1. society
2. welfare
3. healthcare
4. hospital

History
Journey of KK Children’s Hospital – Collective Memories
Oh Moh Chay1, FAMS,FRCPCH, Kee Chong Ng1, MMED (Paediatrics), FAMS, Mahesan Helena2, Nguk Lan Pang3, Lai Yun
Ho4, MMED (Paediatrics), FAMS, Kong Boo Phua5, FRACP, FAMS, Kok Hian Tan6, FAMS, FRCOG
Division of Medicine, KK Women’s and Children’s Hospital, Singapore; 2Division of Nursing, KK Women’s and
Children’s Hospital, Singapore; 3Medical Affairs, KK Women’s and Children’s Hospital, Singapore; 4Department
of Neonatal and Developmental Medicine, Singapore General Hospital, Singapore; 5Gasteroenterology
Service, KK Women’s and Children’s Hospital, Singapore; 6Division of Obstetrics and Gynaecology, KK Women’s
and Children’s Hospital, Singapore
1
Abstract
This paper presents the collective memories of many individuals who were closely associated with the growth
and development of the Children’s Hospital. It is based on the perspective of the authors’ personal recollections
and by no means the whole of this exciting story. The focus is on the development of paediatric medicine in KK
Women’s and Children’s Hospital (KKH). Neonatology will be discussed in a separate paper.
Keywords: Children’s Hospital, Development, SARS
INTRODUCTION
KK Women’s and Children’s Hospital (KKH) was first
built as the fifth General Hospital of Singapore in
18581. This facility in the Kandang Kerbau District
was designated a maternity hospital for the care
of obstetrics and newborn infants in 1924. In 1966,
it was the busiest maternity hospital in the world,
receiving worldwide recognition in the Guinness
Book of Records, with 39,835 deliveries in a single
maternity facility in 19662.
In 1990, KKH embarked on a major restructuring
exercise. Obstetrics and Gynaecology (O&G) and
the two Neonatology Departments from Toa Payoh
and Alexandra Hospitals were moved to KKH. This
laid the foundation of efforts to consolidate the
services for children’s healthcare in Singapore.
PHASE 1: THE GENESIS AND GESTATION OF
PAEDIATRICS IN SINGAPORE
Paediatric care in the Singapore General Hospital
(SGH) first began as a ward in the midst of adult
facilities. In the 1950s, a philanthropist, Mr NR
Mistri, generously donated to the building of a
children’s wing with 274 beds. The building was
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named “Mistri Wing”. The western wing housed the
University department while the eastern wing, the
Government Department of Paediatrics. The first
Head of Department of Paediatrics was Dr Elaine
Field. Professor Tan Cheng Lim was the Head of this
Department from 1977 until the move to KKH in
1997. In 1986, the western wing of Mistri Wing (the
then University Department of Paediatrics) had
moved to a new hospital at Kent Ridge Campus.
In the late 1980s, the Ministry of Health (MOH)
was actively exploring the concept of a Women’s
and Children’s Hospital for Singapore. To public
paediatricians grappling with the frustrations of
the lack of a child-friendly environment in a General
Hospital, the vision of a child-friendly environment
in a new Children’s Hospital where children could
be children was attractive and exhilarating. Seniors
members of the paediatric fraternity and MOH
officials visited renowned children’s hospitals in the
United Kingdom (UK) and United States (US) and
there were many discussions on how to best adopt
the best design practices of these hospitals into the
eventual KK Children’s Hospital. In the 1990s, it was
finally confirmed that a new hospital will be built
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History
opposite the old KKH at 100 Bukit Timah Road.
Following this decision, various workgroups were
formed to prepare for the “birth of the baby”. Dr
June Lou, then in the Department of Paediatrics in
TTSH, led the group for creating inpatient wards,
outpatient designs and emergency care. Senior
paediatricians such as Drs Cheng Heng Kock,
Tan Keng Wee and Ho Nai Kiong, were working
alongside nursing leaders such as Ms Lee Yoke Lan
and the operations team led by Ms Yong Lai Chan.
There was even a competition to select the best
design for the new hospital!
Children’s Intensive Care Unit (CICU)
The main author (COM) was tasked to lead a group to
plan the Children’s Intensive Care unit (CICU) for the
new hospital. The decision from the main hospital
planning committee was that a paediatrician
should provide the leadership role in the design of
CICU following various visits to overseas centres.
Since she had been actively involved in the care
of children admitted to the intensive care unit
(ICU) and was trained in Respiratory Medicine,
the committee believed that she would be the
best (rather the ‘default’) person to put together a
group of people to plan for a Children’s Intensive
Care unit for the hospital. Singapore had no trained
paediatric intensivist then. The bigger challenge
was that these CICU plans had to be completed
in one month for presentation to the then Chief
Executive Officer (CEO) of KKH, Mr Khaw Boon Wan.
Stress after all may not be that counterproductive
and indeed acted as a catalyst for a chain of actions
that ensued. There was an urgent need to engage
the stakeholders and also seek the most friendly
and helpful persons. Key people in this CICU
group were paediatric surgeons, Drs Sim Chiang
Khii, Cheah Siew Leng; cardiothoracic surgeon, Mr
KK Ong, and paediatric intensive care nurses, Ms
Pang Nguk and Ong Lim Liew. All were enthused
about the opportunity to be involved in the design
of the first Children’s ICU in Singapore. Everyone
was highly motivated, collaborative and selflessly
contributed to the discussions and brainstorming
on the preferred design. The group debated on
whether we would have sufficient nurses to take
care of the new ICU if it were all to be single rooms.
It was unanimously agreed that as the nursing
shortage issue could not be resolved in the near
future and that for patient safety and efficiency, the
beds in the new Children’s ICU would not be single
rooms. The group also agreed that there would be
much medical progress in the next decade and
thus transplant rooms were needed and included
in the design, even though transplant in children
were uncommon then. With the strong partnership
and teamwork of this workgroup, the plans were
ready for presentation to Mr Khaw as scheduled.
Soon the new building took shape very quickly.
Children who passed by the new hospital instantly
liked the ‘ship” as it was lovingly referred to then.
Emergency Department
This was the first of its kind in Singapore and we
had been advised by the visiting specialist from
Adelaide Children’s Hospital that we needed to
be prepared for a busy Emergency Department.
One major issue surfaced. The initial design was
intended for walk-in patients only and not for
ambulance cases. The initial design created was
deemed not suitable as an Emergency Department
where high intensity and throughput was
expected. This was part of the reason why this area
had to be altered and renovated several times in
the next few years after KKH opened to meet the
increasing and different demands and needs. In
2002/2003, the triaging stations were built to
facilitate a more timely interaction of the patients
with the healthcare team and in 2008/2009, a room
was delegated for intensifier imaging to facilitate
better alignment in the reduction of fractures.
Inpatient Areas
Besides Haematology (Ward 76) and Paediatric
Surgery (Ward 55), all others were general purpose
wards. Ward 66 had needed to be fitted with more
oxygen points as it was to be the Respiratory Care
ward in the future.
Outpatient Area
The original proposal was to have connecting doors
in the clinic to facilitate teaching and training. This
was not accepted as there was concern about
sound proofing. Except for the Orthopaedics clinic
which had a special requirement for a plaster room,
the other areas were all for common general use.
PHASE 2: BIRTH OF THE PRECIOUS BABY
The Women’s Hospital together with Neonatology
began services in March 1997 in the new premises
at 100 Bukit Timah Road. It was planned that the
Paediatric Department in Tan Tock Seng Hospital
(TTSH) (1975–1997) and Alexandra Hospital (AH)
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229
History
(with only one remaining paediatrician) moved
over on 10 May 1997. SGH Paediatrics, being the
more established of the Paediatric Departments
would move over in stages over six months to a
year as demand for paediatric services in SGH was
expected to remain for some time.
Dr Cheng Heng Kock, the first Chairman Medical
Board, KKH (1997–2003) with his prudence, decided
that there would be a “soft opening” to evaluate
processes and gaps, if any, in the Outpatient,
Inpatient and Emergency Departments before 10
May 1997. This proved to be a wise decision and
indeed there were many ground issues which
which had far greater care acuity and the pharmacy
stocks were consumed at a much faster pace. For
example, the month’s stock of Salbutamol MDI
was depleted in less than a week when operations
commenced. The pharmacy was surprised that
stocks could be depleted in a short period of less
than a week. Ward supplies of blood culture bottles
for septic patients also needed to be replenished
very quickly. These were some hiccups which were
quickly resolved by the incumbent team in KKH
and the incoming team from TTSH. The positive
aspect of these issues was better integration of the
incoming teams and the incumbent operational
team of KKH.
The “baby” was ready to face the real world on
10 May 1997 when the Children’s Emergency
Department (CE) opened its doors to patients,
together with Ward 66 (with one cubicle equipped
for high dependency care), Ward 55 for subsidised
patients, Ward 85 for paying patients and the CICU
which was equipped with state-of-the-art facilities
with inputs from Dr Ong Eng Keow/Dr Irene Chan
who had since completed training in paediatric
intensive care.
KKH was officially opened on the 10 October 1997
by then Prime Minister Goh Chok Tong. This marked
the unification of three Paediatric Departments
from AH, SGH and TTSH, to form a single, large
facility dedicated to the care of children.
PHASE 3: NEONATOLOGY PERIOD
Our “baby” hit the ground in full swing from day
one. The experience of the Adelaide Children
Hospital was to be replayed in KKH. The CE/wards
were overwhelmed from day one of opening.
Fig. 1. The big move.
Courtesy of Nursing Division, KKH
needed to be fixed before opening the doors to the
public. Dr Chay was the first paediatrician to move
across from TTSH to KKH on 2 May 1997 into the
new KKH.
As the operational team at KKH was initially more
familiar with O&G and Neonatology, there were
gaps in meeting the needs of a children’s hospital
230
Meanwhile, the team from TTSH, Drs Lim Kim Whee
(popularly called ‘Papa Lim’), June Lou (Clinical
Head, Paediatric Medicine), Tan Ah Moy, Choong
Chew Thye, Anne Goh and Ho Ling would never
forget doing three ward rounds a day to manage
and expedite discharges in order to continue
admitting patients round the clock. Beds needed
to be brought in and added rapidly. By the end
of the month, all wards had to be put into service.
The nursing teams from TTSH and KKH were not
familiar with one another’s ways and practices, but
they were highly collaborative and had patients’
interest as the top priority. Meanwhile, the team
from SGH had to be deployed to KKH more
quickly than anticipated when all the wards in the
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KK Children’s Hospital
new hospital had to be put into service to meet
patient demands.
Professor Tan Cheng Lim (Head of Paediatric
Medicine), Professor Phua Kong Boo (Clinical Head,
Paediatric Medicine), Drs Ivy Ng, Ooi Boo Chye and
Chao Sing Ming all moved over to KKH within the
month of the commencement of the Children’s
Hospital and the Department of Paediatrics in SGH
stopped admitting children by May 1997.
Phase 4: GROWTH AND DEVELOPMENT
Through the years, pockets of sub-specialisation
have been steadily developed and new subspecialty services to better meet patient needs
were created. Besides General Paediatrics and
Neonatology, there were several designated subspecialties that were created and developed over
these last 15 years.
Department of Paediatric Emergency
When it was decided that the Children’s Hospital
would run the first dedicated emergency
department for children, the need to engage the
young doctors to prepare for the opening became
an urgent matter. Professor Cheng went on a search
for physicians who had an interest in Emergency
Paediatrics. There were three young trainees
identified – Drs Angelina Ang, Ng Kee Chong and
Tham Lai Peng. Dr Sim Tiong Peng was the pioneer
head of the Children’s Emergency. He had a difficult
time dealing with acute manpower shortage, as CE
started with a team of only eight medical officers.
The initial nursing support was led by Ms Zainab
from SGH and the TTSH nurses were led by Ms Lee
Choy Kuan and Chia Lai Heng. Several key nurses
were also transferred from TTSH Ward 51 and
from AH and SGH Paediatrics. In 2005, there was
smooth transition of leadership from Tiong Peng to
Kee Chong.
Children’s Emergency has grown from strength to
strength and is now one of the largest of its kind with
attendance above 170,000 annually. The admission
rate is about 12–15% of total attendances,
comparable with other CEs in developed countries.
There were two major renovations in 2003/4 and
2007/8. At the same time, more child-friendly
initiatives were put in place, including better use
of procedural sedation and analgesia, use of tissue
glue for wound repairs and use of image intensifier
to better help manage fractures in children. CE
helped set up a specialised paediatric field team
to respond to National Civil Emergencies and took
a leadership role in advocating the prevention of
childhood injuries and poisons management and
prevention. CE has also been actively involved in
humanitarian works.
Department of Paediatric Sub-specialties
From the latter half of the new millennium, efforts
were made to deepen sub-specialty development.
Cardiology, CICU, Haematology/Oncology, came
under the new Department of Sub-specialty
which was formed in June 2005. That marked the
beginning of the next lap to consolidate General
Paediatrics and facilitate niche developments.
The progress was very slow, the main obstacle
being manpower issues and the need to cope
with a large general paediatric workload. Not until
January 2009, did the Department welcome its fifth
member, the new Rheumatology and Immunology
Service. Dr Janil Puthucheary has been leading the
Department from 2012 and will continue to focus
on the work to develop tertiary services.
Child Development Unit/Department of Child
Development
This started as a newborn follow-up programme
which later under the visionary leadership
of Dr Ho Lai Yun, transitioned into a Health
Service Development Programme (HSDP) to
provide diagnosis and therapy of children with
developmental disorders. As the larger of the two
centres, KKH currently has satellites in the Health
Promotion Board, Seng Kang Polyclinic and St
Andrew’s Community Hospital. They are currently
strategically positioned to serve about 80% of the
public workload. With Dr Ho Lai Yun in the advisory
role, Dr Lim Sok Bee currently continues to develop
the centre with clear direction to support children
with special needs. The team of developmental
paediatricians, with support from Mr Tang Hui Nee,
a psychologist, together with a high performing
multi-disciplinary team, has done an incredible job
in the advocacy for this group of children, shifting
the focus on disability to functional performance.
With financial support from the Lien Foundation
and PAP Community Foundation (PCF), the
programme Mission I’MPossible now serves 25 PCF
Centres in the Pasir Ris-Punggol area. The team is
in the process of engaging the Ministry of Social
and Family Development (previously known as
the Ministry of Community, Youth and Sports) to
roll out this programme to all children with special
needs in Singapore3.
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History
The Unit was elevated to a full Department in
April 2008. It continues to be active in providing
education to the parents, preschool and school
teachers, to facilitate continuity of care and to
ensure that the children continued to receive the
relevant support for them to be integrated into
our society.
Children Intensive Care Unit (CICU)
This was the first of its kind in the region, led by
Dr Irene Chan and the pioneer team included
Drs Loh Tsee Foong and Kenny Ee. They were
soon joined by Drs Janil Puthucheary, Loh Lik
Eng and Chan Yoke Hwee. The CICU is a multidisciplinary ICU which included medical, surgical
and cardiothoracic surgery patients. This team is
a strong advocate of innovation and Dr Janil was
pivotal in the organisation of the first Children’s
Hospital Emergency Transport team and Paediatric
Simulation Training in this region4. The team also
provides holistic care to our patients and Dr Chan
Yoke Hwee has been championing the Paediatric
Home Care Programme to render support to
families with children relying on high technological
support at home.
Paediatric Cardiology Service
This team was headed by Dr Wong Keng Yean who
has subsequently nurtured a team (Drs Heng Joo
Teck, Anthony Chee, Tan Teng Hong, Jonathan Choo
and Chen Cheng Kit) proficient in state-of-the-art
echocardiography and interventional cardiology.
The current Head of Service, Dr Tan Teng Hong
was our first Cardiology trainee in the Children’s
Hospital.The service now holds a comprehensive
database for congenital heart disease and
Kawasaki’s Disease which is an excellent platform
to launch clinical research. One of their important
contributions was to develop a normogram for
coronary arteries in children5.
Respiratory Medicine
The main author (COM) was the first Head of Service
with the team consisting of Drs Anne Goh and Ho
Ling. The team advocated for childhood asthma by
providing leadership roles in MOH guidelines in the
management of childhood asthma and antibiotic
guidelines in respiratory infections management.
The team subsequently played a pivotal role in
the Singapore National Asthma Programme and
championed the use of the metered dose inhaler
(MDI) with spacer usage for acute asthma during
the outbreak of the Severe Acute Respiratory
232
Syndrome (SARS) in 20036. Under the leadership
of Dr Anne Goh, research activities were further
strengthened and the service participated in
numerous multi-centre clinical trials. In 2009, Dr
Jenny Tang led the service to be the first Sleep
Laboratory in Asia to achieve accreditation by the
Thoracic Society of Australia and New Zealand.
Dr Teoh Oon Hoe took over in 2010 and besides
consolidating the busy service, promoted passive
smoking prevention in children. He was recently
invited by the World Health Organisation to be
one of the pioneers in global initiative to reduce
tobacco smoke exposure. This is a critical link in
preventive healthcare and in optimising the health
of future generations.
Haematology and Oncology
This service was led by Dr Tan Ah Moy and in her
team were Drs June Lou, Tan Cheng Lim, Chan Mei
Yoke and Vasanthi. This team is unique in that it is
a collection of very senior paediatricians from TTSH
and SGH, thereby enabling the exchange of ideas
and promoting best practices in paediatric care.
This service has grown from strength to strength,
providing quality care to 70–80% of the children
in Singapore. With a survival rate of more than
80% for leukaemia, the most common childhood
malignancy, this matches the survival figures from
other renowned international centres. In 1998,
Ward 76 was converted to a full Oncology ward and
in 2002, the Cancer Day Therapy was moved to level
7 to provide a one-stop service for cancer therapy.
The first bone marrow transplant was done in 1999
and the first successful stem cell transplant using
unrelated cord blood was performed in 2006.
Infectious Disease (ID)
Dr Chong Chia Yin was the first trained paediatric
ID physician in Singapore. Her work with Human
Immunodeficiency Virus (HIV) babies and use
of prophylaxis had helped to reduce vertical
transmission rates from HIV positive mothers.
During the SARS period in 2003, Dr Winston Ng
was instrumental in assisting the Division of
Paediatric Medicine in the containment of SARS in
KKH. Drs Thoon Koh Cheng and Natalie Tan, both
with separate clinical niches have contributed
significantly to the growth of paediatric ID. Dr
Thoon Koh Cheng, the current ID Head, leads the
Antibiotic Surveillance Programme by MOH.
Endocrinology
Dr Warren Lee was the first service head and he
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KK Children’s Hospital
went on to play many leadership roles in the
care of diabetic patients. He was later succeeded
by Dr Fabian Yap who had a special interest
in growth hormone and children’s growth. Dr
Fabian continues to advocate for the best therapy
for diabetes in children, and has been actively
involved in the research for the development of an
intelligent insulin pump.
Gastroenterology
This service was headed by Dr Ooi Boo Chye who
went on to develop the endoscopy service and
partnered with the Liver Transplant Programme in
the Department of Paediatrics, National University
Hospital (NUH). Dr Phua Kong Boo has always
been a beacon of strength in the growth and
development of this gastroenterology service and
remains a key player in the international arena in
Rotavirus research7,8.
Genetics
Dr Ivy Ng was the pioneer Head of the first Genetics
Service in KKH. She led the Cytogenetic Laboratory,
Newborn Screening Laboratory and regional
reference laboratory for Thalassemia. She was a
keen clinical researcher with active involvement
and breakthroughs in the area of Thalassemia.
This service is now under the leadership of Dr
Angeline Lai and her legacy in research continues
with involvement in a National Institutes of Health
(NIH) funded study (Magnetic Resonance (MR) of
Heart Iron: T2*/T2 Calibration and Application) and
several externally funded grants for research. In the
true research tradition of the Genetics Service, Dr
Tan Ee Shien won the Clinician Scientist Award from
SingHealth for her research in genetic alterations in
children with mental deficiency.
Nephrology
The first Head, Dr Yap Hui Kim, laid the foundations
for paediatric nephrology in KKH and she was
succeeded by Dr Chao Sing Ming. This is an
example of the collaboration between the two
former neighbours – the East and West Paediatric
Departments in Mistri Wing. The current focus of
growth in nephrology is in the areas of urinary tract
infection (UTI), voiding disorders and nephropathy.
Neurology
Dr Phuah Huan Kee was the first Head of the
Neurology Service. Together with senior members,
Drs Lim Kim Whee and Choong Chew Thye, they
did a wonderful job in attracting and nurturing
the development of young paediatricians to the
field of neurology. Among them is Dr Derrick Chan,
who is currently the Head and has a keen interest
in epilepsy. He was instrumental in facilitating the
first epilepsy surgery in 2011.
PHASE 5: ENHANCEMENT OF SERVICES
The Children’s Hospital had been growing healthily
under the watchful eye of Dr Ho Nai Kiong (first
Division Chairman) and Professor Tan Cheng Lim,
the second Division Chairman. With the quest
to provide the children of Singapore a onestop comprehensive service, providing holistic
compassionate care, the hospital continued to
develop new paediatric services.
Adolescent Medicine
KKH envisioned the need for a special service to
meet the unique problems of adolescence, risk
taking behaviour, eating disorders and adolescents
with chronic illness. This programme stated as a
HSDP project, which included a site in NUH and has
since matured to a comprehensive service, playing
an important role in attending to the needs of a
vulnerable population, for example, teens with
pregnancy and sexually transmitted diseases.
The service also provides holistic care for chronic
illness, and provides a health counsellor for the
school-going children. Drs Kumudhini Rajasegaran
and Oh Jean Yin are both passionate about the
compassionate care of adolescents with troubles.
Rheumatology and Immunology Service
There has been a worldwide shortage of paediatric
rheumatologists and KKH had great difficulty in
starting this service. It was fortunate that we were
able to attract Dr Thaschawee Arkachaisri to helm
the Service of Rheumatology and Immunology. The
comprehensive and dedicated rheumatology and
clinical immunology programme was launched
in January 2009. Dr Arkachaisri is passionate
about providing timely and family-centric care to
his patients. He is also a keen researcher and has
formed a network in the region to advance the
care of rheumatological conditions in children,
particularly in the ASEAN region.
Allergy
Dr Anne Goh is the current Head of the Allergy
Service, created to meet the increasing demands
for the management of allergic diseases in children.
Dr Chiang Wen Chin was our first trained allergist
with a special interest in food allergy. Dr Raj Rao is
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233
History
a new member of the family and has brought with
him a wealth of experience in the management
of children with allergic conditions and also
in education.
Child Mental Wellness Service
This is an important link in providing holistic
service to children. Drs Ng Koon Hock and Sharon
Chan were the two pioneer psychiatrists providing
this critical service as visiting consultants. In 2012,
a service for children was formalised and is now
under the leadership of Dr Ong Say How.
Sports Medicine
Dr Ong Wee Sian led the first such service for
children in Singapore. Aligning with the pattern
of demands, this is now a programme headed
by clinical exercise physiologist, Mr Michael Lim,
and will continue to collaborate with Respiratory
and Adolescent Medicine, with an emphasis on
the weight management programme for children
and also exercise prescription for children with
chronic illnesses.
Besides patient care, support services such as Play
and Music Therapy, the Bereavement Support
Group, as well as various other support groups
for patients and families were initiated. The Child
Abuse Protection team is another area where
effort was channelled to enhance the care of this
vulnerable group.
SIGNIFICANT EVENTS AND MILESTONES
SARS
The author (COM) was into her eighth month as the
Division Chairman and will never forget the date,
22 March 2003. It was in the afternoon when she
was informed of an urgent MOH meeting. MOH
was declaring a concerted fight against SARS with
immediate effect. TTSH was designated the SARS
Hospital. KKH would be given the mandate to run
the paediatric facilities in TTSH. We were given 24
hours to set this up and to be operationally ready.
That this came on a Saturday afternoon added
a further challenge. In the KKH spirit of “can do
attitude”, both the medical and nursing teams
worked tirelessly through the afternoon and night
to get Ward 13A in TTSH ready to receive children
for both general and ICU care. It took the team
less than 24 hours to get Ward 13A operationally
ready. Not knowing much about the condition and
nature of SARS but with adult SARS cases having
234
significant mortality, it was decided that doctors
and nurses who were comfortable with ICU care
would be sent. Retrospectively, this proved to be
unnecessary as unlike adults, for SARS, children
did not have high disease burden. The first doctor
volunteer was Dr Irene Chan and others included
Drs Janice Wong, Darryl Lim and Janil Puthucheary.
The pioneer nursing team who were the critical
partners making this SARS effort successful
included Ms Leong Mei Lan, Helena Mahesan, SNM
Ng Gaik Nai and Pang Nguk Lan, Nurse Clinician
Ong Lim Liew, NM Sim Boon Eng, Lau Gek Muay,
Ng May Yin, Vimala, Cher Loh Boon, Ho Wah Pong,
Kwek Poh Choo, Lim Lee Ngoh, Vannaja and SSN
Moh Chye Huang. They were led by the Director of
Nursing, Ms Lee Heng Pheng.
We met the team from TTSH who were already
in the frontline fighting SARS and they were very
open in sharing their challenges and how best to
protect staff. I recalled Dr Alan Ng, reiterating that
with all the personal protective equipment (PPE)
in place, there had not been another healthcare
worker infected. They too had a request for KKH.
All felt strongly that schools should be closed.
At about 5 pm, the first probable SARS patient
was admitted.
MOH and the SARS taskforce were having difficulty
deciding if the schools should be temporarily
closed. As a paediatrician, the author (COM)
advocated for the children and voiced the ground
sentiments including parental fears and concerns
for the child in the midst of SARS. All schools were
subsequently closed for two weeks.
In Ward 13A, the team provided care for over 70
cases of suspected paediatric SARS referred to
TTSH. Of these cases, there were nine confirmed
cases of paediatric SARS based on PCR results with
the youngest, nine months old. Most of these cases
were part of family clusters of SARS. There was no
mortality in this group9.
Following that was an array of activities in KKH –
from the preparation of CE for triage and right
siting of patients, with suspected cases transferred
to TTSH, conversion of the wards to enable negative
pressure ventilation (it turned out that all that was
needed was to put in place a few extractor fans
and to keep the doors closed to ensure this), the
communications with staff, reassuring the safety
and balancing the need to be cognizant of the
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KK Children’s Hospital
Fig. 2. The extractor fan – providing negative pressure in the ward.
Courtesy of Nursing Division, KKH
potential morbidity and mortality, the necessity of
the inconvenience of temperature monitoring, use
of PPE, and control of visitors. It was an extremely
stressful period, particularly to the management
team dealing with the numerous directives
each day coming from MOH, and the need to be
extremely flexible and adaptable.
About a week later, on 1 April 2003, Dr Ivy Ng took
over the role of Chairman Medical Board (CMB)
from Dr Cheng Heng Kock. This was certainly not an
April fool’s joke for Dr Ivy Ng as KKH’s second CMB.
She immediately plunged into action and under
her sterling leadership, the KKH team navigated
through the amazingly turbulent times. This saga
lasted until August 2003.
H1N1 Pandemic
JCI Journey in 2005
KKH was the first overseas Women’s and Children’s
Hospital to achieve accreditation by the Joint
Commission International (JCI). We had no
issues meeting standards for patient safety and
patient care. However, this was an interesting
journey of awareness on the needs for detailed
documentation of every patient encounter, for
good communications with patients and families,
for patient rights and privileges and the need for
privacy and protection of confidentiality. Some of
us did not immediately agree or accede to, but it
was increasingly visible that the new generation of
patients desires and expects the same standard as
those in USA. We went through JCI accreditation
with flying colours.
Duke-NUS Graduate Medical School
This was a very exciting time for the Children’s
Hospital. Having been part of National University
of Singapore’s teaching faculty for the Department
of Paediatrics, it was the first time that we had
been asked to collaborate as partners in shaping
the Paediatric undergraduate program for this
new medical school. Under the Duke postgraduate
medical school curriculum, the students would be
posted to KKH in their second year for 8 weeks. The
Paediatric Programme Director (COM), together
with Coordinator Dr Loh Tsee Foong and the team
of dedicated clinician educators decided to have
the students immersed in the ward at some point so
that they would not simply gain book knowledge
but enable them to learn to work with medical
and nursing team, so that competencies such as
interpersonal, communication and professionalism
skills could be cultivated and nurtured. Tsee Foong
was one of the key persons who initiated the
Clinical Team Based Learning technique, a concept
which the students were exposed to in their first
year, instead of learning through didactic lectures
for medical knowledge. The first batch of DukeNUS students graduated in 2011.
Paediatrics Residency
Dr Chong Chia Yin, ably led the group to ACGME-I
accreditation in October 2010 with no citations,
quite a feat considering the manpower issues.
It was the KK “can do it” attitude that helped us
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History
through the accreditation. That was the beginning.
Now we are working hard to deliver the high quality
training which all our residents deserve.
Manpower Challenges and Renewal
Manpower was and still remains a constant
challenge. While we continued to fight for more
training positions, we were eventually allowed
with the caveat that these “additional” trainees
must pay a training fee and that KKH would not
receive training subvention to train this group of
“trainees”. Many passionate young medical officers
agreed to have a “pay cut” to fulfill their dreams to
become paediatricians. Many among this group
have gone on subsequently to play key roles in
KKH – Drs Mok Yee Hui, Lee Jan Hau, and Arif
Tyebally, amongst others. Fortunately, this cap on
the number of training position was finally lifted in
2010 to facilitate the recruitment of more residents
for training. In addition, with new staff from many
countries joining the Children’s Hospital, it is
important to be sensitive to many cross-cultural
differences. Many of our new staff have different
backgrounds, life experiences, beliefs, core values
and expectations, but the same passion to provide
the best care for children. The staff population has
evolved to include different generations with their
unique values and aspirations.
Working with three Medical Schools
The Children’s Hospital is now in an interesting
position in that from 2014, we will be training a third
group of students in undergraduate paediatrics
– from the Nanyang Technological University
(NTU)-Imperial College Lee Kong Chian School of
Medicine, in additional to undergraduates from the
National University of Singapore (NUS) Yong Loo
Lin School of Medicine and Duke-NUS Graduate
Medical School. It is a unique and challenging
position and it is also a privilege to be actively
involved in shaping the training of our future
generation of doctors.
Moving forward – The Academic Medicine Journey
August 2011 was another important milestone
for us at KKH. The Children’s Hospital together
with Duke-NUS, embarked on a journey of
academic medicine. With this academic focus,
we will consolidate and develop the educational
and research activities of the hospital to provide
sustainable, high quality care to children in
Singapore. With this new academic role, we have
partnered not just with Duke-NUS but with the
Department of Neonatal and Developmental
Medicine in SGH to form an academic partnership
to drive paediatric care in Singapore forward in this
new century and into the future.
CONCLUSION
Our journey of the creation and development
of KKH, the first and only paediatric hospital in
Singapore and the region, has emulated the
growth and development of a precious baby –
from conception to the arrival of the much awaited
precious child and the trials and tribulations
associated with a “growing baby”. The child is now a
fine 15 year-old adolescent. We have indeed come
a very long way. We have established ourselves as
the premier centre for paediatrics in Singapore.
We will continue to lead and drive paediatric care
for Singapore and our community in the many
years ahead through academic partnerships in
education, research and the delivery of quality
clinical care.
Fig. 3. The extended family
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KK Children’s Hospital
Fig. 4. ACP (PAEDS) – moving forward
Acknowledgments
The Children’s Hospital will not be what it is today
without the partnership of all our colleagues in the
Division of Surgery, Obstetrics and Gynaecology,
Nursing and Allied Health, and the Administrative
Support Team. It takes a village to nurture a child
and indeed without the dedication, commitment,
and “kampong spirit”, we could not have journeyed
thus far. There are many more “kampong folks” who
at some point in time contributed to the growth
of the Children’s Hospital. Though we are unable
to name every individual, our special thanks go to
each and everyone who have walked with us all
these years.
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