Speech by Minister of State for Health Dr Lam Pin Min at the 10th Singapore International Congress of Obstetrics and Gynaecology on 20 August 2015

Assoc Prof Tan Lay Kok, President of OGSS;

Dr Devendra Kanagalingam, Vice-President of OGSS & Chairman of the Congress;

Dr Timothy Lim, Honorary Secretary of OGSS & Vice-Chairman of the Congress;

Dr Paul Fogarty, Vice-President of the RCOG;

Prof Sir Sabaratnam Arulkumaran, President of FIGO;

Distinguished guests from both local and overseas;

Ladies and gentlemen;

Good morning.

           It is my pleasure to join all of you for the official opening ceremony of the 10^th Singapore International Congress of Obstetrics & Gynaecology.

2.        This Congress has been an important gathering of passionate professionals from across the world to learn, share and interact on improving women’s health. Healthcare professionals are increasingly faced with challenges such as the need to keep pace with the newest developments, while continually aspiring to hone their clinical expertise. At the same time, there are growing calls for greater sensitivity to patients’ autonomy. I’m thus glad to see that the organising committee has chosen a very appropriate theme for the Congress.

THE SUCCESSES: MATERNAL MORTALITY, INFANT MORTALITY AND CERVICAL CANCER MORTALITY RATES

3.        As Singapore celebrates its golden jubilee, I am proud to say that our excellent standard of obstetric care adds towards one of our nation’s many successes. We have reduced the maternal mortality rate to amongst the lowest in the world, at 2.4 women per 100,000 births in 2014. Likewise, our infant mortality rate of 1.8 per 1000 live-births in 2014 ranks amongst the best internationally. With better uptake of pap smear screening and better treatment, the mortality rate for cervical cancer has steadily fallen from 6.5 to 2.3 per 100,000 since the late 1970s. These achievements are testament to our dedicated and well-trained professionals, sound policies and good medical facilities.

THE FUTURE

4.        However, just as Singapore looks expectantly to the future, we cannot rest on our laurels. As you may know, Singapore is facing a low fertility rate and a rapidly ageing population. Women are opting for motherhood later in life and having fewer children. Good antenatal care continues to play a key role in ensuring that babies are given the best possible start in life. After all, these are our next generation of Singaporeans. There is growing evidence that developments in-utero may modify the risk of developing chronic diseases, yet more women are also of advanced maternal age and face higher risks of complications in pregnancy. Concomitantly, the incidence of ovarian and uterine cancers is on the rise.

5.        O&G specialists therefore have a unique role in looking after the health of both mother and child, as well as women of all ages, in the face of evolving trends and new evidence. Your community will have to tackle these challenges head-on moving forward.

THE CHALLENGES: EVIDENCE, EXPERIENCE AND CHOICE

6.        These days, there is greater emphasis on developing evidence backed clinical practice guidelines to inform practice. This means ensuring scientific rigour in carrying out clinical trials and conducting meta-analysis. Clinicians are now expected to constantly rethink long standing assumptions and practices, to keep updated, and even initiate their own research. In fact, O&G was a pioneer in this field. Archie Cochrane, the inspiration behind the renown Cochrane Collaboration, referred to a systemic review of care during pregnancy and childbirth as, (I quote) “a real milestone in the history of randomised trials and in the evaluation of care” (unquote) and suggested that other specialties copy the method used. Practising evidence-based medicine is now the expected standard.

7.        The emphasis on evidence-based medicine, however, cannot diminish the value of clinical experience; rather, it has made it all the more essential. Evidence by itself is mere knowledge, but its appropriate application is a true skill gained through years of experience. This is especially true for O&G, where clinical outcomes are often only as good as the surgeon’s technical skills. Experienced professionals – this includes not just doctors but also nurses, and allied health professionals – grow to become sensitive to nuances such as patients’ expectations, and religious and cultural influences.

8.        The role of the patient in the decision-making process has also changed. Patients are now more educated and expect their opinions to be taken into consideration for their care. Choice is also a particularly heartfelt issue for many O&G professionals, especially when decisions impact not just the mother, but the baby too. This socio-cultural shift has led to challenges in the area of medico-legal matters and medical indemnity.

9.        Evidence, experience and choice. These are important issues for the O&G community, and I am sure that these next few days will provide many excellent opportunities for fruitful, engaging discussions.

THE OBSTETRICAL AND GYNAECOLOGICAL SOCIETY OF SINGAPORE

10.      I would also like to take this opportunity to commend the O&G Society of Singapore for its good work done thus far in improving women’s health and promoting good professional practice. From its relatively humble beginnings, the society now has over 400 members comprising not only O&G specialists but also trainees and doctors from other specialties.

11.      The society has also done well in training the next generation of professionals. These include administering the SS Ratnam Book Prize for outstanding undergraduates, mock clinical examination preparations for postgraduates, as well as organising regular medical updates for continued education. Other activities include taking the lead to explore various means to best protect its members during medico-legal claims, and raising awareness of pertinent O&G issues at various public forums.

CONCLUSION

12.      All these efforts, large and small, are geared towards improving the well-being of your patients. Indeed, your dedication and hard work in the field of women’s health has touched the lives of many of them and their families. It gives me great pleasure to launch a presentation of heartfelt thanks and encouraging messages from some of these patients, and to declare the 10^th Singapore International Congress of Obstetrics and Gynaecology open. I wish everyone an enjoyable and fruitful Congress ahead.

Thank you.