As a medical student 30 years ago, something happened that will forever be seared in Tan Hak Koon's memory. The young doctor, who was attending to a pregnant woman, witnessed her death during childbirth – a tragic event that played a big part in his decision to specialise in obstetrics and gynaecology.
Fast forward to today.
Not only is Tan an associate professor and a senior consultant, the 54-year-old is also the head of Singapore General Hospital's (SGH) Department of Obstetrics & Gynaecology. And as a Singapore International Foundation (SIF) specialist volunteer himself, he led team members of the SIF's Enhancing Maternal and Child Health Services Programme on a mission to Karnataka, India last year. Such trips – where medical practitioners from both countries share knowledge and expertise on maternal and child health services – have been ongoing since the programme began in August 2016.
The three-year training partnership between the SIF, Singapore Health Services (which SGH is a member of) and the State Institute of Health and Family Welfare, Government of Karnataka, India has helped to improve care for pregnant mothers and manage high-risk pregnancies.
The programme aims to reduce the number of mothers and babies lost at childbirth due to preventable causes and create sustainable healthcare improvements for the community. The plan is for 200 healthcare professionals from tertiary and secondary care government hospitals in Karnataka to be trained by a multi-disciplinary team of obstetricians, neonatologists, midwives and senior nurses from SGH.
Of the 200 trained Indian healthcare professionals, 40 master trainers will then train another 200 more medical professionals, cascading the impact of better healthcare within the community.
A matter of life and death
"Maternal death is one of the most important health issues in the world, and decreasing the maternal mortality ratio is one of the few Millennium Development Goals of the World Health Organisation,"
says Assoc Prof Tan. "A woman shouldn't die having a baby."
So, while the maternal mortality ratio has improved in Singapore to about 10 or less per 100,000 live births, it can number a few hundred in other parts of the world.
Having been involved in several overseas medical missions with SGH, it came naturally for Assoc Prof Tan to become an SIF specialist volunteer in Karnataka. On one of his volunteer trips to India, he was struck first by how advanced healthcare in the country's top centres are, and second, by the sheer size of its population. "None of us had seen so many deliveries at a time.
There are an estimated 25 million babies born each year in India, so every hospital is full, and the doctors there work so hard every day. There's no way everyone can benefit from their limited resources."
Many living in rural areas do not have access to healthcare. Assoc Prof Tan hopes that the 200 doctors and nurses he trains can help train others. Eventually, some 5,000 healthcare workers can be trained to benefit a larger segment of the population, particularly in the more remote areas in the country.
Learning across cultures
One thing clear to Assoc Prof Tan from the start is that the aim is not only to teach but also learn from his Indian counterparts. "In Singapore, we have developed to such an extent that everything is orderly, whereas real-life situations elsewhere are not like what we deal with back home."
"There are many life-and-death situations in the outskirts of India that we can learn from. Because they face many challenges that medical professionals in Singapore don't face, we can learn from them how to do the same job with less and be able to handle these types of situations."
A senior doctor, Associate Professor Suresh S Kanakannavar from Bangalore Medical College and Research Institute & Vanivilasa Hospital, left a particularly deep impression on Assoc Prof Tan for his inventiveness. As imported kits used for stopping postpartum haemorrhage are very expensive, Dr Suresh created his own contraption that costs just S$2 and is equally effective.
Beyond medicine, Assoc Prof Tan has also benefitted by learning from India's diverse cultures and way of life.
"We go there to share what we know – our way of practice, our system, our method of training doctors. "But at the same time, we also hope to learn from them their way of practice and through these collaborations, get to know them better and understand their culture. The benefits go beyond medicine, because we establish links and friendships. With the world getting smaller, it is important to build more inclusiveness across cultures," he adds.
From wariness to mutual respect
There was, of course, some initial reticence from their Indian counterparts. But by the second visit, they had warmed up more, and Assoc Prof Tan was already being welcomed at the local hospitals, and all the way to the government levels. A mutual admiration and respect was borne out of this connection. Says Dr Suresh of Assoc Prof Tan: "He put in a huge effort to compress the training into three working days. It was a splendid workshop. The whole team was very disciplined, friendly and approachable.
The training was of a high standard and explained in understandable, simple English as there were nursing staff among our trainees who needed things to be explained in simple terms."
In turn, Assoc Prof Tan had much to take home with him. Just as there are different races and cultures, there are different approaches in the practice of medicine.
For Assoc Prof Tan, the most satisfying part about volunteering overseas is the opportunity to meet people, understand the world better and not be so narrow-minded. "My advice to those who want to go in future is that we are not the greatest. Not at all. Other people have something to show us," he says, pointing out that there is always mutual learning to be had.
"Volunteering has made me a more mature person. I learn along the way and have a better understanding of not just medicine, but human beings."