Mr Cheng Wai Keung, Chairman, SingHealth
Professor Kenneth Kwek, Chief Executive Officer, Singapore General Hospital (SGH)
Associate Professor Tan Chieh Suai, Head, Renal Medicine, SGH
Friends, partners, distinguished guests, ladies and gentlemen
It gives me great pleasure to join you this evening to celebrate the 50th anniversary of SGH’s Department of Renal Medicine. If I recall correctly, since becoming Minister for Health, this is the first time I am attending a departmental anniversary. Please accept my heartiest congratulations for reaching this significant half-century milestone.
Advancements and achievements in renal care over the years
2. The achievement of SGH’s Department of Renal Medicine is not just about the passage of time, but the capabilities you have built up and the impact you have delivered over the years. You can see it in the testimonies of the patients in the video just now. This history dates back to your formal establishment in 1973.
3. The first Singapore haemodialysis (HD) treatment was done in 1961 and at that time, death was imminent for kidney failure patients. You performed Southeast Asia’s first deceased donor kidney transplant in 1970; Singapore’s first living related donor kidney transplant in 1976, after the Department was formally established; the first living unrelated donor kidney transplant in 1991; and in 2015, the first paired kidney donor exchange transplant with National University Hospital. To date, SGH has performed more than 1,600 kidney transplants and given new leases of life to many kidney patients.
4. Peritoneal Dialysis (PD) was introduced in Singapore at SGH in 1980 as an alternative for patients. Soon the PD unit was designated as a regional reference centre for training and education. Today, it is a PD centre, providing one-stop training and outpatient treatment.
5. The Department thrives on partnership and collaboration. Recently, you partnered the National Kidney Foundation (NKF) to right-site the treatment of blocked central venous catheters used for HD. A hundred NKF nurses have learnt to perform the procedure, saving patients many trips to the hospital’s emergency department.
6. You have also been working with local medical technology company AWAK Technologies to co-develop the world’s first automated wearable artificial kidney device. When ready, the device will allow patients to have PD on the go, and further regain their normal lives.
7. Undergirding all these examples of achievements I have cited, is the Renal Department’s emphasis on developing your people. You support doctors, nurses, medical social workers, pharmacists, transplant coordinators and renal coordinators, to familiarise themselves with the latest developments in the field. This has enabled them to set up new services and programmes such as an interventional nephrology programme, transplant programme, renal palliative clinical service and critical care nephrology programme.
Developments ahead
8. While the Renal Department has made great strides over the last 50 years, the patient load continues to increase because of exogenous factors, and that has become a big challenge for our healthcare system. The healthcare system is at the receiving end of these exogenous trends.
9. It is driven by unhealthy lifestyle habits and the ageing of our population. Because of all these reasons, the chronic diseases incidence rate has been rising. Each day, six new patients are diagnosed with kidney failure in Singapore and at present, there are 8,700 kidney failure patients on dialysis in Singapore, up from 5,500 ten years ago. I think it is going to continue to rise.
10. The healthcare system cannot be at the passive receiving end of this disease anymore. We are broadening the ecosystem to go upstream to deliver preventive care and reshape the social determinants of health. If the onset and progression of chronic illness is like a travellator, we have to try to intervene at every stage. Let me describe our plans to manage kidney disease, starting with preventing people from stepping onto the travellator in the first place.
11. We can do more to help residents stay healthy, detect health issues early and manage them well. Preventive care starts with the individual. There is a lot of personal responsibility involved. The simple thing to do is to reduce our sugar and sodium intake, so as to reduce the risk of chronic kidney disease (CKD).
12. Last year, the Health Promotion Board (HPB) introduced the Nutri-Grade labelling requirements and advertising prohibitions on pre-packaged beverages. Overnight, even before the law came into place, it led to a major reformulation of sugary drinks in the industry in anticipation of the new law. We are extending these measures to freshly prepared beverages by the end of this year. We are pushing for a ‘siu dai’ default at coffee shops and hawker centres. Some vendors have decided to go further and make ‘kosong’ the default.
13. We also started a sodium reduction strategy last year to encourage the use of lower-sodium alternatives over regular salt. HPB will soon be launching a campaign to encourage industry and F&B operators to reduce the sodium content of their dishes, by resetting recipes to 2010, where the average dish contained 20% less sodium than the same dish today.
14. The anchor of our preventive care strategy is Healthier SG, which will strengthen primary care and the role of family physicians. Enrolment is currently strong, and enrolled residents have been following up with their first appointments and health screenings. We have also developed a protocol for family physicians to regularly monitor the kidney function of patients with high blood pressure and diabetes.
15. As for residents who are already on the travellator with the onset of chronic diseases, we need to prevent their condition from getting worse. We are doing this via the HALT-CKD programme, which stands for Holistic Approach in Lowering and Tracking Chronic Kidney Disease. This is a nation-wide programme implemented at all public healthcare institutions. It systematically identifies and tracks patients with CKD to prevent kidney failure, by addressing lifestyle factors like smoking, and the initiation and optimisation of kidney-protective medication.
16. As for patients who has gone quite far down the travellator, and already have more advanced CKD, we will better support them. Most of them will require dialysis. As there is a limit to building new dialysis centres, the Ministry of Health (MOH) has adopted a PD-preferred strategy. PD can be done at home, gives patients more freedom in their daily activities, with clinical outcomes comparable to HD.
17. In April last year, we launched the National PD Home Support Programme. The Programme will improve access to home visits for PD patients and help patients and their caregivers to confidently perform PD at home. We will continue to work with all stakeholders to push this. We have not seen any real results but I think we will work hard at this and move the needle.
18. For certain patients, the long-term solution to their CKD is a kidney transplant. The benefits are long-term and help the patient restore his normal life. MOH and the National Organ Transplant Unit have been working on many fronts to raise public awareness of organ donation. We need to better understand the barriers to transplantation and encourage more members of the public to step forward to save lives. My sense is many people are prepared to donate their organs, and we have to find a way to reach them.
19. Finally, for patients who are coming to the end of the journey, the renal community will need to sensitively conduct honest and sincere conversations with the patients and their family members to facilitate their advance care plan, including palliative care.
20. Most patients towards the end of their life journey prefer palliative care at home than to undergo further treatment in hospitals. We are therefore expanding the capacity of palliative care. We have just announced recently that we are increasing funding and hospitals are carrying out more compassionate discharges. This, I think, we are seeing the needle move a bit. We are seeing a slight reduction in the percentage of patients passing away in hospitals. But it is early days, and I am not announcing any numbers. MOH will provide a more complete report by next year.
Closing
21. In conclusion, tonight is the celebration of the 50th anniversary of the Renal Department of SGH. There are a lot of achievements to be happy about and for us to recognise. In Chinese medicine, the five key elements that make up our body are 金木水火土 (metal, wood, water, fire and earth). The kidney regulates water, which is the essence of life. Regardless of cultures, or whether it is Western or Chinese medicine, the kidney is vital to our lives, and the work of the Renal Department is critical.
22. I would like to extend my heartfelt thanks to the many pioneers present this evening, who have led the way in providing the best care and outcomes for renal patients in the last 50 years. I would also like to thank all in the care team who heal and provide comfort to patients and their loved ones. I wish SGH’s Department of Renal Medicine a happy 50th anniversary! Thank you.