My encounters with doctors as a young boy influenced my decision to practise medicine. My father was the Director of Middleton Hospital, which was Tan Tock Seng Hospital's infectious diseases wing during World War II. We lived in the matron quarters on the grounds of the hospital for about three years, from the time I was nine till 12. It had a wide, open compound filled with fruits trees like chiku, mangosteens and rambutans.
Two encounters with doctors when I was growing up left a lasting impression on me. One was an encounter with a Japanese doctor who was the superintendent of Middleton Hospital, under whom my father worked during the Japanese Occupation. The Japanese doctor gave us a loaf of bread as a gift for Christmas in 1944. A loaf of bread was a rare commodity during those days and I admired his generosity.
The other doctor who made an impression on me was Dr Gopal Haridas. He was the paediatrician-in-chief at General Hospital at that time and cared for me whenever I fell ill. Despite his high rank, he would take care of me personally. He was a thorough professional and his meticulous care of me each time impressed me deeply even as a young boy.
These encounters influenced my decision to study and practise medicine. I wanted to help and heal people. When I graduated in 1960 with a general degree in Medicine, I was posted to Middleton Hospital.
There, I got the opportunity to work with Dr Leong Kok Wah, who was the hospital medical superintendent at that time. He was the one who patiently taught me the ropes. It was his kindness that made a positive impact on me during my training days and so I carried on working at CDC.
As a young doctor practising at Middleton Hospital, Dr Monteiro was involved in the fight to eradicate common infectious diseases such as diphtheria, cholera and polio in the 1960s and 1970s.
When HIV and the AIDS epidemic reached Singapore in the 1980s, it was a disease unlike any of the other infectious diseases that the Communicable Disease Centre (CDC) had dealt with in the past. This was mainly due to the fear and stigma attached to this particular disease.
In our medical training as doctors in Singapore in the 1950s and 1960s, we saw and treated different infectious diseases like measles, diphtheria, dysentery, cholera and polio.
We knew it was just a matter of time before the HIV epidemic would hit our shores.
Before the epidemic came to our shores in 1985, we already knew quite a lot about the disease. We knew that the HIV virus caused much damage to the immune system and a patient diagnosed with HIV will not be able to survive even a simple infection.
We had learnt from other countries like America and Africa on their management of the HIV epidemic and we had plans in place on how to manage the epidemic when it hits here.
However, even though we had all these plans, the reality was quite different. When the hospital staff knew that we were receiving our first patient with HIV, the natural reaction was of course, fear. At that time, everyone knew that there was no cure for HIV, and that anyone who was infected would pass away. This was where we needed to educate with facts and scientific knowledge to address the fears.
CDC received the first patient with HIV in 1986. The patient was a seaman in his 50s. We were psychologically prepared because we had been designated to treat patients with HIV by the Ministry of Health in 1985.
Yet, there was still some fear among the staff when CDC received the first patient with HIV.
It was important to get the right information across to our staff to allay those fears. One of the things I did was to send three of our nurses to attend a conference on AIDS in Australia. They could then see how healthcare workers in other countries have coped with the disease and come back with the correct mindset and knowledge to share with the rest of the staff at CDC.
At that time, as doctors specialising in infectious diseases, we were more familiar with waterborne, food-borne, or insect-borne diseases like malaria and dengue. We were not familiar with sexually-transmitted diseases like HIV. Nor were we used to dealing with patients who were intravenous drug users.
We had to persuade both our patients and the groups who were at high risk of getting HIV to cut down on their risky behaviours. For those who were at risk of sexual transmissions, we had to educate and persuade them to use condoms. For those who were at risk due to sharing of needles, we had to persuade them to use brand new needles and stop sharing needles.
It was the combined efforts of the healthcare workers at the CDC and the staff from the Sexually Transmitted Diseases clinic who made a difference for these patients.
Throughout it all, we worked as a team to provide the best treatment and care possible at that time.
As HIV entrenched
itself in Singapore, healthcare workers had to adapt and understand that the
treatment and care for patients with HIV goes beyond their diagnosis.
In the early days of HIV treatment, HIV medicines were expensive and entirely paid for by the patients.
A particular case I remember was a man with AIDS who had come down with Tuberculosis (TB). He responded well to treatment for TB but could not afford the drug regime for the anti-HIV treatment. Several months later, he returned to see me and his condition had deteriorated. We found out later that he had a sister who was mentally challenged and he had chosen to set aside money for her so that she could continue to be provided for.
Beyond the treatment and care of patients with HIV, we had social workers and counsellors like Ms Iris Verghese and Ms Ho Lai Peng who chose to work with patients with HIV. They were the ones who saw the patients with HIV as human beings first. The social workers got to know the patients personally and socially, beyond what us doctors were able to do.
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