By Anne Loh, Assistant Director, Communications and Outreach
A big part of the LKCMedicine student experience has to do with giving back in the form of Community Involvement Projects (CIP). Since the first annual LKCMedicine Community Involvement Recruitment Fair at the medical school’s Experimental Medicine Building in 2015 which showcased 17 project booths, students have been able to volunteer for peer-led initiatives that align with their interests. Fast forward to 2018 and there is now a strong stable of local and overseas CIPs undertaken by students year after year. All projects started by students are under the purview of the LKCMedicine Medical Society (MedSoc), guided by faculty mentors and see a healthy succession of student leaders.
There are some concerns relating to sustainability for example, especially programmes in countries where the bulk of the volunteers are transients and not residents; other concerns have to do with inadvertent harm by undue interference and disruption, creating a culture of dependency, exploitation, perhaps out of inexperience or insufficient knowledge on the ground. Some volunteers just look for a short-term feel good factor. Even local-based community projects could run into some issues, especially with certain Corporate Social Responsibility (CSR) programmes that just revolve around holidays of the year, such as the Lunar New Year or Christmas.
These have been on the minds of our students. Their key considerations therefore have been that LKCMedicine CIPs take place on a regular basis and select the most sustainable partners to work with, whether organisations, institutions or NGOs. Being part of a CIP is now part of the fabric of LKCMedicine student experience.
The CIP as LKCMedicine tradition
CIPs have grown to such an extent that two student leaders head up local and overseas CIPs on the MedSoc. Working with project heads, they serve as the liaison with LKCMedicine staff and faculty to ensure there is the necessary support from the School and NTU. The projects are regularly reviewed for relevance while new ones are assessed.
Both Samuel Fong, former Overseas CIP (OCIP) head, and Joshua Tan, former Local CIP (LCIP) head consider CIP to be a great LKCMedicine tradition that allow students to put what they learn to good use. Joshua said, “I believe that this tradition of CIP is important in keeping us grounded and giving us opportunities to put into practice the ideals we had when we decided to read Medicine.”
Faculty mentors Vice-Dean of Clinical Affairs and Lead for Professionalism Prof Pang Weng Sun, A/Prof of Human and Microbial Genetics Eric Yap and Senior Lecturer Dr Claire Canning for Projects Songkeum, Davao and Saukya respectively believe that OCIPs give the students much-needed, valuable perspective.
"When we don't have enough resources to provide medical care, we are challenged to think about what's really important to people in need. We are often surprised by their resilience, despite their lack of resources," said Prof Pang. "We hope that even as our students learn to care and share in their OCIP, they also learn to see life from a different perspective. Empathy is about understanding people and sharing their joys and sadness. Only then can we co-create care plans that are meaningful to them. I have no doubt our students will be enriched even as they attempt to serve in these communities," said Prof Pang.
A/Prof Yap concurred, “Leaving our country and comfort zones allows us to experience uncertainty and insecurity — hopefully, we learn to cope. Vehicle breakdowns, power failures, road diversions, lack of internet or mobile connection are all par for the course. This could make us more understanding and empathetic doctors, wherever we choose to build our careers.”
With Project Saukya, which is a health promotion collaboration with Rajarata University of Sri Lanka students, addressing Chronic Kidney Disease of Unknown Origin (CKDu) in particular, Dr Canning pointed out that it provided a different experience for LKCMedicine students. “The students spend a lot of time planning their project scope and look at the data collected on previous trips,” she said. “Our students are very mindful about not going into the community from a First World country and telling them what to do."
Areas of concern
In today’s current climate, Dr Canning has two major areas of concern on her mind where OCIPs are concerned and Project Saukya in particular. “For me, I worry about the students’ safety and also extreme weather.”
Naivete is what A/Prof Yap is most concerned about. “With the best of intentions, we want to give of our skills and wealth by teaching, diagnosing or providing, but unless we take time to understand the real needs of the people, we may be bringing the wrong solution to solve a misdiagnosed problem,” he said. “Could we be breeding dependency by giving free equipment or vitamins, or undermining confidence in the local healthcare system? Primum non nocere – first, do no harm.”
Sustainability of the projects, both local and overseas, feature largely on Samuel and Joshua’s radar. "We want to avoid creating dependancy and we also do not wish to impose our own frameworks and mindsets on our partners," said Samuel. Joshua added, "The number of LCIPs has increased with the increase in student population. However, some LCIPs may not fare as well as others through the years and we have to decide how best we can support them. For new LCIPs, we have to ensure that their objectives and working model is sound."
Indeed, continual revisits to the same community is the basis of sustainability, as it allows for follow-ups. Project Davao takes place twice a year in March and July so there’s continuity of care and teaching. “For example, over three visits, we diagnosed, persuaded and then supported a young patient with early onset cataracts through surgery,” A/Prof Yap said.
In the case of LCIPs, Project ANGEL stands apart as it addresses the special needs sector which is not reflected on the LKCMedicine curriculum. Project lead Ian Koh said, “Through this project we are able to interact with and better understand those with Autism Spectrum Disorder or Down Syndrome. The domain of special needs is currently not very well understood and Project ANGEL aims to address these misconceptions among our student population as well.” Awareness of this issue is currently channeled through the group’s social media and panel discussions, such as the Insights into Autism which took place in March. The group now works with St. Andrew’s Autism Centre and Down Syndrome Association Singapore. They are working towards a big publicity drive next year.
Fitting into the healthcare landscape
Many may question the need for the existence of NGOs and medical volunteers. Shouldn’t any population’s health and well-being be the responsibility of the government health agency? Would governments step up their game if they see the situation already well taken in hand by external parties?
“NGOs play an important role in supporting the development of a local community, but not entirely replacing the efforts of the local population and authorities. They are necessary because there are circumstances that put various communities at different stages of development,” Samuel said. “However NGOs must go into every community with an exit plan in mind, being aware of the end goal to let the locals thrive independently. Thus, along the way, which could easily last over a decade, one’s action plan must change according to the stage of the community.”
Context is everything, said Dr Canning. “Look at the rise of diabetes and obesity here and ask if a health education approach works. This may not fit into a rural community with no public communication tools such as newspapers, TV and where the children don’t go to school,” she said.
NGOs and medical volunteers can make independent situation assessments, said Joshua, to determine the needs and then make a targetted approach to meet those needs. “Even with state-wide measures, there will be people or communities who fall through the cracks,” he added.
A/Prof Yap pointed out that LKCMedicine CIPs serve best when they partner local doctors, NGOs and community leaders. “We can be resource people, proving specialised knowledge, tools or perspectives. We can also train the trainer —conducting refresher courses for healthcare volunteers in the villagers,” he said.
Every CIP endeavours to do good work, with lasting benefits. Some visits though would invariably stick in the mind because of a learning point, poignant encounter or mindset change.
Samuel’s most memorable trip was on Project Aasha to rural Nepal where he presented a diagnosis of malaria to the accompanying doctors, which included Subject Lead (Emergency Medicine) and Assistant Dean for Year 5 A/Prof Tham Kum Ying. ”Prof Tham guided me to consider the epidemiology — the malaria vector, and thus the parasite had no way of surviving 2,000m above sea level! We were able to accurately diagnose and treat typhoid fever instead. This incident taught me the importance of looking at the full picture and not let pre-existing assumptions cloud my judgement.”
“Constructing Care Collaboration is a CIP I joined in Year 1 and am now in charge of, together with a Year 4 student from NUS YLLSoM. Student volunteers speak to migrant workers as they wait for their consultation at community GP clinics and then accompany them throughout the visit,” Joshua shared. “It had a profound impact on me because it broke down many of the misconceptions I had of migrant workers. There was also a strong senior-junior teaching culture and it felt less like a CIP and more like a big family to me!”
For Dr Canning, the community spirit in the Sri Lanka villages that are under Project Saukya and the joy with which the villagers always greet the students when they visit really made a huge impression on her. “To see how a community respond to health promotion outreach is incredibly empowering,” she said. "I think it’s good for the students to try out different projects, they can see that they are part of something greater.”
“CIPs serve as a constant reminder that our journey as medical students is not just working towards a profession, but a path to achieve our greater calling to provide care through the practice of medicine for the good of humanity,” said LCIP SGMarrow Lead, Evelyn Chng. Working with Singapore Bone Marrow Donor Programme, the team aims to conduct a donor registration drive within NTU and expand to other universities.
“The bedrock of good medicine lies in the culture of serving others,” said Gwyneth Joy Lim, OCIP Project Saukya Lead. “With an overseas project like Saukya, we learn to work around limitations and effect change in the community by engaging with the villagers to take ownership of their life changes through support and encouragement. We also hope to build strong, lifelong friendships with our partners through our collaboration.”
Whether in Singapore or overseas, LKCMedicine students’ efforts to make a difference, even while still picking up medical knowledge and skills, can still make a positive impact on the communities they encounter as sincerity, empathy and compassion will win the day.