But few have had the opportunity to do as much of this Dr Tan T’zu Jen, who spends nine out of 12 months a year at a 25-bed rural hospital on the border of Thailand and Myanmar, moving far beyond the norms of a regular volunteer. MIMS had the privilege of meeting Dr Tan during one of his three months back in Singapore to obtain this exclusive interview.
Meeting him at the lobby of Khoo Teck Puat Hospital, where he works part-time as a Senior Consultant in Surgery, it was hard to reconcile his refined manners and mild temperament with the person who spends so much of his time in sometimes rugged conditions along the Thai-Myanmar border. Regardless, one thing was very clear throughout: His passion for this subject is both unwavering, contagious and needs to be shared with the world.
MIMS: Many healthcare professionals can probably say they have had some experience at one point or another in medical volunteering – but you have certainly taken it way beyond what most have done. Could you run us through a bit more of what you do there?Dr Tan: Firstly, it is important to understand that there are many ways to serve as a medical volunteer, whether through disaster-relief medicine, short-term medical mission visits, or volunteering on a long-term basis. Secondly, the patients can be a diverse group, from those in the slums to the rural poor, stateless and displaced peoples, as well as refugees. Each of us has the opportunity to serve in the intersection between our passion, our abilities, and the circumstances that present themselves.
Short-term volunteers have many options open to them, whether it is to provide general health screenings, treat minor conditions, create awareness, raise funding, etc. Some teams are able to bring along all their required operation and sterilisation equipment and set up a controlled environment in a school or other facility. With the appropriate specialty skill sets, operations can be performed to treat physically or socially debilitating conditions, especially those that do not require complex or long-term follow-up.
In the hospital that I volunteer at, I work mostly with the stateless and refugees. Stateless patients are often the result when a particular minority group becomes the target of a civil war. Usually they are forced to live on the border of countries and since they have no documentation, they have no access to healthcare aid or travel. Registered refugees usually have limited access to some funding for specific health conditions and can have travel documents prepared for referral of care in their host country.
At Kwai River Christian Hospital, we deal mainly with those who are unable to go to hospitals in Yangon or Thailand due to war and lack of status. Beyond the everyday challenges of reading up and training to cover the wide breadth of tropical medicine and surgical cases, the focus of my work is also on building up local capabilities in terms of diagnostics, procedural techniques, best practices, technology transfer and equipment upgrades. For more complicated cases, I also serve as a direct resource to the local team where necessary.
You mentioned the upgrading of equipment and technology – things that almost certainly require finances to obtain, not to mention your trips there would require financing too. Do you work together with an association? How do you source for these?The majority of the equipment I have brought are personal donations, either from myself or from colleagues, hospital staff and friends in Singapore who either contribute items or donate to the hospital charity funds in support of this cause. The key to making good stewardship of these donations is to identify critical areas that the local hospital needs help with, and assist with the development of these areas in ways that make sense for the population.
At this time, Kwai River Christian Hospital does not have access to CT scans, and it is the only full-time staffed surgical facility in a 200km radius. An example of accommodating and adjusting to the situation for us has been in using diagnostic laparoscopy in place of CT scans to make the diagnosis of a tuberculosis infection of the ileum and colon that presented as a malignant-appearing apple-core lesion.
My trips are mainly self-funded along with some supplemental support from the Medical Missions Fellowship of the Christian Medical Dental Association, personal friends and my church. Care Channels International is a mission-sending organization that I come under to maintain transparency in accounting for this.
What does medical volunteering mean to you, and what are your thoughts on where Singaporean doctors stand, with regard to medical volunteering in general?Very basically, it means the use of our resources and abilities to be servants of the poor and sick who need our help.
Singapore is in a unique position – both in terms of the keen interest of our doctors to help beyond our borders, and in the global recognition of our high standard of medical care. With the opening up of ASEAN Free Trade Areas, there are many regional opportunities for Singaporean doctors to be role models in humanitarian work. Traditionally, western countries have taken the lead in this, but through the ASEAN agreements, Singaporean healthcare professionals have easier access to certain regions and are more familiar with the cultural attitudes and acceptances of healthcare.
I also do feel that we have some responsibility to assist these areas where so many gaps exist. The good thing is, doctors here have that strong sense of altruism, and many are willing to be involved even at the expense of time and funds.
How does your family handle you being away for such long stretches at once? (Dr Tan has nine-year-old twins, and another 11-year-old)(Laughs) Actually, we’ve been bringing the kids along on most of my previous trips, even back when I was volunteering during my vacation time. My entire family and I are moving over to the village of Huay Malai this year, and we will be home-schooling the kids, as the area we will be in does not have access to international schools.
It’s not something my wife and I were familiar with initially, but it’s definitely necessary - we do recognise that coming out away from Singapore’s internationally acclaimed and robust schooling system is a big price to pay, and to help the kids adjust and perhaps be able to enter back into the Singapore school system at some point, we think that home-schooling will be the right way.
Your dedication and passion about this area is truly admirable – it does lead one to wonder, how did you get started with this and how do you maintain your enthusiasm?I wouldn’t describe any one experience as ‘starting’, per se – I just always wanted to use the resources and skills available to me to help the more needy, plus personally I thrive on the challenge of being able to maximise resources in a resource-limited environment.
I just find this sense of joy in being able to use whatever gifts and abilities I have to help others – not just within my specialty, but also in playing a coordination role and help other volunteers to contribute in their areas of specialisation and interest as well.
How do you handle the language and cultural barriers?You have to be sensitive to and take time to learn the local culture. I have spent much of the last year learning the Thai language with the plan of eventually sitting for the Thai medical licensing examination – but that is of course mostly only feasible if you intend to do serve in a particular area long-term.
In terms of healthcare assistance, I would say it is most important to learn from other volunteers who have already had the experience in that cultural context. They can also help identify the ‘touchpoints’ that require the most attention as well as the appropriate way to convey and come alongside, e.g. do the local healthcare workers need more training? Or is a lack of equipment a more pressing concern?
Of course, if you’re visiting the area on a longitudinal basis, it will naturally become apparent which areas are the most lacking, and just how you can help. Repeated visits are very important to assess the needs and the willingness to change – you may be very enthusiastic about helping, but locals also need to buy into what is proposed. It is key to understand how to handle change management, how to build trust, and have in mind how skills and technology transfers can proceed in a culturally sensitive manner.
What sort of preparations would you advise aspiring volunteers to consider?First, assess what you would like to do, whether it is short-term primary care provision, or as part of a specialised surgical team, through community health development, longer term involvement to build up specialised care through lectures or mentorship and then follow a team that has already developed an effective model for helping a particular community in that manner. It is important to see that there are clear objectives and a specific plan of action in place. Choosing a team with a model of care that you agree with, which will ensure your time and effort spent feel all the more worthwhile.
Next you should understand the local context of medicine and resources in the area you are going to and develop your own skill sets. If you are looking at a longer term commitment to serve a community through a hospital overseas – among things to be considered include the working environment, the licensing and paperwork involved, and putting aside time to immerse in the local language and culture.
Is there anything else you would like to say to aspiring volunteers who will be reading this?If you really want to get involved, my advice is simple: A journey of a 1,000 miles starts with a single step. You have to start somewhere, whether it be joining a team for a short visit, or going out to listen to talks and finding out more. A good place to find out more could be the Singapore Christian Medical and Dental Association – they are open to all (both Christians and non-Christians) and they keep track of and coordinate many trips which focus on developing lasting community impact. There are many talks and seminars out there that allow doctors with these interests to meet, develop a better understanding of the issues and pitfalls and have opportunities to network to participate in trips too.
Most of all, I urge you to think long and hard about what sort of legacy you want to be remembered for, in whichever community you go to. If you think about whether what you intend to do has any long-term impact for them, you will be able to tell whether it is something that can be said to truly be done for their benefit, or for your own - and thus properly shape what sort of legacy you want to leave behind. MIMS
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