E2 - Singapore Sling | Pausing Healthcare | Chris Pearce - Part1

Singapore was one of the first countries outside China to go into lockdown.  Find out how their previous experience with SARS helped them in the early stages of the pandemic.

Chris Pearce is an Orthopaedic Surgeon based in Singapore.  In this first episode, we chat about how Singapore managed the pandemic in the early stages.

Transcript

My name is Chris Pearce.

I'm an orthopaedic surgeon I trained in the UK

I did my fellowship with James Calder. In 2008, I did a fellowship with Hans Split in Dresden, and then I got a consulting job in the UK and then fairly soon moved to Singapore, where I'm now the Head of Foot and Ankle in NUHS, which is the National University Health System. 

So I'm the Head of Foot and Ankle in three hospitals here and I'm Associate Professor in the University as well.

Ros 

And just briefly, why did you end up in Singapore? 

Chris 

Well, the I grew up in Hong Kong is the short answer. So I was always a bit of an Asia boy. But 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. 

But at the time where people were leaving London to get out of the rat race and moving to Cornwall, because they're working too hard, and their wives are 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. And hopefully stay married which I have done so far, very happy as well that

Ros 

If I take you back to sort of pre-COVID, and how would you say that life was for you from work-life balance and from where you were going professionally because you're probably mid-career consultant? 

I know that doesn't feel good. I know we still feel that we're still very young. But that's the reality of where we are.  So sort of three to six months before what was your life like?

Chris 

So um, yeah, it was good. I mean, the work-life balance here is much better than the UK was the main reason why I moved here. Partly because it only takes me 10 minutes to get to work on my Ducati in 10 minutes home again. So, you know, as opposed to an hour or more each way in London often. That's much better. 

My job is, is good, like everybody else as you move further up that sort of ladder you do more and more managerial type stuff, which is inevitable, I guess. 

The clinical load is less in Singapore in general than in the UK, which is a downside. But the research opportunities are very good. And I've got nice colleagues and you know, it's a nice place to work and there's a really the base of it.

Ros 

And did you have a kind of five-year view at that stage? Where did you think you were going to be in five years’ time? before COVID? What did you see your life being like?

Chris 

Well, 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 and go back to work with James again and, and do some work with professional athletes. That's another side of things that we don't have here. But my wife had initially not wanted to move anywhere, and she didn't you know, she didn't. She'd never lived abroad before we came here. She said, there's no way she would move back to the UK. She was saying it'd be like nail marks on the tarmac at Changi Airport if I tried to take her home, so I had a bit of a tough time with that. 

But then just around the time 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 that you came to and spoke brilliantly, and managed to get a lot of people from all around the world to come and it was a great meeting and, and then soon after that, I was promoted to associate professor and then they merged the hospitals.  

I became the first head of any section of orthopaedics and in fact, pretty much most medical specialities to be the head of the section across all three of them. I find I've finally gotten my foot and ankle Empire. I was happier, with everything I've got, I've got seven consultants now. I think it's a big opportunity to really get things started on the research front and, you know, making a name for foot and ankle in Singapore, you know, but, of course, COVID came I just as I was kind of putting all those things together. So it's now been put on hold a little bit, but there are some great young consultants in the unit I think there are some good things that can be done anyway.

Ros 

And, I mean, we've chatted about this before, but foot and ankle for, for me was very much a speciality that was an evolving and probably the most, most exciting speciality in orthopaedics. When you combine, you know, multiple pathologies with what we can use technology-wise. There seems to be a big explosion in Asia with foot and ankle and all the research that they're doing and that seems to be to be very much more recent than maybe what the States has been doing. From an opportunities perspective, I take it that's one of the things that's really reignited your passion.

Chris 

Yeah, I mean yeah, I mean I'm lucky really that the probably the only other foot and ankle guy that was around my levels 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 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 

So the experience in Singapore of COVID is very different from what we've had in the UK.  I remember phoning you, as COVID was literally about to hit us and seeing what do we need to do? 

I remember you vividly saying that Asia had been through all of this with SARS in Singapore.  How did you get ready for COVID coming and what impact did it have on your immediate practice in the way that you're working day today, you know, sort of at the beginning it must have been about January / February time.

Chris 

January Yeah. What you say about SARS is very true, like Singapore was hit very hard by SARS as was Hong Kong also. Certainly one of the things about SARS was that quite a lot of healthcare professionals died of SARS in Singapore. 

So the hospital that I work in now, well one of the three hospitals anyways is called Ng Ten Fong Hospital in Jurong and that 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, you know those kinds of things and there's positive pressure rooms and negative pressure rooms and all these sorts of things. It is set up specifically for this kind of thing. 

And Singapore again, has had an experience of a pandemic, which, which was quite bad, so they were very quick to put things in place to prevent the spread. So actually, the first wave here was dealt with extremely quickly. And that time, I think, you know, that was early January, actually, we have our first case here, 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, or, you know, people that were living there, they weren't staying there indefinitely, they all came back to the UK and a lot of those patients tested positive. 

That was the second wave, which again, you know, that the Singapore government were amazing really, that 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 is (big) with however many thousands of people a day that travel across that border when it's open. So, we did get the second wave. 

And now we have what you might call it the third wave, which is what we're really dealing with now which is the foreign workers.  Here they call them here foreign workers, construction workers, mostly from the Indian subcontinent. 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 the COVID then it spread very quickly. 

So, as of today, I think we've got about 33,500 confirmed COVID cases that we've had 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. We initially were going down to help out in the emergency department. They built three tents that were built in three stages.  These ‘fever tents’ are 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 and we have a we have a tents outside the dormitory, and we will see anybody that presents with any kind of symptom because the dormitories have now been locked down so that you know, they're now quarantined in the dormitory, we have a medical team there. And we will deal with whatever medical issues that they have. Of course, if somebody's ill, we'll send them to hospital. But if, if they just need a repeat prescription for diabetic medicine or something, we can sort that out. But then of course, also, if they present with any sort of upper respiratory tract infection, signs or symptoms, then we will swab the.  And if they're positive, they get moved out to isolation facilities. In fact, they get moved out anyway, 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 have to be vetted by the operating theatre committee like those kinds of places. 

But we still do have the odd list running for those who is mostly just trauma and, and cancer work at the moment. 

This week, I'm actually on the contaminated team. So 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’re not doing any elective activity?

Chris 

Basically, I have one Foot and Ankle Clinic a week on a Wednesday morning now and I have one fracture clinic equivalent on a 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 February or late January, early February. I haven't been to NUH. That's 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 

Yeah, well, I wasn't actually in Singapore for SARS. I actually remember when I was living in England, but I went to the Hong Kong sevens during the SARS I remember like, leaving London when they government said there is no advisory against going to Hong Kong. And then as I landed in Hong Kong, and as I turned my phone on it said, you know, the government advises against any non-essential jobs on there. But 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. So they're very quick to do contact tracing, you know, with something that Singapore did better than most places.

And isolating, you don't break the rules and Singapore, really if you can help it so, you know.  So the stay at home notice that you had when you came back from the UK or us or whatever, you had to stay at home for two weeks. 
And you better do what you're told.