OTGV #26 - Human Organ Transplant Act (HOTA)

Broadcast Date: 27/01/03

Organ transplant isn't in the realm of science fiction anymore.

In fact, it is done with such regularity around the world that the problem is the shortage of transplant organs.

Last year, the Slim 10 incidents worldwide highlighted the dire need to increase the supply of organs available for transplant.

Hi welcome to On the Grapevine with me Chong Ching Liang.

This week I look at the Health Ministry move to re-tool the Human Organ Transplant Act or HOTA.

Minister of State for Health Balaji Sadasivan explains why now.

"The Human Organ Transplant Act was enacted about 15 years ago and it has served us very well with regards to transplantation. It has allowed us to increase transplantation for patients with kidney failures. But over the last 15 years, there have been considerable progress in the field of transplantation surgery, and also the public have understood and have accepted transplantation surgery as a form of treatment."

Under the present HOTA (circa 2003), only the kidneys from accident victims can be used.

With the proposed revision, liver and corneas will be added to the list and in addition, deaths from non-accident causes can also be used.

But this doesn't mean a floodgate will open, allowing all kidney or liver failure patients to get the vital organ they need.

Health Ministry's Director of Medical Services Tan Chorh Chuan.

"What are the things that make someone not suitable as a donor. Generally if their medical condition affect their organs like the liver and the kidneys to the degree that it is not going to be very useful for the transplantation and the other is that say they've got infections because if they have infections, this may carry over to the transplant process. So many of the conditions, the medical situations do not allow these organs to be optimally used for transplantation."

Even with the new revisions, there will be only 12 more donors per year.

12's the average number of brain dead patients from non-accident causes.

So the prioritising of giving younger patients kidneys over the senior citizens may not be changed.

Singapore General Hospital's principal investigator in renal transplantation, Dr Vathsala.

"Well, as you see we have a huge backlog of people who are within the age limit who are actually very, very fit to receive a transplant. We have 666 patients as of now and it will take a lot more kidneys to change the actual criteria. But certainly people will wait shorter periods, we think more people will get transplanted within a year, so that means they wait less. And if they wait less, then they have a reduced burden of dialysis. The debt on dialysis will be lower, so I think there are a lot of advantages."

Dr Prabhakaran of the National University Hospital's Liver Transplant Programme also gives a good prognosis of the proposed changes.

"It gives new hope to more than 12 patients who might get an organ because one liver donor can potentially save two lives. A liver can be split to a child and an adult. So if you have 12 new donors because of the new regulations and assuming that we can only get good livers from only 6 patients Then you can potentially save 12!"

But the revisions to HOTA will not include heart or lungs as the transplantation of these organs are still fairly experimental.

Dr Balaji as to why heart isn't included.

"Why are hearts not included? I think we want to go at a step by step process. we've had only kidneys in HOTA and moving from kidneys to liver is one step. Liver transplantation is much more established than heart transplantation. Possibly at some point in the future, we will have to look at cardiac transplantation."

Organ transplant, like death is often not openly discussed in Singapore.

In fact, one may intentionally shy from such thoughts.

So should the Health Ministry be the one to push across the donations of other organs like hearts and lungs as well?

Health Ministry’s Professor Tan explains why public policy makers need to thread carefully.

"It's trying to put out a balance approach to put out something which we think meets the professional needs because right now ,it's really the kidney failure and liver failure patients who are in a sense the most needy in terms of the numbers and the severity of impact. And also cornea because although it is not life saving, it's sight saving. So really it's trying to strike a balance. Present something that will meet our need and yet in a sense will not put people off."

Last year, Ms Rajah died from liver failure arising from Slim 10.

Dr Balaji explains why distant relatives are subjected to more scrutiny.

"Basically if you are not related, then what is important will be a psychological assessment, make sure you know what you are doing and to make sure you know all the risks that are involved. If that's done and there does not appear to be any financial inducement or organ trading, then the approval will be very quick. But with regulations that we draw up, we hope the process will be much clearer to every one."

The Health Ministry says this additional layer of bureaucracy is necessary because there needs to be checks and balances to prevent organ trading.

What do you think?

Provide your feedback to the Health Ministry in one of its public forum.

The first such forum is on the 29th of this month.

You can also forward your thoughts to Health Ministry via e-mail at MOH_HOTA@moh.gov.sg

or via fax at 6325-1686

This is Chong Ching Liang for Newsradio 938.

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Related Links:

Newsradio938
http://newsradio.mediacorpradio.com

Health Ministry's FAQ on HOTA
http://www.moh.gov.sg/corp/systems/organ/hota/faqs.do

National Kidney Foundation Website on Organ Donation on Laws and Policies
http://www.thegift.org.sg/why_organ_donation/policies_laws.html

National University Hospital Liver Transplant Programme
http://www.nuh.com.sg/sitemap.html

OTGV #25 - Pay for Social Workers

Broadcast date : 10/02/03

They really are the forgotten professionals.

Well... maybe not forgotten but definitely taken-for-granted.

We are talking about Social Workers.

Hi, Welcome to On the Grapevine with me Chong Ching Liang.

Dr Myrna Blake has been involved in the training of and has been practicing social work for nearly half a century and, she has noticed changes in the profession over the years.

"The whole profile of the client and also, I guess the expectations of social workers. The field of social workers is enormous. We're not just dealing with public assistance. We are talking about human development, in terms of people making the most of what they have. I once gave a talk where I compared social workers to Batman. When they need to be down in the ground in detail, but up in the sky to see a wide breadth. And also to be able to shift from one side to the other."

Most of the time, social workers work very long hours with salaries that dip below that of most other professions.

But they are increasingly being recognised by the government.

Since 1999, outstanding social workers have been rewarded with the Outstanding Social Workers Award or the OSWA.

One of the winners is Esther Koh, a young social worker for whom the OSWA means quite a lot.

"I am very amazed that I received the award. Very honoured and very affirmed and encouraged that as a younger social worker, I won the award."

However, recognition doesn't feed the stomach as some wisecracks say.

So recognition can go only so far to keep good, decent social workers on the job.

The other OSWA winner Maureen Fung says social workers need to be seen as a professional and at the same time have a fairly adequate wage structure to retain good workers.

"How to reconcile that is going to be tough. Yeah? It's going to be needing time and effort on the part of professional bodies as well as relevant authorities that are working with social services, even our funding bodies, to ensure that social workers are adequately paid for us to have them and sustain them in their job. We are not talking about big bucks where profit organisations are concerned, but adequate you know, comparable to you know, what they are paying social workers in the civil service."

Maureen is a career social worker who has spent her entire working life in the Samaritans of Singapore and most recently, the Asian Women Welfare Association.

The National Council of Social Service is the organisation directly involved in regulating the profession of social work.

The NCSS sees itself as being responsible for upgrading the image of social workers .

It is also looking to upgrade the remuneration package for social workers so that the sector can retain its best workers.

Frances Lui Director of Corporate Communications, NCSS

"NCSS is working with the other government agencies to re-look at the salaries structures and also the career structures of a social service professional. Our objective is to ensure that as professionals, their salaries will be pegged and aligned close to what the civil service is getting."

How much will this help?

Well, for one veteran social worker, this little move will go far.

Maureen Fung again.

"With this latest move of raising the salary scheme of social workers. I think this is important. It will draw people who want to enter with that passion but still need to feed a family to come in. We know there are people who love to do it. I have come across male social workers, they are starting a family and it's not adequate. Had they stepped outside it would be more. And we lose them. Yeah? And we do need male social workers as well. Nonetheless, whatever the sex, we ought to be reasonably paid to do the job."

Nominated MP and chairperson of the 2002 OSWA selection Committee Braema Mathi says more can be done to show social workers Singapore does appreciate their work.

"I think these are steps but I still feel that they are small. Good steps but I feel they are a little long in coming I think it will be great to bring the social workers on par as soon as possible. That's the clearest signal that we can send into society that we appreciate the work they do."

But raising the salary structure and implementing a more structured career path may not solve the problem of funding.

Most Voluntary Welfare organisations or VWOs are cash strapped because volunteers run them.

So increasing the size of their payroll won't help them at all.

But to call simply for the government to step in to contribute more funds may not be the answer either.

Dr Myrna Blake paints the dilemma for me.

"There is a real advantage for the voluntary welfare organisation because they have a freedom in being able to develop programmes that they like. If everything was under the control of the government, there will be a little more of control and you know necessarily because of budget. So if you look at the VWO sector, there's a huge range of how each has developed in terms of specialisation and innovative programmes It would be a pity if that was stifled. And yet on the other hand there is this tension of not having money and stuff sometimes and committees having to spend lots of time fund-raising rather than doing the sort of things they should be doing. But I don't know the answer to this. I just can see the dilemma."

The current rate of social workers dropping out is at 10 percent of the cohort.

Maybe it will change with better pay and recognition that social work is a highly skilled profession.

After all, we mustn't take advantage of social workers just because they have a good heart, right?

This is Chong Ching Liang for Newsradio 938.

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Related Links:

Newsradio938
http://newsradio.mediacorpradio.com

Singapore Association of Social Worker's Past OSWA Recipients Webpage
http://www.sasw.org.sg/public/aboutsocialwork.htm#Outstanding_Social_Worker_Award_(OSWA)

Samaritans of Singapore
http://www.samaritans.org.sg/

Asian Women Welfare Association
http://www.awwa.org.sg/

National Council of Social Service
http://ncss.org.sg/ncss/index.asp

OTGV #24 – Primary Care Partnership Scheme

Broadcast Date: 13/01/03

For the aged poor, polyclinics may be the only means to treat their common ailments.

But polyclinics aren't as conveniently located as private clinics.

Hi, Welcome to On the Grapevine with me Chong Ching Liang.

The Health Ministry introduced the Primary Care Partnership Scheme or PCPS for the aged poor last March.

It'll allow them to seek treatment at private clinics at polyclinic prices but not all who are eligible are onboard yet.

Dr Steven Ang has a clinic in the Redhill area where there's a high concentration of the aged poor.

"PCPS scheme was started some time in March or April last year and my clinic has been on the scheme since then. We noticed that for my clinic there hasn't been a big demand for this particularly service. Recently I noticed that the Ministry of Health has launched a campaign to recruit more members for the scheme. We would expect an increase in demand for our services."

Currently, there're about 4,600 elderly folks in the scheme and the Ministry hopes to double this number by year's end.

To this end, it's looking towards a more collaborative approach to recruit more needy elderly for the scheme, says MOH's Deputy Secretary Chang Hwee Nee.

"There have been publicity in the media but it still has not reached out to the elderly. So this is really an effort, a collaboration with Lions Befrienders, in the course of their voluntary work, they have come across these needy elderly and we are very appreciative of them identifying these elderly and bringing them here so that our staff can go the extra mile and help them to fill up the forms."

Last month, about 100 elderly from the Mei Ling and Redhill estates signed up for PCPS.

They were identified and bussed to the Ministry by the Lions Befrienders so that ministry staff could help them fill up the PCPS enrolment forms.

Ms Chang explains the experiential benefits for her colleagues.

"This collaboration with Lions Befrienders will give our officers an opportunity to have personal interaction with the elderly. [It'll] give them a greater appreciation of the needs of the Elderly. And I think they will remember well, the next time they develop a scheme or design an application form, they will make sure that scheme is well-communicated and easily understood, and the application process is citizen-friendly."

Another thing to bear in mind would be the convenience of bringing the registration process to the elderly.

The 100 folks who signed up for PCPS last month live in a common block of flats designated for senior citizens

So, it might have been more convenient if the processing had been done where they lived.

In fact, some of them said there was a slight hiccup with the arrangements that day

"We waited for a long time at Redhill! We waited for almost 2 hours for them to pick us up. No one's there to send us here. Later some one came."

More crucially, some elders avoid Singapore General Hospital and its vicinity for superstitious reasons.

An elderly lady from Redhill explains why some of her neighbours didn't show up.

"Only those of us involved with the Senior Citizen centre are invited. But some people don't want to come. When I asked them to come along, they reacted strongly and say they don't want to come. Superstitious you see, they don't want to be near SGH. I asked them but they shooed me away."

But this doesn't mean that those left behind will be forgotten.

Lions Befrienders' executive, Melissa Rodrigues, says her organisation will follow-up on these cases.

"Most of these Elderly here, they actually belong to our sub-centres. For example the elderly here belong to Mei Ling Street and it is a drop-in centre where the elderly actually live in the block in which our centre is built at. From today's exercise we will actually know who are the elderly that actually slipped through the cracks and we can actually track them and actually talk to them one on one and actually explain to them the benefits of this scheme."

In fact, the elderly might be able to make a more informed decision in a familiar setting.

"Even though they can't make it here or they don't want to come, we can actually do the application at the centre itself. I think they will feel more comfortable talking to the staff whom they know, rather than coming to a strange place, talking to strange people."

Despite the problems, those who signed up for PCPS are pleased, as summarised by this elderly lady from Redhill.

(hokien)
"It's very good and very cheap. The senior citizen centre sent us here to apply for the scheme. We're happy. It's very good for us elderly."

She says prior to PCPS, most of them either goes to the polyclinics or not at all due to the high costs of healthcare involved.

But she sees the potential with PCPS

"There are many private GPs. There's one in Block 86, 70-something. We live in Redhill. There's many. But we've never visited a GP so we don't know if they're part of the scheme. We can go ask. See if there's the PCPS sticker on the GP's window. We won't go in if there's no sticker."

The practitioners also welcome this scheme.

Dr Steven Ang Clinic and Surgery has done its share of philanthropy and this scheme will allow more to be helped, says Dr Ang.

"Well, my clinic is located at Redhill where there is a large population of the Elderly. All along we have been seeing poor patients and we have actually been providing services to them either free of charge or at a great discount. With this scheme, the government actually extends its assistance to this group of people directly. It is a win-win situation for everybody involved."

So, for our elderly poor, the next health visit may be to a private G-P below or near their block instead of the polyclinic in the town centre.

This is Chong Ching Liang for Newsradio 938.


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Related Links:

Newsradio938
http://newsradio.mediacorpradio.com

Ministry of Health PCPS Factsheets
http://www.moh.gov.sg/corp/elderlycare/pcps/intro.do

Lions Befrienders
http://www.lionsbefrienders.org.sg/