Communicating with Persons with Disabilities

Issue 49
Feb 2024

ALL IN THE FAMILY

By Neighbourhood Health Service (NHS) Programme Directors Ivan Li, Matthias Ho, Phase II NUS Medicine students and Dr Goh Lay Hoon, NHS Mentor, Department of Family Medicine, National University Health System (NUHS)

Minister Desmond Lee taking a selfie with the NHS Committee and NUS Medicine Faculty Members at the NHS Screening on 28 October 2023.

Mission and history of NHS

The NHS is a population outreach project of the Yong Loo Lin School of Medicine, National University of Singapore (NUS Medicine). It started in 2007, and is in its 17^th year. Since its founding, NHS has been focusing on helping residents from lower socioeconomic backgrounds to access healthcare. Many of these residents are elderly and living in rental flats.

Despite overall healthcare improvement and innovation over the years in Singapore, residents living in rental apartment blocks have remained more vulnerable and disengaged from the healthcare system than the average Singaporean¹. These residents face socio-economic, psychological, knowledge, and cultural barriers that prevent them from accessing healthcare regularly^{2, 3}. Moreover, chronic diseases and their complications remain common; residents from disadvantaged communities are especially at risk due to suboptimal health-seeking behaviours.

Hence, NHS aims to identify residents who have fallen through the cracks, break down barriers to healthcare access, and reconnect them to the healthcare system. In addition, NHS has an ongoing research arm. As with previous years, we will be analysing the data gathered from this year’s screening exercise to gain insights into the health status and needs of this year’s screened population.

Outreach by NHS

For 2023, NHS chose to engage with residents in the Boon Lay district because of its high concentration of rental blocks. The screening was conducted on 28 and 29 October at the Boon Lay Community Club. The Minister for National Development, Mr Desmond Lee, together with local grassroots leaders and members from the NUS Medicine Office for Students attended the event.

An elderly resident accompanied by a volunteer, to have his blood taken at the phlebotomy station during NHS 2023.

NHS 2023 Screening – All about the residents

We wanted to be a “one-stop shop” for busy residents to be screened for multiple diseases in one visit. Hence the screening modalities included blood taking, functional screening for seniors, cancer screening, social work screening, falls risk assessment, dental health survey and health education. Our partner providers include the National University Health System, Health Promotion Board, Agency for Integrated Care and the Singapore Cancer Society. In addition, students from NUS Social Work and Singapore Institute of Technology Physiotherapy, members from Singapore Physiotherapy Association, and staff from the National University Centre for Oral Health also lent their support to the event. All services were provided free of charge to residents.

On the days of the outreach, student volunteers and committee members accompanied residents through the screening stations. Wheelchairs were also deployed to bring residents with mobility issues to and from their homes and the screening venue.

VintageRadio SG, a not-for-profit enterprise that supplies digital radio services, provided the background music to enliven the atmosphere at the venue. Additionally, our adorable NUS Medicine mascots, Meddy and Neddy moved around the venue to interact with the residents. At the end of the screening, we also gave each resident a gift bag containing beverages, snacks, and household items from various sponsors.

Collaboration, building partnerships, and ensuring continuity of care

NHS comprises healthcare students from NUS and other healthcare institutions. We have medical and nursing students from NUS Yong Loo Lin School of Medicine, social work students from the NUS Faculty of Arts and Social Sciences, medical students from the Lee Kong Chian School of Medicine, and physiotherapy students from the Singapore Institute of Technology. Drawing on each other’s expertise to run the various stations at the NHS screening event, healthcare students were exposed to the benefits of working as a team and how collaboration enables them to serve the community holistically.

Concurrently, we brought together various community and healthcare partners to successfully conduct this year’s screening event. Besides leveraging our partnership with Boon Lay district, which is part of the Healthy Precinct initiative that aims to integrate health promotion efforts in the community, NHS also actively works with community partners in health promotion, including the Ministry of Health Office for Healthcare Transformation and the NUHS Regional Health System Office.

Additionally, NHS facilitates the referral of Boon Lay residents with newly diagnosed chronic conditions to their GPs or polyclinic doctors. We engaged community partners such as Boon Lay Social Service Office, NTUC Crest, and Thye Hua Kwan Family Service Centre, to ensure continuity of follow-up and care beyond the screening event.

NHS committee member and volunteers knocking on doors in Boon Lay on 14 October 2023 to publicise the NHS Screening.

Post-screening plans

NHS has put into place an active follow-up strategy to ensure that residents with newly detected chronic conditions, or previously diagnosed but uncontrolled conditions, take active steps to manage their health. In the months after the screening, NHS will follow up with vulnerable residents from the rental blocks. We will make phone calls to check on the well-being and health status of residents, and also determine whether they have sought further medical attention for their identified problems.

We will also make home visits for patients with more complex situations such as multi-morbidity or mobility issues. During these visits, we will seek to understand their underlying beliefs and motivations using tools like motivational interviewing. The committee will then connect the residents to the appropriate community resources and assist them in coming up with possible solutions to overcome their challenges in accessing healthcare. As a new initiative this year, we will be partnering our NUS Social Work friends in the follow-up programme, and assisting the residents with their Healthier SG enrolment.

Lastly, NHS aims to raise awareness and educate residents on disease prevention and management, as well as correct misconceptions about health. We believe that targeted education and sustained engagement will empower residents to take ownership of their health and induce positive health-seeking behavioural changes. Hence, NHS has plans to launch a pilot health education programme under our Publicity, Health Education and Community Outreach Committee this year.

Reflections

NHS has come a long way since 2007. Entering a new district in Boon Lay this year meant building fresh relationships with new partners. This has also afforded us a fresh opportunity to rethink how NHS can evolve alongside other national healthcare programmes and promotion efforts, including the recently launched Healthier SG.

Wee LE, Lim LY, Shen T, Lee EY, Chia YH, Tan AYS, et al. Choice of primary health care source in an urbanized low-income community in Singapore: a mixed-methods study. Family practice. 2014;31(1):81-91.
Wee LE, Cher WQ, Sin D, Li ZC, Koh GC-H. Primary care characteristics and their association with health screening in a low-socioeconomic status public rental-flat population in Singapore- a mixed methods study. BMC Family Practice. 2016;17(1):16.
Wee LE, Tsang TYY, Yi H, Toh SA, Lee GL, Yee J, et al. Loneliness amongst Low-Socioeconomic Status Elderly Singaporeans and its Association with Perceptions of the Neighbourhood Environment. International Journal of Environmental Research and Public Health. 2019;16(6):967.