Part 1: Physiotherapy & Occupational Therapy – Singapore General Hospital Observations

In this post “Career Counselling Singapore”, I mentioned visiting the physiotherapy and occupational therapy departments in the hospitals. It was to gauge if I would like the type of work that therapists do. At first I didn’t know I could do an observation with the departments and I only found out that I could after reading on a forum. I quickly contacted Singapore General Hospital (SGH), as there wasn’t much time before the application for WDA’s PCP* closed on 31 October 2014. In October, I was also traveling for vacation with my parents and relatives.

*Workforce Development Agency’s Professional Conversion Programme. WDA partnered with employers (hospitals and nursing homes) to sponsor training for interested mid-career professionals who want to make a career switch to the healthcare industry, working as a physiotherapist (physical therapist), occupational therapist, diagnostic radiographer or registered nurse. Sponsorship holders will need to maintain a min. GPA (I can’t recall the rating) when pursuing their 3-year Diploma studies at Nanyang Polytechnic. For more information, please visit:
WDA PCP – Occupational Therapists
WDA PCP – Physiotherapists
WDA PCP – Diagnostic Radiographers
WDA PCP – Registered Nurses

I’ll be sharing this experience into two posts:
Part 1: Physiotherapy & Occupational Therapy – Singapore General Hospital Observations
Part 2: A 1-Day Pre-Conference Visit – National Occupational Therapy Conference

Foreword

Thank You

Before I go into the details, first and foremost I would like to express my heartfelt gratitude to the team of physiotherapists, occupational therapists and the administrative staff for accommodating to my date requests, as well as their dedication, hard work and care toward their patients and families. Although they are in a supportive role and their jobs may not be as glamorous as the doctors, they are just as important. Without one or the other, health care – a basic human need – would not be able to run at all. Thank you.

Photography is not allowed in the wards, so as to respect the privacy of patients and their families, and most importantly, to preserve the dignity of man especially in times of suffering and grief. I will also not be naming any names. Images used are royalty-free stock images.

Differences Between Physiotherapy and Occupational Therapy

Physical Therapist

It was also the first question I had when I was deciding between applying for physiotherapy and occupational therapy, and what better way than to ask the therapists themselves. Physiotherapists are specialists of the human body anatomy and they prescribed exercises to improve conditions due to physical trauma. You or someone you know may have be in contact with a physiotherapist before, because they manage a wider range of conditions e.g. back pain at the outpatient level.

Occupational Therapist

Meanwhile, we may or may not have experience with an occupational therapist, perhaps unless you have a hand injury that affects your daily activities e.g. buttoning of clothes and showering. An occupational therapist’s job is to ensure that the patient will be able to resume fully (if possible) or up to a certain degree of their day-to-day activities and if need be to assist the patient better, they are the only ones who can prescribe mobility aids e.g. wheelchairs and even make recommendations to HDB* to modify the patient’s environment e.g. toilet grab bars and ramp at the entrance to the flat.

One major difference is occupational therapists deal with cognitive skills, so patients with conditions such as dementia, autism and ADHD, also fall under their purview. In one of the therapists’ words, “Occupational therapy is a philosophy.”

*HDB is the abbreviation of Housing Development Board. HDB manages the public housing developments in Singapore.

General Observations

Singapore Hawker
Hawker stall in Chinatown, Singapore

My first observation was in the hands department, where patients travel to SGH for follow-up rehabilitative treatments and/or assessments by the occupational therapists. Despite the name, the department also sees a variety of injuries related to the arm. A number of them are housewives, who sustained injuries while doing household chores. Others are the blue-collared workers or hawkers, who injured themselves at work. For some of them, it’s hard to fully recover, because they cannot avoid engaging in the same repetitive action unless they change their job.

It’s a busy place and 1 occupational therapist can sometimes see 4-5 patients concurrently. While the therapist is explaining to one patient, the other patient can go for water heat therapy, while 1-2 patients could work on hand exercises. Another patient would wait while 1 of the 2 therapist assistants makes the support braces.

Time, Quality & Money

On the other hand (pun’s not intended :p), the inpatient department could be less bustling (however it also depends on which ward). Although the physiotherapist or occupational therapist seems able to work on one patient longer, they actually have a min. quota of 12 patients to see every day. Upon hearing about the quota, I was a little surprised, or maybe I shouldn’t be. Having the quota simply ensures that the hospital generates cash flows to keep their operations going. When patients are seen, they get billed for the services rendered. Although SGH is a public restructured hospital owned by the government to provide affordable healthcare to the masses, there isn’t any way we can ignore the finances if the hospital has to be kept running sustainably.

Please Love Your Legs

Including internal meetings and seeing patients, as much as the therapists would like to, sometimes they couldn’t spend more time with each patient. All the therapists I spoke to usually have to take on more patients, as there are a lack of therapists in the industry. Last I remember was that there were only 1 occupational therapist and 1 physiotherapist for the oncology wards. I also find that physiotherapists in the general surgery department* are particularly stretched, because they frequently see 16 patients per day!

*General surgery would be surgery for knee replacement, hips fractures, amputation due to diabetes and so on.

Physical Therapist Helping Patient to Walk

It is paramount that the patient is able to walk, and this duty falls onto the physiotherapist’s shoulders. If the patient cannot walk, it means he/she has to lie in bed longer and beds cannot be freed for other patients constantly admitting to the hospital. Usually the acute care hospitals would want to discharge the patients as quickly as possible, for step-down rehab care at home or other institutions e.g. community hospitals or nursing homes.

Now that’s why it’s 16 patients / day for 1 physiotherapist…even then, the government is very selective of who they are sponsoring for the WDA PCP and they do not reveal the exact intake number per occupation. Previously, they are looking at a combined of 70-ish places for all 4 occupations – occupational therapists, physiotherapists, diagnostic radiographers and nurses.

Being in the wards make me realised that how such a seemingly easy activity such as walking for most of us could give not just mobility, but also it could affect a person’s confidence, outlook of his/her future and relationships with others. Patients I have encountered recognised this. A middle-aged uncle trying his best to walk despite the pain. I walked with an elderly grandpa who persevered walking down the wards corridor, and he only stopped just to catch his breath.

We Are All Interdependent

HOPE is Hold On, Pain Ends

I also remember a young girl, who seems to be in her late teens. Physiotherapists assisted her in every part of her walking, used a mobile hoist to help her walk and correct each foot as she lands. It seems to me that there wasn’t much sensations in her legs. While the physiotherapists worked on her walking, the occupational therapist delivered electric stimulations to improve sensations for one of her arms. He also worked with her on daily activities e.g. wearing and buttoning clothes with one arm and sitting down, so she could do this by herself as time goes along. Her eyelids were taped upwards so she could see to do the activities like picking up objects and stacking them. A speech therapist also came by to work on her swallowing and speech exercises.

At times, I can see her frustration while doing the activities and during a quiet moment with her father, her tears flowed. Although it saddened me to see such a young girl in this state and there are a lot of uncertainty for her future, one thing for sure is she has a team (including her father and perhaps her other family members) who supports and care for her. I pray that she must never give up hope or life itself.

Because these people are not ready to give up on her.

Resilience Trumps Adversity

Keep Moving Forward

When I stepped into the burns department, I totally have no inkling of what I’m going to expect. People are warded for burns due to fire or chemical. M’s case was the latter and his entire body was covered with burns. Patients with such serious case will be isolated individually in a room with an ensuite bathroom, and we had to suit up (gloves, mask, wraps for shoes and body) before we enter to minimise the chances of infections for the patient.

His injuries was so bad that he even has difficulty brushing his teeth because as the skin heals, they will fuse and create folds. It applies to any other part of the body and it is especially important to moisturise the skin so they don’t fuse. If they do, I think then the nurse would have to pry or cut away the excess skin…just thinking of this gives me the goosebumps. When his dentist visited and asked what happened, I then came to learn that someone mistakenly took the chemical for water and poured on him when he repeatedly requested for water. it was really unfortunate. Despite his adversity, I’m glad that he showed extreme resilience and had his family’s support.

Lessons

In the hospital, there are many stories of struggle and suffering, and we can empathise with the patients because all of us share in this humanity.

Between birth and till we depart from this world, it is how we live – our treatments to relationships we have with the people around us, will make the difference in the quality of life you will get. Simply put, you reap what you sow.

Everyone dies, but not everyone knows how to live.