National Environment Agency (NEA) has observed an increase in the number of dengue cases

We have seen recent report on the rise of Dengue Fever and the trending is hitting a high especially in the early part of the year.

We like to highlight that Dengue Fever is a covered event in our Accident & Health plans.

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Den-1 Risk Areas Residents living in the following nine areas with a higher risk of DEN-1 virus transmission are advised to step up dengue prevention measures by checking for stagnant water in their homes at least once a week. Our population has lower immunity of the DEN-1 virus serotype which could mean quicker transmission of dengue in these neighbourhoods if effort is not taken to remove all mosquito breeding habitats. NEA on its part will work together with members of the Inter Agency Dengue Task Force to step up checks in the public areas in these neighbourhoods. The areas are:

• Jurong West Ave 1 / Jurong West Street 51 • Fernvale Road / Fernvale Link • Lorong 5 Toa Payoh / Lorong 7 Toa Payoh • Claymore Hill • River Valley Close / River Valley Road • Serangoon Road • Bedok Reservoir Road • Lorong 6, 8, 10, 12 Geylang • Lorong 22, 24, 24A, 26, 28, 30, 32 Geylang

Latest Dengue Data

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Happy CNY 2013!

Dear all readers,

Wishing you all a Prosperous and Wealthy Year of the Snake!

Newlyweds face CNY hongbao "heartache"

Give too small a hongbao and you could look bad. Give too generously and you could feel the pinch.

This is the dilemma some young Singaporeans face in their first Chinese New Year as a newly married, hongbao-dispensing couple. Without previous experience, some couples do not know "the market rate" or if there is even such a thing at all.

Couples tell SundayLife! that they decide the amounts based on what their parents had given their relatives over the years, what they themselves had received growing up and on their income.

Total hongbao budgets are between $500 and $2,000 for each couple, with individual red packets ranging from $4 for a child and $50 for a younger sibling to $200 each for a parent or a grandparent.

Newlyweds Jacelyn Tan, 26, and Ng Kok Weng, 29, will give $18 and $28 hongbao to nephews and nieces. Ms Tan, a civil servant who is Teochew, says her Cantonese sales and marketing executive husband prefers sums ending with the numeral 8 because it is an auspicious figure in Cantonese.

The couple, who had a civil marriage last October, are still living apart and with their respective parents.

Singapore Hokkien Huay Kuan council member Tan Kian Choon says there are "no hard and fast rules" on the amounts to give. Practices differ from clan to clan. "Ultimately, how much to give depends on the relationship between giver and recipient," he explains. "The closer the ties, the more the couple may want to give to express their gratitude for the care given."

Sums for older folk should be "dignified, showing gratitude and care", the 68-year-old adds.

For children of distant relatives, $6 may be an "acceptable minimum". Mr Tan says: "It's a good number - not too stingy or too lavish for young couples, bearing in mind the high cost of living."

Hongbao giving is both an art and a science, says business undergraduate Onson Li, 25, who married two months ago. "You want to give enough so that you won't feel guilty but not too much that the other party will feel guilty about it because he could have given you much less."

One of his methods to calculate the amount to give is to forecast "inflow and outflow". He explains: "I would forecast the total inflow based on the trends of what I had received in the past multiplied by the number of children we have, then divide that by the number of children I expect to meet to get the figure of each red packet."

But he adds that his wife, analyst Zhang Yacong, 25, is "nicer and we'll err on the generous side".
Ms Zhang says: "The hongbao is a blessing the giver wishes to bestow on others, taking into account his circumstances. So $10 from a less well-to-do aunt means more than $50 from a Ferrari-driving uncle."

As they are just starting out as a family, Ms Zhang and Mr Li, who live in a Yishun condominium, hopes the $6, $8 and $10 hongbao they plan to give to friends' children will be well-received. They will also be giving each of their parents a three-figure sum.

For Mr Timothy Koh, 26, and his wife Christine Pang, 31, they intend to carry on the practice in his family, which is to "upgrade" the amount a child receives as he grows older.

Red packets came in single-digit sums in primary school, "going up by $2 every two or three years" till they were double-digit sums in his secondary school years, says Mr Koh, a support team leader at a software house. "I will also start with a single-digit sum for younger children and increase it as they grow older."

Ms Pang, who manages outpatient specialist clinics at a hospital, says amounts from relatives "didn't change with age in my family because the hongbao is meant as a token" but she will take her husband's lead.

The couple, who wed last September, live with MsPang's parents in their executive maisonette in Tampines. They will be contributing to the hongbao kitty equally as both husband and wife are working.

Other couples plan to do the same. But civil servant Joan Wu says her analyst husband Emmanuel Wu will put aside about $800 from his kitty for both sets of parents, grandparents, siblings and several nephews and nieces.

Both in their mid-20s, the couple, who have been married since November last year, live in MrsWu's family home, a terrace unit, near Bukit Batok.

Mrs Wu says with a laugh: "We voluntarily offer our money, depending on whose account has more then. This year, it's his account for the hongbao."

Newlyweds may want to take a leaf from second- year hongbao-givers Jasmine Chua Huilin, 27, and her husband Vincent Ha Kwang Yuen, 28.

Theirs is a four-tier system of "small, normal, bigger and special" hongbao, says Ms Chua, a principal executive at the National Trades Union Congress.

The first lot at $8 each is for helpers and "kids of strangers" while "normal" red packets of $10 go to nephews, nieces and younger or unmarried cousins.

She adds: "Our parents were generous even to domestic helpers and they gave more to our elders and those from lower-income families. We would do that too."

In the third tier are $50 packets for children from less well-to-do families and who are "very close".

The "special" hongbao of between $100 and $500 will be set aside for parents and grandparents.

Mr Ha is a co-founder and chief executive officer of Gushcloud, a social media crowd-sourcing tool.

The couple are living with his parents in their terrace home in Bishan while waiting to move into their executive condominium in Punggol at the end of the year.

They spent $2,000 on hongbao last year. It will likely be half that amount this year as Mr Ha is in San Francisco and Ms Chua will fly over to meet him, spending two weeks in the United States over the festive period.

She and her husband each used to net four-figure "hongbao hauls" every year before marriage, adds MsChua. She says in jest: "So it was rather 'heart pain' to start giving out. We have a running joke that we should have children soon to 'recoup'."

Former S'pore Idol contestant on beating ovarian cancer

Singapore Idol contestant Daphne Khoo reveals how she pulled through a series of health scares, including a rare form of ovarian cancer last year.

SINGAPORE - It is harder to recognise former Singapore Idol contestant Daphne Khoo, 26, these days with her chic pixie cut.

The third runner-up in the first season of singing contest Singapore Idol in 2004 and former lead singer of indie band West Grand Boulevard had long locks that the audience came to know her by.

She snipped them off in June last year in preparation for chemotherapy.

That was also the year she had a most stressful experience battling wave after wave of debilitating illnesses.

The 26-year-old was diagnosed with a form of ovarian cancer so rare that it affects perhaps one Singaporean a year.

Yet, she does not pity herself, telling Mind Your Body: "I see the illnesses as part and parcel of life. When life knocks you down, you just roll with the punches."

The petite music student takes a light-hearted approach to her hiatus from school, joking that the cancer was a welcome break after four rigorous semesters at the Berklee College of Music in Boston in the United States.

But while she looks on the bright side, she will not easily forget how she discovered her cancer. After a morning gym session in March last year, she had an outbreak of hives from her neck to her ankles.

Her eyes swelled up "like golf balls", so her Korean roommate whisked her off to the emergency department at Brigham and Women's Hospital nearby, where she was given antihistamines intravenously for close to eight hours.

Though her symptoms were alleviated, Miss Khoo decided to consult an allergist.

When skin prick tests yielded no conclusive results, she underwent a full-body check-up, which included a Pap smear of her cervix.

10cm growth in left ovary

It was during this physical examination that a nurse raised the alarm about Miss Khoo's bloated abdomen, which Miss Khoo said she had had since she was 18.

Back then, she had asked her mother to feel her abdomen, but there did not seem to be an abnormal mass.

Unknown to them then, it was abnormal for a woman to have swelling of the abdomen without weight gain in other places.

Miss Khoo said: "We just never thought it could be cancer as I felt no pain there."

After a pelvic ultrasound scan, she was told there was a 10cm growth in her left ovary which had to be surgically removed.

She still held up well when told by a nurse over the phone that it might be cancerous, but broke down when she was asked if any of her family members were with her.

She had lived alone in the US for the last two years for her studies, and the bad news could not have come at a worse time. Her parents, both 60 years old, and 30-year-old elder sister were then on vacation.

Miss Khoo first called her younger sister, a 25-year-old marketing executive, and then called her parents.

Her retiree father cut short his golf vacation in Atlanta and was by her side three days later. Her mother, a treasury manager in her own firm, steeled herself on her flight back to Singapore from Japan.

Mrs Denise Khoo said: "I had no mood to enjoy being in business class. I just kept praying for Daphne."

Mrs Khoo had herself been diagnosed with early stage breast cancer at the age of 49 and had had surgery, chemotherapy and radiation therapy.

So it pained her to know that her daughter was faced with a similar ordeal.

Rare form of ovarian cancer

Miss Khoo had surgery on May 17 last year at Brigham and Women's Hospital while her parents and then-boyfriend waited anxiously outside the operating theatre during the four-hour procedure.

The surgeon told them he removed her left ovary and left fallopian tube, together with the tumour which was, in fact, 13cm in diameter.

A few days later, they learnt, to their relief, her cancer had not spread to other areas of the pelvis.
However, it had spread to the tissue lining her peritoneal cavity or abdomen.

Miss Khoo had a rare type of germ cell cancer, known as dysgerminoma. The Singapore Cancer Registry noted that there were nine such cases in a decade, from 1998 to 2007.

A spokesman from the Ministry of Health said there was just one case between 2008 and 2010. Of every 100 cases of ovarian cancer, only about five are cases of germ cell cancer, said Dr Tay Eng Hseon, medical director of the Thomson Women Cancer Centre.

Germ cells are cells in the ovaries or testes that go on to form eggs or sperms. Most germ cell tumours are not cancerous, though the testicular cancer suffered by disgraced cyclist Lance Armstrong was a form of germ cell cancer.

The other, more common, types of ovarian tumours are those of the epithelium (tissue covering the ovaries) and sex cords (structures that develop into ovarian follicles where immature eggs grow).

Dr Tay said dysgerminoma can grow rapidly, from being impalpable to a large tumour in the span of a few months.

The typical symptom, therefore, is a fast-enlarging abdominal mass associated with pain. The cancer tends to strike women between 15 and 25 years old.

Dr Tay said this cancer was highly fatal until the late 1970s, when the platinum group of chemotherapy drugs was introduced.

The disease is highly sensitive to this class of drugs, to the point that almost no one will die from it now. The exception is a small group of patients with an even rarer and highly aggressive form of germ cell cancer which is still difficult to treat, Dr Tay said.

Obstructed bowels

A few days after her surgery, Miss Khoo was racked with such pain she could hardly lay still. She was constipated and vomiting bile.

She had fallen prey to an uncommon complication of abdominal surgery. Adhesions, or internal scar tissue, forming as part of the healing process, were creating blocks in her bowels.

The obstruction prevented her intestines from functioning properly.

Back at the hospital, Miss Khoo had a tube passed through her nose, down the oesophagus, and into the stomach to remove the contents that had accumulated since the bowel obstruction.

She said: "It felt like someone was stabbing me in the throat. It took everything in me to stay calm during the insertion."

Five days later on her mother's birthday on May 29, Miss Khoo finally had the tube removed. By that time, her intestinal obstruction had somehow resolved on its own. She was able to move her bowels.

The problem recurred a week later but, fortunately, the obstruction cleared on its own. Then there was also the trauma of losing her hair, for which Miss Khoo had been mentally prepared by her mother.

Two weeks before she began chemotherapy at the Memorial Sloan-Kettering Cancer Centre in New York, she had her chest-length hair cut in an avant-garde style with a bob on one side and the other shaved bald.

She said with a grin: "I felt it was a fun way of preparing myself for hair loss. I wanted to do it in style."

She also had her eggs retrieved and frozen to preserve fertility.

Don't brush off complaints

That was the positive part. After three cycles of chemotherapy that lasted nine weeks, Miss Khoo lost 7kg to weigh 45kg, though her body mass index (a measure of body fat based on weight and height) showed that this was still normal for her 1.52m frame.

The food lover tried to stimulate her appetite by viewing pictures of food, and tried to swallow the soup her mother cooked lovingly for her but nothing helped.

She joked that the upside to chemotherapy drugs was that they helped to clear her eczema and gave her baby-smooth skin.

She has since gone back to college, where she is completing her final semester to graduate in May. She has also switched her major from songwriting to professional music.

The past year has been hard for her as she loathes being dependent on others for her needs and kept indoors mostly.

When asked what she missed most during her illness, she said it was her hearty appetite, before adding softly: "I also appreciated my mum more."

Mrs Khoo said parents should take note.

"When young girls say they feel bloated, don't brush it off as nothing. Bring them for ultrasound scans because this could save lives."

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Can Sabah Snake Grass cure cancer?

SINGAPORE - Its leaves look like shoots of wild grass and its stem appears plastic-like.

Nothing about this fruitless plant stands out. And it's not surprising if most people mistake it for something worthless.

Yet this unassuming plant - called the Sabah Snake Grass, or Clinacanthus nutans - is highly prized in Singapore.

Sabah Snake Grass - named for its initial use in treating snake bites - is worth its weight in gold because its claim to be a cure for cancer.

Despite these claims, which come amid anecdotes of its curative properties, there has not been any scientific proof that the herb has any actual effect on cancer.

One nursery owner in Pasir Ris in particular has watched with amazement as demand for the plant has slithered upwards in just four years.

Mr Alan Loh, 67, tells The New Paper on Sunday: "More than five years ago, nobody asked for it."

Only a small group of people with kidney problems bought the Sabah Snake Grass initially from Mr Loh.

He says: "At its peak two years ago, the demand grew from almost zero to about 10 customers each day asking or wanting to buy the plant from me. I often ran out of stock."

Mr Loh said the popularity of the herb can be traced back to the story of a Malaysian's miraculous recovery from Stage 4 thyroid cancer.

The man, Mr Liu Hui Lian from Perak, was told by doctors in 2008 that he had only three months to live.

Every medical treatment he tried proved futile until he found out about Sabah Snake Grass. After five months of consuming the leaves, he claims that his cancer had disappeared, he tells TNPS in a telephone interview this week.

Mr Liu, 58, says in Malay: "This March will be the fifth year that my cancer has not returned. It's a bonus for me and there's a good chance I'm totally cured."

After Mr Liu's story was covered by several Chinese newspapers and a TV station in Malaysia, the plant's popularity soared.

A website - www.sabahsnakegrassfarm.com - by another farm owner in Seremban, Malaysia, documents Mr Liu's medical history from diagnosis to an apparent improvement shown in a medical examination taken in 2009.

To date, that site has garnered 97,000 views from 90 countries.

Malaysians make up 56 per cent of those who had visited the site while Singaporeans, the second largest group, make up 18 per cent.

Now, Mr Liu runs an eight-acre farm - about the size of eight football fields - that grows the herb. He usually gives away small samples to cancer sufferers.

He also teaches them how to replant the herb in their gardens.

Mr Liu says: "If you believe (that you can be cured after consuming the herb), half the battle is won. You're on the way to being cured like me."

Yet, some medical professionals here remain unconvinced. Medically, there's no "magic bullet" for cancer, they say.

Still, Mr Liu's story has led to a healthy demand here as well, said the general manager of Hua Hng Trading, a plant and tree wholesale centre off Sembawang Road, who gave her name as Madam Ang.

The woman, in her 50s, says: "Five years ago, I stocked 50 small pots of Sabah Snake Grass at any one time.

"Today, I stock close to 1,000 pots."

Smaller nurseries, like Mr Loh's outfit in Jalan Loyang Besar, have also hopped on the bandwagon.

At his nursery, roughly the size of two basketball courts, seven small plots are devoted to Sabah Snake Grass harvesting.

He sells three pots for $10 while its leaves can be bought for $30 per kg.

Mr Loh isn't the only one peddling the plant.

There are other herb farms and several online "agents" here selling the Sabah Snake Grass. About four other nurseries here supply the plant at wholesale quantities, says Mr Loh.

Those who consume the Sabah Snake Grass usually blend the leaves with green apple juice.

"You could also eat it raw," says Mr Loh, handing this reporter a leaf he had plucked from a potted plant.

There wasn't any nasty aftertaste.

How much to consume depends on which stage of cancer the sufferer is in, says Mr Loh.

"European tourists have visited me asking how to grow the plant in their gardens."

He claims: "One old man, a cancer sufferer, came in a wheelchair but three weeks later, after consuming the Sabah Snake Grass, he walks into my garden without any help.

"I'm not a doctor but I see that they've regained their strength and appear more comfortable."

Snake grass may bring false hope to cancer patients

What do you tell a child when her life may be cut short?

That's the question plaguing a mother whose daughter suffers from stomach cancer.

To Niki Ng, seven, and her mother, Mrs Ng from Taiping, Perak, the Sabah Snake Grass is a godsend.

Speaking to The New Paper on Sunday over the phone from Mr Liu Hui Lian's farm, Mrs Ng, 38, says in Malay: "I just want her to lead a normal life like other children. The herb represents hope for us."

Niki was diagnosed with the gastric carcinoma in September last year, and had undergone chemotherapy without success.

After consuming Sabah Snake Grass in November, Niki's 5cm polyp began to shrink, claims Mrs Ng.
Yet, such herbal treatments aren't all proven remedies, say medical professionals here.

Says Ms Joanna Liew, 28, a registered physician at Bao Zhong Tang TCM Centre: "The danger here is that what works for one person, may not work for another.

"There is also no 'magic bullet' in the treatment of cancer."

Dr Wong Seng Weng, Medical Director & Consultant Medical Oncologist at The Cancer Centre says that the US Food and Drug Administration (FDA) had previously approved a herbal treatment for advanced prostate cancer.

Unfortunately the approval was withdrawn.

This was due to serious problems with the quality control in the production of the herbal preparation including contamination with arsenic, says Dr Wong.

He adds: "No alternative therapies for cancer has been approved by FDA since."

Some of Dr Wong's patients have tried the Sabah Snake Grass. However, his findings may be hard to swallow.

He says: "All (his patients who consumed the Sabah Snake Grass) experienced worsening of their cancers. Hence my personal observation of the effects of Sabah Snake Grass has been very negative."

Similarly, the Health Sciences Authority (HSA) says that it is "not aware of any scientific evidence that substantiates the medical use of Sabah Snake Grass in the treatment of cancer."

Like Dr Wong, HSA reminds cancer patients to exercise caution.

Says Dr Wong: "Patients with an incurable disease may be in a state of emotional desperation and can be very vulnerable to people peddling false hope."

What's important in the treatment of cancers is its early detection, says Ms Liew, 28.

"I have heard of many horror stories of people delaying cancer treatment," she says.

She adds that the longer the patient waits in making a treatment decision, the lower the chances of success.

Snake gall bladder

The gall bladder of a snake, believed to help cleanse blood and detoxify the body, can be found in traditional Chinese medical halls here.

"It is not popular with locals, but mainland Chinese, especially those from Fujian and Xiamen, seem to like it," says a Thye Shan Medical Hall spokesman.

It is also known to alleviate rheumatism, she adds.

Snake gall bladder is mostly imported from countries such as Indonesia, Thailand, and India, and is typically consumed after soaked in wine.

The teardrop-shaped ingredient, which is sold in a dried form at medical halls, can also be sliced and cooked before being eaten.

It costs a hefty $200 to $400 per 100g, depending on the grade, says the spokesman.

Snake fruit

Also known as salak, this fruit has reddish-brown, prickly skin that resembles that of a snake.

The skin breaks away to reveal lobes of white, juicy flesh, which tastes like a combination of honey and pineapple.

The fruit grows in Indonesia, Brunei, and Malaysia. Finely sliced, it makes a great ingredient in salads, and packs a big dose of vitamin C.

Tampines St 45 dangerously accident-prone, say residents

TAMPINES - A day after the horrific accident, people were still jaywalking.

Pedestrians at Tampines Street 45 were seen ignoring traffic lights as they crossed the street, casually strolling with their earphones plugged in.

Some students even ran across the road.
This, despite the fact that the street is infamous among residents there.

"The area is dangerously accident-prone," claimed Mr Michael Seet, 60, a retiree.

The resident of Block 491C did not witness Monday's tragedy, but claimed to have seen other accidents happen on Street 45, such as one involving a woman early one morning two years ago.

On Dec 6, 2011, Madam Mislia Ahmad, 65, was killed by a car turning right from Street 45 into Tampines Avenue 9, reported The Straits Times.

Near misses

Many residents also told The New Paper about their near misses with speeding vehicles there.

Mr John Tan, 64, claimed he was almost hit by a lorry at the junction of Street 45 and Avenue 9, when the traffic lights had been in his favour.

"Many lorries speed here," said the retiree, who lives in Block 489. "They are really too fast.

Accidents like that (Monday's accident) can be avoided if they weren't so fast."

TNP understands there is a construction site beside Block 491E. Two blocks of flats and a multi-storey carpark are being built there.

Residents also complained about how there were too many heavy vehicles on the narrow road.
Street 45 is a two-lane road that runs to the four-lane Tampines Avenue 9.

Opposite the road is All Saints Home, a nursing home for the elderly.

There is a zebra crossing just outside Dunman Secondary School, with signs warning motorists of crossing students. The speed limit for Street 45 is 50kmh.

When The New Paper went to the junction at 1.30pm yesterday, many school buses were turning into the narrow road.

They were there to drop off students after school and when they turned, they took up nearly half of the street.

We also counted a total of 34 heavy vehicles between 5pm and 6pm, including buses, cement trucks and other construction trucks.

Monday's accident had happened at around 5.50pm.

"The turning is so narrow that when the heavy vehicles turn, there is no space for the children to stand. It's very dangerous for them," said Mrs Priya Senthil, 32, who lives in Block 498B.

The mother of two claimed that children often walk along the road from Dunman Secondary School or from Tampines North Primary School.

Others, like Mr Muhammad Adanan, 23, blamed the traffic lights.

Mr Adanan, a tow-head driver who moves containers around shipyards, claimed that during peak hours, only four or five cars can drive through the Avenue 9 junction each time before the light changes.

"I often see people try to speed up, to beat the lights," he said.

Between 5pm and 6pm yesterday, we witnessed at least six vehicles trying to beat the red light.
Mr Adanan lives in Block 494 with his family. In the six months he has lived there, he has heard of three accidents there, he claimed.

"It's quite a scary place, quite dangerous. I hope something can be done," he said.

Many residents are now calling for a change.

"We need more speed bumps and more traffic police here," said a resident, who wanted to be known only as Madam Koh.

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Boy, 2, may not live to adulthood

His life expectancy may be less than the average person's, but Branden Lim's family are determined to make the most of his remaining years.

It is a perfectly average domestic scene set around the family dining table.

Mother Yap Sook Yee, 38, is keeping an eye on five-year-old Jaden to ensure that he doesn't get so distracted by his iPad game that he doesn't eat his lunch, and Branden, two, is demanding his father Edmund Lim's attention by repeatedly calling out "Pa! Pa! Pa!" from his baby chair.

There are only two things to disturb this pretty family picture: the nasogastric tube going into Branden's left nostril, and the two blue support cushions tucked in snugly on either side to help keep him sitting upright.

Life has not been easy for the Lims ever since they discovered that Branden is suffering from a genetic disorder called spinal muscular atrophy (SMA).

Unsuspected disorder 

With firstborn Jaden being a regular, healthy kid, and no known history of genetic diseases in either family, Yap and Lim, 39, had no inkling that they were actually carriers of a defective, recessive copy of the SMN1 gene.

This gene is in charge of producing a protein called survival motor neuron (SMN), which, as its name states, is crucial for the survival of motor neurons.

Motor neurons are nerve cells located within the central nervous system, which control both voluntary and involuntary muscle movement.

The lack of the SMN protein leads to the early death of these motor neurons; and as neurons have very limited regeneration capacities, this spells very bad news for the affected person.

While carriers of the defective gene are not affected physically, each offspring of two such carriers has a one-in-four chance of inheriting two recessive copies of the SMN1 gene, resulting in them developing SMA.

Warning signs 

Yap shares that while her pregnancy with Branden was normal, the first intimation that something might be wrong came during his birth.

"When Branden was delivered, he was immediately admitted to the NICU (neonatal intensive care unit) because he didn't really cry - there was fluid in his lungs." she says.

Lim, a commercial manager with a multinational company, recalls that Branden had to be put on continuous positive airway pressure (CPAP) at that time, in order to help him breathe.

However, he recovered enough to be discharged eight days later, although the doctor advised that he be kept away from crowded places.

The next few months passed by uneventfully, until Branden reached three months of age.

Yap recalls: "He was able to turn at three months, but that was the first and last time he ever did it."
As the months went on, Branden started missing more milestones, like sitting up and crawling, but his parents thought that he was just a more "relaxed" baby. He also developed trembling fingers.

Then, at five months, Branden's paediatrician found him to be hypotonic, ie his muscles had less tone or strength than normal.

"He said it was a general symptom, which could indicate multiple different conditions, from simple to complex," says Lim.

"Branden was then started on physiotherapy, which worked for awhile, but then, it stopped having any effect."

However, the alarm bells really started to ring when Branden was about a year old.

"At one year of age, he had only gained 100g (from six months)," says Yap.

Lim adds: "That was one of the key indications that something was wrong; he was missing more milestones."

It was then that Yap started researching Branden's condition, and soon realised that something was not right with him.

With a few conditions in mind, she took Branden to his paediatrician, who agreed with her on the possibilities, and referred them to a paediatric geneticist. "He did multiple tests, then confirmed that the diagnosis was SMA."

Immediate reaction 

Initially, Yap had kept quiet about the tests to Lim, as he was working in London on an overseas assignment. But he arrived back in time for them to receive the results together.

"It was like the whole house had fallen down around us; we were totally shocked by the diagnosis," he recalls.

And if that weren't bad news enough, three days later, Jaden came down with chickenpox.

Yap had to move with Branden to her sister's house as a quarantine measure, while Lim took care of Jaden at home.

This meant that the shock and heavy weight of Branden's SMA diagnosis had to be borne separately for the mother and father, on top of caring for each son. "We went through the stages of grief separately," Lim shares.

Those 14 days of quarantine also gave them time to research the condition.

"We quickly signed up with Families of SMA, who reached out to us and sent us a care package on SMA immediately," says Lim.

Families of SMA is an American-based non-profit organisation formed by parents of children with SMA, which aims to support families affected by SMA, and to fund research, which could lead to a treatment, and eventual cure, for the condition.

They also decided to inform their family and friends via a Facebook note and email of Branden's diagnosis. "After all, we had nothing to be ashamed of," says Lim, who adds that sending out that message also helped them to move on from their initial shock and grief.

Emotional support 

While medical help and expertise were readily at hand, what Yap and Lim wanted was emotional and practical support from parents who are, or have been, in their position.

"We knew that time was not on our side; SMA is a genetic killer, so we had to be really quick in finding other people who also have it.

"We wanted to reach out to other parents to learn from them and also, for emotional support."

Their paediatrician had told them about a local 16-year-old SMA patient, whom they were eager to get in touch with.

Coincidentally, two days after they had posted their Facebook note, one of their friends realised that she knew this girl and her family, and was able to put the two families in touch.

"It gave us hope, to see someone with a fairly bad case of SMA, still able to live until her teens," says Yap.

Prioritising needs 

The scares were not over though, as Jaden contracted hand, foot and mouth (HFM) disease about a month after his chickenpox, which promptly got passed on to Branden.

Unfortunately, the disease hit the younger boy harder, and he had to be hospitalised for five days.

Following that, the Lims' Cambodian maid got a belated case of the chickenpox, and had to be sent off to Yap's mother's house.

"Our hearts never stopped beating really fast that whole time," Yap recalls, with a smile.

Their maid's chickenpox fortunately, turned out to be the last of the two months of bad news and domestic chaos, allowing them to finally settle down and prioritise what needed to be done for Branden's condition.

Yap, who had worked part-time in the fashion and beauty industry prior to Branden's birth, and had intended to go back to work after he turned one, now gave up that idea to remain a fulltime homemaker.

Lim, being of practical mind, immersed himself in research for solutions to Branden's multiple problems.

SMA can be divided into four categories based on age of onset of the disease, with Type I being the most severe form, and Type IV, the least severe.

Branden's symptoms and age of onset place him between Type I and Type II.

At his current two years of age, he is able to sit up with support, move his arms and legs, and eat solids. However, he gets physically tired easily, and does not have enough strength to press a piano key down.

Nutrition has been a major concern for Yap, as Branden is underweight for his age.

"That's my biggest headache - I don't know if it is because he is in his terrible twos, but because he can't talk properly, it's difficult to tell if he is full or doesn't like the food," says Yap.

Lim adds: "We have to figure out what are the most 'power-packed' foods to give him, for example, juice versus water.

"And now that he's getting fussy, we have to figure out what he likes, which is also nutritious enough for him."

Like Yap, most people are unlikely to realise the sheer number of muscles involved in the digestive process.

From chewing and swallowing, to the involuntary muscles that prevent food from coming back out the stomach, and those involved in passing motion, every muscle that participates in this process is affected by SMA.

Living in fear 

Thus, Branden frequently gets constipated because he doesn't have the strength to push out his stool.

He also vomits fairly often, as the involuntary muscles of his stomach are not strong enough to hold in too much food, which ends up being regurgitated.

Because of this, aspiration pneumonia is a major source of concern. In fact, pneumonia is one of the main causes of death for SMA patients.

In aspiration pneumonia, food that is regurgitated up the oesophagus gets diverted into the trachea and down the lungs. Once in the lungs, it results in pneumonia.

Branden has already been hospitalised for pneumonia once last August. That is where he obtained his nasogastric tube, which his parents are using to supplement his nutrition.

"We were so happy with the tube, but we didn't know the flow rates. We thought that we could give him as much milk as he needed through it, but then it all just came out again, like the Merlion in Singapore," says Lim with a laugh.

"That's where support is so important," says Yap. "We called a friend in Singapore who is an SMA mother, and she advised us on the best way to use the tube."

Lim adds: "Maintaining his calorie intake, and trying to track whether he has silent aspiration, are our current priorities."

Continuing challenges 

Breathing is another major concern for SMA patients.

While Branden can currently breathe on his own, he does need help clearing out the secretions from his lungs, and his parents are careful to monitor his oxygen levels both day and night.

However, Lim acknowledges that at some point in the future, Branden may be unable to breathe on his own, and will need some sort of mechanical assistance.

A further complication is likely to be the onset of scoliosis, which tends to develop in SMA patients at the age of seven or so.

Branden's range of movement will also becoming increasingly limited, as he grows older and his muscles, weaker.

In order to give him a shot at as regular a life as possible, he will need items like custom-made wheelchairs, bath equipment and special utensils; intensive and ongoing physiotherapy, occupational therapy, speech therapy and hydrotherapy; and home-schooling, among others.

Lim laments that while many of these things are provided for, and even taken for granted in the United States, Malaysia is lagging far behind in terms of appropriate and available home equipment, and educational opportunities.

No insurance company here covers SMA, and while medical treatment and adjunct therapies are available in public hospitals for a minimal fee, the Lims have to provide for the various equipment Branden needs at home.

And there is also his older brother, Jaden.

"The other challenge is having a sibling - teaching him to care for his sibling, and also, a lot of attention has to be given to Branden, so he is also being challenged emotionally," says Yap, adding that they try to allocate time for herself and Jaden, Lim and Jaden, as well as couple time for herself and Lim.

Lim adds: "We always try to think of activities we can do as a family, things that Branden and Jaden can do together."

Thankful 

They are also fortunate to have a good support system.

Lim says: "Family support is very important and so helpful. All we need to do is ask, and they will help us.

"Support from our friends has also been invaluable, although some have not known how to react to the news.

"My company and my boss have also been very understanding and supportive."

Even their neighbours are very helpful, being ever willing to help provide meals, or even lend their maid when needed, says Yap. (Their own maid has returned to her country, and they now cope alone with the help of Lim's mother, who stays with them.)

Because there are so many bodily functions affected by SMA, which develop at different times, Yap and Lim are focusing on one step at a time.

"We will follow Branden's development, and react accordingly," Yap says.

Although Branden may not live a normal lifespan, his parents are determined to enjoy him in the time that they have.

"We accept that it is not going to get any better, but we are going to make the best of it," she says.

"Branden is such a happy boy, he brings us a lot of joy, and there's really a lot to celebrate about him. We want to enjoy him in the present, as he is."

SMA Facts

• Some basic information on the genetic disorder spinal muscular atrophy (SMA):
• It is a rare autosomal recessive disease affecting one in 6,000 - 10,000 individuals.
• It is the leading genetic cause of death in children under two years of age.
• Around one in 40-50 people are carriers of the defective SMN1 gene.
• There is no cure.

Type I (Infantile; Werdnig-Hiffmann disease)

Age of onset: 0 - 6 months
Characteristics:

• Ususally exhibits floppy baby syndrome, a weak sucking reflex, difficulty breathing and sucking, and is unable to stand or sit without help.
• Has a poor prognosis, with most patients dying before two years of age from pneumonia-induced respiratory failure.

Type II (Intermediate Dubowitz disease)
Age of onset: 6 - 18 months
Characteristics:

• Has delayed motor development, usually unable to crawl or stand, but can sit unsupported.
• At higher risk of respiratory infections
• Often live into their teens, but with significant motor impairment

Type III (Juvenile; Wolhlfart-Kugelberg-Welander disease)
Age of onset:   After 18 months
Characteristics:

• Characteristics: Symptoms can appear any time from 18 months to adolescence.
• Can usually stand and walk independently, but may eventually lose these abilities as their condition progresses. Fingers and hands may tremble.
• Life expectancy is near normal

Type IV (Adult)
Age of onset:   Adulthood
Characteristics:

• Symptoms usually appear after the age of 35, although they can manifest as early as 18 years of age.
• The least common type of the disease.
• Shows progressive muscle weakness and tremours.
• Life expectancy is normal.

COE premiums mostly down after latest bidding exercise

SINGAPORE: Certificate of Entitlement (COE) premiums were mostly down at the end of the latest bidding exercise at 4pm on Wednesday.

For small cars, the premium fell S$1,090 to S$91,010.

The premium for big cars closed down S$709 to S$95,501.

In the goods vehicles and buses category, the premium was down S$2,949 to end at S$57,051, while COE premiums for motorcycles ended at S$1,781, down S$152.

The only category where premiums rose was the open category, which went up S$1,788 to S$97,889.

While the changes are not significant, some car dealers are advising consumers against holding out on buying.

Mr Raymond Tang, a car dealer, said: "If you carry on waiting, because of the next quota premium, the COE is getting less, it is definitely not going to benefit you. But of course, you have to see your own financial status. If you don't want to spend so much, you can actually go to the used-car market."

Mr Tang expects premiums to continue heading north, going forward.

Singapore Dec inflation likely edged up to 3.85% y-o-y

SINGAPORE - Singapore's inflation likely edged higher to 3.85 per cent year-on-year in December, quickening from November's 3.6 per cent as car prices rose at a faster pace, according to the median estimate of 12 economists polled by Reuters.

Singapore's central bank forecast is for headline inflation to come in slightly above 4.5 per cent in 2012 and to slow in the following year to between 3.5 and 4.5 per cent.

The city-state's inflation averaged 4.6 per cent in the first 11 months of 2012.

Earlier, when the poll involved 10 economists, the median forecast for December inflation was 3.8 per cent year-on-year. With two more economists, the median rose to 3.85 per cent.

Higher subsidies to make child & infant care more affordable

SINGAPORE: From April, lower and middle income families will enjoy higher government subsidies in child and infant care services, under a new subsidy framework.

The framework complements other measures to defray the costs of child-raising under the Marriage and Parenthood Package announced on Monday.

All parents will continue to receive a basic subsidy at the current rate of S$300 a month for child care and infant care programmes.

Families with a gross monthly income of S$7,500 and below will receive an additional subsidy.

Eligible families using full-day programmes will see an increase in their current child care subsidies of at least S$100 and infant care subsidies of at least S$200, with lower income families receiving more.

For example, a lower income household with a monthly income of S$2,500 and below will get an extra S$440 for a basic full-day childcare programme. This will bring its total subsidy to S$740.

The additional subsidy will replace the Centre-Based Financial Assistance Scheme for Child Care (CFAC) which provides child care related financial assistance for families earning S$3,500 and below.

Up to two-thirds of households will benefit.

Acting Minister for Social and Family Development Chan Chun Sing announced the new framework after a visit to YWCA Child Development Centre on Wednesday.

He said it puts Singapore comfortably in the top half of OECD (Organisation for Economic Cooperation and Development) countries, in terms of affordability of pre-school services.

Mr Chan said the subsidies will cover a large part of costs, as the median cost of a full-day childcare programme in an HDB estate is about S$615.

The new subsidy framework will increase the government's investment in child and infant care by S$105 million and bring the total budget for government spending in this area to about S$360 million for financial year 2013.

New scheme to help defray children's healthcare bills

SINGAPORE: From March, the Ministry of Health (MOH) will set aside S$8 million annually under a new Medifund Junior scheme to help needy Singaporeans defray their children's healthcare bills.

The scheme, applicable to children aged below 18, will require an additional S$10 million in Medifund assistance over 5 years, to supplement current funds. The ministry will review whether the amount is sufficient thereafter, said the MOH in a statement.

Needy families will be able to draw on Medifund Junior for help with their children's healthcare bills at public hospitals, said the ministry.

"By creating Medifund Junior, MOH can target more financial assistance for sick children from needy families. This will also help defray costs incurred by children diagnosed with congenital or neonatal conditions before 1 March 2013," said the ministry.

From March, MediShield coverage for congenital and neonatal conditions will kick in. All Singaporean newborns born on or after March 1 will be covered, without having to be assessed for pre-existing conditions, if their parents do not opt them out.

All existing policyholders will automatically receive coverage for any congenital conditions diagnosed on or after March 1, 2013. This extension will be implemented together with previous MediShield enhancements announced earlier.

To support Singaporean families pay for their child's MediShield premiums and defray other healthcare expenses, the government will set up a Medisave account and deposit a one-off Medisave grant of S$3,000 over two tranches for all newborn Singapore citizens born on or after August 26, 2012.

The KK Women's and Children's Hospital (KKH) puts up on average 400 Medifund applications a month.

95 per cent of these applications are usually successful with families getting assistance from Medifund.

However, as Medifund is targeted at lower income families, the middle income families are usually left out as they don't meet the criteria.

"Some of them, even though they are from the middle income families, some of the bills can be quite costly. So for these large bills, we are giving the hospitals more flexibility under the Medifund Junior to be able to help these middle income families," said Health Minister Gan Kim Yong.

Healthcare institutions will assess the out-of-pocket expenses by the needy families and their family resources before offering them assistance under this new fund.

Needy children diagnosed with congenital or neonatal conditions before 1 March will also be able to use the new fund to help defray costs. These include stays at the Neonatal Intensive Care Unit (NICU) at KKH.

Ms Mavis Teo, a medical social worker at KKH, said: "For example, a couple with a newborn child with congenital problems and this is a dual-income family with an average income of about S$4,000...if (the child stays) in NICU and it costs them about S$20,000 to S$30,000, we would be able to help them to cover some of the medical expenses for the NICU stay."

For those with more serious premature cases or those with neonatal or congenital conditions, hospital stay may range between one month and six months, and on the average bills can be anything from S$10,000 to S$60,000.

In extremely rare cases, babies with severe complications needing multi-stage surgeries and treatment, medical expenses may even exceed S$100,000.

The hospital's NICU, which also treats premature babies, will be expanded.

Doctors at the KKH say that its NICU is usually run at full capacity due to the rising number of admissions in the past few years.

As such, the unit will undergo renovation and see its bed capacity rise from the current 24 to 40 in the next five years, making it the largest facility in the region.

Associate Professor Samuel Rajadurai, a doctor at KKH, said the incidence of premature babies has gone up by 10 to 13.5 per cent over 20 years.

A number of factors have led to this phenomenon, including the older age of mothers and better monitoring of mothers during their pregnancies.

The hospital also plans to expand its outpatient as well as ambulatory services and increase the number of beds.

Contact me now to find out more about the new changes in the MediShield Plan

Singapore cooling: Mortgage loans could drop up to 20%

Singapore’s broad range of new property curbs is an indication that the government is willing to trade off economic growth for social issues, said DBS Chief Executive Piyush Gupta (pictured).

The official forecast for GDP growth this year is between one and three percent and Gupta believes that Singapore will likely perform in the bottom end of the range.

This as the government puts social priorities ahead of the economy, as seen in its latest restrictions that “are likely to have a lot more teeth than anything we’ve seen so far”.

“You don't have to be terribly prescient because they've been making it very clear now - for some time - that they're willing to trade off growth for what they call sustainable growth. Which means they're willing to trade off growth for social harmony.”

Meanwhile, there could be a significant decline in mortgage loans for 2013, according to DBS’ chief.

“I think there will be a slowdown because of all three things - higher cost to property, lower loan to valuation ratios and higher debt burden ratios.”

“Rates are still at historic lows, so we've to balance a lot of money available with low rates, because of all the measures. So it's tough to call how much the slowdown will be.”

He expects a drop of between 10 and 20 percent “on a sustained basis in terms of mortgage loans”.

Polytechnic graduates' starting salaries up in 2012

An annual graduate employment survey has found that the median gross monthly starting salary for post-national service graduates last year went up from $2,100 in 2011 to $2,253 last year.

The Graduate Employment Survey, jointly conducted by the five polytechnics in 2012, revealed that polytechnic graduates who are currently in the workforce have enjoyed an increase in starting salaries. This increase applies to both fresh graduates and post-National Service (NS) graduates.

The employment rate also remains high at 91.0% for fresh graduates, and 93.1% for post-NS graduates.

The percentage engaged in full-time permanent employment rate was 65.4% for fresh graduates and 77.8% for post-NS graduates.

A total of 9,982 fresh graduates took part in the Survey. As at Oct 1, 2012, the overall employment rate was 91.0%, compared to 92.1% in 2011. The proportion of economically active fresh graduates in full-time permanent employment was 65.4%, compared to 67.0% in 2011.

Median gross monthly salary among fresh graduates in full-time permanent employment was $1,950, compared to $1,850 in 2011.

Among the 4,347 post-NS respondents, the overall employment rate was 93.1%, compared to 94.7% in 2011. The proportion of economically active post-NS graduates holding full-time permanent jobs was 77.8% compared to 80.1% in 2011.

The median gross monthly salary of post-NS graduates in full-time permanent employment was $2,253, compared to $2,100 in 2011.

Among the fresh graduates in full-time permanent employment, the course categories with the highest median gross salaries are from the Health Sciences ($2,000) and Built Environment, Engineering & Maritime ($2,000) courses.

Among post-NS graduates in full-time permanent employment, the course categories which commanded the highest median gross salaries are: Health Sciences ($2,429); Business, Management, Design & Others ($2,400); and Built Environment, Engineering & Maritime ($2,300).

The annual Graduate Employment Survey is jointly conducted by Nanyang, Ngee Ann, Republic, Singapore and Temasek polytechnics to ascertain the employment status of polytechnic graduates.

The 2012 Survey was conducted between October and November 2012 and attracted a total of 14,329 respondents. They were asked to respond based on their employment status on Oct 1, 2012.

The respondents comprised fresh graduates who completed their studies in 2012 and were not liable for National Service after graduation, and post-NS graduates of 2009 who completed their full-time National Service between April 1, 2011 and March 31, 2012.

Small car COE breaches $92,000 mark

SINGAPORE - The COE premiums for small cars (up to 1,600cc) breached the $90,000 mark, finishing the year's first bidding session at $92,100.

This is up 12.4 per cent from last month's bidding where prices ended at $81,889.

Prices for big cars in Cat B (above 1,600 cc) also reached a new high, ending at $96,210. The previous record-breaking price was $94,502 in August 2012.

Premiums for motorcycles and the open category (used for any vehicle type but used mainly for luxury cars) also saw increases from the previous session that ended on December 19.

COEs for motorcycles will now cost $1,933, up from $1,701 while prices in the Open Category rose to $96,101, up from $95,990.

There was some relief in the commercial vehicle category with prices dropping to $60,000, down 3.5 per cent from last bidding's $62,201.

Jan 2013 - First bidding
Category	Jan 09 prices	Dec 19 prices
Cars (1,600CC below)	$92,100	$81,889
Cars (above 1,600CC)	$96,210	$93,501
Commercial vehicles	$60,000	$62,201
Motorcycles	$1,933	$1,701
Open category	$96,101	$95,990

Top 10 healthcare changes to note for 2013

The new year is beginning and the changes announced by the Government in 2012 will soon be rolled out.

Keep abreast of the latest developments by reading on the top 10 upcoming health care changes that all Singaporeans should know about:

Improvements to MediShield  

IN A NUTSHELL: From March, the Ministry of Health will introduce sweeping changes to the MediShield insurance scheme, the low-cost catastrophic illness insurance plan covering 92 per cent of the population which was introduced in 1990.

The maximum age covered by MediShield will be raised from 85 to 90 years, to ensure people will get health coverage even as they live longer.

The current maximum entry age of 75 will also be scrapped so that more healthy elderly people who are uninsured can join the scheme.

The maximum amount claimable each year as well as the lifetime claim limit will also be raised so that more exceptionally large bills are are covered.

Acute psychiatric hospital care and short stays in emergency departments will also be covered, so people do not miss out on timely and appropriate treatment of mental illnesses.

The changes followed public consultation in July and August last year.

SIGNIFICANCE: The enhanced MediShield covers more people for more types of illnesses for a longer time span. It offers a lifeline to those worried about hefty medical bills even as they live longer.

It is also good news to those who have difficulty upgrading to a more comprehensive insurance plan due to health reasons or because they had almost reached the benefit limits, as they should be able to enjoy improvements to their current plans.

But broader coverage means premiums will have to rise to meet the increased claim amounts and number of claims.

The premiums will increase by less than $10 per month for those aged 65 and below and up to $21 per month for those aged above 65.

To help with higher premiums and deductibles, the Government will give a one-off Medisave top-up of up to $400 to all Singaporeans insured under MediShield or Medisave-approved integrated shield plans. The money will be credited to the accounts from March.

In addition, 85 per cent of Singaporeans aged 66 and older will get a Medisave top-up of $250 to $450 every year under the Goods and Services Tax Voucher scheme. The scheme helps lower- and middle-income Singaporeans with their expenses.

With the top-ups, people aged 60 years and older, and those 20 years and younger, will pay lower premiums for the next two years.

New medical school 

IN A NUTSHELL: The new Lee Kong Chian School of Medicine will open this year with 54 students. The school, which will focus on "treating the patient and not the illness", is jointly run by the Nanyang Technological University and Imperial College London in Britain.

Tan Tock Seng Hospital will be the main training hospital for the students. They will start interacting with patients from the first year and track patients' progress from their time of hospital admission to their stays in a nursing home and outpatient rehabilitation.

SIGNIFICANCE: It will be the third medical school here, after the Yong Loo Lin School of Medicine at National University of Singapore and the Duke- NUS Graduate Medical School.

The three schools will eventually produce 500 medical graduates a year.

This would improve the ratio of doctors to patients here.

With 10,057 doctors on the registry in 2011, Singapore has one doctor for every 537 people. This is a far better ratio than the one doctor to 700 people in 2001, but it is still behind that of most developed countries.

The United States has one doctor for every 390 people, while Australia has one per 334 people. The need for doctors will continue to grow, given the new hospitals that are set to open in the next few years.

These include the 700-bed Ng Teng Fong Hospital in Jurong and the Integrated Building for Changi General Hospital and St Andrew's Community Hospital, both slated to open next year. By 2015, new community hospitals will also be built next to Ng Teng Fong Hospital and Khoo Teck Puat Hospital in Yishun.

A third community hospital will be set up next to the 700-bed Sengkang General Hospital, both of which are to be completed by 2018.

Ban on unhealthy food ads 

IN A NUTSHELL: Advertisements which make unhealthy food and drink appealing to children will be banned from early this year as part of Singapore's battle against obesity.

Topping the list of ads likely to be affected are those for sweet drinks and fast food which contain high amounts of oil and salt.

Announcing this last October, Health Minister Gan Kim Yong said the action is not targeted at specific brands, but at unhealthy food.

In the same month, 14 major food and beverage firms belonging to industry association Food Industry Asia pledged to cut back on advertising on unhealthy food to children.

The firms include Coca-Cola, Nestle, Ferrero and McDonald's.

The pledge covers products high in saturated fat, trans fat, sugar and salt.

Under this voluntary framework, firms will not advertise on television, in print and on websites where 35 per cent or more of the audience are aged below 12.

SIGNIFICANCE: The move is an important initiative because eating habits are formed at a relatively young age and Singapore is seeing a steady rise in obesity rates.

These rates have risen by 1per cent a year over the past three years. In Singapore today, 11 per cent of adults and 9 per cent of children are obese.

Half of these children will grow up to be adults with diabetes, which increases a person's risk of serious illness, including blindness, stroke and heart attack.

The proportion of adults aged 18 to 69 suffering from diabetes has grown from 8.2 per cent in 2004 to 11.3 per cent in 2010.

The experience in the West indicates that there will be a tipping point - when obesity affects 17 per cent to 18 per cent of the population - beyond which the rate rises even faster.

Hence, it is important to act now to prevent obesity from becoming a real epidemic.

S'pore to host first regional World Health Summit 

IN A NUTSHELL:  Singapore will host the first regional conference of the prestigious World Health Summit in April.

Its theme is health for sustainable development in Asia. The three-day event will be hosted by the National University of Singapore and MOH Holdings, the holding company for public health-care assets.

About 500 to 600 participants - including leaders in health care, policy and research - are expected.
The topics discussed will include health issues in the region, ranging from an ageing population to illnesses related to rising pollution levels.

SIGNIFICANCE:  This will be the first time that a regional version of the annual World Health Summit will be held outside Berlin, Germany, since the summit started in 2009.

Regional meetings have tended to be planning sessions for the Berlin event.

The regional summit will offer opportunities for Asian countries to take stock of the health challenges ahead and outline strategies to counter these threats.

IVF guidelines tightened 

IN A NUTSHELL:  By Tuesday, all assisted reproduction centres have to conform with standards established by Australia's Reproductive Technology Accreditation Committee.

Fertility centres now have to be recertified every two years.

There are 10 assisted reproduction clinics in public hospitals and in the private sector.

SIGNIFICANCE:  This latest measure follows revised guidelines on licensing terms and conditions of assisted reproduction centres implemented by the Ministry of Health last April.

They were aimed at boosting standards in clinical practices and workflow processes after an in-vitro fertilisation (IVF) botch-up at Thomson Fertility Centre in 2010.

A mix-up in sperm samples led to a woman having a baby, now two years old, with a stranger's sperm. Key additions include a list of proper laboratory practices and stringent counter-checking of specimen identification.

New ward at KTPH to ease bed crunch 

IN A NUTSHELL: A new 32-bed ward is expected to be ready early this year at Khoo Teck Puat Hospital (KTPH) in Yishun.

The 980 sq m area is being converted from a rooftop garden.

A new lift will also be added, since the current ones in Tower B, where the new ward will be, are already operating at optimum capacity. Construction started last July.

SIGNIFICANCE: The building of a new ward at KTPH will mean more beds for patients.

The need for the newest public hospital in Singapore, which opened in 2010, to expand, highlights how critical the public hospital bed crunch situation is. Alexandra Health group chief executive
Liak Teng Lit said he had expected to add more wards only after the hospital had functioned for five to 10 years.

KTPH is facing occupancy rates of more than 80 per cent, which is considered very high. Private hospitals prefer to keep occupancy rates in the low 70 per cent for a comfortable turnover of patients.

Changi General Hospital, Tan Tock Seng Hospital and, occasionally, National University Hospital, are experiencing an even bigger squeeze, with bed occupancy rates of more than 90 per cent.

The continued high demand for hospital beds has come as a surprise to many, since the opening of
KTPH added 550 more beds, bringing the total number of beds in public general hospitals to more than 5,800.

Part of the problem, it seems, is that families are often reluctant to take home elderly relatives who are recovering from illnesses.

Faster approval for high-risk medical devices 

IN A NUTSHELL: From this month, doctors and hospitals will be able to bring in many high-risk medical devices more quickly and cheaply.

These devices are categorised as Class C devices, such as X-ray machines and ventilators, and Class D devices, such as breast implants and intra-uterine devices. They account for roughly 40 per cent of all medical device applications.

Class C devices are now expected to be approved by the Health Sciences Authority (HSA) within 120 working days, at an evaluation fee of $3,000, down from 220 working days, at an evaluation fee of $5,700.

They have to be first approved by at least one foreign health authority recognised by the HSA.
The turnaround time for class D devices is now 180 working days, at an evaluation fee of $5,400, significantly less than the previous 310 working days, at an evaluation fee of $11,400 for the full evaluation route.

They have to be first approved by two or more foreign health authorities.

SIGNIFICANCE: These changes should make for speedier delivery of health care. Since 2010, the HSA has mandated that high-risk medical devices must be registered before they can be used here.

Last January, it extended this rule to include medium- and low-risk devices.

The move drew much criticism from doctors and importers. They questioned whether it was necessary for the HSA to assess devices which have been approved in other countries.

They argued that the high cost and complexity of registration and the time taken to process applications would push up health-care costs and reduce the number of devices in use here.

Within two weeks of these problems being highlighted last April, the HSA scrapped registration for about 4,700 class A or low-risk devices, such as wheelchairs, and cut the application time and fees for about 3,650 class B or low- to medium-risk devices devices, such as catheters.

Last August, the HSA cut the costs for devices brought in through the special authorisation route - items needed in a hurry, or for specific patients, exhibitions or training - from $500 to between $150 and $350.

Blueprint of genes linked to myopia mapped 

IN A NUTSHELL: A blueprint of the main genes linked to myopia will be unveiled by researchers here by the end of this year.

The project combined the results of three large studies on 5,000 myopic adults and children here, comparing their genetic make-up to that of those without the condition.

It has identified several genes associated with high myopia of 600 degrees and above.

The researchers hope to fine-tune, in a few years' time, a test to identify such sufferers for early treatment, before they become severely myopic and face the risk of going blind.

The massive research effort to uncover the genetic basis of myopia involves researchers from the Yong Loo Lin School of Medicine at National University of Singapore, the Duke-NUS Graduate Medical School, Singapore Eye Research Institute and the Genome Institute of Singapore.

SIGNIFICANCE: Short-sightedness or myopia, typically caused by an elongated eyeball, is the result of both genes and the environment.

A blueprint of the main genetic variants of myopia will allow researchers to develop predictive tools that combine gene tests with environmental factors, and recommend treatment for those who need it the most.

One of the leading causes of visual impairment and blindness, myopia poses a significant public health burden in Singapore and the region.

Asia is experiencing a myopia epidemic, particularly in its big cities. Rates of the visual defect have been rising over the past two decades.

In Singapore, the myopia capital of the world, eight in 10 people are short-sighted by the time they are 18.

New medical complex at Farrer Park 

IN A NUTSHELL: Connexion at Farrer Park (right), a development which includes a hospital, hotel and medical suites, is expected to open this year.

Built directly above the Farrer Park MRT Station, the six-storey podium with two 20-storey high-rise wings will have a medical centre housing more than 200 medical specialists in 189 consultation suites. It will also have a 83-bed private hospital with a luxury hotel and a shopping mall.

It is run by the Farrer Park Company, comprising private medical and hospitality specialists as well as foreign investors.

SIGNIFICANCE: Connexion at Farrer Park will open on the heels of Mount Elizabeth Novena Hospital, run by regional private health-care provider Parkway Pantai, and Fortis Colorectal Hospital, run by Indian private health-care group Fortis Healthcare. Both opened last July.

They could strengthen Singapore's position as a destination for medical tourism.

Already, foreign patients make up a significant number in some private hospitals here. For instance, at Mount Elizabeth Hospital, about half of its patients hailed from overseas, The Business Times reported last March.

Despite the economic boon of medical tourism, some experts have warned that excessive growth of the industry may put more stress on the health-care system and squeeze the supply of doctors here even further.

Heart centre moves to new home 

IN A NUTSHELL: The National Heart Centre Singapore will move into a new 12-storey, $266million building at the end of this year.

The new 8,800 sq m site will be just down the road - about 400m away - from the present four-storey building on the Singapore General Hospital campus.

The centre will operate on a new concept that wraps services around the patient. For instance, patients, who are often the elderly, can see a doctor and have a blood test and an electrocardiogram on the same floor, instead of having to walk from place to place for these services.

Other features designed with the elderly in mind include distinctly coloured signs with large font, non-slip vinyl floors and motion-sensor lights.

SIGNIFICANCE: The new building is designed with the growing number of patients at the centre - one in three of whom are aged 65 and above - in mind.

The centre treated 108,000 patients last year, a figure that is set to rise by 60 per cent in the next decade.

The number of first-time elderly patients has shot up by 44 per cent since 2002. There will be 38 consultation rooms - more than double the current 18.

How to be happy

The results of the recent Gallup poll, as well as other surveys, seem to indicate that Singaporeans are an unhappy people. This surprises me because, objectively, we should be a happy people.

I consider myself a happy person. I would therefore like to share with my fellow Singaporeans 10 rules which may help to make them a more happy people.

RULE NO. 1

Be a positive, optimistic and kind person.

Whether you are a happy or unhappy person depends largely on yourself.

Negative and pessimistic people are generally unhappy people. Be kind to others. Kindness begets kindness. Try to do a good deed every day.

You will find that by brightening the lives of others, you will brighten your own life.

RULE NO. 2

Have a happy family.

Be good to your parents. If they are elderly and living by themselves, try to visit them at least once a week and share a weekly meal with them. One of the problems encountered by our older folks is loneliness.

Be on excellent terms with your spouse. Whenever I am asked to speak at wedding dinners, I always advise the groom to do three things: Be faithful to his wife, treat her as if they were still courting and give her all his money. The last advice does not apply in cases where the wife is a spender and not a saver.

As for how to behave towards one's children, I have always liked the advice given by Kahlil Gibran: "And though they are with you yet they belong not to you. You may give them your love but not your thoughts. For they have their own thoughts."

If you are lucky enough to have grandchildren, love them with all your heart.

RULE NO. 3

Find a job you enjoy doing.

I think one of the reasons so many Singaporeans are unhappy is that they do not like their jobs. Since we spend so much of our lives at work, it is important to find a job which is not a chore to endure but a pleasure to do.

In recent years, I have noticed a trend of many Singaporeans leaving their jobs for other jobs which pay them less but give them greater satisfaction. This is a good thing.

RULE NO. 4

Treasure your friends.

In your life journey, you will make many friends - at school, at university, in sports or other activities and at work. I hope you will develop a small circle of very good friends, friends who will stand by you in good times and bad times.

RULE NO. 5

Exercise regularly.

My wife and I try to swim every day. Exercise not only makes you healthier, it also makes you feel better. Therefore, make regular exercise a part of your lifestyle.

You can't be a happy person if you are not in good health.

RULE NO. 6

Enjoy eating but eat healthily and avoid the sin of gluttony.

Singapore is a culinary paradise. Food is abundant, diverse and affordable.

You can eat well on any budget. Let us enjoy our food but let us also exercise some discipline when choosing what to eat. I have always tried to follow the ancient Asian wisdom of stopping when I feel 80 per cent full.

RULE NO. 7

Be a volunteer and support philanthropy.

I once heard a speech by Mrs Barbara Bush, the wife of the 41st President of the United States. She said there was a period in her life when she suffered from depression. Instead of seeing a psychiatrist or taking medication to overcome her depression, she decided to be a volunteer. She found that by helping others less fortunate than herself, her depression gradually disappeared.

Whether we are rich or poor, we should contribute to a cause or causes close to our hearts. In spite of our favourable tax regime and the presence of many wealthy people in our society, I was very disappointed to see how lowly Singapore ranked in the table of countries for philanthropy.

A wise man once said that no man could be truly happy if he lives only for himself.

RULE NO. 8

Read books and listen to music.

Reading is an excellent habit. Books keep me company when I am alone. Books transport me to another country, another culture, another time and into the lives of other people. Reading is an endless source of happiness.

So is music. I listen to music every day. I thank 92.4 FM for bringing me so much joy every day.

RULE NO. 9

Take pleasure in the little things in life.

My wife and I love our regular walks in the Botanic Gardens. I love to watch the sunset.

I find joy in meeting an old friend, attending a concert at the Esplanade and visiting a wonderful exhibition at one of our museums.

Most of all, I enjoy being with my grandson.

RULE NO. 10

Don't envy others.

I received this good advice from a wise man, Dr Wee Kim Wee, our sixth President.

Dr Wee once told me that one of the reasons which caused people to be unhappy was that they were envious of others. Dr Wee said he never envied his friends who had a better education or earned more money or lived in bigger houses or owned more expensive cars.

His rule was to be contented with what he had. I think this is a good rule.

Philosophically, it would be even better if you could feel vicariously happy when you see your friends and former students doing well in life.

Professor Tommy Koh is Ambassador-at-Large with the Ministry of Foreign Affairs, Singapore.