000 men in each. We have tents outside the dormitory, and we we'll see anybody that presents with any kind of symptom in there because the dormitories have now been locked down. They are now quarantined in the dormitory, and we have a medical team in there. We will deal with whatever medical issues that they have. If somebody becomes ill, we send them to hospital. But if, if they just need a repeat prescription for diabetic medicine or something, we can sort that out. If they present with any sort of upper respiratory tract infection, signs or symptoms, then we will swab them. And they get moved to an isolation facility that day. Singapore has built lots and lots of isolation facilities for people, mainly infected workers.
Ros
So what surgery are you actually doing? What operating are you doing?
Chris
At the moment only really trauma or you know emergency cases, so trauma obviously carries on. And cancer work carries on. Initially up until April we were able to do sort of urgent cases. Like a high ankle sprain.
For example, I had a young guy who had a high ankle sprain and I said, I can't wait till August to be dealt with a bad high ankle sprain. But those kinds of cases have to be vetted by the operating theatre committee.
But we still do have the odd list running, but it is mostly just trauma and, and cancer work at the moment.
This week, I'm actually on the contaminated team. I'm not going to the dormitories, but I basically see any patient that comes into the hospital who is either suspected or positive with COVID and has an orthopaedic issue then I am the person that sees them with an SHO (Senior House Officer).
Yesterday I did a guy who had slashed his forearm and needed to repair some tendons in the forearm which is not an area of anatomy that I’ve done recently but yeah, it wasn't too bad.
Ros
You are not doing any elective activity?
Chris
Basically, I have I have one Foot and Ankle Clinic a week on a Wednesday morning now and I have one fracture clinic equivalent on the Wednesday afternoon. The rest of the days I am freed up to go to the dormitories or whatever. One of those isolation facilities is essentially a huge shopping centre that closed down a few months ago that's connected to my hospital by our walk-bridge. Now in the process of converting that to a 3500 bedded isolation facility for patients who've got COVID but are not particularly ill. Of course, they need medics to check on them daily. That is obviously going to be mostly down to my hospital. So I might I don't know if I'm going to be going there or not?
Ros
And do you have any indication or idea when you might restart with elective?
Chris
Yeah, so hopefully, in July. The other thing I mentioned is that we one of the things that they did very early on was to stop cross institution or movement.
When I said that I was Head of Foot and Ankle of three hospitals I had to stay in one as of late January / early February. I haven't been to NUH at all since then, because we were not allowed to do any sort of cross institutional movement. So
Ros
I assume that means social, you don't get to socialise with any of your colleagues from those institutions apart from
Chris
Social distancing includes not having lunch with anybody. That's a national thing that's not necessarily the hospital, for the last two months, basically is the stay at home. You can only go out for emergencies or to go shopping for groceries, all the restaurants and bars are sharp. All the schools have been shot for that long home-schooling for the kids.
Ros
And is that similar to when they had SARS or is it very different? It's much more organised?
Chris
I wasn't actually in Singapore for SARS. I was living in England, but I went to the I went to the Hong Kong sevens during the SARS. I remember leaving London and the UK Government said there is no advice against going to Hong Kong. But when I landed in Hong Kong and turned my phone on it said the UK Government advises against any non-essential journeys. I still went to the Sevens; probably wasn't a very good idea in retrospect, but luckily, I was okay.
From what I'm told, I think it took a lot longer for the SARS response, because it was something that had never happened before. Whereas this time, they had the experience from SARS. They're very quick to do contact tracing. That is something that Singapore did better than most places.
And isolating; you don't break the rules and Singapore, if you can help it so, you know. So the stay at home notice that you have when you came back from UK or US or whatever, you have to stay at home for two weeks. And you better do what you're told.
The Sounds of Recovery from a Pandemic
What would you do if every day for the rest of your life you were given £86,400?
Guaranteed.
Like everything in life that sounds too good to be true. There is a catch, and it’s non-negotiable. If you don’t use it, you lose it.
Now the next day you will be given exactly the same amount of money, £86,400. The same rule, spend it that day, or at the end of the day, it is gone. Other than that, every day, for the rest of your life, you will receive the money.
If that really existed, you would buy that lottery ticket. If that was the contract, you would sign on the dotted line. If that was your return on investment, you would become an angel in a heartbeat. If that was the cure for your pain, you’d give your consent.
Everyone should be interested in finding out more.
The reality is that only a tiny minority, the real top 1%, do. And this is the top 1%, not that group that appears on the Forbes or Times top 100, though admittedly some of them are there.
This unique group of individuals have done their due diligence, asked the right questions, and are completely satisfied that the deal is real.
If you need something to entice you over the line, there is a free bonus guarantee.
Everybody is eligible.
Though this club is unique, it also genuinely is non-discriminatory. It really does not matter, the colour of your skin, the shape of your body, or how you identify based on gender, culture or sexual orientation. There is no difference if you are a lawmaker or a rule breaker if you are low-life or a lord, the deal and the reward are exactly the same. £86,400 every day for the rest of your life, but you have to use it.
A new decade brings new hope and new resolve. For goals setters, it is a stake in the ground on which to mark the start of something better.
Hogmanay had been really magical. At a fantastic country house deep in Perthshire, the whole family had come together after a long hard decade, that had seen both success and failure, love and loss.
New Year’s resolutions were made.
The end of February, following a business improvement course in central London, I felt optimistic that had finally I had found something that would help me carve out the next few years.
That evening I operated with one of my favourite anaesthetists, at one of the top private hospitals in London.
The bit that stood out for me was the most striking thing I had seen in a very long time.
Fear.
And it was in the most unexpected of places.
Over the last few months, I have had time to reflect on what that fear was.
As a Medic, I have trained for and seen tragedy and crisis, but there was something very different about this.
For most healthcare workers, when a major incident like a fire, car crash, explosion, even a terrorist attack happens, it happens ‘outside’ the hospital. Patients are brought into our place of safety, we fix them and then, most of them go home.
What was different with this was that patients were bringing the danger into our place of safety, and that we may take home to our loved ones, or worse, we might not get home at all.
That’s was what the fear was.
And whilst we all knew that we would step up and do our job, no questions asked, some may and have paid for it with their lives.
The last months have been devastating for some, harrowing for many and terrifying for all.
Lockdown has created a completely new way of life. All with a backdrop of death and dying alone. Funerals have been without hugs for siblings, and babies born with grandparents not able to cuddle them.
Many businesses have failed, others have re-invented and thrived.
For some, it has been incredibly stressful and exhausting but for many, it has also given time.
Time to stop and reflect about WHO is important.
To pause and think about WHAT important.
To consider how we have been living our lives, how we look after each other and the planet.
In an increasingly, instant access world, this moment in history has woken most of us up to the fact that our most valuable commodity is our time, and our most precious asset is ourselves.
Both of which we have either been giving away free or abusing greatly.
It is our time that is the lottery win. These 86,400 seconds that we are all given, every day to use, that disappear at the end of the day if we haven’t, and are re-deposited every single new day, regardless of how we choose to spend them.
That is how we are all born equal, we all have exactly the same amount of time each day, and we can never get it back once it is spent.
Like most people up and down the country, and indeed around the world, I think of myself as having two aspects of my life.
Work, which I spend with colleagues. Individuals who I work with on a regular basis or get to catch up with periodically at conferences.
And personal. Family and friends, people I care about deeply, am sometimes frustrated by, and definitely take for granted that they will always be there.
That day in late February, the anaesthetist and I did as we always do when we see each other, we put the world to rights.
But this time it was different, and it was in her eyes that I saw Fear.
The first time I really became aware of anything going on, was early January. My partner works in industry and he mentioned that there was something going on with their supply chain. By February, he was tracking numbers of new cases and I must admit, I didn’t really pay a lot of attention.
But then the media started to report that cruise liners and the ski-slopes of Europe were being affected. The first cases were appearing in the UK and then in Bonnie Scotland. Milan and Venice started to report being overcome. The UK realised that our turn was coming too.
People started panic buying toilet roll and making homemade hand sanitiser from Gin.
My GP colleagues where getting inundated with phone calls, which were diverted to NHS 111 and airport car parks were now turned into testing centres.
BOND got cancelled, GLASTONBURY’S 50th Anniversary got cancelled. EVERYTHING got cancelled – This was SERIOUS.
The World Health Organization declared a global pandemic. Everyone who could, came home as flights got cancelled and grounded.
Where Brexit had divided, the country was now uniting to stay home, save lives and protect the NHS.
And then the first DEATHS in the UK were registered.
With fixtures and events cancelled, sportspeople and celebrities turned to do their bit on social media to raise awareness
Lockdown was declared.
And an unprecedented £330 billion pounds of cash was injected into the economy.
The country was now on life support.
A new group of workers emerged, key-workers, so too did the stories of desperation start to appear.
The vulnerable and elderly were now being told on an almost hourly basis by the media, that they were unlikely to get on a ventilator. Those that could, offered calm reassurance.
In a blink of an eye, society continued to hold its collective breath, to see if we really have flattened the curve, at least enough to give the scientists time to find a vaccine.
New words and ways of life appeared, “homeschooling” and “furlough” was the new norm.
School leavers and students up and down the country stressed about exams, graduations were done by zoom, leavers balls cancelled.
Joe Wicks kept parents sane as he got the nation’s children fit.
As we watched healthcare systems around the world become overwhelmed, the nation realised, that the NHS must be protected at all costs. Companies devised systems and innovative ways to help and responded in their droves.
The nation retrained dressed up, and did everything and pretty much anything to boost morale.
The Prime Minister and the Queen delivered unprecedented peacetime messages to the nation. This was now REALLY SERIOUS.
The death toll continued to rise. ’Key Worker’ Deaths were announced. Each and every one loved and cherished by their own family. And for thousands, there was heartache and despair .
The Prime Minister was in Intensive Care.
The combination of social distancing and isolation, coupled with the trauma of grief, has been reflected by an increasing number of mental health issues.
We were in this together and for 10 weeks the whole nation clapped every Thursday night.
Surgeons clapped, the cleaners, the porters, the admin staff and the doctors and nurses being most exposed in the high-risk COVID-19 wards and Intensive Care Units. Celebrities said thank-you on behalf of the nation. Individuals found ways to connect to the rest of the community through song.
At Easter, Andrea Bocelli reminded us of the empty spaces, the stillness and the silence.
Where Katherine Jenkins and Gary Barlow sang a duet, so would a Father and Daughter.
And as if on cue Gareth Malone trained his choir, as did NHS choirs up and down the country.
The virtual wave of community was not just song, it was also music. From Andrew Lloyd Webber to the Naval cadets.
It was dance. From the start of Strictly to those by themselves around the world, people were finding novel ways to stay connected to each other.
It was in art, with people recreating famous paintings at home.
Premier league footballers tried to lighten the nations spirits with fancy footwork tricks with toilet rolls. Football fans move from supporting the beautiful game to supporting their beautiful community.
Pretty much all sport had been cancelled. Football, the six nations, the Grand Prix, test matches, the London Marathon, Wimbledon.
People found new ways to train and stay fit, from running marathons on their balconies, to cycling the equivalent of three, 12 hours shifts in the NHS, to raise money.
This tiny virus is only point one of a micrometer.
1 millionth of a meter.
It infected one person, who infected two, and a chain reaction was set in motion
As some became many, the rate of infection rose exponentially.
It became clear that the only way to give the healthcare system the ability to cope, was to lockdown, in an effort to flatten the curve.
But the many continued to spread. And soon the whole world got infected.
People stressed about not being able to get to the hairdressers to get their roots done. Goats were taking over in Wales and the canals of Venice now have fish, dolphins and swans.
Perhaps the climate change protests that started with a schoolgirl were actually right?
Maybe the virus is not the real killer, but the human race, killing the planet.
And as we consider our future, it was one man (Sir Tom Moore) connected to our past that reminded us of our fighting spirit.
£1000, became £8 million, and finally turned in to over £30 million. His efforts were rewarded with a RAF Flypast, becoming the oldest person to get and number 1 record and a well-deserved tap on the shoulder from the Queen.
The country celebrated VE day with socially distanced tea parties and a wartime fighting spirit rained down through the sunshine.
The lockdown happened over a few weeks.
But the lift is going to take months if not years.
Where the virus killed, the lockdown saved many lives, but there was also a greater level of unintended, but as yet undefined harm that has been caused.
There seems to have been a loss of continuity as to why the lockdown was required in the first place – to ensure capacity for the health service. We managed that, we were not overwhelmed, and we have created additional capacity in the Nightingale and Louisa Jordan Hospitals should there be a second wave.
Much as there has been loss and heartache, there has also been an incredible amount of good. Is there a way to keep all that has been positive about this surreal experience as we ease into the ‘lift’. Can we cultivate this rediscovery of the local community, and combine that with the togetherness of these new virtual communities.
As the scientists and the politicians start to work out the details of the lift, society needs to think about how we remember and how we, as a society, learn the lesson of all of this. To decide what we really want our present and future to look like.
There will be memorials to the dead.
Global organizations will reconsider their priorities, efforts and philanthropy will continue lay foundations for the future.
35 years after BandAid, the culture of celebrity galvanizing the nation still exists to raises money for a relief effort.
But this time has also been a magnifying glass on the inequalities of health, education and social justice.
It has become a pressure cooker for protests, highlighting that while we may all have the same 86,400 seconds.
But the environment into which we were born and the opportunities inherited from our ancestors, is definitely not equal.
The ability to spend those seconds is not equitable.
While most of society is born at the start line of a 100 meters race, there are a few that are born inches away from the finish line, while far too many have not even had a chance to enter the arena.
Just a short couple of months ago, I was enjoying what I thought was a pretty good life. I could travel essentially where I wanted, I could buy things easily if I had to queue for more than two minutes, I became frustrated.
I had instant access online to almost anything, I just need to click and pay.
The 4th industrial revolution, with all its convenience and immediate gratification, allows us to live the life we lead, lockdown had given us all time to pause and reflect.
It has also given the planet time to take a giant breath.
Perhaps the greatest memorial of all would be for us to reset.
To work out how we positively atone for the decisions of our ancestors, abuse and exploitation of our fellow humans and the planet.
20 years ago my father and mentor left me the legacy of his love, wisdom and kindness.
"Care for those who cannot.
Be open to new challenges and the possibilities they bring.
Always have an enquiring mind.
Learn from the lessons of the past and the present to make the future better.
Remember you have a responsibility to use your talent to make things great, don’t waste it.
And above all else, always have hope."
So what do we think the legacy of all of this should be.
Never before has the world had a global pause?
Perhaps the answer to the question of what our future should be is not the responsibility of the politicians?
Maybe they really are just the servants of society, who implement the answer?
Maybe society should use this time of pause and reflect to see what impact our individual lives have had?
Collectively, by committing to not going straight back to life as it was BL – Before Lockdown, society as a whole has this one unique opportunity to reset for our own present and the next generations future.
Those who lost loved ones will need support.
Instead of the inevitable finger-pointing that has started and comes with the benefit of hindsight, let us be reminded of the greatest lessons our teachers taught us, how to learn from events.
How do we practically turn the new-found respect for all types of key workers, from a clap for careers into something fundamentally more practical and sustainable?
This is a challenge that must be risen to.
And practical help and support are also needed for those, who despite being catastrophically affected the economic crisis, still played their part and did their bit to sustain the nation.
And then lets party. We will need a massive party after all of this. Let's have a series of celebrations around the country and around the world. Bring together all those talented everyday heroes with their celebrity idols, to say thank-you to celebrate life and the talents of all of us.