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If left uncontrolled, it is estimated that up to a million Singaporeans will have diabetes by 2050, according to Diabetes Singapore.
Based on a conservative estimate, the disease will affect at least one in nine people aged 18 to 69.
As Singapore ramps up its efforts to promote a HealthierSG and combat the chronic health issues that come with ageing, we got in touch with three healthcare professionals who are on the frontlines in the ongoing fight against diabetes.
The chilling statistics on diabetes come as no surprise to Zakiah Halim, a Dietitian.
“In fact, I have seen patients as young as 17 with diabetes,” shared Zakiah, 28, who works at Changi General Hospital.
Patients who are newly-diagnosed with the disease will usually be referred to a dietitian as the first step in their treatment journey.
“As a dietitian, I help patients to understand the impact of different food groups on their blood sugar levels, and how dietary changes can help manage their condition,” Zakiah explained.
Podiatrist Arnold Hu and Prosthetist and Orthotist (P&O) Ng Li Bing are also healthcare professionals who work regularly with diabetic patients.
Hu, 29, a Senior Podiatrist who works at Ng Teng Fong General Hospital shared: “As a podiatrist (someone who treats ailments of the feet), we act as gatekeepers for diabetic patients to educate them on good foot care and appropriate footwear to prevent diabetic foot ulcers.”
Ng, 28, a Senior P&O at Tan Tock Seng Hospital, on the other hand, often works alongside podiatrists like Hu, to provide customised leg braces (orthoses) for patients with complex diabetic foot wounds.
Her role involves not only supporting patients who have diabetic foot wounds but also prescribing, manufacturing and fitting artificial limbs (prostheses) for diabetic patients who have had amputations.
While the three of them meet diabetic patients at different points in their treatment journeys, one thing they all agree on is that cases are on the rise and the diabetic patients they treat are getting younger.
In fact, diabetic patients comprise a majority of the cases that Hu sees.
“Singapore has one of the highest diabetes-related lower limb amputation rates in the world, with an average of four amputations done daily,” he noted. The startling figure is echoed by Ng.
Zakiah and Ng also helped to clear up some common misconceptions that patients often have of the disease.
One example is how diabetics tend to limit or avoid fruits or rice totally, with many replacing the latter with bread or noodles, shared Zakiah.
“However, foods such as bread, cereals and noodles also contain carbohydrates and have an impact on blood sugar levels,” she explained, adding that portion control is a more effective way to manage one’s sugar intake.
Fruits too, should not be cut out totally from one’s diet.
“People with diabetes can eat any fruit, as long as it is within the carbohydrate requirements of their meal plan,” clarified Zakiah.
Zakiah in her role as a dietitian. Photo from Changi General Hospital.
If you think the worst-case scenario that diabetics face is the loss of a limb due to infection and amputation, think again.
One thing Ng, wishes diabetic patients know, is that it is not just a disease which leads to lower limb amputation if managed poorly.
She shared: “It is a multi-organ disease which can affect one’s heart functions, kidney functions, vision, and even the nervous system if diabetes is left undetected or untreated.”
When it comes to their jobs, all three healthcare professionals admit many folks they meet are clueless or have misconceived ideas about what they do.
Hu, for one, clarified that podiatrists are “neither pedicurists nor foot masseurs”.
Ng shared too, how people often think her job only entails fitting prostheses to patients.
Orthotics, a lesser-known field, involves her customising and fitting braces to support the limbs and the spine.
Interestingly, her job entails fitting remoulding helmets (cranial orthoses) for babies to correct the shape of their skulls.
Ng oversees a cranial helmet fitting for an infant. Photo from Tan Tock Seng Hospital.
In addition, “we do see a fair share of patients who might require limb or spinal braces post-surgery or for fracture management”, explained Ng.
As for Zakiah, don’t call her the “food police”.
“As dietitians, we do not promote feelings of guilt or shame with eating. Our role is to guide patients towards better food choices, while still taking into consideration each patient’s preferences, lifestyle and beliefs,” said Zakiah.
Being able to obtain a scholarship to pursue their dream career was definitely a highlight for all three, who have been in their respective professions for at least four years.
All three pursued their studies in Australia.
Hu revealed: “My family was very proud of me as I was given the opportunity to study in Australia on an overseas scholarship.”
Hu working on customising an insole in the hospital’s podiatry workshop. Photo from Ng Teng Fong Hospital.
He also shared how his decision to study podiatry stemmed from personal experience.
“My first encounter with podiatry happened because I was a patient myself,” said Hu.
The avid tchoukball player was representing Singapore in the Asia Pacific Tchoukball Championship in 2012 when he suffered a foot injury.
“I received treatment from a podiatrist who then encouraged me to find out more about the profession,” he added.
For Ng, “[The scholarship] granted my wish to become a P&O and allied healthcare professional and I am happy to be where I am,” she shared.
At the moment, P&O and podiatry scholars would have to head to either Australia or the UK to pursue their studies.
Initially uncertain about which professional track to follow, Ng eventually felt that prosthetics and orthotics was “the one” for her, after a job-shadowing opportunity.
She added: “It has both clinical and technical aspects, is never dull (because all patients are never the same), and is essentially the most rewarding job.”
As for Zakiah, studying overseas would also not have been possible due to her family’s financial background.
This was also partly because there were no local universities offering Dietetics undergraduate programmes then. Currently, the Singapore Institute of Technology offers a four-year degree course in dietetics and nutrition.
All three scholars shared that their greatest accomplishment in their jobs is in helping to improve the lives of their patients.
“I want to empower patients to make better food choices and help them live their healthiest lives,” expressed Zakiah, whose ambition was inspired by her younger brother who was born with a genetic condition known as adrenoleukodystrophy (ALD).
The condition causes damage to the protective membrane of nerve cells in the brain and spinal cord.
“My brother eventually required enteral feeding, where liquids are administered via a tube directly to the stomach,” Zakiah shared.
Her brother also lost a lot of weight as a result of his difficulties in swallowing.
With the help of a dietitian who planned his feeding regime, Zakiah saw how her brother slowly regained his weight and vitality.
One case Hu remembers well was when he treated an elderly woman for a wound on her toe.
He had noticed that her foot was showing signs of impaired blood flow and referred her to vascular doctors.
“With early intervention, we managed to heal the wound and prevented the patient from losing her toe. The patient and her family were very grateful and still remembers me by name after all these years,” he shared.
In another case, Hu had to treat a young diabetic patient who had infected foot ulcers on both feet.
Her lower right leg and a toe on her left foot had to be amputated, and while this saved her life, she was demoralised and worried she would not be able to live a normal life if she also lost her left leg to diabetes.
With some medical care and counselling on Hu’s part to ensure her wounds healed well, the woman eventually gained an optimistic mindset and returned to a life of normalcy with the help of a prosthetic leg.
“Seeing my patients being able to go on living their lives, knowing that my work as a podiatrist is not in vain and I am able to help them continue doing what they used to do, drives me in my job!” Hu added.
Ng agreed. Her fondest memory so far on the job is of a patient who finally got his first prosthesis fitted after a lengthy wait.
For now, the war against diabetes continues for all three healthcare warriors.
Said Zakiah: “As we move towards a Healthier SG, I am particularly drawn to specialising in diabetes as I feel it can have a large impact on the community that I care about, my fellow Singaporeans.”
Interested in pursuing a career in healthcare? MOHH offers both local and overseas scholarships for a wide array of health science disciplines such as Allied Health, Pharmacy and Nursing. Find out more here.
Top image via Ng Teng Fong General Hospital, Changi General Hospital, Tan Tock Seng Hospital
This article was first published in Mothership.sg. Republished with permission.