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.