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TA H O
THE HEARTBEAT OF NATIONAL UNIVERSITY HEART CENTRE, SINGAPORE
KE ME
M !
E
ISSUE 35
AUGUST 2020
WWW.NUHCS.COM.SG
Special
Covid-19
Edition
A Look Behind The Scenes | PG 6
IN THIS PG 24 PG 28 PG 34
ISSUE Floral Fantasy The Next Generation The Iron-Man Suit
In Heart Recovery for Proteins
MCI (P) 151/03/2019. All information is correct at time of print.
PULSE | ISSUE 35 | TABLE OF CONTENTS
04
TABLE OF Director's Message
CONTENTS
Message from Prof. Tan
COVID-19 SPECIAL
14
05 To Fit Like A Glove
THE TEAM Impact Of Covid-19 On Specialised nurses deployed to
Patients provide support at the National
Editorial Directors Infographic: What we know Centre for Infectious Diseases
Prof. Tan Huay Cheem about Covid-19 (NCID)
A/Prof. Poh Kian Keong
Editors
Mr. Don Chan
Ms. Juliette Lim
Publications &
Abstracts
Ms. Fion Tay
Ms. Lin Xiao Yun
Ms. Tan Sze Hwee COVER STORY |
A Look Behind The Scenes
Publishing Agency
The Orange Press Pte. Ltd
06 16
Pulse is a biannual A Look Behind The Scenes A Pandemic Transforms
publication by the Snapshots of National University Cardiac Rehabilitation
National University Heart Centre, Singapore (NUHCS) Delivering cardiac rehabilitation
Heart Centre, Singapore during the pandemic remotely
(NUHCS)
1E Kent Ridge Road, NUHS
08 17
Battling A Pandemic Learning Continues Even
Tower Block, Level 9,
Opinion piece by Prof. Tan on his In A Pandemic
Singapore 119228
view of the impact of Covid-19 An opportunity to reshape
medical education
nuhcs@nuhs.edu.sg 10
Inevitable Changes With
www.nuhcs.com.sg Covid-19
Opinion piece by A/Prof. Yeo on
www.youtube.com/user/NUHCS
his thoughts about the Covid-19
www.facebook.com/NUHCS pandemic
12 18
Copyright © is held by the Time Is Of Essence Conquer The Fear
publishers. All rights reserved. Managing life-threatening Supporting Covid-19 patients in
Reproduction in whole or in parts
emergencies in a pandemic critical care
without permission is prohibited.
2
PULSE | ISSUE 35 | TABLE OF CONTENTS
20 CLINICAL 33
From The Scene Of The Last Hurdle –
The Dorms 28 An Inquisition
Volunteers share their The Next Generation In Asst. Prof. Choong recounted taking
experiences working at Heart Recovery his viva voce during the pandemic
foreign workers' dormitories Achieving hemodynamic
stabilisation with percutaneous
RESEARCH
22 ventricular assist devices
Full Speed Ahead
In a race against time to set up
Tuas South Community Care
Facility
EVENT
23 34
29 The Iron-Man Suit For
Winning Gold Leading A New Era Proteins
Youths researched on Opinion piece by Asst. Prof. Chai Drum Lab created first man-made
experimental heart surgery for on his new appointment shells to protect proteins
showcase at fair
30 NEWSBYTES
Forging Ties Across Borders
Governing the Singapore Chapter 35
of the American College of Promotions
Cardiology Congratulations to our newly-
promoted doctors!
EDUCATION
24 31 36
Floral Fantasy Quality Improvement
Gaining Firsthand Project (QIP) Award
National University Heart Centre,
Singapore Annual Dinner & Dance Experience Winners
2020 Dr. Kua trained under
instantaneous wave-free ratio
pioneer 37
26 Publications & Abstracts
A Hearty Party To Warm
Hearts
Caring Hearts Support Group
annual year end party 2019 ERRATUM NOTICE:
In our last issue on page
34, the name of the award
27 was wrongly printed as
Leading The Heart Health 32 Quality Improvement Patient
Experience Award. It should
Movement Healthy Hawker Eats be the "Quality Improvement
Prof. Tan outlined his goals as Tips on making healthier food Project (QIP) Award". We
Singapore Heart Foundation's choices at a hawker centre apologise for the error.
(SHF) fourth Chairman
3
PULSE | ISSUE 35
DIRECTOR'S
MESSAGE
Dear readers,
The Covid-19 pandemic brought When Singapore raised its be deployed where they were
unspeakable pain and suffering Disease Outbreak Response needed, including intensive care
to patients, families, and the System Condition (DORSCON) units (ICU) to care for Covid-19
world. What first begun as a status to “Orange” on 7 February patients and to volunteer
medical issue quickly evolved 2020, NUHCS immediately in swab teams required in
into a social issue affecting set in motion emergency emergency rooms as well as off-
everyday lives as movement risk management protocols, site facilities.
restrictions were implemented establishing revised workflows
and social gatherings banned and infrastructure layout to Ranks and work scopes were
almost worldwide. It was prevent cross infection as cast aside as every trained
sombre to witness trade and well as to be prepared for staff pitched in to help and
businesses slow to a near halt contingencies in managing the responded to the call of duty.
and once bustling streets empty ongoing pandemic.
overnight. Despite the uncertainties and
Time was of the essence – risks we face in the course of
Yet it is also a humbling segregated medical teams were our work, our unity kept our
experience that humanity has set up to ensure round-the- morale high owing to the fact
been brought to its feet by an clock continuity of care and that we work alongside zealous
invisible enemy, and to witness to prepare for future possible colleagues and friends – all
the world literally shut down events such as the infection equally committed to seeing the
and change forever. of one of our staff. We needed sick walk out of our hospital as
to re-learn many things, adapt healthy individuals.
As part of the larger nationwide to instantaneous changes
healthcare team battling this happening every hour, and In times like these, we are
pandemic, National University respond to ongoing situations stirred to rise to our highest
Heart Centre, Singapore erupting every second. potentialities – to be the hope
(NUHCS) kicked into high gear and comfort for the sick and
to contain the outbreak with Amidst this stressful situation, I suffering.
two priorities at the top of our am in awe of the resilience of our
list – to provide continued care staff. Grappling with the limited
for our cardiovascular patients supply of healthcare workers, Tan Huay Cheem
and to protect the health and each and everyone stepped Prof. Tan Huay Cheem
wellbeing of our staff during this up to take on additional roles Director and Senior Consultant,
outbreak. and shifts and were willing to Department of Cardiology, NUHCS
4
PULSE | ISSUE 35 | COVID-19 SPECIAL
MORTALITY RATE
10.5%
ARTICLE BY
NUHCS Pulse Editorial 5
PULSE | ISSUE 35 | COVID-19 SPECIAL
A LOOK BEHIND
THE SCENES
Snapshots of National University Heart Centre, Singapore (NUHCS) during the pandemic
Faced with a pandemic, NUHCS responded quickly to manage the expected influx of critical
patients. This meant implementing emergency risk management protocols to prevent
infection outbreak within the centre and prioritising medical supplies and facilities for the
most urgent procedures. Take a look behind the scenes at NUHCS.
6
PULSE | ISSUE 35 | COVID-19 SPECIAL
7
PULSE | ISSUE 35 | COVID-19 SPECIAL
BATTLING A
PANDEMIC
Opinion piece by Prof. Tan on his view of the impact of Covid-19
Battling a highly infectious un- (PPE), instituting operative strat-
known virus which could poten- egies which minimise time of
tially escalate quickly into death, exposure, stepping up measures
brought about changes on many for acute resuscitation such as
fronts at every level throughout airway intubation and formu-
the National University Heart lating plans for right sitting of
Centre, Singapore (NUHCS). patients for post-operative care
after acute stenting procedures.
Change in Patient Care
Management To conserve our resources for
Research showed that the coro- the most critical patients, we Fortunately, the Western STEMI
navirus has a direct toxic effect had to redesign our rehabilita- network had been established
on the heart causing myocarditis tion programme to minimise earlier and played a crucial role
and heart muscle injury, poten- hospital visits while ensuring in this pandemic battle as sug-
tially exacerbating existing heart our patients progress with their gested by Italy’s and Spain’s ex-
conditions, weakening the heart recovery. Such challenges that perience where the centralisation
and even provoking a heart at- came up at every turn were met and streamlining of active STEMI
tack through systemic inflamma- with innovative approaches by care to a few centres potentially
tion. our team. In this case, wearables minimised crossover infections
and mobile applications provid- amongst patients and healthcare
To manage our current patients ed a solution. workers while freeing up trained
as well as Covid-19 patients, the intensive care unit (ICU) staff to
critical first step was to develop NUHCS’s role within Singapore’s support in other areas.
clear treatment pathways and healthcare network
algorithms for treating cardiac As the only centre in the National As part of the larger nationwide
patients, especially those with University Health System (NUHS) healthcare team, everyone in NU-
acute emergencies such as acute cluster that provides round-the- HCS, including our allied health
myocardial infarction (AMI), with clock emergency angioplasty and support staff, stepped up to
or without concurrent Covid-19 service for patients with heart at- volunteer where they can and
infection. tacks, NUHCS’s Cardiac, Thoracic took on extra workload in this
and Vascular Surgery Surgeon public health crisis. Our doctors
This meant changing clinical pro- (CTVS) Extracorporeal Membrane maintained a fortnightly roster at
tocols overnight such as formal- Oxygenation (ECMO) team is a the National Centre for Infectious
ising transportation protocols, critical resource and has since Diseases (NCID) and multiple
team segregation, implement- been called upon to treat two pa- teams from NUHCS volunteered
ing strict protocols on the use of tients at National University Hos- at off-site testing and care facili-
personal protective equipment pital (NUH), as of April 2020. ties for Covid-19 patients.
8
PULSE | ISSUE 35 | COVID-19 SPECIAL
Connecting with Medical professionals all over gency cardiac care team may
the global medical the world connected virtually be exposed to AMI patients who
community to discuss crucial observations concomitantly have Covid-19,
More than ever, and continue their knowledge thereby having to self-quarantine
medical and scien- exchange to keep up with the and shut down the entire essen-
tific experts around evolving pandemic. While we tial service.
the world need to
come together to This will take all of us
share their find- Reiterated by many, this pan-
ings to develop Such challenges that demic is an unprecedented is-
patient treatment came up at every sue and has changed our lives.
strategies. Howev- turn were met with To date, we are still battling with
er, many meetings innovative approaches the pandemic with gaps in our
and conferences by our team. understanding of the virus. This
were cancelled due Prof. Tan Huay Cheem, Director and Senior is a battle involving all of us and
to travel bans and Consultant, Department of Cardiology, we will need to work together to
lockdowns to sup- NUHCS win this.
port physical distancing meas- are busy saving lives, we must
ures and curb the spread of be prepared and equip ourselves Having witnessed the strength
the virus. so that we are better able to an- and support of my colleagues
ticipate the longer term conse- over the past few months, it is
Yet there was an unprecedented quences of the pandemic. with optimism and hope that I
rapid flow of information with am confident we can look back
new findings or complications What comes next? on this day and share stories of
related to cardiac care dissem- One of the most glaring observa- triumph.
inated in real-time across the tions shared was the significant
globe, in the race to uncover reduction in the number of heart This is an opinion piece by Prof. Tan
more about the virus and to find attack patients (about 40-70%) Huay Cheem, Director and Senior
the cure. A tremendous surge in who sought treatment in hospi- Consultant, Department of Cardiol-
related research originated from tals across the USA, Europe and ogy, NUHCS sharing his reflection on
the impact of the global pandemic
China, followed by Singapore, other Asian countries. This was
on NUHCS written in May 2020.
Europe and the United States. attributed to people’s fear of con-
tracting the virus if they stepped
NUHCS has been active in shar- into hospitals. Unfortunately, this ARTICLE BY
ing our experience with our inter- results in further complications Prof. Tan Huay Cheem
Director and Senior
national colleagues in China and and increased death rates in pa- Consultant, Department
the Asia-Pacific region through tients, which could potentially of Cardiology, NUHCS
webinars with active and ro- trigger a post-Covid-19 public
Prof. Tan is a professor
bust discussions on health crisis. of medicine at Yong Loo
how to manage Lin School of Medicine, National University
of Singapore and possesses a Master of
cardiac patients Another concern brought up Medicine in Internal Medicine. He is an active
clinical researcher, visiting professor at several
with Covid-19 was that in many countries, hospitals in China and invited speaker at many
infection. especially in Asia, the emer- international cardiology meetings.
9
PULSE | ISSUE 35 | COVID-19 SPECIAL
INEVITABLE
CHANGES ARTICLE BY
A/Prof. Yeo Tiong Cheng
Deputy Director and
WITH
Senior Consultant,
Department of
Cardiology, NUHCS
COVID-19
A/Prof. Yeo is the outgoing
Head of the Department of Cardiology, NUHCS.
His concurrent appointments are Senior
Consultant, Department of Cardiology, NUHCS
and A/Prof. at Yong Loo Lin School of Medicine,
Opinion piece by A/Prof. Yeo National University of Singapore. He is also a
fellow of the American College of Cardiology
on his thoughts about the and a specialist registered with the Academy of
Medicine, Singapore.
Covid-19 pandemic
S
ingapore diagnosed its first Inevitably, life for healthcare workers
confirmed case of Covid-19 on also changed – compulsory proto-
23 January 2020 in a Chinese cols were rolled out in hospitals and
national who travelled here from clinics. These include temperature
Wuhan. Very soon after, changes taking for all staff twice daily, cancel-
unfold almost on a weekly basis… lation of non essential elective sur-
geries to prioritise facilities and sup-
A rapid increase in confirmed cases plies for urgent cases, the required
was reported as testing and contact donning of appropriate personal
tracing teams went into full swing to protective equipment (PPE) and seg-
ring fence the source and curtail the regation of clinical teams to ensure
spread of infection. that our core teams can continue to
function and operate when the situ-
About two weeks later, Singapore ation escalates.
raised its Disease Outbreak Res-
ponse System Condition (DORSCON) Amongst the medical and scientific
level to Orange, the second highest communities, there is a quiet sense
level. This sparked widespread pan- of urgency as experts race to learn
ic with panic buying and hoarding more about this infection and devel-
of essentials such as rice, instant op tools to protect our patients as
noodles and toilet paper amongst well as the healthy communities.
other things.
10PULSE | ISSUE 35 | COVID-19 SPECIAL
While numbers are still low in Singa-
pore, we need to be mindful that Singa-
Amongst the medical pore is an urbanised country in a highly
and scientific globalised world. Our open economy
communities, there is a and the high density of city dwellers
make us highly vulnerable to imported
quiet sense of urgency
infections.
as experts race to
learn more about this I expect more changes to come, espe-
infection and develop cially since our ability to stop this infec-
tion is not only dependent on Singa-
tools to protect our
pore’s efforts. Equally important is how
patients as well as the successful our neighbouring countries
healthy communities. and the rest of the world are in over-
A/Prof. Yeo Tiong Cheng, coming this virus.
Deputy Director and Senior Consultant,
Department of Cardiology, NUHCS
There is truth in the adage – change is
the only constant.
Here, we too are bracing ourselves
for the possible impact when the Some things, however, remained the
virus hits us like a storm. Medical same – I drank a lot of green bean
supplies are quickly checked and soup during the severe acute res-
re-checked to ensure that we piratory syndrome (SARS) outbreak
have enough when we need them in 2003 because my mother-in-law
in an emergency. said that "it has anti-SARS proper-
ties". I am still drinking green bean
Our teams are working double soup now…
time to care for our patients and
spending as much time as pos- This opinion piece was written in early March
sible to soak up new information 2020 before the first two Covid-19 deaths
from our counterparts around the were reported on 27 March 2020 and strict-
world. We try to gather as much er movement control measures such as the
new clinical knowledge about circuit breakers and closure of non-essen-
SARS-CoV-2 as possible because tial services were implemented in efforts to
knowledge is the only ammuni- reduce community spread in Singapore. At
tion that we have against this un- press time, the pandemic situation contin-
known virus. ues to evolve with no vaccine available yet.
11PULSE | ISSUE 35 | COVID-19 SPECIAL
TIME IS OF
ESSENCE
Managing life-threatening
emergencies in a pandemic
S
T1 segment elevation myo-
cardial infarction (STEMI) is
a more severe form of heart
attack where the coronary artery
is blocked off by a blood clot for a
prolonged period of time affecting
a large area of the heart. Virtually, Cardiac and
emergency
the heart muscle being supplied teams working
by the affected artery starts to die, together
during PCI
leading to a life-threatening emer-
gency.
For STEMI patients, time is of es-
sence – their condition must be
diagnosed and treated promptly.
Compounded with the Covid-19
pandemic, cardiac centres world-
wide now face the risk management
of virus infection in healthcare facil-
ities in addition to managing the
sudden surge in demand for large
capacities of material and human
resources in an already finite cir-
cumstance.
In addition, one of the catheteriza-
tion labs (cath lab)2 at the National
Additional protective
University Heart Centre, Singapore gowns to be worn
(NUHCS) was undergoing reno- during procedures
such as N95 respirators
vations but this was halted due to and eye-shields over
the nationwide isolation of migrant sanitary clothing.
workers. When faced with a sudden
influx of emergency cases and all
cath labs were occupied, rooms at
the Department of Diagnostic Im-
aging (DDI) were transformed for DDI rooms
time-sensitive procedures to be become reserved
backup cath labs
carried out.
12PULSE | ISSUE 35 | COVID-19 SPECIAL
To avoid the risk of cross con- and continuously making ad-
Other hospital staff like tamination, critical procedures justments to ensure optimal
security and nurses don
protective gear to help were redistributed across the healthcare delivery and uncom-
transport critical patients
to and from procedure
Western STEMI network and promised critical patient care in
and recuperation rooms medical teams were confined to a pandemic.
one site. This saw all emergency
angioplasty3 services and STEMI 1
ST – ST is seen on an ECG reading. It is a resting
period of the heart during its conduction.
cases requiring definitive treat-
2
cath labs – A special hospital room (different
ment being routed to NUHCS from a surgery room) where a specially trained
which freed up limited facilities cardiac team performs minimally invasive tests
and procedures where the patient is usually
at Ng Teng Fong General Hos- awake.
pital (NTFGH) for Covid-19 pa- 3
angioplasty – Procedure which restores blood
tients. flow through arteries.
asymptomatic – Refers to a patient’s condition
4
where there is no symptom.
The possible asymptomatic 4
5
positive ventilation systems – An air ventilation
nature of Covid-19 also meant system which controls condensation to create
the necessary implementation a supply of fresh, filtered air and reduce surface
condensation, mould growth and dust in a room.
of maximum protection proce- 6
percutaneous coronary intervention (PCI) – A
dures to prevent widespread non-surgical procedure to treat the narrowing
of the coronary arteries, often done through
contamination of the surround- balloon angioplasty.
ing environment. 7
median door-to-balloon time - Calculated
from the patient’s arrival at the hospital to PCI in
patients with ST elevation or left bundle branch
Because cath labs are built with block (LBBB) on ECG performed closest to
For STEMI patients, normal or positive ventilation hospital arrival time.
time is of essence – systems5, a terminal clean fol-
their condition must lowing each procedure is re- ARTICLE BY
quired. Donning protective gear Dr. Gavin Ng Yeow Peng
be diagnosed and Consultant, Department of
and performing primary percu- Cardiology, NUHCS
treated promptly. taneous coronary intervention
Dr. Gavin Ng Yeow Peng, Consultant, Dr Gavin Ng is a cardiology
(PCI)6 while in full protective consultant at NUHCS with
Department of Cardiology, NUHCS
gear can also lead to longer special interest in coronary
artery disease and acute coronary
treatment times. syndrome. He is active in undergraduate and
postgraduate medical education as a core faculty
member of the Cardiology Senior Residency
In spite of the extra precaution- Program and a clinical lecturer at Yong Loo
ary measures, the collabora- Lin School of Medicine, National University of
Singapore.
tion across the Western STEMI
Network saw an average medi- A/Prof. Low Fatt Hoe Adrian
Clinical Director,
an door-to-balloon time7 of 43 Angiography Centre, Senior
minutes in the months of Febru- Consultant, Department of
Cardiology, NUHCS
ary and March, similar to 2019,
while managing a total caseload A/Prof. Adrian Low is also the
current Programme Director of
of 107 STEMI patients. Acute Coronary Syndrome Programme in NUHCS.
As a Senior Consultant, his focus remains clinical
where he has expanded the radial vascular access
While the situation remains dy- program at NUHCS and advocates for radial and
namic and may escalate, NU- small access vascular interventions. He is a keen
researcher and is also an advocate of functional
HCS is closely studying global evaluation of coronary artery disease and the use
healthcare recommendations of pressure wire guided interventions to reduce
unnecessary procedures.
13PULSE | ISSUE 35 | COVID-19 SPECIAL
TO FIT LIKE
A GLOVE
Specialised nurses deployed to provide support at the National Centre for Infectious Diseases (NCID)
I
n Singapore’s healthcare re- protocols. The newly deployed ing trained from different depart-
sponse to the Covid-19 situ- team had to be retrained on put- ments and hospitals. Everyone
ation, nurses from Singapore ting on powered air-purifying understood the urgency of the
General Hospital (SGH) and Na- respirator (PAPR) and personal crisis and banded together to fo-
tional University Hospital (NUH) protective equipment (PPE) in cus on the task at hand, tapping
were deployed to the National order to standardise the practice on their experience and contrib-
Centre for Infectious Diseases across NCID. uting wherever they can to en-
(NCID) as part of the first nation- sure patients received at NCID
al augmented team. To orientate the newly deployed had the best care possible in the
nurses with NCID’s operations, situation.
Three specially trained extracor- the Director of Nursing (DON),
poreal membrane oxygenation Assistant Director of Nursing “I am grateful for the opportu-
(ECMO) senior staff nurses (SSN) (ADON) and administration staff nity to contribute during this
from the Cardiothoracic Inten- of Tan Tock Seng Hospital (TTSH) Covid-19 crisis,” says Ms. Hong
sive Care Unit (CTICU), National greeted and welcomed the de- Yaping. “Although it was stress-
University Heart Centre, Singa- ployed nurses on their first day. ful and challenging, everyone
pore (NUHCS), Ms. Ter Ying Ying, pitched in and worked togeth-
Ms. Ei Phyu Sin and Ms. Hong The deployed nurses went er which made the job on hand
Yaping were part of this team through a two-week induction even more gratifying.”
who joined NCID on 23 March programme which included on- ARTICLE BY
2020. the-job training to familiarise the Pauline Oh
nurses with the clinic space and Senior Nurse Manager,
CTICU, NUHCS
“For me, it was an exciting chal- workflow to prepare them for
lenge but inevitably I had some emergencies and allow them to Ms. Oh embarked on
her nursing career with NUH
apprehension about working in a respond quickly when needed in 1992 before progressing
new workplace and fitting in with whilst ensuring that the hospi- to join the specialised care
team at NUHCS as a critical care trained nurse
the team,” shared Ms. Ei Phyu Sin. tal’s protocols were adhered to. in CTICU. Presently as a Senior Nurse Manager,
she oversees a team of highly trained nurses in
CTICU, managing post cardiac surgical patients
While hospital operations are What became apparent was the and those requiring ECMO. She also oversees
centred on patient safety, there medical personnel’s commit- ECMO training and competencies for the nurses
in CTICU and the paediatric intensive care unit as
were slight differences in hospital ment to patient care despite hav- well as for the respiratory therapists.
14PULSE | ISSUE 35 | COVID-19 SPECIAL
M
s. Ter Ying Ying, SSN II, CTICU, Q: How does caring for Covid-19 patients differ from your
NUHCS is an ECMO-trained usual work scope?
nurse and is an active mem- There are different things to look out for. Covid-19
ber in the CTICU Unit Practice Coun- patients often have more complex medical
cil (UPC). She has worked in CTICU comorbidities and issues compared to our usual post-
for the last seven years where she operative patients. There are also tighter infection
works with intensivists and the sur- control measures that we need to follow.
gical team to provide immediate
post-operative care for patients. Q: Could you describe your deployment experience?
It was an opportunity for me to pick up other skills,
She was also one of the nurses de- such as the respiratory management of patients,
ployed to NCID in March 2020. Here, which I could bring back to NUHCS. I reviewed my
Ms. Ter spoke with us candidly about own approach in caring for patients and realised how
her deployment in a pandemic… simple gestures such as moving the patient’s bed closer
ARTICLE BY
to glass doors help patients and their families connect
NUHCS Pulse Editorial whilst being in intensive care. This makes a significant
difference for both the patients and their families.
Q: How do you feel being a frontline healthcare worker
during this pandemic?
The health and care of my elderly parents were the
first issues that came to mind. I had to be sure my
work would not be putting them at risk. Once that was
settled, I have always been confident in our healthcare
system about implementing the appropriate measures.
As a trained professional, the care of our patients
remain our top priority. Our team quickly updated
ourselves with the latest guidelines and adjusted to
the new protocols to ensure a safe environment for our
patients and ourselves. It is an honour to be able to play
a role in this pandemic.
Q: Are there any challenges that you have faced during
your course of work?
Having worked in
Having to quickly adapt to a new workplace as well as
the intensive care
learn the different approaches to patient management
unit meant we were has been challenging. Thankfully, I have the support and
uniquely trained and guidance of my new colleagues during my deployment.
prepared for such a
scenario. For that Q: What is one takeaway that you have gained from this
reason, I consider it experience?
a privilege for being The most important takeaway for me will be the
able to play a role in friendship with my new colleagues. It has been a true
this pandemic. honour to work together in this fight!
Ms Ter Ying Ying, SSN II, CTICU,
NUHCS
15PULSE | ISSUE 35 | COVID-19 SPECIAL
A PANDEMIC Cardiac rehabilitation is not
just home-based exercises.
TRANSFORMS It is evidence-based and
helps cardiology care teams
CARDIAC monitor the progress of our
patients’ health
REHABILITATION
Dr. Wang Yi Ting Laureen, Associate
Consultant, Department of Cardiology, NUHCS
Delivering cardiac rehabilitation remotely
“Please don’t postpone my teams to explore and identify The technological approaches
heart rehab programme,” a pa- solutions that can be rapidly im- implemented during this pan-
tient recently diagnosed with plemented to prevent patients’ demic is a leap forward in cardi-
coronary artery disease pleaded deterioration in health. ac rehabilitation and should be
in an email, shortly after Singa- further developed to transform
pore announced the first few Present day technology has al- and increase patient engage-
cases of Covid-19 transmission lowed National University Heart ment, and promote cardiovas-
within the local community. Centre, Singapore (NUHCS) to cular prevention in a sustaina-
provide cardiac rehabilitation to ble way.
Since then, change has been the patients with relative ease and
only constant. quick implementation. Being Cardiac rehabilitation is a mul-
able to do so was especially re- ti-disciplinary, innovative yet
Amongst the flurry of changes, assuring as patients with cardi- structured and evidence-based
hospitals and medical facilities ovascular diseases had shown programme to help patients
too are moving to respond to to have poorer outcomes with stay on track in improving and
the pandemic. This meant that Covid-19. monitoring their cardiovascular
elective appointments and pro- health. This is especially so in a
cedures including cardiac reha- The team at NUHCS looked at a long-drawn pandemic, where
bilitation need to be relegated combination of options includ- this virus infection can result in
to free up resources for emer- ing wearable trackers, phone the destabilisation of pre-exist-
gency patients that are expect- apps, mobile chat groups, video ing cardiac conditions.
ed to increase significantly in a conferencing and social media
pandemic. to reach patients in a lockdown, ARTICLE BY
overcoming even the barriers Dr. Wang Yi Ting Laureen
While most people worry about faced during traditional cardi- Associate Consultant,
Department of Cardiology,
their exposure to SARS-CoV-2, ac rehabilitation. The team’s NUHCS
many who are sick and in the findings and recommendations
Dr. Wang is a practising
midst of their treatment are have since been compiled and clinician in cardiology and
rightfully worried about missing recently published in the Euro- internal medicine at NUHCS and
Alexandra Hospital, Singapore. Dr Wang is also
their medical follow-up. As such, pean Journal of Preventive Car- active in preventive medicine for chronic diseases
this pandemic has created an diology. and women's heart health issues.
impetus for all cardiology care
16PULSE | ISSUE 35 | COVID-19 SPECIAL
LEARNING CONTINUES
EVEN IN A PANDEMIC
An opportunity to reshape medical education
With no vaccine in sight, public session, a report is generated In fact, this platform can be fur-
health measures including physi- which captured the attendance ther expanded to include more
cal distancing are critical in slow- of participants, making it easy participants from all over the
ing the transmission and spread for course administrators to track world as long as they have a sta-
of Covid-19. This inadvertently and record the CME progress of ble internet connection and a
presented an opportunity to try each participant. working device.
new ways of working when the
usual cannot happen. Conducting CME virtually cer- p.s. Mobile phones work too. Just
tainly has its benefits – it is more imagine the possibilities!
For the first time, the National convenient for participants to
University Heart Centre, Singa- join in the sessions and reduces
pore (NUHCS) team conducted redundancy in organising repeat ARTICLE BY
Continued Medical Education sessions for those who are una- Asst. Prof. Yeo Wee Tiong
Senior Consultant,
(CME) sessions in the virtual ble to attend in-person sessions. Department of
space through Zoom’s video con- Cardiology, NUHCS
ferencing platform to avoid un- Live video conferencing has al- Asst. Prof. Yeo is one of few
necessary human contact. lowed our dispersed medical electrophysiologists with
experience in adult congenital
professionals in different hospi- heart disease arrhythmia management following
The platform was intuitive and tals, specialty centres, medical his fellowship at the Royal Brompton Hospital
in the UK, and is a certified Electrophysiology
user-friendly – course presenta- centres, clinics as well as aca- specialist by the European Heart Rhythm
tion was done easily where pre- demic institutions located island Association (EHRA). He is active in undergraduate
and postgraduate medical education as Assistant
senter can mark out notes and wide to come together, albeit vir- Professor at the Yong Loo Lin School of Medicine,
National University of Singapore and Programme
communicate with participants tually, be connected and aligned Director of the Cardiology Senior Residency
in real time through video chat on the latest medical updates Programme.
or text messaging functions built and progress.
into the platform. After each
17PULSE | ISSUE 35 | COVID-19 SPECIAL
CONQUER Everyone around me is
THE FEAR
contributing in his or her
own way in this unified battle
against an unknown disease.
Asst. Prof. Ramanathan K.R.,
Supporting Covid-19 patients in critical care Senior Consultant, CTVS, NUHCS
The closure of state borders For his part, Asst. Prof. Ramana- measures when sending investi-
and strict movement controls in than K.R., Senior Consultant, gations such as double bagging
response to the Covid-19 pan- Department of Cardiac, Thorac- and transporting specimen in a
demic hampered the ease and ic and Vascular Surgery (CTVS), special box to the laboratories
speed of information exchange, National University Heart Cen- by hand.
crucial in gathering evidence to tre, Singapore (NUHCS) outlined
develop public health interven- key considerations on infection On Singapore’s Preparedness
tions. control measures during ECMO “It is a real privilege to contrib-
such as the ideal personal pro- ute and be a part of Singapore's
With haste, the medical and sci- tective equipment (PPE) to be healthcare set up that is the cy-
entific communities turned to used, the feasibility of remote nosure of the world's eyes for its
the virtual space to exchange monitoring and control during preparedness, ability to tackle
and gather critical knowledge ECMO runs as well as the nec- and train and come out with
and information in managing essary inter-hospital and/or solutions,” remarked Asst. Prof.
the Covid-19 pandemic, relying intra-hospital transport of Cov- Ramanathan.
on video conferencing software id-19 ECMO patients.
and even social media plat- Being part of Singapore’s Min-
forms. “Understandably, the sudden istry of Health (MOH) National
situation has caused a bottle- ECMO Services Advisory Work-
Sharing Singapore’s Experience neck shortage in medical sup- group, Asst. Prof. Ramanathan
Globally plies and hence, hospitals will contributes to the nation’s
On 20 March 2020, the Extracor- need to evaluate their available pandemic response and man-
poreal Life Support Organisation resources and formulate their agement such as streamlining
(ELSO) held the first of a webinar own guidelines which will differ ECMO criteria to manage hospi-
series to exchange global experi- across medical centres,” said tals’ limited capacities.
ences in managing Covid-19 pa- Asst. Prof. Ramanathan weigh-
tients on extracorporeal mem- ing in during the question and Furthermore, an article high-
brane oxygenation (ECMO) and answer session. lighting the importance of ECMO
to address concerns such as the preparedness and pandemic
preparations required to cope Without conclusive evidence on action plan during outbreaks
with the surge in demand whilst how the virus spreads, he further of emerging infectious diseas-
addressing limited healthcare recommended medical centres es has since been published in
capacities. to undertake precautionary the March 2020 edition of The
18PULSE | ISSUE 35 | COVID-19 SPECIAL
EXTRACORPOREAL
LIFE SUPPORT
ORGANISATION
(ELSO)
Lancet Respiratory Medicine ti- Nonetheless, the specially ELSO is an international
non-profit consortium of
tled “Planning and provision of trained ECMO and MICU team health care institutions ded-
ECMO services for severe ARDS1 worked tirelessly day and night, icated to the development
during the Covid-19 pandemic tracking his progress and nursed and evaluation of novel ther-
and other outbreaks of emerg- him back to health, until the pa- apies for support of failing
ing infectious diseases”. tient was finally explanted and organ systems. To facilitate
knowledge sharing, ELSO has
eventually discharged from the set up a free dedicated online
When fighting against an un- hospital. This was after many resource for medical centres
known virus, Asst. Prof. Ramana- days in intensive care. managing Covid-19 patients
than described some moments with updates on the latest sci-
of helplessness where the med- It was a tear-jerking moment for entific data, clinical manage-
ment guidelines and to facili-
ical team could do nothing but the patient and his family. His re- tate discussions on managing
hope for the patient to over- covery came as a much needed ECMO in Covid-19 patients.
come the disease on his own. morale booster for the medical
teams and motivated everyone
He recounted an experience to persevere and overcome the 1
ARDS – Refers to acute respiratory distress
when one of the Covid-19 pa- daily challenges they were fac- syndrome which is a life-threatening lung injury
which causes the lungs to be filled with liquid
tients had to be put on ECMO ing with another Covid-19 ECMO and prevents oxygen from reaching the blood,
and cared for in the Medical In- patient who had been in inten- eventually causing organ failure if not treated.
tensive Care Unit (MICU) at NUH. sive care for more than 70 days.
ARTICLE BY
It was especially heart-wrench- Sharing advice with other Asst. Prof. Ramanathan K.R.
Senior Consultant, CTVS,
ing when the medical team had healthcare colleagues working NUHCS
to inform the patient’s family in this pandemic, Asst. Prof. Ra-
Asst. Prof. Ramanathan
that their only breadwinner was manathan said, “Be safe. There is an adult cardiac intensivist
fighting for his life. Worse, they are no emergencies in an out- instrumental in educating
medical students and professionals in
could not share much about break. Make sure you take care intensive care medicine and extracorporeal
the patient’s prognosis since of yourself. Never let the fear life support through his leadership positions
within ELSO in US, Bond University
the global data on outcomes of of the disease conquer you. I in Australia and Singapore’s National
ECMO in Covid-19 patients were am sure we will overcome this University Hospital and Yong Loo Lin
School of Medicine, National University of
limited then. phase.” Singapore. He currently sits in the National
ECMO Services Advisory Workgroup under
Singapore’s MOH and remains committed
to research programmes involving post-
operative care and extracorporeal support.
19PULSE | ISSUE 35 | COVID-19 SPECIAL
FROM THE
Ms. Audrey Leong, Clinical
Research Coordinator, NUHCS
SCENE OF
THE DORMS
Volunteers share their experiences
working at foreign workers' dormitories
W
hen dormitories were usually performing vascular
identified as outbreak scans, cardiovascular research
clusters during the studies co-ordinators as well
Covid-19 pandemic in Singa- as the essential services daily
pore, more help was required to operations staff from NUHCS
support the largescale testing were amongst the many who
and monitoring of the health of voluntarily raised their hands to
hundreds of migrant workers be part of this team.
who lived in these dormitories.
This required their willingness Ms. Cristine Araral, Medical Technologist, NUHCS
The largest dormitory in to perform duties outside of
Singapore, Sungei Tengah Lodge their job descriptions, having to
which has 10 blocks and could change their work routines and
house up to 25,000 residents had don an uncomfortable attire
one of the heaviest burden of to swelter in the mid-day sun
Covid-19 infections. continuously for days until the
situation is stabilised.
National University Heart Centre, Mr. Alvin Tay, Asst. Director, Operations
and Administration, NUHCS
Singapore (NUHCS) assembled
a mobile medical team
despatched to the dormitory ARTICLE BY
to provide the medical support
required. Beyond nurses and
Dr. Koo Chieh Yang
Christopher It’s incredibly
doctors at the frontline, there
Associate Consultant,
Department of
commendable that
were many other members who Cardiology, NUHCS a number of our
made up the team. Dr. Koo is presently an colleagues stood up
Associate Consultant at NUHCS
having completed his cardiology training in
to help out during
Echocardiography technicians 2018 and concurrently obtained his Master of this pandemic when
who perform ultrasound scans of Clinical Investigation. His research interests
are focused on coronary artery disease and most people are
the heart, diagnostic laboratory
technicians who perform stress
examines the effects of sleep-disordered
breathing on cardiovascular disease. Presently, fearful of the virus.
he is also investigating the effects of cancer and Dr. Koo Chieh Yang Christopher,
testing, laboratory technicians cancer treatment on the cardiovascular system.
Associate Consultant, Department
of Cardiology, NUHCS
20PULSE | ISSUE 35 | COVID-19 SPECIAL
M
s. Maridel de Castro, Princi- 1. Why did you choose to volunteer at the dormitories?
pal Medical Technologist at This is the best time to show our unity as a nation.
NUHCS, was one of the volun- There was an urgent need for skilled medical staff to
teers who headed to the dormitories head out and help so naturally I volunteered as I am
to support routine testing efforts on familiar with the required procedures.
the ground as part of public health
efforts to contain the outbreak. 2. Could you describe your job at the dormitories?
I helped with isolation rounding and manning the
She usually works in the cardiac medical post. I also supported in administrative
catheterization laboratory where duties such as assisting doctors in registering patients,
she assists doctors in ballooning and checking their documentation, screening, taking vital
stenting of the blood vessels as part signs and triaging patients for fever and any acute
of various diagnostic tests required respiratory infection symptoms. After which, the data
by cardiologists in the diagnosis and is being recorded in a master list.
treatment of patients.
3. How has the experience been like for you?
Here, she shares candidly about her It was challenging because we are working in a
volunteer experience… makeshift environment that is different from the
ARTICLE BY
comfortable set-up you have in a hospital. Wearing
NUHCS Pulse Editorial a full gear of personal protective equipment (PPE)
also makes it uncomfortable after a few hours in our
humidity.
Yet, the job has been very fulfilling as we got to
interact with patients and we can see that the workers
are grateful. It has been reassuring for them to know
that they are not left out in our pandemic battle.
Ms. Maridel de Castro,
Principal Medical For me, I got to be part of a working team and made
Technologist, NUHCS
new friends who are equally passionate about their
jobs and helping people.
4. What are your thoughts of being a healthcare worker
at the frontline during this pandemic?
While we worry about our heightened exposure to
Ms. Maricris Navarro,
Senior Medical the virus, it is also gratifying to be helpful and be part
Technologist, NUHCS of a national effort to keep people safe. This will be an
extra busy period and as tired as we are, all of us are
forging on and looking forward to the rainbow after
the storm.
5. Is there anything you would like to say to the people
who have been affected by this virus?
Don’t be afraid and don't give up! Stay strong and
positive! Everyone has a part to play during this
pandemic. By staying home and abiding the health
advisories, we can reduce the number of infections.
21PULSE | ISSUE 35 | COVID-19 SPECIAL
FULL
SPEED
AHEAD
In a race against time to set up Tuas South Community Care Facility
Singapore has a robust system of care across the different fa- The first patient was received
of care for Covid-19 patients cilities and to meet the needs of on 16 May 2020. Since then, the
that is tiered according to their patients. facility has received over 2,400
healthcare needs. Patients are patients. This was only possible
triaged1 into appropriate med- Dr. Lim Yinghao, Associate Con- with the dedication of all parties
ical facilities such as Commu- sultant, Department of Cardiol- in surmounting the numerous
nity Care Facilities (CCFs) and ogy, National University Heart challenges and tight timeline.
Community Recovery Facilities Centre, Singapore (NUHCS) was 1
triage – The process of prioritising patients
(CRFs) to avoid overwhelm- tasked with setting up the Tuas based on their need for medical attention.
ing limited resources in the South CCF in end April 2020 to
hospitals. cater to the needs of Covid-19
patients in the early phase of
Most patients picked up by their illness. There were already I am grateful for the
testing, present with mild or more than 15,000 cases of Cov- support and guidance
no symptoms and they usu- id-19 patients in Singapore by of all colleagues and
ally recover with minimal in- then, and there was a pressing mentors, and for the
tervention. These patients are need for additional CCF beds.
opportunity to lead
generally admitted to a CCF for
monitoring and review. Patients Medical and non-medical
this endeavour.
Dr. Lim Yinghao, Associate Consultant,
who remain well would then be personnel from diverse back- Department of Cardiology, NUHCS
transferred to a step-down CRF grounds were brought togeth-
at a later phase of their illness er to focus on this tasking. The ARTICLE BY
for further recovery prior to dis- facility had to be set-up with Dr. Lim Yinghao
charge back to the community appropriate equipment, and Associate Consultant,
Department of Cardiology,
or dormitories. processes and workflows had NUHCS
to be designed. Medical and Dr. Lim is presently an
To support these complex oper- non-medical volunteers work- Associate Consultant at
NUHCS. He is the course
ations, Singapore’s healthcare ing at the facility had to undergo co-director for the Chia Boon Lock Cardiology
workforce was tapped upon and strict training to ensure the safe- Review Course and the Cardiology PACES Course.
His interests are in the fields of pulmonary
deployed to the various facilities ty of patients and themselves. hypertension, structural heart disease as well as
to provide an appropriate level medical and device innovation.
22PULSE | ISSUE 35 | EVENT
WINNING
GOLD
Youths researched on experimental
heart surgery for showcase at fair
Three students from NUS High Utilising a cardiopulmonary
School of Mathematics and bypass machine1, they flushed
Science undertook a research water with neutral buoyancy
project for their submission particles into the left ventricle
at the Singapore Science and of an explanted swine heart to
Engineering Fair 2020 where simulate hemodynamic flow.
budding scientists and engineers With a cardioscope2, the team (A) Cardioscopy Snapshot of Particle
compete to showcase their observed the mitral apparatus Movement at Respective Valves
(B) Traced Outline of Particle Trajectory at
passion in these fields. and used tracking software to Respective Valves.
map out the left ventricle's flow A1, B1: Native valve,
Granted the opportunity to pattern with various heart valves. A2, B2: Medtronic Open Pivot Mechanical
Valve and
work with the team at the A3, B3: Medtronic Mosaic Bioprosthetic Valve
National University of Singapore After much analysis, the students
(NUS) Cardiac Surgery Lab, the observed that prosthetic valves 1
cardiopulmonary bypass machine – A machine
that provides a bloodless field for cardiac
students – Ms. Tay Qi Ying, Mr. were more disruptive, with the surgery by taking over the function of the heart
Poon Cheng Jun and Ms. Sashew mechanical valve having a more and lungs by maintaining the circulation of
blood and oxygen during a surgery.
Chew, collaborated with Mr. disruptive flow pattern compared 2
cardioscope – A tube-like instrument that is
Ong Zhi Xian, undergraduate to the bioprosthetic valve3. Their inserted into the heart through an incision with a
tiny camera at the end which allows the operator
from Yong Loo Lin School of observations affirmed previous to see the interior of the heart projected onto a
Medicine, National University findings that mechanical valves screen.
of Singapore (NUS) to discover have a higher risk of complication 3
bioprosthetic valve – Manufactured from swine
heart valves or bovine pericardium which has
more about mitral valves than bioprosthetic valves. been harvested, cleaned and processed as a
under the supervision of Dr. Md biomaterial.
Faizus Sazzad, Research Fellow, The team's research findings have ARTICLE BY
Department of Cardiac, Thoracic been captured in their paper, A/Prof. Theodoros Kofidis
and Vascular Surgery, Yong “Cardioscopic Evaluation and Head and Senior Consultant,
Department of CTVS, NUHCS
Loo Lin School of Medicine, Qualitative Estimation of Mitral
NUS. Dr. Sazzad is a plethoric Apparatus in A Quasi-Dynamic A/Prof. Kofidis is recognised
for his innovative surgical
research fellow and innovator State in An Ex-Vivo Swine Heart discoveries focused on less
who is part of the team under Model”, published in the Journal traumatic heart surgery. His
passion in this area led to his founding of the
A/Prof. Theodoros Kofidis, of Biomedical Engineering and Initiative for Research & Innovation in Surgery
Head and Senior Consultant, Research in April 2020. (IRIS). He continues to present his work at
numerous international conferences as well
Department of Cardiac, Thoracic as lead training workshops for medical teams
and Vascular Surgery (CTVS), Needless to say, the team walked around the world. He actively contributes to
the industry through his multiple concurrent
National University Heart Centre, away with the Gold Award at the appointments held globally. He remains active
Singapore (NUHCS). fair and, an even brighter future in research with many published works, a
number of patents, and sits on the editorial
ahead. review board for a number of scientific journals.
23PULSE | ISSUE 35 | EVENT
Floral
Fantasy
ANNUAL DI NNER
& DANCE 2020
24PULSE | ISSUE 35 | EVENT
N
ational University passionate rendition of pop
Heart Centre, Singa- song classics.
pore (NUHCS) got to-
gether on 17 January 2020 at During the contest segment,
the Regent Singapore for its Asst. Prof. Low Ting Ting,
eagerly awaited Annual Din- Consultant and Asst. Prof.
ner and Dance. Chai Ping, Head and Senior
Consultant, Department of
With the theme of “Floral Cardiology, NUHCS won the
Fantasy”, more than 400 staff Best Dressed prizes with their
turned up dressed in their spontaneous catwalk perfor-
picture-perfect interpretation mances.
of the theme and took many
pictures with the fantastical It was a night to remember
garden props in the reception as everyone clearly had fun,
area. dancing on the floor after din-
ner till late.
The evening was not short of
entertainment with a slew of NUHCS Annual Dinner and
performances which starred Dance 2020 would not have
talents from NUHCS as well. been possible without the
planning and support from
Led by Advanced Practice the Operations and Admin-
Nurse Juvena Gan, the nurs- istration department, in par-
es performed an energetic ticular Ms. Christina Ng and
song and dance number that Ms. Juliette Lim.
was both captivating and hu-
morous, while the Cardiolo- Cheers to another great year
gy Senior Residents staged a ahead at NUHCS!
ARTICLE BY
Asst. Prof. Devinder Singh Dr. Lim Yinghao
Director of Cardiac Associate Consultant,
Informatics and Senior Department of
Consultant, Department of Cardiology, NUHCS
Cardiology, NUHCS
Dr. Lim is presently an
Asst. Prof. Singh has keen Associate Consultant at
interests in clinical cardiology, NUHCS. He is the course co-director for
cardiac rhythm disorders (arrhythmia), the Chia Boon Lock Cardiology Review
cardiac pacing (including cardiac Course and the Cardiology PACES Course.
resynchronization therapy) and cardiac His interests are in the fields of pulmonary
magnetic resonance imaging. He performs hypertension, structural heart disease as
electrophysiology study and radiofrequency well as medical and device innovation.
ablation of cardiac arrhythmias. He also
implants pacemakers and defibrillators.
Before joining NUHCS, he was an Associate
Consultant in the cardiac department at
Khoo Teck Puat Hospital.
25PULSE | ISSUE 35 | EVENT
A HEARTY
PARTY TO CARING HEARTS SUPPORT
GROUP (CHSG)
WARM HEARTS
Caring Hearts Support Group Annual Year End Party 2019
Interested readers who wish to join CHSG
may write to mchia@kucinta.com
Caring Hearts Support Group walks, educational talks, Our annual party serves as
(CHSG) closed 2019 with its exercise sessions, networking an informal way to affirm
annual year end party on 29 sessions, social get-together and encourage members to
December with heartfelt home- and community engagement continue with our inspiring
cooked meals and merriment to events are organised on a work whilst bringing long-time
warm all heart patients. regular basis aimed at helping collaborators and friends from
patients maintain a healthy NUHCS and Singapore Heart
CHSG is a voluntary initiative heart but to also help them Foundation (SHF) together for a
organised by patients of the understand about their hearts to heart-warming year end party.
National University Heart empower them to take charge of
Centre, Singapore (NUHCS) their health. Where applicable, As the year closed, every smile
and established with the aim activities are conducted online. was returned, every friendship
to support patients in their re-affirmed, every heart touched
journey to remain heart healthy. CHSG plays a pivotal role and warmed, as members
Through CHSG’s regular out- in supporting patients post pledged to embody our motto,
reach and engagement, patients treatment at NUHCS. For some “Caring Begins With Me”.
have found meaningful support patients, getting back to their
and companionship. normal daily lives may take ARTICLE BY
longer than expected and the Ms. Magdalene Chia
Programme Coordinator,
Membership is free and journey to full recovery could be CHSG
open to any cardiovascular difficult or depressing.
Magdalene Chia is a patient
patient of NUHCS who have of NUHCS and a Volunteer
completed their basic cardiac Hence, CHSG hopes to inspire Member of CHSG. Together
with CHSG members, she helps lead CHSG with
rehabilitation at the NUHCS and motivate patients through meaningful activities and steer CHSG forward
Heart Rehab Centre. Activities caring for one another. to bring forth positive changes to heart patient
members’ lives. Her passion in CHSG is to spread
and events such as monthly care and kindness to all whom the Group meets.
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