​Ward 76

In the early days, nobody wanted to share the same ward with patients with HIV so we put them here in Ward 76. This was the main HIV ward and only patients with HIV were admitted here. We decided to place acutely ill patients in the first two rooms close to the nursing counter. This way, the nurses could get to them quickly.

While this was an adult hospital, there were instances where we had to care for children. There was a whole family – father, mother and son who were infected with HIV. After the father died, the mother had to frequently be admitted and she was the only caregiver to the son, who was barely two years old. This was their favourite spot, they were always outside here, mother and son. Both of them were very skinny but they always came to take their walks out here.

There was a room set aside in Ward 76 for intravenous therapy including outpatient eye infusion. 

Outpatient Parenteral Antibiotic Therapy (OPAT)was conducted in Ward 76.

Operating Theatre
In the past, with limited treatment advances, many patients with HIV developed eye infections during the later phase of their condition. The standard treatment for this type of debilitating eye infection was to give daily intravenous infusion indefinitely. Without treatment, patients would soon lose their eye-sight. The medication called ganciclovir cost about $300 per vial and this was beyond the means of almost every patient. Prof Lim Tock Han, then a young ophthalmology surgeon bravely set-up an eye procedure to directly inject the medicine into the infected eye of patients with HIV. Because only a fraction of the dose was needed for this procedure, one vial of this expensive medicine could be given to 20 to 30 patients at a time. This procedure required a sterile environment. Hence, the Operating Theatre built next to Ward 76 was used for the eye treatment. We would line up patients each time and he would inject the medicines directly into their eyes.

He did thousands of eye injections and achieved an excellent success rate. His method and outcome were published and taken up by other resource-limited countries like Vietnam.

The PCC fundraised to buy the medication. This together with Prof Lim’s eye procedure enabled us to provide a cost-effective treatment for our patients. 

Ward 76A

By the mid-1990s, there were an increasing number of HIV cases especially those needing long-term care and we realised we did not have enough beds for acute patients. That is why we opened Ward 76A. However, it operated for only one year because Protease Inhibitors had become available and we didn’t need so many inpatient beds for patients with HIV.

Ward 76A opened in the mid-1990s to cater for long-term care.

(Photo taken after closure of CDC)

We renovated this ward as it was old and rundown. We decided that this ward should have more of a community hospital set up feel. We created a therapy area with a small gym. Although it closed down after a year, we kept the gym open.

Ward 76A was renovated with a small therapy area for patients.

(Photo taken after closure of CDC)

I once had a patient who refused treatment, his bed was at the far end of this ward. He was diagnosed around 1993 with lung infection and I could foresee two years of having to go through the sequential events of pain before he passed on. Once he got through the initial infection, he made his life plan in preparation for his death. He did not want expensive treatment because he only had a few thousand dollars in his CPF. He wanted to save that money for his aging parents.

He was very resistant to treatment even though we tried to encourage him to take his medication. He suffered from multiple infections and this eroded his lungs. Then, his eye was affected and the course of eye injections rendered him partially blind. He suffered more chronic bacterial infections, including multiple episodes of fever and mouth ulcers, which were very common in the end-phase of the disease.

When the Protease Inhibitors became available, we had to persuade him to take these. His condition turned around and the recovery process took about one to two years. He recovered and is still alive today but he's partially blind, extremely skinny, and with much damage to his body.

Ward 71 

Over time, we concentrated all our manpower here and patients with various infections were all housed here.

The mini garden area outside Ward 71 added to the community feel and aided in the healing of the patients housed in the ward.

(Photo taken after closure of CDC) 

Patients with HIV were put at the very end of the ward, together with patients suffering from other acute infectious conditions. There wasn't a need to tell other patients that they were housed with patients with HIV as the information was confidential. Also we practiced good infection control and the staff knew what they were doing.

Inside Ward 71 – This ward had an old architectural design with high ceilings.

 (Photo taken after closure of CDC)

Mortuary 

The greatest story I have about the mortuary is my encounter with the late Minister Dr Balaji Sadasivan. This was in the early 1990s. At that time, HIV treatment was still not readily available and many patients died of conditions we really did not know much about or why.

There was a particular patient with multiple complications, including neurological disorder. He could not use his legs in the latter part of his life, and eventually succumbed to HIV. We were puzzled about his neurological manifestations and wanted to understand more about the disease pathology. So, we challenged the system to find someone who would do a post mortem for us. Up to that point, we could not get any post mortem done on patients with HIV because nobody wanted to do it.

Dr Balaji, a neuro-surgeon in Tan Tock Seng Hospital at the time, volunteered to do the biopsy on this patient. He came to this very mortuary with his own equipment from his neuro-surgical theatre. I was also present at the biopsy. He took a portion of the spinal cord and sample tissues for examination.

This was a significant incident because it was the first case to have a partial post mortem and the only time we ever had a partial post mortem, right here in this room. What the patient had was HIV related neurological complications, what we call Vacuolar Myelopathy. The spinal cord just hollowed out because of HIV. Clinically it manifested with many disabilities. While it wasn't a unique case, this post mortem gave us answers we didn't have before.

The exterior of the Mortuary which ceased operations in 2003.   

(Photo taken after closure of CDC)

The very first post mortem on a patient with HIV was conducted in the CDC Mortuary.

(Photo taken after closure of CDC)