CHIA ZHONG YI

Background information of the project

Our project aims to find out on the role of polyclinics in healthcare. These include on why polyclinics were built; whether they replaced some other medical community service centre; the overall healthcare plan for screening and treatment of health problems and the positioning of polyclinics in this plan; the types of services available and the costs of these services; the demographic that the polyclinics were designed to serve; interesting stories from those who worked in polyclinics. The value of this project is to present information to the public in a way which can be easily known. We decided to present this via a website, where information can be put neatly in different tabs for further clarity and also be aesthetically pleasing.

Process

1st week

During our first week, we went to Pasir Ris polyclinic on Monday to meet our mentor Dr Peter Moey. He gave an overview of how polyclinics worked and showed us his plans for the upcoming Eunos polyclinic. We were also given a tour of the polyclinic. After that, we discussed how to go about doing our research and what we wanted to achieve as an end goal. In the end, we decided to make a website that people could visit to learn more about polyclinics. In the next few days, we travelled to other polyclinics such as Outram, Bedok and Marine Parade polyclinic to interview their staff and patients. We mainly asked them about their opinions towards the services provided, and also the experiences they had. We included some of the interesting experiences in our website so that people could get firsthand accounts of the staff's experiences and understand their perspectives. We also got to see a cooking demonstration that was about to happen. It was a cooking demonstration of a weaning diet for newborn babies. We then got a tour of the behind the scenes at Outram Polyclinic and got an insight into the working environment of clinical staff in a polyclinic. We got the see the storage of drugs and found out that medicine colour labels are very important. Red colour meaning that these drugs are tightly controlled. Labels for proper storage can also be seen everywhere as it is very important for the quality and effectiveness of the drug

Research questions:

1) Why were polyclinics built?

Polyclinics were built to provide more affordable and accessible primary care to the public. Instead of going to a hospital or a general practitioner, they could now go to a polyclinic instead. The construction of polyclinics meant that more medical service centres are available, hence there would be a reduced waiting time in hospitals or other centres. It provides treatment for acute medical conditions, management of chronic diseases, women & child health services and also dental care.

2) Did polyclinics replace some other medical community service centre?

Polyclinics have replaced conventional clinics and some other centres such as the Maternal and Childhealth Centres, Outpatient Dispensaries and Outpatient Pharmacies.

3) What is the overall healthcare plan for screening and treatment of health problems?

Polyclinics do not provide comprehensive health screenings, meaning that any person who walks in and requests for a full body screening will be denied. However, they do provide screenings for specific diseases such as diabetes, hypertension and high cholesterol. Women over 25 years old are able to receive subsidies for cervical cancer screenings, while screenings for high blood pressure, obesity, diabetes and high blood cholesterol are subsidised for those over the age of 40. For those over 50, screenings for colorectal and breast cancer are also included in these subsidies. The SHP Care Management Program also proactively screens chronic patients for psycho-social issues that may affect how well they can manage their condition.

Savings plans such as the Central Provident Fund(CPF) helps to make healthcare treatments more affordable by making use of schemes such as Medisave and Medishield Life. Medisave is a personal savings plan which tackles heavy medical expenses, while Medishield Life is a low-cost insurance initiative that pays for more expensive treatment or hospitalisation.

4) How are polyclinics being positioned in this plan?

Polyclinics in Singapore are split up into 3 different clusters which are managed by three different groups. As for the Western region of Singapore, polyclinics are managed by the National University Health System (NUHS). For the Central region of Singapore, polyclinics are managed by the National Healthcare Group. Whereas for the Eastern region of Singapore, polyclinics are managed by Singapore Health Services.

Polyclinics are usually located in the heartlands of Singapore. This means that polyclinics are located in residential areas where there are many public housing which are being subsidised by the government. These polyclinics are also often surrounded by MRT stations, bus stops and eateries. The purpose of this is so that the polyclinics are more easily accessible by the public. By building polyclinics in concentrated subsidised housing areas, it allows for more people to be able to easily access a government healthcare facility which is more affordable as compared to private healthcare facilities such as GPs.

5) What are the types of services available and the costs of these services?

The types of services available include medical care, vaccinations, medical examination and screening, allied health services, clinical laboratory and diagnostic radiology, dental care and special services on Saturday.

The costs of different services may vary as the stated costs only serve as guidelines. Prescriptions for medication may be needed, hence additional costs may be incurred. The costs can also be subsidised by following the various healthcare schemes (CHAs, Medisave, Medishield, etc). Below shows a tentative guideline:

Interview questions:

• How is your (working) experience in a polyclinic?

您在诊所的工作经验如何?

• Are you regulars at this polyclinic?

你常常会来到这个诊所吗

• What is your age group? (Eg. 20-25, 25-30, 30-35 etc)
• why do you think polyclinics are important?

您认为这些诊所 有什么意义/很重要吗?

• Have you visited a GP(全科医生) (私人) before? If so, why do you still choose to come to polyclinics?
• Which is the best polyclinic you have visited? And what makes it better than others?

您认为哪一个诊所的设施最好? 好在哪里?

• What difficulties/issues/inconveniences have you encountered while in a polyclinic?

你在诊所里是否有遇到什么困难或者有什么不方便的地方？

• What are some improvements in the use of space in the polyclinic? What would you change in this polyclinic?

您认为这个诊所还有哪些可以进步的空间吗?

(do you think you will have a better patient/ working experience if there was a particular type of music or other form of entertainment?)

• What suggestions do u have for the system or polyclinic?

你为诊所有任何的建议吗？

• What are some interesting stories or memorable experiences u had in a polyclinic?

您在诊所看诊/工作时有没有一些精彩/难忘的经验? 可以分享一下吗?

• How have polyclinics changed over the years? how has patients attitude changed?

你觉得现在的诊所跟以前的诊所有什么变化？你认为现在的患者们的态度跟以前的患者们有什么不一样？

• Do you think the cost of polyclinics are reasonable? why/why not?u

您认为看诊的价格合理吗? 为什么?

• Do you think polyclinics are accessible? why/why not?

您认为来诊所很方便吗?为什么?

• With rising affluence, more and more people are turning to private healthcare, do you think having more polyclinics is necessary?

Here are the interview questions that we asked both staff and patients. For the patients, we first asked them general information about them like their age group and whether they are regulars at a polyclinic. We then proceeded to ask them about their experience in polyclinics and gathered feedback from them about how polyclinics can further improve.

For the staff, we asked them about their working experience and if they have any interesting stories or memorable experiences to be shared with us. We also asked them about how polyclinics and patients used to be so as to gather more information.

These are some of the responses that we have collated from our interviews. For the inconveniences and issues faced, many people complained about the waiting time at polyclinics as it can take quite long. One of our interviewee also said that even though they had made an appointment with the HealthBuddy app, the waiting time was inaccurate. There’s also a lack of PMA accessibility in the polyclinic such as lack of wheelchair bases and narrow corridors. There’s a lack of seats and seating areas when the polyclinics become crowded. Sometimes, the staff provide unclear directions and instructions to the patients. Patients also need help in using the self-service kiosks, especially the elderly.

These are some suggestions that we have based on our interviews.

• Devices displaying interactive media about various health issues can be implemented such as Ipad or laptop. so that patients can view them while waiting for their appointment to pass the time. This would also enable them to gain more insight into any health related inquiries and learn about how to better maintain a healthy lifestyle.
• The corridors or walkways could be expanded to fit more PMA users, making it more convenient and safe for them to get around as there have been many incidents of PMAs breaking glass privacy panels
• Vending machines so that people can get coffee or snacks while waiting
• more areas for physical therapy - for muscle rehab after injury
• More wheelchair bases for people with PMAs to wait for their turn, when we visited Bedok polyclinic they had wheelchair bases, but when we visited Pasir Ris polyclinic, they did not have wheelchair bases and it was difficult for them to move around

Interview responses (staff):

Interviewee #1: Nurse Manager Ng

Background information: She delivered about 100 babies in her lifetime in hospitals, all free of charge. She had done both normal and abnormal deliveries - an abnormal delivery is if the mother has health issues such as anaemia etc.

In 1968, they stopped having midwife services as 2 midwives were raped in the clinic by people who lived in the Sembawang neighborhood. They stopped having services for home deliveries and overnight stays in the clinic. One of the older midwives resigned while the younger midwife went overseas and came back to become staff nurse.

She used to work as a staff nurse in Aljunied road when it was still MCH clinic (Maternal & Child Health).

Singaporeans were poor back then and there was 1 family of 6 children who would attend her cooking demonstration classes. Usually, she would do a fish/meat/chicken/vegetable such as spinach and carrots, porridge demonstration and the mother of 6 would bring all her kids to the demonstration at the clinic.

For one class, there will be about 20 parents with their children.

It was only 1 storey flat ground with an open space in the clinic fully packed.

After the demonstration is finished, the porridge will be given out to the kids, about one plastic cup per family. However, in the present, they cannot let the people eat the food as they are worried that people will complain if they contract salmonella infection.

The mother of 6 said if there was leftover porridge, she wants to give it to her other 5 kids. Hence, the mother will just wait for the cups of porridge to be passed out to everyone else to give her kids food. She was grateful to the nurse because she was poor and didn’t have enough money to cook lunch for her kids.

Interviewee #2: Pharmacy technician Tian Hock

In the past there was just a clinic and it wasn’t well equipped. The clinics would be in attap houses.

Patients in the past were more thankful and kind toward clinical staff and sometimes would even send them tokens of appreciation

Past clinics had only three pharmacy technicians with each different roles, and they had to be fast or the system will jam up

Tablets and liquid medicine were made from scratch in medical stalls, an attachment which future pharmacy technicians had to attend before given appointed as a pharmacy technician.

Nurses could give patients their medication as long as they do not have any additional symptoms, as according to their previous diagnosis by the doctor.

Tablets given to the patients were produced one by one hence the pharmacy technician had to manually count them

Clinical staff had to record everything in hardcopy and hence storage was very bulky

His first place of work is at Queenstown dispensary which is opposite Queenstown library. There would be about 100 patients per day as compared to now where there are 400-500 patients per day.

In the past, there were no trays but now there are trays for prescribing medication.

They would use a paper envelope to pack the tablets and use a stapler but the tablets may not be well sealed, so as time passes by, the tablets may not be in good condition already. Now the staff can just scan and the label stickers will come out, in the past, they needed to type manually on the computer.

Creams will be put in ice cream cups, however some patients will still bring their own containers as they think ice cream cups can be messy.

Interviewee #3: Nurse from Marine Parade Polyclinic

The patient had social issues and financial issues had diabetes and the children had to juggle between looking after them and work studies so she gave transport moneys out of her pocket.

People now more educated, so they expect a better service, especially the younger generation. Sometimes, a few elderly will have anger management issues. Sometimes, the senior citizens will not understand how the appointment system works. Patients might lose their lab forms and displace them, or its not given to them, they might come to the emergency room just to get the staff to print the forms for them and this cost them alot of time.

Most of the patients know the nurses, because after time they get to know them, and they get to hold conversations

Over time they know about the patients' preferences and put them in their remarks

The patients will feel happy when the nurses remembered their preferences or when the nurses call them by their names

Initially, when don't know the patient it can be stressful, but after time and experience, it gets less stressful

Interviewee #4: Admin staff at Marine Parade Polyclinic

For things that doesn't fall under nursing or pharmacy, falls under her department such as facilities, patient feedback

Other industries are aligned with the technological advancements and can change instantaneously, however, this is not the case for polyclinics since a lot of it depends on whether the polyclinic gets government funding and whether it fits in the budget.

Although Medical Social Workers (MSW) are available, not a lot of people use it due to stigma around it

Patients usually use a 5 minute consultation time to ask a lot of things and that itself prolongs the waiting time for other patients.

For marine parade patients, they have this mentality that because they are the pioneer or merdeka generation, they can be more demanding.

2nd week - 3rd week

During our second week, our group met up in the library to create and design the website, while also planning how to film clips to put in our website.

The third week was mostly just filming and editing of the video clips, in which we went back to Pasir Ris polyclinic to film. However due to some unfortunate circumstances the clips were not able to be used, as we were unable to return back to the polyclinic to refilm, we had to refilm them in school this week and edited the video in school.

The fourth week would be us completing the website and the final editing of the videos which we filmed

Final product (website)

3 content knowledge

Firstly, i learnt that people nowadays are not very appreciative for the nurses and often take them for granted. In the past none would challenge a medical staff on their advises or prescriptions for them, some would even give up their seat for nurses on the bus when they see them. However, people these days are more educated, and with the advent of the internet, many search up their symptoms online and and to come with an incorrect diagnosis for themselves. They then challenge the nurses and this can be a big headache for medical staff. Many do not thank the nurses and some are even hostile toward them

Secondly, i learnt that many services available in the past were halted due to safety concerns. For instance, in 1968, they stopped having midwife services as 2 midwives were raped in the clinic by people who lived in the Sembawang neighborhood. They stopped having services for home deliveries and overnight stays in the clinic. This is sad as people who actually need these services cannot have access to them anymore due to these people.

Thirdly, a skill that i have learnt is how to create a website. Initially i was nervous as it was not beginner friendly but i managed to quickly learn the user interface and successfully create a website.

2 interesting aspects

Firstly, when we were at Outram Polyclinic, a pharmacy technician led us on a tour of the polyclinic, he showed us behind the scenes of a polyclinic, how to medicine of a patient was recorded then dispensed in a tray. There were many medicine behind the counter of different strictness grades and it was just many shelves of medicine. At the back there were even more shelves of medicine stored there and it was amazing how the pharmacy technician could remember all the names of them, what disease they treat, as well as the varying strength of the medicines for each disease.

Secondly, I have found out that polyclinics are actually very well equipped with facilities. During our tour with Dr Moey, I found out that polyclinics had a blood test lab and even a X ray machine. This shows that us people in Singapore are given access to affordable healthcare of many forms.

1 takeaway for life

1 takeaway for life from this WOW! programme has to be the opportunity given to hear the personal stories and experiences told by senior staff who worked in old polyclinics have a peek into healthcare services and old polyclinics back in the past. It was very heartwarming hearing of all the stories and having the rough sketch and picture in the mind as they spoke and described the setting of their work environment. These insights are something that is very real and hard to be able to get hold of.