Monthly Archives: December 2012

Caring for the dying


Written: Oct 2012

For a Science Journalism module.

Also published in SALT online here.

Caring for the dying

Saving lives may be the priority of many doctors. But to Dr Ramaswarmy Akhileswaran, ensuring that patients live their lives to the fullest before they die is even more important.

Dr Akhileswaran (centre) in a consultation with a patient (left) and a nurse (right) at HCA Hospice. PHOTO: COURTESY OF HCA HOSPICE

The Chief Executive Officer and Medical Director of HCA Hospice, Dr Akhileswaran, or more affectionately known as Dr Akhilesh to his staff and patients, has been practising medical care for the dying – palliative medicine – for 10 years.

Previously specialising in the treatment of cancer patients as a radiation oncologist after being trained in India more than two decades ago, Dr Akhilesh, 53, has been asked the same question many times.

“Other doctors ask me, why choose cancer when 40 per cent of your patients are not going to survive?” he says. “And now, for palliative medicine, it’s even worse – 100 per cent of my patients are dying.”

But Dr Akhilesh finds his passion in caring for patients who are at the last stages of their lives. It is a different challenge compared to treating patients for other illnesses, he admits.  “What’s crucial is not prolonging the patients’ lives, but enabling them to have a better quality of life – reducing their pain, enabling them to go in peace,” he says.

“Sometimes, patients just want us to listen to them. To us, it may not seem much, but to them, it may be a huge difference,” he adds.

He says for healthcare workers specialising in palliative care, showing love, care and compassion towards patients is of utmost importance. “Death is a sensitive topic – no one likes to be told that they are dying,” he says. “It is usually difficult for patients and their family members to accept this fact.”

One common difficulty the palliative medicine specialist often encounters is balancing patients’ expectations and family members’ demands, for instance when the family members request to hide the severity of the patient’s illness from the patient.

“The family members feel that their loved ones would not be able to handle it if they knew they were dying,” he says. “But on the other hand, some patients want to know the truth of their condition. Sometimes they have issues they want to settle before they die, or problems they hope to reconcile with their loved ones, and if they know their days are numbered, they will want settle it so that they will not leave with regrets.”

When confronted with this dilemma, Dr Akhilesh would speak to the family members to understand why they prefer to hide the truth from the patients, and work with them on how they can break the news to the patient stepwise in a gentler manner.

On a more personal level, working with hospice patients is also emotionally draining for Dr Akhilesh. “72 per cent of our patients pass away within three months,” he says. “When we see them, develop a relationship with them and watch them pass on, it affects us. And it happens all over again for the next patient.”

“So very often, we need to recharge, to protect ourselves, to give us the energy and motivation to continue doing what we do,” he added. He spoke about a particular instance when his personal friend for several years was diagnosed with rectal cancer. This friend was a middle-aged volunteer at HCA Hospice and used to play the piano for patients. He chose to receive home hospice care to be in the company of his elderly mother.

“I never expected that he would become a patient himself,” says Dr Akhilesh. But he never managed to see him before he passed away in 2006. “I knew he wanted to see me that day – he was just admitted into Dover Park Hospice. I rushed down, but it was too late,” he says. “I reflected a lot on what happened. Ultimately, I had to tell myself – I did my best. We just have to move on from there.”

To many patients, Dr Akhilesh is a doctor who genuinely cares for them.

Low Soo Eng, 67, who has been a day care patient at HCA Hospice for four years after being diagnosed with kidney failure, says in Hokkien: “I can’t speak English to the doctor, and he also doesn’t speak Mandarin or dialect, so I can’t say a lot to him. But he always tries to see that I’m well, whether I’m in pain or uncomfortable. He’s a doctor who really loves us.”

Dr Akhilesh sees giving the best care he can as his duty. He says: “Treating the dying requires greater sensitivity and resilience. We need to be patient with them, respect their wishes, and we need to be emotionally strong to go through the last stages of their lives with them. It’s not easy.”

To ensure that his team understands how to deal with complicated cases, such as problems with patients and their family members, Dr Akhilesh holds a meeting with his HCA nurses twice a week to discuss each case that the nurses need help with.

Senior nurse manager Angela Tan, who has been working at HCA hospice for two years, says: “He will make sure that the nurses know what to do, and also assess our medical knowledge from time to time. We learn a lot from him.”

Dr Akhilesh’s work has also inspired some medical students to specialise in palliative medicine. He gives lectures to local medical undergraduates twice to thrice a year. Some were even inspired to volunteer as medical social workers at the hospice.

He also shares his experiences with his wife, a local pathologist, and occasionally with his two sons aged 19 and 23.

To him, being a specialist in palliative medicine is more than simply the job itself. “Learning about palliative care allows us to reflect on life and death, and many things that are out of our control,” he says. “We learn to deal with many emotions, make a difference, and it makes us better human beings.”


Young entrepreneurs taking the road less travelled


Written: Oct 2012

For a Business Journalism module.

Young entrepreneurs taking the road less travelled

Not your conventional career

Going to university was no longer an option for 22-year-old Jody Ang when she failed to get into NUS law school. Not wanting to pursue another degree she had no interest in, the straight ‘A’ student from Victoria Junior College decided to drop all her university applications and spend her time doing what she has always enjoyed – baking.

That was three years ago.

Grin Affair is a cosy dessert shop managed by Ms Jody Ang and two part-timers, selling homemade cakes and puddings in jars. PHOTO: CANDICE NEO

Grin Affair is a cosy dessert shop managed by Ms Jody Ang and two part-timers, selling homemade cakes and puddings in jars. PHOTO: CANDICE NEO

Now, she has transformed her hobby into a business, baking daily in her dessert shop Grin Affair, which is tucked away in the neighbourhood of Everton Park, a 10-minute walk from Outram MRT station.

“Everyone was like, why don’t you go to university? But I didn’t want to get a degree just to get employed, which is what nearly everyone else is doing. I wanted to pursue what I like, and I wasn’t interested in any courses in university,” says Ms Ang, who opened her shop in November last year.

She is one of the rising number of young people in Singapore who are veering away from the conventional path of getting a job after graduation, and choose to be their own bosses instead.

With the rising affluence of the younger generation which breeds a culture of risk-taking, more youths are starting up their own businesses, says Professor Wong Poh Kam, the Director of the National University of Singapore (NUS) Entrepreneurship Centre (NEC).

Although Singapore used to be entrepreneurship-shy in the last few decades, this trend appears to be changing, he adds, observing that NUS students who approach the NEC for start-up advice has increased steadily by less than 10 per cent over the last five years.

“The older generation tends to be more risk-averse and shy away from setting up their own businesses,” he says. “But now, the family size is smaller, so the burden of supporting the family is less great. The middle and upper middle income are also richer and can afford the start-up capital.”

“Also, with so many graduates out there competing for a job and trying to move up the corporate ladder, the opportunity costs of getting employed is higher,” he adds. “So these young people want to differentiate themselves.”

With the growing climate of entrepreneurship in Singapore, more opportunities are also available for those willing to take that leap of faith. Government agencies such as Spring Singapore offer start-up grants. Entrepreneurship-related competitions organised by corporates such as Google and Ideas Inc. and even the local universities are common.

Entrepreneurship programmes and modules at NUS, NTU, Singapore Management University (SMU) and Singapore Institute of Management (SIM) are also open to the general student population, and enrolled students can get hands-on experience on starting a business and advice from experts.

“These opportunities drive interest even more,” adds Prof Wong.

Technological start-ups are in fashion

In recent years, one major development in the entrepreneurship scene is that technological start-ups such as mobile applications are increasingly common, Prof Wong says.

“This is due to the diffusion of intelligent devices, greater connectivity among young people and the low barriers of entry in this industry,” he says.  “Everything is done on an online platform. You don’t need to worry about space and rental, which saves a lot of cost. Singapore also has a good broadband infrastructure.”

One such technological venture is an iPad rental service founded by Nanyang Technological University (NTU) business graduate Kevin Chan and two of his ex-schoolmates. Their 10-month-old start-up SGPad targets corporates that use iPads during events such as meeting conferences and exhibitions.

“These events require using iPads as a one-off session, so renting is more practical than buying them,” says Mr Chan, 23. Currently, 40 iPads are available at SGPads for rental.

His company also does app development for corporate and educational organisations, for instance creating apps for clients to improve their outreach to customers. So far, SGPad’s clients include major players such as Japan Tourism Board, Standard Chartered and OCBC.

Each app can cost from $5,000 to $50,000, depending on its complexity.

There is a growing market for such apps due to its innovative nature, says Prof Wong. “People always want new variety,” he says. “There are more opportunities for differentiation through smartphone and enterprise applications.”

Unconventional services such as that SGPad offers gives it an edge. According to Mr Chan’s research, there are three other smaller players offering similar services, but his company is the only one attracting the larger corporate clients.

Coffee, dessert and good music

The interior of Grin Affair is decorated with simple Do-It-Yourself wooden furniture. Owner Ms Jody Ang also sells little trinkets like fabric tape and hand-dyed T-shirts. PHOTO: CANDICE NEO

The interior of Grin Affair is decorated with simple Do-It-Yourself wooden furniture. Owner Ms Jody Ang also sells little trinkets like fabric tape and hand-dyed T-shirts. PHOTO: CANDICE NEO

Besides technological start-ups, young entrepreneurs also tend to go into the Food and Beverage (F&B) industry, as Ms Ang did. “The barriers of entry for F&B are not high,” Prof Wong explains. “But for this industry, new players need to have a very good understanding of the market before they start. Learning experience and innovation is very important.”

Indeed, Ms Ang started out by experimenting with dessert recipes and working at various cafes and bars to better understand the F&B industry before opening Grin Affair. She also has a unique concept for her dessert, which sets her apart from other cafes and dessert shops – her cakes are sold in jars. To be environmentally friendly, she encourages customers to return the jars.

In another creative concept of combining literature, music, art, film and alcohol, bar café The Pigeonhole is also a popular hangout for young people. Set up in March last year, founders film editor Rayner Lim, 33, and his lawyer girlfriend Ave Chan, 27, wanted to support the local arts scene through the café. They regularly invite independent musicians to perform, and offer an exhibition space for local artists to showcase their work in the café. Book lovers can also browse through a small international collection of books on the shelves.

Like Ms Ang, both founders also decided to step away from the conventional route of being in a nine-to-five job, which they left to start up the café. Now, while operations are stabilized, Mr Lim is freelancing as a film editor while Ms Chan is an in-house lawyer at a private equity fund.

However, for Ms Chan and Ms Ang, starting up their own business was not an easy decision in the beginning with parental objections. Ms Chan says: “My parents were initially not too keen on the idea (of setting up the café) as they were concerned that it would not be as stable as legal practice, but they gradually warmed to the idea.”

Similarly, Ms Ang admits her mother still nags at her occasionally to return to her studies. “She believes that I should at least get a university degree,” Ms Ang says. “But she is still supportive of what I’m doing and comes to help out at the shop frequently.”

Having control of time

Venturing into entrepreneurship is more than simply risk-taking and being different. One major perk of becoming the boss is the flexible hours on the job.

Says Mr Kevin Chan: “I want the flexibility to create life on my own terms. By working for yourself, you can figure out how to create an efficient system, and a good balance between family and work life.”

He adds that he was heavily influenced by his father, who started his own business nearly two decades ago. “Because his time was flexible, he always had time for the family. It’s like, Dad was always there, to attend my school events and all,” he says. “I want to do that too.”

Another young businessman Zhao Shiyu, who graduated from NTU last year, also admits that he enjoys having control of his own time when he set up his company CF Ideas with two other friends, selling Polaroid cameras on online platforms such as Gmarket and Groupon.

The 24-year-old mechanical engineering graduate says: “When I was on internship during my third year at a large engineering firm, I realized that most of my colleagues were doing mundane, repetitive tasks at work. I don’t want to lead such a life.”

“Now, I work with a flexible timing of around 1 to 7pm, and I deal with a wide variety of things such as packaging, checking with suppliers, coordination etc,” he adds. “There are new changes every day, and this unpredictability keeps me excited and gives me motivation.”

Charity can be a business

Not only do young entrepreneurs strive to take charge of their businesses, but they do good along the way as well. According to Prof Wong, the rise of social entrepreneurship is another phenomenon in Singapore.

“In the past, philanthropists donate money to charity. But nowadays, young people want to help disadvantaged groups and solve social problems through their businesses,” he says.

One such social enterprise that was incubated by NEC is Start Now, an online portal that serves as a bridging platform for non-profit organisations and volunteers. Its main aim is to encourage volunteerism by reducing the administrative work needed when people want to volunteer.

One of the co-founders of Start Now, Ivan Chang, having fun at Marina Barrage with a resident of the Sree Narayana Mission Home.  It was a tie-up between Start Now and the Home to bring the elderly out earlier in May this year. PHOTO: COURTESY OF START NOW

One of the co-founders of Start Now, Ivan Chang, having fun at Marina Barrage with a resident of the Sree Narayana Mission Home. It was a tie-up between Start Now and the Home to bring the elderly out earlier in May this year. PHOTO: COURTESY OF START NOW

One of its two co-founders, Ivan Chang, 23, who has been volunteering at Make-A-Wish Foundation and other organisations for the last six years, found that an unnecessary amount of paperwork often goes back and forth between the volunteer and the charity organization.

“This slows down the process and can be very frustrating,” says Mr Chang, an undergraduate at SMU double majoring in Business Management and Information Systems. “On our portal, we link individual volunteers, schools and companies up with charity organisations that are looking for volunteers. Everything else that is needed in the process – contacting both sides, coordination and technical work – is all settled by us.”

“People also prefer to volunteer with friends, and want feel appreciated,” says Mr Chang. “Start Now users can share volunteering activities on Facebook to gather friends to volunteer together, and we also send thank you cards to them on behalf of the non-profits.”

After the website was built late last year, the Start Now team began outreach to corporates and non-profit organisations in January this year. Its database now has 192 non-profit organisations, 10 Small and Medium Enterprises and around 45,000 users interested to volunteer.

Currently running on Spring Singapore’s start up grants and past competition winnings, the team aims to make their business sustainable by charging corporates for services that eases employee volunteerism, such as helping companies monitor the activities their employees volunteer in.

 Expanding into the Southeast Asian market

But besides looking at the domestic market, young businesspeople should aim to expand internationally too, says Prof Wong.

“We want to encourage new start-ups to enter the ASEAN market,” he says. “At the university level, it is important to build social networks with people in the region to develop more awareness. We need to know our own backyard.”

“Many Singaporeans don’t know much about the markets in Thailand, Indonesia and other neighbouring countries. ASEAN is under appreciated – there is actually so much potential there,” Prof Wong adds. “We can bring our advantages – such as good communicative and technical infrastructure – to the other Southeast Asian countries that don’t have them.”