NNI, Lien Foundation roll out early palliative care for patients with neurological conditions
SINGAPORE – The first time Mr Chia Shyh Shen experienced weakness in his right arm, he thought little of it.
It was 2021, and the now-71-year-old was trying to change a ceiling light bulb at home.
He could not hold his arm raised. At the time , he and his wife, Madam Tam Fee Chin, 70, attributed what they thought was temporary weakness to old age.
But soon, M r Chia, who along with his wife was employed at a relative's gold jewellery shop in Johor Bahru, could not even lift a tray at work.
Mr Chia was diagnosed in October 2021 with amyotrophic lateral sclerosis (ALS), t he most common type of motor neurone disease, which affects how nerve cells communicate with the muscles .
In 2022, the Malaysian couple sought help in Singapore.
There is no cure for ALS, which was formerly known as Lou Gehrig's disease. There are around 300 to 400 people living with ALS in Singapore.
The condition is more common to individuals older than 50, and afflicts more men than women.
Mr Chia is becoming weaker as his motor neurons – the nerve cells sending signals from the brain and spinal cord to the muscles, enabling movement – degenerate and die. He now has minimal mobility below the neck.
And as his disease progresses, he will lose the ability to speak, eat and , finally, breathe.
Mr Chia, however, remains cheerful, and is looking forward to future trips.
His doctor at the National Neuroscience Institute@Tan Tock Seng Hospital, where Mr Chia is a patient, is helping to make sure this stays the case for as long as possible.
While this may not sound like much , it reflects the transformation of care that is taking place there, particularly after NNI and the Lien Foundation rolled out in April 2024 a $6.8m five-year initiative to provide palliative care from diagnosis onwards.
They call it NeuroPal, which stands for Neuropalliative Ecosystem of care.
Prior to 2024, patients were referred to palliative care after experiencing advanced symptoms, said Dr Ang Kexin, a senior consultant at NNI, who has undergone training in palliative care.
'They came to me when they were bed bound or could not talk. Now they come earlier and can express their needs,' she said. 'We ask them about their hobbies... We anticipate their needs. We journey with them.'
NNI and the Lien Foundation held a press conference on May 29 to announce NeuroPal and its aim of integrating palliative care into standard neurological care.
It will go some way to help alleviate the suffering of patients living with ALS , dementia, Parkinson's disease and other complex brain, spine, nerve and muscle conditions.
Palliative care patient Chia Shyh Shen (bottom) was diagnosed in October 2021 with amyotrophic lateral sclerosis, the most common type of motor neurone disease, which affects how nerve cells communicate with the muscles.
ST PHOTO: KUA CHEE SIONG
NeuroPal has screened nearly 2000 NNI patients with neurological conditions, of which 370 patients are given palliative care.
NNI@SGH started the programme at one clinic in 2024. By the time NeuroPal ends in five years' time , it should have supported more than 3,600 NNI patients annually at TTSH and SGH, said NNI and the Lien Foundation.
The hope is to expand it to other hospitals, and more community care partners. NNI specialists treat patients at seven hospitals across Singapore.
With NeuroPal, patients are routinely screened for psychosocial issues and support can then be tailored for them, based on their distress levels.
Associate Professor Adeline Ng, Senior Consultant, Neurology, NNI and NeuroPal co-lead, said they use a self-reported short questionnaire called the Distress Thermometer to understand what matters most to the patients.
The initiative pumps funding into training and hiring more palliative care staff, including two psychologists, three medical social workers, four nurses and others.
Palliative care patient Chia Shyh Shen (bottom) with Tan Tock Seng hospital staff (from centre-left) National Neuroscience Institute Senior Consultant Dr Ang Kexin, Principal Occupational Therapist Huang Huixin and Senior Speech Therapist Yong Xing Tong at the Centre for Geriatric Medicine, in Tan Tock Seng Hospital, on May 29.
ST PHOTO: KUA CHEE SIONG
Lien Foundation's CEO Lee Poh Wah said during the press conference that with the initiative, they want to dismantle the misconception that palliative care is only for the end of life.
'It's naive to frame neurological diseases as a battle to be fought at all costs... I think we need a more humane and humble approach to healthcare, one that acknowledges the complexities of living with serious illness.'
Palliative care aims to help relieve the symptoms and stress of serious illness and support caregivers, and it can help to reduce unnecessary suffering when it is given early in the disease trajectory, he said.
Neurological conditions often unfold as a long journey of progressive decline, where a patient suffers emotional distress and is gradually robbed of his or her independence.
Among those who receive palliative care, 60 per cent are cancer patients, but cancer only accounts for 26 per cent of all deaths, he said.
The hope is to train more healthcare professionals to deliver general palliative care, he added.
Associate Professor David Low, Deputy CEO (Clinical), NNI, told the media that people often think of palliative care as something that is given at the terminal stages of life.
But for neurological conditions, the care can start early, for instance, when a person is diagnosed with motor neuron disease.
ALS patients typically live for around 3 to 5 years, but there are a lot of outliers, and Mr Chia is one of them, said Dr Ang.
To help improve his quality of life, the NeuroPal team at NNI@TTSH regularly monitor him and recommend solutions to help him cope with the inevitable changes that the disease brings.
They recently let him try out an eye-tracking device called Tobii, which will enable him to communicate with others or pick out videos to watch, and a tilted wheelchair that can support his neck.
'We are future-proofing him. With Tobii, he can learn it faster now because he can still communicate verbally,' Dr Ang said.
With that wheelchair, should he opt to buy it, he can travel in greater comfort, she added.
Join ST's WhatsApp Channel and get the latest news and must-reads.
Hashtags
Try Our AI Features
Explore what Daily8 AI can do for you:
Comments
No comments yet...
Related Articles
Straits Times
26-07-2025
- Straits Times
A 'critical' and 'serious' shortage of healthcare workers in Johor
Find out what's new on ST website and app. Johor Bahru's main hospital, Hospital Sultanah Aminah, is Malaysia's second busiest government hospital, serving more than 2,000 patients a day. – Cardiologist Ng Kim Fong worked long hours as a specialist at Johor Bahru's main hospital, tending to around 100 patients a day for years. His daily shifts, for five days a week, consisted of morning rounds serving up to 40 patients in the wards of Hospital Sultanah Aminah, and then tending up to 30 outpatients in the hospital's clinic from noon. This would be followed by tending to another 30 or so patients in the wards before he could call it a day. He switched to private practice in September 2024, after nearly two decades with the hospital. 'That was what we as government doctors had to do. It's part of our job. But in recent years, the patient numbers have been increasing,' Dr Ng told The Straits Times. He is now a consultant cardiologist at the KPJ Kluang Specialist Hospital in the Kluang district, some 100km from Johor Bahru, and his pay has more than tripled. 'There is definitely a severe shortage of healthcare workers in Johor – especially staff nurses, medical officers and specialists,' he said, noting that public healthcare staff are overworked and overwhelmed. The issue was spotlighted by Johor Menteri Besar Onn Hafiz Ghazi on July 14, when he said the state is facing a 'critical and serious' shortage of healthcare officers in major government hospitals. Top stories Swipe. Select. Stay informed. Singapore Students hide vapes in underwear, toilet roll holders: S'pore schools grapple with vaping scourge Singapore 'I've tried everything': Mum helpless as son's Kpod addiction spirals out of control Singapore Almost half of planned 30,000 HDB flats in Tengah to be completed by end-2025: Chee Hong Tat Singapore Black belt in taekwondo, Grade 8 in piano: S'pore teen excels despite condition that limits movements Singapore As Asean looks to nuclear energy, public education efforts are needed: UN nuclear watchdog chief Asia Thousands rally in downtown Kuala Lumpur for resignation of PM Anwar Asia Death toll climbs as Thai-Cambodia clashes continue despite calls for ceasefire Asia Shunsaku Tamiya, who brought perfection to plastic race car models, dies at 90 Doctors from the Johor Doctors Association told ST that more healthcare professionals are needed, as Malaysians from across the country move to the Johor capital city and its surrounding areas, which many use as a base for working in Singapore. The migration to southern Johor districts is also due to the booming economy, leading to a wide availability of jobs for those not keen to work in Singapore. Added to this is the longstanding issue of Malaysian nurses and doctors seeking jobs abroad, including in Singapore, for better salaries, said Johor's top health official, Mr Ling Tian Soon, on July 10. Datuk Onn, during a visit to a government hospital ward on July 14, said that a nurse in Johor Bahru has to serve between 10 and 14 patients on every shift. Each nurse should ideally serve between six and eight patients, he added. 'The situation is not just unfair to our workers, but it is also not safe for our patients if we let this continue,' he said. Mr Ling told ST that Johor needs at least 4,600 healthcare workers – including doctors, nurses, and specialists – to meet local demand. He added that a task force was formed with Malaysia's Ministry of Health, after a meeting with its minister, Dr Dzulkefly Ahmad, on July 15 in Putrajaya. But, he said, the current 4,600 number might be just a short-term fix, as many more may be required. 'You hear about patients saying they have to sleep in waiting areas, and doctors needing to put extra beds in between the wards. This is happening because there are too many people and too few staff,' he told ST over the phone. Mr Ling said the two main hospitals in Johor Bahru, the 1,206-bed Hospital Sultanah Aminah and Hospital Sultan Ismail, which has 704 beds, are operating at 100 per cent to 110 per cent capacity each day. 'The actual number of healthcare workers needed in Johor may be more, taking into account the current population, so when we met the Ministry of Health, we told them to get the more than 4,000 (healthcare) positions ready first,' he explained. Health Ministry data shows that Johor has 12 public hospitals across its 10 main districts, providing more than 5,200 beds. Hospital Pasir Gudang, a new RM500 million (S$150 million) project in Bandar Baru Seri Alam – about 14km east of Johor Bahru – was initially expected to begin operations in August, but this has been delayed to 2026. Mr Ling said the 304-bed hospital needs 500 new staff members for its first phase of operations, but only 315 vacancies have been filled. Johor has about 6,800 doctors and 10,800 nurses for its more than four million residents, or roughly one doctor per 600 people, according to publicly available data from the ministry in 2022. The Malaysia-wide ratio is better, with one doctor per 412 people. Singapore, a developed nation offering high salaries, has an even lower doctor-to-population ratio, of about one doctor per 353 people as at 2023. 'The morale among healthcare workers is at an all-time low,' said Johor Doctors Association president Mohamed Amin Kader . 'Johor has suffered far too long. Besides Johor Bahru, we have Batu Pahat, Muar, Kluang, Segamat, Pontian, Mersing, each with a big population that lacks healthcare workers, with some sub-specialists even covering the entire state or two to three districts,' added the internal medicine specialist from Pantai Hospital Batu Pahat, located about 120km from Johor Bahru. Johor's population was 3.6 million just 10 years ago , according to Malaysia's department of statistics. This has jumped 11.1 per cent to 4.01 million today. The Johor Bahru district, where the state capital sits, recorded some 1.8 million people in 2024, making it one of Malaysia's biggest cities by population. In contrast, Kuala Lumpur has 2.06 million people and the Klang district in Selangor state has 1.17 million. The Johor population surge compares with the slower rise of 9 per cent in Malaysia's overall population to 34.2 million today from around 31.2 million 10 years ago. The Regent of Johor, Tunku Ismail Idris Sultan Ibrahim, said on July 8 that he has called on the federal government to 'expedite the approval and hiring process to fill vacancies' that are causing 'significant congestion' in Johor's hospitals. During a recent visit by ST to Hospital Sultanah Aminah, patients complained to this paper about the long waiting times despite them having appointments, the lack of staff, the ageing equipment and even the shortage of chairs for those waiting. At the hallway leading to the patients' wards, caregivers were seen seated on the floor and on concrete kerbs holding their queue slips. 'I came to the clinic at 9am for an orthopaedic appointment for my broken finger, and we got out only at 3.30pm,' said Kulai resident Mohammad Amirul Johari, 30, who met with an accident while riding his motorcycle two weeks ago on the way back home from work in Singapore. The Singapore factor in attracting healthcare professionals is another issue that Johor, and the rest of Malaysia, has to contend with over the years. Countries in the Middle East also offer good pay for medical staff. Senator R.A. Lingeshwaran on July 8 was quoted in Malaysian media as saying that a recruitment agency had offered local doctors an annual package of $110,000 plus housing and other perks, to work in Singapore. Dr Lingeshwaran, a former director at a Penang hospital, said a Malaysian medical officer with three years' experience earns a gross salary of only about RM72,000 (S$22,000) a year. Former public dentist Choudhry Sundaram Padiachee told ST: 'Low salaries, overworked staff, bad work culture, and lack of clear career prospects are among the reasons why I left, and why, I believe, many have left and are leaving.' Dr Choudhry, who worked in Hospital Sultan Ismail for nine years, now runs Habib Dental in Bandar Dato Onn, a suburb 12km north of Johor Bahru.
AsiaOne
25-07-2025
- AsiaOne
Avoid water activities around Tuas Second Link, Raffles Marina after chemical tank accident: NEA, Singapore News
SINGAPORE — The public should avoid primary water contact activities like swimming and recreational fishing in the waters around Tuas Second Link, including areas around Raffles Marina, said the National Environment Agency (NEA) on July 24. NEA gave this precautionary advice after an accident earlier in the day on the Malaysian side of the Second Link bridge involving two heavy tankers, which resulted in a chemical tank containing propylene glycol falling into the sea. In a post on Facebook, NEA said it understands that the other tanker remained intact, with no chemical spill on the bridge. Primary contact activities are those where a person's whole body or face and trunk are frequently immersed, and it is likely that some water will be swallowed. They include wakeboarding, windsurfing and water immersion training. Propylene glycol is not classified as a hazardous substance and is biodegradable. The chemical is commonly used in food, pharmaceuticals and cosmetics, said NEA. However, propylene glycol may cause low dissolved oxygen levels in the Lim Chu Kang fish farming zone, said NEA. It added that the Singapore Food Agency (SFA) has alerted fish farms in the area to be vigilant and have mitigation measures on standby. They should also notify SFA if there are abnormal fish and water conditions. Singapore's desalination plants are currently not affected, and national water agency PUB is monitoring the seawater intake at the plants closely, NEA said. NEA and other agencies are in close communication with their Malaysian counterparts, added the agency. It is also actively monitoring water quality in the affected area. Malaysia's Iskandar Puteri Fire and Rescue Station chief Mohd Faiz Suleiman said an accident involving two lorries carrying propylene glycol had caused a tank from one of the lorries to plunge into the sea from the Second Link bridge. He added that the fire department in Johor was alerted to the incident at about 5.40pm on July 24, and seven firemen and a Fire Rapid Tender vehicle were deployed to the scene, reported Malaysian daily The Star. There was no contamination in the waters where the tank fell into the sea, and there were no signs of leaks from the tanks involved in the lorry accident, said Mohd Faiz. The accident caused delays for departure traffic at Tuas Checkpoint, said Singapore's Immigration and Checkpoints Authority. A video posted on social media on July 24 shows a moving tanker hitting another tanker that appears to be stationary. After impact, the moving tanker tips towards the edge of the bridge, sending the tank it is carrying into the sea. The incident comes just a day after NEA held a chemical spill exercise at Tuas Second Link with Malaysia's Department of Environment and other agencies. The exercise was part of a bilateral co-operation programme under the Malaysia-Singapore Joint Committee on the Environment. All three lanes of the Singapore to Malaysia-bound carriageway on Tuas Second Link were closed to vehicular traffic from 5am to 2pm on July 23 for the exercise. [[nid:720572]] This article was first published in The Straits Times . Permission required for reproduction.
Straits Times
25-07-2025
- Straits Times
This 5-cent meme stock just made up 15% of US trading volume
NEW YORK – Shares of tiny Healthcare Triangle stood out as the most actively-traded name on US exchanges on July 24 - just one example of the meme-stock mania sweeping the stock market once again. The little-known healthcare information technology company saw its stock price more than double to just above 5 US cents, with over three billion shares changing hands. That was equivalent to about 15 per cent of the total shares traded on US exchanges for the day, data compiled by Bloomberg show. After surging 138 per cent at the open, Healthcare Triangle's shares closed up 115 per cent, with no apparent news to spark the eye-popping move. The total value of shares traded for the day stood at approximately US$150 million (S$192 million), nearly seven times the company's market capitalisation. As with previous meme-stock episodes, the targets were struggling firms that influencers hyped as underdogs in a market controlled by Wall Street pros. That's what happened during the original meme mania in 2021, when GameStop and AMC Entertainment Holdings soared during a burst of trading spurred by a well-known Reddit user. Meme‑driven spikes can deliver multibillion‑dollar windfalls – and steep losses for anyone who jumps in too late. Here's what to know. Top stories Swipe. Select. Stay informed. Business GIC posts 3.8% annualised return over 20 years despite economic uncertainties Business GIC's focus on long-term value aims to avoid permanent loss amid intensifying economic changes Opinion No idle punt: Why Singapore called out cyber saboteur UNC3886 by name Asia Cambodia and Thailand are willing to consider ceasefire: Malaysian PM Anwar Asia Deadly Thai-Cambodian dispute puts Asean's relevance on the line Business MAS' measures spark cautious optimism for Singapore stock market revival: Analysts World Trump, Fed chief Powell bicker during tense central bank visit Life Hulk Hogan, who helped turn pro wrestling into a billion-dollar spectacle, dies at 71 Why do these frenzies keep happening? Meme stocks tend to share several characteristics – including that they catch the internet's imagination and get promoted on social media by influential retail investors. The posts are often accompanied by images or videos – memes – that incorporate pop culture references. Buying the stocks can be seen as a badge of honour or a way to join a club, with investors cheering on one another to snap up shares. Most meme moments have involved high-profile consumers brands like GameStop and AMC in 2021. In the current frenzy, it is Opendoor, Krispy Kreme, GoPro and Beyond Meat. They also tend to be stocks that have a large short interest – meaning that professional investors are betting against them – and are often cheap on a per-share basis. How does this round of meme mania compare with the Covid-era saga? The backdrop in 2025 is fundamentally different from what existed in 2021, when US investors who were stuck at home during the pandemic and flush with stimulus checks swapped tips on social platforms. Economic conditions like those hanging over the market in 2025, including elevated interest rates and uncertainty over tariff and trade policy, normally would deter investors from making risky bets, but speculative corners of the market are once again lighting up. The latest meme frenzy involves fewer stocks than in 2021, but the rallies have been volatile and often short-lived. Take Opendoor: Its shares jumped 43 per cent on July 21, when 1.9 billion shares traded, amounting to nearly 10 per cent of all US stock-trading volume that day. Behind the sharp rally lay an explosion in options flow: More than 3.4 million contracts changed hands on July 21, a level eclipsing even the highest one-day total during GameStop's 2021 surge. Meanwhile, companies such as Kohl's and Krispy Kreme ripped higher amid short squeezes, market terminology for what can happen when traders bet on a price falling by borrowing shares and immediately selling them, only to have the price suddenly rise instead. The traders are forced to quickly buy back the securities, further fueling the rally. The surge wasn't sustained for Krispy Kreme – while shares of the doughnut maker rose as much as 39 per cent when the market opened on July 23, it closed only 4.6 per cent higher. Are meme stocks risky? Trading meme stocks can be very risky because the reasoning behind buying them has almost nothing to do with the performance or prospects of the underlying business. Meme stocks also can be volatile, elevating the risks of buying and selling the shares, especially for inexperienced market participants. For instance, GameStop stock has lost more than 70 per cent of its value from its peak in January 2021, while AMC has plunged nearly 99 per cent since its June 2021 high. The main driver for meme stocks to rally is the rush of the crowd looking to strike out against the Wall Street establishment, but as AMC and GameStop showed, sooner or later a company's fundamentals tend to prevail, bringing the party to an end. Why do these flare-ups happen? A sudden, unexplained run-up in the share price of a consumer company often can be traced to posts on Discord, Reddit, trader chatroom StockTwits and other sites. In 2021, the GameStop frenzy began when bullish posts by investor Keith Gill, known by his online persona Roaring Kitty, sent the retailer's shares soaring. In the July 2025 meme-stock episode, Opendoor was the subject of chatter among retail traders on social media after Eric Jackson, founder of Toronto-based hedge fund EMJ Capital, made a series of posts on X encouraging buying. It was then listed as one of the most actively traded names on StockTwits, and was being heavily cited by posters on Reddit's WallStreetBets thread. Is all of this legal? The US Securities and Exchange Commission polices illegal market manipulation, but it has to prove intent. Talking up a stock can be illegal if it is done by someone seeking to push the price higher and then profit from the momentum. The ethics of social media influencers driving share swings have been hotly debated. Skeptics argue that meme-stock promoters often don't disclose important details such as the size of their positions in companies, when they trade them and whether they are paid to endorse stocks. Others argue that promoting investments on social media is similar to activist investors pushing for changes or short sellers releasing reports targeting companies in order to profit. BLOOMBERG
